2015 State Fiscal Year - (09/01/14 to 08/31/15)

COMMUNITY CARE and NURSING FACILITY - RATE ENHANCEMENT LEVELS

Updated: 09/15/16

KEY FOR PARTICIPATION COLUMN: NE = Not Enrolled, PHC-P = Priority, PHC-NP = PHC Nonpriority, PHC-B = Both PHC Priority and Nonpriority

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000010100 PHC 1 09/01/14 PHC B 2 2

000011000 PHC 1 09/01/14 PHC B 28 31

000011100 PHC 1 09/01/14 PHC B 31 22

000011600 PHC 1 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000012200 PHC 1 09/01/14 PHC B 23 23

000012700 PHC 1 09/01/14 PHC NP 18

000012900 PHC 1 09/01/14 PHC NP 31

000016500 PHC 11 09/01/14 PHC B 29 29

000017300 PHC 11 09/01/14 PHC B 23 23

000017500 PHC 11 09/01/14 PHC P 31

000017900 PHC 11 09/01/14 PHC B 3 31

000018000 PHC 11 09/01/14 PHC B 31 31

000018500 PHC 11 09/01/14 PHC B 31 31

000018600 PHC 11 09/01/14 PHC B 12 23 Enrollment limited to level achieved on 2012 cost report

000019200 PHC 11 09/01/14 PHC B 31 31

000019600 PHC 11 09/01/14 PHC NP 29 Enrollment limited to level achieved on 2012 cost report

000021100 PHC 1 09/01/14 PHC B 6 20 Limited to increase as per 1 TAC §355.112(f)(4)

000022800 PHC 2 02/11/15 Terminated 2/2/15: Level NP 18

000023000 PHC 2 01/08/15 Terminated 12/19/14: Level 14/14 Final Requested

000023300 PHC 2 09/01/14 NE

000023700 PHC 2 09/01/14 PHC B 2 2

000024300 PHC 2 09/01/14 PHC NP 23

000024500 PHC 2 09/01/14 PHC B 31 31

000030400 PHC 10 09/01/14 PHC B 31 31

000031100 PHC 10 09/01/14 PHC B 28 31 Level supported by 2015 Request for Revision report

000031200 PHC 10 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000031800 PHC 3 08/06/15 CA 7/31/15 to 001026953: Level NP 31 Final Requested

000034400 PHC 3 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000034500 PHC 3 09/01/14 PHC B 31 31

000034900 PHC 3 09/01/14 PHC B 31 31

000035100 PHC 3 09/01/14 PHC NP 31

000036000 PHC 3 09/01/14 PHC B 29 29

000037600 PHC 3 09/01/14 PHC B 15 20

000038800 PHC 3 09/01/14 PHC NP 29

000039400 PHC 3 09/01/14 PHC B 2 2

000041500 PHC 2 09/01/14 PHC B 31 31

000042100 PHC 4 09/01/14 NE

000043400 PHC 2 09/01/14 PHC NP 23 Enrollment limited to level achieved on 2012 cost report

000044100 PHC 2 09/01/14 PHC B 28 31 Level supported by 2015 Request for Revision report

000044400 PHC 2 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000052600 PHC 3 09/01/14 PHC B 29 31

000053000 PHC 3 09/01/14 PHC B 31 31

000053200 PHC 3 09/01/14 PHC NP 23

000053300 PHC 3 09/01/14 PHC B 31 31

000055600 PHC 3 09/01/14 PHC B 31 31

000055800 PHC 3 09/01/14 PHC B 17 29

000057300 PHC 5 09/01/14 NE

000058500 PHC 5 01/01/15 PHC B 22 22 Changed EN date NP only from 9/1/14-12/31/14

000058700 PHC 5 09/01/14 PHC B 31 31

000060200 PHC 6 09/01/14 PHC B 31 31

000060900 PHC 6 09/01/14 PHC B 23 4

000061800 PHC 6 09/01/14 PHC B 31 31

000063600 PHC 7 09/01/14 PHC B 23 23

000063900 PHC 7 09/01/14 PHC B 30 30

000064100 PHC 7 09/01/14 PHC B 31 31

000064700 PHC 6 09/01/14 PHC B 30 30

000064900 PHC 6 09/01/14 PHC B 31 31

000065500 PHC 7 09/01/14 PHC B 23 23

000065900 PHC 6 09/01/14 PHC B 31 31

000066200 PHC 7 09/01/14 PHC B 31 31

000067700 PHC 6 09/01/14 PHC B 3 28

000068000 PHC 6 09/01/14 PHC B 31 31

000069100 PHC 6 09/01/14 PHC P 30

000069200 PHC 6 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000069600 PHC 6 09/01/14 PHC B 25 25

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000071400 PHC 4 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000071800 PHC 4 09/01/14 PHC B 29 31

000072100 PHC 7 09/01/14 PHC B 31 31

000073900 PHC 4 09/01/14 PHC B 31 31

000075300 PHC 7 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000076700 PHC 7 09/01/14 PHC B 20 31

000076900 PHC 7 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000077300 PHC 7 09/01/14 PHC B 29 15 Enrollment limited to level achieved on 2012 cost report

000080500 PHC 11 09/01/14 PHC B 25 25

000081000 PHC 11 09/01/14 PHC B 31 31

000081100 PHC 11 09/01/14 PHC B 31 31

000081700 PHC 11 09/01/14 PHC B 31 31

000082000 PHC 8 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000082900 PHC 8 09/01/14 PHC B 31 31

000083100 PHC 8 09/01/14 PHC B 31 31

000083700 PHC 8 09/01/14 NE

000083800 PHC 8 09/01/14 PHC NP 22

000084900 PHC 11 09/01/14 PHC B 31 31

000085400 PHC 11 09/01/14 PHC NP 31

000085500 PHC 11 09/01/14 PHC P 25

000086500 PHC 8 09/01/14 PHC B 28 31 Level supported by 2015 Request for Revision report

000087900 PHC 8 09/01/14 PHC NP 18 Enrollment limited to level achieved on 2012 cost report

000089200 PHC 8 09/01/14 PHC B 31 31

000089300 PHC 8 09/01/14 PHC NP 31 Level supported by 2015 Request for Revision report

000089700 PHC 8 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000089900 PHC 8 09/01/14 PHC NP 31

000090700 PHC 8 09/01/14 NE

000090800 PHC 8 09/01/14 PHC B 31 31

000093900 PHC 8 09/01/14 PHC B 31 31

000094000 PHC 8 09/01/14 PHC B 31 31

000094200 PHC 8 09/01/14 PHC B 31 31

000095400 PHC 9 11/19/14 Terminated 10/31/14: Level NP 20 Final Requested

000095500 PHC 9 09/01/14 PHC B 31 31

000100200 PHC 10 09/01/14 PHC B 31 31

000101500 PHC 6 09/01/14 PHC B 31 31

000101800 PHC 6 09/01/14 PHC B 31 31

000102300 PHC 5 09/01/14 PHC B 30 30

000102600 PHC 5 09/01/14 PHC NP 23 Enrollment limited to level achieved on 2012 cost report

000104200 PHC 10 09/01/14 PHC B 31 31

000104300 PHC 10 09/01/14 PHC B 3 14

000104900 PHC 10 09/01/14 PHC B 31 31

000106600 PHC 6 09/01/14 PHC B 31 31

000106900 PHC 6 09/01/14 PHC B 31 31

000107300 PHC 6 09/01/14 PHC B 31 31

000107800 PHC 6 09/01/14 PHC B 31 31

000107900 PHC 6 09/01/14 PHC NP 29

000108300 PHC 6 09/01/14 NE

000108600 PHC 6 01/01/15 NE

000108700 PHC 6 09/01/14 PHC B 31 31

000109000 PHC 6 09/01/14 PHC B 20 31 Level supported by 2015 Request for Revision report

000109100 PHC 6 09/01/14 PHC B 22 22

000109700 PHC 6 09/01/14 PHC B 31 31

000109900 PHC 6 09/01/14 PHC B 22 31 Level supported by 2015 Request for Revision report

000110100 PHC 6 09/01/14 PHC B 24 31 Level supported by 2015 Request for Revision report

000110200 PHC 11 09/01/14 PHC B 31 31

000111500 PHC 11 09/01/14 PHC B 31 31

000111600 PHC 6 09/01/14 PHC B 31 31

000112500 PHC 11 09/01/14 PHC B 31 31

000112700 PHC 11 09/01/14 PHC NP 31

000112800 PHC 11 09/01/14 PHC NP 29 Enrollment limited to level achieved on 2012 cost report

000112900 PHC 11 09/01/14 PHC NP 31

000113100 PHC 11 09/01/14 PHC B 31 31

000113700 PHC 11 09/01/14 PHC B 20 31

000114100 PHC 6 09/01/14 PHC B 30 30

000114200 PHC 11 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000114400 PHC 11 09/01/14 PHC B 31 31

000114600 PHC 11 09/01/14 PHC B 31 31

000114700 PHC 6 09/01/14 PHC B 29 29

000115100 PHC 11 09/01/14 PHC B 31 31

000115200 PHC 11 09/01/14 PHC NP 29

000115300 PHC 11 09/01/14 PHC B 31 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000116000 PHC 11 09/01/14 PHC B 31 31

000116400 PHC 11 09/01/14 PHC B 19 29 Enrollment limited to level achieved on 2012 cost report

000116700 PHC 6 09/01/14 PHC B 29 29

000116800 PHC 6 09/01/14 PHC B 31 31

000116900 PHC 11 09/01/14 PHC B 31 31

000117000 PHC 6 09/01/14 NE

000117500 PHC 11 09/01/14 PHC B 23 20

000117700 PHC 11 09/01/14 PHC B 21 23

000118000 PHC 6 09/01/14 PHC B 6 23 Level supported by 2015 Request for Revision report

000118200 PHC 6 09/01/14 NE

000118500 PHC 11 09/01/14 PHC B 31 31

000118600 PHC 11 09/01/14 PHC B 31 31

000118800 PHC 11 01/23/15 Terminated 11/21/14: Level NP 19 Final Requested

000118900 PHC 11 09/01/14 PHC NP 31

000119100 PHC 11 09/01/14 PHC B 18 31

000119400 PHC 11 09/01/14 PHC B 31 31

000119800 PHC 11 09/01/14 PHC B 31 31

000120300 PHC 9 09/01/14 PHC B 31 31

000120500 PHC 9 09/01/14 PHC B 28 31 Level supported by 2015 Request for Revision report

000120600 PHC 9 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

000121100 PHC 6 09/01/14 PHC B 31 31

000121400 PHC 6 09/01/14 PHC B 2 2

000121700 PHC 11 09/01/14 PHC B 31 31

000122500 PHC 11 09/01/14 PHC NP 23

000123300 PHC 11 09/01/14 PHC B 31 31

000123800 PHC 11 09/01/14 PHC B 31 31

000124000 PHC 11 09/01/14 PHC B 31 31

000124400 PHC 11 09/01/14 PHC B 5 31 Level supported by 2015 Request for Revision report

000124500 PHC 11 09/01/14 PHC B 31 31

000124600 PHC 11 09/01/14 PHC NP 27

000124800 PHC 11 09/01/14 PHC NP 31

000126400 PHC 6 09/01/14 NE

000126600 PHC 6 09/01/14 PHC B 31 31

000127200 PHC 6 09/01/14 PHC B 25 25

000128300 PHC 6 09/01/14 PHC B 3 19

000128400 PHC 6 09/01/14 PHC B 29 22

000128600 PHC 6 09/01/14 PHC NP 31

000129500 PHC 11 09/01/14 PHC B 11 31

000129700 PHC 11 09/01/14 PHC B 31 31

000131400 RC 3 09/01/14 NE

000135800 RC 4 09/01/14 22 Terminated 8/31/14

000136000 RC 4 09/01/14 22

000136100 RC 6 09/01/14 NE

000136600 RC 4 09/01/14 22

000137600 RC 6 09/01/14 NE

000137900 RC 6 09/01/14 NE

000138300 RC 8 09/01/14 23

000139000 RC 2 09/01/14 NE

000139500 RC 6 09/01/14 NE

000140100 RC 6 09/01/14 NE

000147100 RC 3 09/01/14 NE

000147500 RC 11 05/14/15 Terminated 3/31/15: Level NE

000150200 RC 4 09/01/14 NE

000195100 DAHS 11 09/01/14 23

000300500 DAHS 11 09/01/14 31

000300600 DAHS 6 09/01/14 25

000301500 DAHS 3 09/01/14 31

000302100 DAHS 8 09/01/14 31

000302900 DAHS 11 09/01/14 NE

000303600 DAHS 3 09/01/14 20

000303900 DAHS 11 09/01/14 31

000304000 DAHS 8 09/01/14 31

000304400 DAHS 4 09/03/15 Terminated 8/31/15: Level NE

000304700 DAHS 11 09/01/14 31

000304900 DAHS 11 09/01/14 17

000305500 DAHS 11 09/01/14 31

000306100 DAHS 11 01/12/15 Terminated 11/20/14: Level NE

000306600 DAHS 11 09/01/14 9 Enrollment limited to level achieved on 2012 cost report

000307100 DAHS 11 09/01/14 25

000307300 DAHS 11 09/01/14 3

000307700 DAHS 11 09/01/14 30

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000307800 DAHS 8 09/01/14 31

000308100 DAHS 11 09/01/14 31

000308300 DAHS 11 09/01/14 31

000308400 DAHS 11 09/01/14 23

000309700 DAHS 11 09/01/14 21

000320500 DAHS 11 09/01/14 31

000321000 DAHS 6 09/01/14 31

000321800 DAHS 11 09/01/14 NE

000321900 DAHS 11 09/01/14 NE

000322500 DAHS 11 09/01/14 NE

000322900 DAHS 8 09/01/14 NE

000323300 DAHS 11 09/01/14 18

000323800 DAHS 11 09/01/14 31

000324200 DAHS 8 09/01/14 NE

000325000 DAHS 11 10/31/14 Terminated 10/14/14: Level 31 Final Requested

000325100 DAHS 11 09/01/14 31

000326800 DAHS 11 09/01/14 20

000327100 DAHS 11 09/01/14 NE

000327300 DAHS 8 09/01/14 29

000327800 DAHS 11 09/01/14 15

000328400 DAHS 9 11/19/14 Terminated 11/17/14: Level 16 Final Requested

000329600 DAHS 11 09/01/14 31

000329800 DAHS 3 09/01/14 29

000330200 DAHS 8 09/01/14 13

000330300 DAHS 10 09/01/14 31

000330800 DAHS 1 09/01/14 31

000331100 DAHS 11 09/01/14 NE

000331200 DAHS 11 09/01/14 31

000331500 DAHS 11 09/01/14 12

000331800 DAHS 8 09/01/14 31

000332100 DAHS 11 09/01/14 31 Level supported by 2015 Request for Revision Report

000332300 DAHS 11 09/01/14 31

000332500 DAHS 11 09/01/14 NE

000332600 DAHS 11 09/01/14 31

000332900 DAHS 11 09/01/14 15

000333000 DAHS 11 09/01/14 25

000333400 DAHS 11 09/01/14 22

000333500 DAHS 11 09/01/14 31

000334000 DAHS 11 09/01/14 15

000334500 DAHS 6 08/06/15 Terminated 7/31/15: Level 20 Final Requested

000334600 DAHS 1 09/01/14 31

000334700 DAHS 11 09/01/14 31

000335000 DAHS 9 09/01/14 23

000335500 DAHS 11 09/01/14 31

000335600 DAHS 11 12/02/14 Terminated 8/1/14:Level 23 Final Requested

000335800 DAHS 8 09/01/14 NE

000336100 DAHS 11 09/01/14 31

000336300 DAHS 3 05/28/15 Terminated 3/15/11: Level NE from Appeal

000336400 DAHS 8 01/12/15 Terminated 1/9/15: Level NE

000336700 DAHS 3 09/01/14 23

000337300 DAHS 8 09/01/14 25

000337500 DAHS 4 05/21/15 Terminated 5/30/14: Level 23 Final Requested

000338000 DAHS 4 09/01/14 29

000338300 DAHS 11 09/01/14 31

000340100 DAHS 11 09/01/14 31

000340400 DAHS 11 09/01/14 15

000341000 DAHS 8 09/01/14 23

000341900 DAHS 11 09/01/14 31

000342200 DAHS 8 09/01/14 29

000342300 DAHS 11 09/01/14 17

000342500 DAHS 11 09/01/14 NE

000342600 DAHS 11 09/01/14 31

000343000 DAHS 8 09/01/14 31

000343600 DAHS 7 09/01/14 29

000344600 DAHS 11 09/01/14 12

000345000 DAHS 11 09/01/14 31

000345100 DAHS 8 09/01/14 23

000345200 DAHS 11 09/01/14 31

000345900 DAHS 10 09/01/14 31

000346400 DAHS 11 09/01/14 31 Level supported by 2015 Request for Revision Report

000346800 DAHS 11 09/01/14 NE

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000346900 DAHS 8 03/30/15 Terminated 3/20/15: Level 31 Final Requested

000400001 NF n/a 09/01/14 27

000402605 NF n/a 12/16/14 CHOW 11/30/14: Level 12 Final Requested

000403104 NF n/a 09/01/14 21

000403504 NF n/a 09/01/14 8

000404801 NF n/a 09/01/14 27

000407202 NF n/a 09/01/14 24

000407502 NF n/a 09/01/14 13

000407807 NF n/a 09/01/14 24

000407904 NF n/a 09/01/14 27

000408402 NF n/a 09/01/14 13

000409002 NF n/a 09/01/14 18

000409501 NF n/a 09/01/14 13

000409807 NF n/a 03/17/15 CHOW 2/14/15: Level 13 Final Requested

000410501 NF n/a 09/01/14 NE

000410601 NF n/a 09/01/14 27

000411803 NF n/a 03/17/15 CHOW 2/28/15: Level 27 Final Requested

000414505 NF n/a 09/01/14 7 Level Supported by 2015 Request for Revision Report

000415302 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

000415602 NF n/a 01/30/15 Terminated 1/22/15: Level 21 Final Requested

000415903 NF n/a 09/01/14 27

000416003 NF n/a 09/01/14 27

000416101 NF n/a 09/01/14 10

000417603 NF n/a 09/01/14 10

000417903 NF n/a 09/01/14 27

000418002 NF n/a 09/01/14 11

000418305 NF n/a 09/01/14 19

000418403 NF n/a 09/01/14 17

000420206 NF n/a 09/01/14 7

000421004 NF n/a 09/01/14 17

000422101 NF n/a 09/01/14 27

000422703 NF n/a 09/01/14 NE

000423601 NF n/a 09/01/14 27

000424804 NF n/a 09/01/14 6

000425403 NF n/a 09/01/14 NE

000426102 NF n/a 09/01/14 7

000426606 NF n/a 03/09/15 CHOW 2/27/15: Level 27 Final Requested

000428401 NF n/a 09/01/14 27

000431906 NF n/a 02/23/15 CHOW 1/31/15: Level 13 Final Requested

000433505 NF n/a 03/09/15 CHOW 2/25/15: Level 13 Final Requested

000434202 NF n/a 09/01/14 NE

000434404 NF n/a 03/06/15 CHOW 2/25/15: Level 13 Final Requested

000435808 NF n/a 09/01/14 27

000436301 NF n/a 09/01/14 27

000436907 NF n/a 09/01/14 15

000437301 NF n/a 09/01/14 27

000438404 NF n/a 09/16/14 CHOW 8/31/14 to 001026065: Level NE

000439602 NF n/a 09/01/14 20

000439904 NF n/a 12/13/14 CHOW 11/30/14: Level 19 Final Requested

000440202 NF n/a 09/01/14 7

000441305 NF n/a 12/16/14 CHOW 11/30/14: Level 12 Final Requested

000442006 NF n/a 09/01/14 25

000442609 NF n/a 09/01/14 10

000443003 NF n/a 08/18/15 CHOW 7/31/15: Level 13 Final Requested

000443101 NF n/a 09/01/14 27

000443701 NF n/a 01/09/15 CHOW 12/31/14: Level 27 Final Requested

000444706 NF n/a 12/16/14 CHOW 11/25/14: Level 13 Final Requested

000445204 NF n/a 09/01/14 24

000446304 NF n/a 09/01/14 27

000446604 NF n/a 02/11/15 CHOW 1/31/15: Level 6 Final Requested

000448902 NF n/a 09/01/14 NE

000449403 NF n/a 09/01/14 27

000449901 NF n/a 09/01/14 7

000451204 NF n/a 09/01/14 7

000453108 NF n/a 09/01/14 7

000454002 NF n/a 09/01/14 27

000455003 NF n/a 09/01/14 23

000456001 NF n/a 09/01/14 7

000456406 NF n/a 10/16/14 CHOW 9/29/14: Level 16 Final Requested

000458410 NF n/a 02/23/15 CHOW 1/31/15: Level 7 Final Requested

000458606 NF n/a 02/13/15 CHOW 02/03/15: Level 7 Final Requested

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000459806 NF n/a 12/16/14 CHOW 11/26/14: Level 9 Final Requested

000460901 NF n/a 09/01/14 27

000461501 NF n/a 09/01/14 27

000462606 NF n/a 10/17/14 CHOW 9/29/14: Level 10 Final Requested

000464001 NF n/a 09/01/14 26

000464506 NF n/a 10/15/14 CHOW 8/30/14: Level 6 Final Requested

000465204 NF n/a 03/02/15 CHOW 1/31/15: Level 11 Final Requested

000465306 NF n/a 09/01/14 27

000465403 NF n/a 09/01/14 27

000465504 NF n/a 02/11/15 CHOW 1/31/15: Level 8 Final Requested

000465804 NF n/a 09/01/14 10

000466801 NF n/a 09/01/14 NE

000467206 NF n/a 12/13/14 CHOW 11/30/14: Level 7 Final Requested

000467501 NF n/a 09/01/14 21

000468201 NF n/a 09/01/14 27

000469401 NF n/a 04/23/15 CHOW 4/1/15: Level NE

000470504 NF n/a 02/23/15 CHOW 1/31/15: Level 10 Final Requested

000472206 NF n/a 09/01/14 18 Enrollment Limited to level achieved in 2012

000472709 NF n/a 09/01/14 6

000474302 NF n/a 03/09/15 CHOW 2/27/15: Level 3 Final Requested

000474806 NF n/a 11/19/14 CHOW 10/31/14: Level 31 Final Requested

000475304 NF n/a 09/01/14 7

000477606 NF n/a 11/18/14 CHOW 10/31/14: Level NE

000478107 NF n/a 09/01/14 7

000479603 NF n/a 09/01/14 7

000479906 NF n/a 09/01/14 24

000480903 NF n/a 09/01/14 8

000481506 NF n/a 10/15/14 CHOW 8/30/14: Level 10 Final Requested

000483101 NF n/a 09/01/14 19

000483606 NF n/a 02/13/15 CHOW 02/03/15: Level 6 Final Requested

000483703 NF n/a 10/17/14 CHOW 8/31/14: Level 27 Final Requested

000484204 NF n/a 12/13/14 CHOW 11/30/14: Level 27 Final Requested

000485901 NF n/a 09/01/14 7

000486101 NF n/a 09/01/14 NE

000487002 NF n/a 10/16/14 CHOW 9/30/14 to 00102637: Level NE

000488807 NF n/a 10/30/14 CHOW 9/30/14 to 001026254: Level 7 Final Requested

000488901 NF n/a 09/01/14 15

000489607 NF n/a 11/19/14 CHOW 10/31/14 to 001026248: Level 7 Final Requested

000489901 NF n/a 10/30/14 CHOW 10/17/14: Level 6 Final Requested

000490001 NF n/a 09/01/14 27

000490304 NF n/a 09/01/14 NE

000490505 NF n/a 09/01/14 18

000490707 NF n/a 09/01/14 7

000491006 NF n/a 12/16/14 CHOW 12/04/14: Level 15 Final Requested

000492706 NF n/a 02/23/15 CHOW 1/31/15: Level 7 Final Requested

000493307 NF n/a 03/09/15 CHOW 2/27/15: Level 19 Final Requested

000493402 NF n/a 12/16/14 CHOW 11/30/14: Level 7 Final Requested

000497101 NF n/a 09/01/14 27

000498106 NF n/a 09/18/14 Terminated 3/31/14: Level 1 Final Requested

000498208 NF n/a 09/01/14 12

000498807 NF n/a 03/09/15 CHOW 2/28/15: Level 27 Final Requested

000499607 NF n/a 02/23/15 CHOW 1/31/15: Level 7 Final Requested

000500206 NF n/a 07/24/15 CHOW 6/30/15: Level NE

000501202 NF n/a 09/01/14 25

000501905 NF n/a 09/01/14 3

000502206 NF n/a 01/09/15 CHOW 12/31/14: Level NE

000502401 NF n/a 09/01/14 NE

000504006 NF n/a 02/26/15 CHOW 9/30/14: Level 8 Final Requested

000504406 NF n/a 09/01/14 CHOW 8/30/14: Level 9 Final Requested

000504803 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

000504906 NF n/a 10/09/14 CHOW 8/30/14: Level 7 Final Requested

000506401 NF n/a 09/01/14 18

000509302 NF n/a 09/01/14 27

000509501 NF n/a 09/01/14 19 Enrollment Limited to level achieved in 2012

000509801 NF n/a 09/01/14 27

000511001 NF n/a 09/01/14 7

000512001 NF n/a 09/01/14 7

000512401 NF n/a 09/01/14 27

000512607 NF n/a 04/01/15 CHOW 2/28/15: Level 27 Fnal Requested

000513304 NF n/a 09/18/14 CHOW 8/30/14: Level NE

000513905 NF n/a 01/09/15 CHOW 12/31/14: Level 7 Final Requested

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000514806 NF n/a 04/13/15 CHOW 2/28/15: Level 27 Fnal Requested

000516001 NF n/a 09/01/14 27

000516506 NF n/a 05/01/15 CHOW 3/31/15 to 001026820: Level 9 Final Requested

000517001 NF n/a 09/01/14 23

000517503 NF n/a 09/01/14 13

000517601 NF n/a 09/01/14 27

000518001 NF n/a 09/01/14 27

000518303 NF n/a 03/09/15 CHOW 2/27/15: Level 13 Final Requested

000518701 NF n/a 09/01/14 6

000518903 NF n/a 09/01/14 27

000519101 NF n/a 09/01/14 27

000519501 NF n/a 09/01/14 7

000521201 NF n/a 09/01/14 10

000521303 NF n/a 09/01/14 10

000521403 NF n/a 04/16/15 CHOW 3/31/15: Level 23 Final Requested

000521901 NF n/a 09/01/14 27

000522102 NF n/a 04/01/15 CHOW 2/27/15: Level 9 Final Requested

000523501 NF n/a 09/01/14 13

000523901 NF n/a 09/01/14 NE

000524303 NF n/a 03/09/15 CHOW 2/27/15: Level 27 Final Requested

000524601 NF n/a 09/01/14 27

000524901 NF n/a 09/01/14 27

000526303 NF n/a 06/10/15 CHOW 5/31/15: Level 13 Final Requested

000527702 NF n/a 05/04/15 10 CHOW 4/30/15 to 001026844: Level 10 Final Requested

000528401 NF n/a 09/01/14 10

000528501 NF n/a 09/01/14 10

000528701 NF n/a 09/01/14 8

000530301 NF n/a 09/01/14 NE

000530801 NF n/a 09/01/14 27

000531801 NF n/a 09/01/14 27

000533201 NF n/a 09/01/14 7

000533701 NF n/a 09/01/14 13

000535801 NF n/a 09/01/14 NE

000536001 NF n/a 09/01/14 18

000536601 NF n/a 09/01/14 7

000537101 NF n/a 09/01/14 20

000537202 NF n/a 09/01/14 6

000537501 NF n/a 09/01/14 10

000538001 NF n/a 09/01/14 7

000538401 NF n/a 09/01/14 27

000539201 NF n/a 09/01/14 NE

000615900 CBA 9 09/01/14 7 Terminated 8/31/14

000623100 CBA 4 09/01/14 31 Terminated 8/31/14

000625100 RC 7 09/01/14 NE Terminated 8/31/14

000629300 RC 4 09/01/14 22 Terminated 8/31/14

000629900 RC 8 09/01/14 15 Terminated 8/31/14

000632900 CBA 3 09/01/14 31 Terminated 8/31/14

000634100 CBA 2 09/01/14 22 Terminated 8/31/14

000635300 CBA 1 09/01/14 31 Terminated 8/31/14

000635700 CBA 8 09/01/14 555 Terminated 8/31/14

000635800 CBA 10 09/01/14 31 Terminated 8/31/14

000636800 CBA 7 09/01/14 31 Terminated 8/31/14

000637700 CBA 9 09/01/14 31 Terminated 8/31/14

000638300 CBA 8 09/01/14 31 Terminated 8/31/14

000639400 CBA 5 09/01/14 30 Terminated 8/31/14

000645200 CBA 8 09/01/14 31 Terminated 8/31/14

000647700 RC 7 09/01/14 NE Terminated 8/31/14

000652200 CBA 3 09/01/14 29 Terminated 8/31/14

000652300 CBA 1 09/01/14 28 Terminated 8/31/14

000653400 CBA 1 09/01/14 31 Terminated 8/31/14

000653600 CBA 1 09/01/14 31 Terminated 8/31/14

000661800 CBA 2 09/01/14 31 Terminated 8/31/14

000662000 CBA 8 09/01/14 31 Terminated 8/31/14

000662100 CBA 10 09/01/14 31 Terminated 8/31/14

000666300 CBA 8 09/01/14 31 Terminated 8/31/14

000667500 CBA 2 09/01/14 31 Terminated 8/31/14

000668800 RC 7 09/01/14 NE Terminated 8/31/14

000671200 CBA 2 09/01/14 NE Terminated 8/31/14

000671500 CBA 4 09/01/14 31 Terminated 8/31/14

000672200 CBA 7 09/01/14 31 Terminated 8/31/14

000676700 RC 4 09/01/14 NE Terminated 8/31/14

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

000680000 CBA 3 09/01/14 31 Terminated 8/31/14

000681200 CBA 5 09/01/14 31 Terminated 8/31/14

000683100 RC 3 09/01/14 NE Terminated 8/31/14

000690400 RC 3 09/01/14 NE Terminated 8/31/14

000692800 CBA 9 09/01/14 31 Terminated 8/31/14

000695500 CBA 2 09/01/14 31 Terminated 8/31/14

000695600 CBA 9 09/01/14 31 Terminated 8/31/14

000696400 CBA 8 09/01/14 31 Terminated 8/31/14

000696800 CBA 4 09/01/14 31 Terminated 8/31/14

000854200 CBA 2 09/01/14 NE Terminated 8/31/14

000857300 RC 1 09/01/14 NE Terminated 8/31/14

000857400 RC 5 09/01/14 15 Terminated 8/31/14

000860500 RC 7 09/01/14 NE Terminated 8/31/14

000869400 CBA 7 09/01/14 31 Terminated 8/31/14

000873000 RC 7 09/01/14 NE Terminated 8/31/14

000873300 CBA 2 09/01/14 NE Terminated 8/31/14

000879700 RC 9 09/01/14 NE Terminated 8/31/14

000900700 CBA 2 09/01/14 31 Terminated 8/31/14

000900800 CBA 3 09/01/14 31 Terminated 8/31/14

000950700 RC 7 09/01/14 22 Terminated 8/31/14

000952600 CBA 2 09/01/14 NE Terminated 8/31/14

000953100 RC 2 09/01/14 NE Terminated 8/31/14

000958900 RC 4 09/01/14 22 Terminated 8/31/14

000961400 RC 4 09/01/14 22 Terminated 8/31/14

000961700 RC 4 09/01/14 22 Terminated 8/31/14

000962300 RC 2 09/01/14 22 Terminated 8/31/14

000963000 CBA 3 09/01/14 31 Terminated 8/31/14

000963100 CBA 8 09/01/14 31 Terminated 8/31/14

000963200 CBA 7 09/01/14 31 Terminated 8/31/14

000968200 RC 7 09/01/14 22 Terminated 8/31/14

001000427 NF n/a 10/30/14 CHOW 10/17/14: Level 7 Final Requested

001000459 NF n/a 09/01/14 27

001000476 NF n/a 09/01/14 27

001000512 NF n/a 08/06/15 CHOW 7/31/15: Level 14 Final Requested

001000551 NF n/a 10/09/14 CHOW 9/23/14: Level 27 Final Requested

001000624 NF n/a 09/01/14 20

001000653 NF n/a 01/07/15 CHOW 12/31/14: Level NE

001000698 PHC 11 09/01/14 PHC B 31 31

001000718 NF n/a 09/01/14 27

001000719 DAHS 8 09/01/14 29

001000759 PHC 11 05/08/15 Terminated 4/30/15: Level 29/29 Final Requested

001000765 NF n/a 09/01/14 13

001000786 CBA 3 09/01/14 23 Terminated 8/31/14

001000812 DAHS 8 09/01/14 31

001000813 PHC 3 09/01/14 PHC B 28 31 Level supported by 2015 Request for Revision report

001000815 CBA 3 09/01/14 31 Terminated 8/31/14

001000831 PHC 8 09/01/14 PHC B 16 15

001000837 DAHS 6 06/10/15 Terminated 6/8/15: Level NE

001000846 NF n/a 09/01/14 27

001000874 DAHS 4 09/01/14 10

001000918 PHC 11 09/01/14 PHC B 31 31

001000930 PHC 11 09/01/14 PHC B 31 31

001000933 PHC 11 09/01/14 PHC B 11 31 Enrollment limited to level achieved on 2012 cost report

001000964 DAHS 11 09/01/14 20

001000965 PHC 6 09/01/14 PHC B 31 31

001000971 PHC 6 09/01/14 PHC B 31 31

001000981 PHC 5 09/01/14 PHC B 31 31

001000983 DAHS 11 09/01/14 31

001000985 DAHS 11 09/01/14 31

001001011 PHC 3 09/01/14 PHC B 22 22

001001020 NF n/a 09/01/14 6

001001034 PHC 8 09/01/14 PHC B 31 31

001001035 CBA 8 09/01/14 29 Terminated 8/31/14

001001036 PHC 9 09/01/14 PHC B 31 31

001001041 DAHS 8 09/01/14 20

001001043 PHC 4 09/01/14 PHC B 31 31

001001054 DAHS 11 09/01/14 3

001001067 PHC 3 09/01/14 PHC B 30 30

001001074 CBA 5 09/01/14 22 Terminated 8/31/14

001001084 DAHS 3 09/01/14 NE

001001090 NF n/a 07/20/15 CHOW 5/31/15: Level 20 Final Requested

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001001105 PHC 3 09/01/14 PHC NP 31

001001122 NF n/a 09/01/14 16

001001123 NF n/a 09/01/14 6

001001132 RC 3 09/01/14 NE

001001135 PHC 8 09/01/14 PHC B 22 22

001001143 PHC 6 09/01/14 PHC NP 28 Level supported by 2015 Request for Revision report

001001149 RC 7 09/01/14 NE Terminated 8/31/14

001001161 PHC 4 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001162 CBA 4 09/01/14 31 Terminated 8/31/14

001001169 NF n/a 09/01/14 7

001001170 RC 2 09/01/14 NE

001001188 DAHS 11 05/08/15 Terminated 4/30/15: Level 31 Final Requested

001001200 PHC 4 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001201 CBA 4 09/01/14 31 Terminated 8/31/14

001001202 PHC 5 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001203 CBA 1 09/01/14 31 Terminated 8/31/14

001001204 PHC 11 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001207 NF n/a 09/01/14 27

001001208 PHC 11 09/01/14 PHC B 31 31

001001215 DAHS 11 09/01/14 NE

001001224 PHC 11 09/01/14 PHC B 31 31

001001241 RC 3 09/01/14 20

001001256 DAHS 8 09/01/14 10

001001262 PHC 6 09/01/14 PHC B 31 31

001001263 PHC 8 09/01/14 PHC B 23 20

001001271 NF n/a 09/01/14 13

001001288 DAHS 11 09/01/14 29

001001310 DAHS 11 09/01/14 25

001001316 DAHS 11 09/01/14 31

001001322 NF n/a 09/01/14 7

001001349 DAHS 1 09/01/14 31

001001363 RC 3 09/01/14 NE

001001366 DAHS 11 09/01/14 NE Level supported by 2015 Request for Revision Report

001001374 RC 4 09/01/14 31 Terminated 8/31/14

001001383 CBA 4 09/01/14 31 Terminated 8/31/14

001001396 PHC 6 09/01/14 PHC B 31 31

001001399 NF n/a 09/01/14 7

001001403 DAHS 10 09/01/14 8

001001420 DAHS 11 09/01/14 NE

001001421 RC 6 09/01/14 NE

001001430 RC 3 09/01/14 NE

001001445 RC 2 09/01/14 NE Terminated 8/31/14

001001449 RC 2 09/01/14 NE

001001471 DAHS 7 09/01/14 23

001001480 DAHS 8 09/01/14 31

001001486 PHC 11 09/01/14 PHC B 31 31

001001489 RC 4 09/01/14 31 Terminated 8/31/14

001001513 NF n/a 09/01/14 27

001001524 PHC 1 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001525 CBA 1 09/01/14 31 Terminated 8/31/14

001001526 PHC 2 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001527 CBA 2 09/01/14 31 Terminated 8/31/14

001001528 PHC 3 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001529 CBA 3 09/01/14 31 Terminated 8/31/14

001001532 PHC 5 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001533 CBA 5 09/01/14 31 Terminated 8/31/14

001001534 PHC 6 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001536 PHC 7 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001537 CBA 7 09/01/14 31 Terminated 8/31/14

001001538 PHC 8 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001539 CBA 8 09/01/14 31 Terminated 8/31/14

001001540 PHC 9 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001541 CBA 9 09/01/14 31 Terminated 8/31/14

001001542 PHC 10 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001544 PHC 11 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001001547 DAHS 11 09/01/14 NE

001001558 PHC 11 09/01/14 PHC B 31 31

001001619 PHC 4 09/01/14 PHC B 29 29

001001620 CBA 4 09/01/14 29 Informal level from NE to Level 29 - Terminated 8/31/14

001001621 PHC 5 09/01/14 PHC B 29 29

001001622 CBA 5 09/01/14 29 Informal level from NE to Level 29 - Terminated 8/31/14

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001001623 PHC 7 09/01/14 PHC B 29 29

001001624 CBA 7 09/01/14 29 Informal level from NE to Level 29 - Terminated 8/31/14

001001630 DAHS 11 09/01/14 31

001001632 DAHS 11 09/01/14 31

001001651 DAHS 11 09/01/14 13

001001652 NF n/a 09/15/15 CHOW 8/31/15: Level 13 Final Requested

001001687 PHC 6 09/01/14 PHC B 25 25

001001696 CBA 8 09/01/14 31 Terminated 8/31/14

001001699 NF n/a 10/17/14 CHOW 9/24/14: Level 27 Final Requested

001001701 NF n/a 09/01/14 13

001001711 NF n/a 08/18/15 CHOW 7/31/15: Level 16 Final Requested

001001727 RC 2 09/01/14 8 Terminated 8/31/14

001001728 DAHS 8 09/01/14 NE

001001729 PHC 11 09/01/14 PHC B 31 31

001001756 PHC 6 09/01/14 PHC B 31 31

001001761 NF n/a 09/01/14 6

001001762 NF n/a 12/16/14 CHOW 09/30/14: Level 23 Final Requested

001001770 NF n/a 09/01/14 NE

001001771 NF n/a 09/01/14 NE

001001772 NF n/a 09/01/14 NE

001001773 DAHS 8 09/01/14 29

001001785 NF n/a 12/16/14 CHOW 09/30/14: Level 7 Final Requested

001001787 NF n/a 12/16/14 CHOW 09/30/14: Level 15 Final Requested

001001788 NF n/a 10/30/14 CHOW 10/17/14: Level 15 Final Requested

001001789 NF n/a 12/16/14 CHOW 09/30/14: Level 15 Final Requested

001001790 NF n/a 09/01/14 13

001001797 PHC 11 09/01/14 PHC B 31 31

001001842 PHC 11 09/01/14 PHC B 31 31

001001901 RC 7 09/01/14 NE

001001908 RC 1 09/01/14 20 Terminated 8/31/14

001001911 NF n/a 09/01/14 7

001001918 NF n/a 09/01/14 27

001001928 NF n/a 08/17/15 CHOW 7/31/15: Level NE

001001934 RC 3 09/01/14 NE

001001953 DAHS 8 09/01/14 31

001002708 PHC 6 09/01/14 PHC B 14 3 Enrollment limited to level achieved on 2012 cost report

001002958 PHC 1 09/01/14 PHC B 31 31

001002964 DAHS 10 09/01/14 12

001002969 PHC 11 09/01/14 PHC B 31 31

001002975 PHC 4 09/01/14 PHC B 29 29

001002976 CBA 4 09/01/14 29 Terminated 8/31/14

001002977 PHC 5 09/01/14 PHC B 29 29

001002978 CBA 5 09/01/14 29 Terminated 8/31/14

001002979 PHC 6 09/01/14 PHC B 29 29

001002980 CBA 6 09/01/14 29 Terminated 8/31/14

001002981 PHC 7 09/01/14 PHC B 29 29

001002982 CBA 7 09/01/14 29 Terminated 8/31/14

001002983 PHC 8 09/01/14 PHC B 29 29

001002985 PHC 11 09/01/14 PHC B 29 29

001002987 NF n/a 09/01/14 13

001002989 NF n/a 09/01/14 14

001002990 NF n/a 09/01/14 13

001002993 NF n/a 09/01/14 13

001003004 NF n/a 09/01/14 10

001003060 DAHS 11 09/01/14 20

001003061 RC 11 09/01/14 10

001003062 RC 4 09/01/14 10 Terminated 8/31/14

001003085 PHC 8 09/01/14 PHC B 31 31

001003086 CBA 8 09/01/14 29 Terminated 8/31/14

001003087 PHC 11 09/01/14 PHC B 31 31

001003105 RC 3 09/01/14 NE

001003139 DAHS 6 09/01/14 23

001003151 RC 4 09/01/14 1 Terminated 8/31/14

001003160 DAHS 10 09/01/14 31

001003182 NF n/a 09/01/14 7

001003183 NF n/a 09/01/14 6

001003186 NF n/a 09/01/14 7

001003187 NF n/a 09/01/14 27

001003189 NF n/a 09/01/14 6

001003190 NF n/a 09/01/14 6

001003191 NF n/a 09/01/14 7

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001003195 NF n/a 09/01/14 13

001003196 NF n/a 09/01/14 6

001003207 NF n/a 09/01/14 13

001003215 NF n/a 09/01/14 20

001003283 RC 3 09/01/14 NE

001003284 RC 4 09/01/14 23 Terminated 8/31/14

001003286 RC 4 09/01/14 23

001003287 RC 3 09/01/14 NE

001003288 DAHS 11 09/01/14 31

001003295 DAHS 5 09/01/14 NE

001003304 RC 4 09/01/14 NE

001003313 PHC 11 09/01/14 PHC NP 31

001003326 PHC 3 09/01/14 PHC P 2

001003341 NF n/a 09/01/14 13

001003342 PHC 9 08/05/15 Terminated 7/20/15: Level 3/14 Final Requested

001003344 PHC 10 09/01/14 PHC B 31 31

001003348 PHC 7 09/01/14 PHC B 8 22

001003354 NF n/a 09/01/14 13

001003363 NF n/a 09/01/14 13

001003368 NF n/a 10/09/14 Terminated 9/10/14: Level 13 Final Report Required

001003369 NF n/a 09/01/14 13

001003370 NF n/a 09/01/14 13

001003381 RC 7 09/01/14 NE Terminated 8/31/14

001003382 RC 7 09/01/14 NE

001003386 RC 6 07/24/15 NE Terminated 7/03/15 : Level NE

001003399 PHC 5 09/01/14 PHC B 15 29 Enrollment limited to level achieved on 2012 cost report

001003452 NF n/a 09/01/14 16

001003461 NF n/a 09/01/14 7 Level Supported by 2015 Request for Revision Report

001003564 CBA 4 09/01/14 31 Terminated 8/31/14

001003580 NF n/a 09/01/14 7

001003582 NF n/a 09/01/14 7

001003600 RC 6 09/01/14 NE

001003601 NF n/a 09/01/14 7

001003602 NF n/a 09/01/14 7

001003629 PHC 11 09/01/14 PHC B 31 31

001003642 NF n/a 05/08/15 CHOW 4/30/15: Level 13 Final Requested

001003643 NF n/a 13 CHOW 4/30/15: Level 13 Final Requested

001003644 NF n/a 09/15/14 CHOW to 001026024 eff 9/1/14: Level 13 Final Requested

001003645 NF n/a 09/01/14 13

001003646 PHC 1 09/01/14 PHC NP 26 Enrollment limited to level achieved on 2012 cost report

001003647 CBA 1 09/01/14 20 Terminated 8/31/14

001003648 PHC 2 06/10/15 Terminated 6/3/15: Level NP 26 Final Requested

001003649 CBA 2 09/01/14 20 Terminated 8/31/14

001003650 PHC 9 06/10/15 Terminated 6/3/15: Level NP 29 Final Requested

001003651 CBA 9 09/01/14 20 Terminated 8/31/14

001003658 PHC 11 09/01/14 PHC B 31 31

001003663 PHC 8 09/01/14 PHC B 11 31 Enrollment limited to level achieved on 2012 cost report

001003664 NF n/a 09/01/14 7

001003700 NF n/a 09/01/14 13

001003719 PHC 3 09/01/14 PHC B 29 29

001003749 DAHS 11 09/01/14 23

001003769 PHC 7 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001003774 PHC 4 09/01/14 PHC B 23 23

001003796 PHC 3 09/01/14 PHC B 31 31

001003827 NF n/a 09/01/14 2

001003830 NF n/a 09/01/14 2

001003831 DAHS 11 09/01/14 31

001003843 PHC 3 09/01/14 PHC NP 29

001003845 PHC 4 09/01/14 PHC NP 29

001003846 CBA 4 09/01/14 29 Terminated 8/31/14

001003848 NF n/a 09/01/14 27

001003862 CBA 6 09/01/14 29 Terminated 8/31/14

001003874 PHC 3 09/01/14 PHC B 20 20

001003876 PHC 11 09/01/14 PHC B 31 31

001003883 PHC 8 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001003884 CBA 8 09/01/14 NE Terminated 8/31/14

001003887 NF n/a 01/09/15 CHOW 12/31/14: Level 27 Final Requested

001003894 DAHS 11 09/01/14 31

001003909 PHC 6 09/01/14 PHC B 3 21

001003919 DAHS 11 09/01/14 NE

001003925 PHC 3 09/01/14 PHC B 3 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001003937 PHC 11 09/01/14 PHC B 31 31

001003939 RC 6 09/01/14 NE

001003942 NF n/a 09/01/14 26

001003957 PHC 3 09/01/14 PHC B 23 7

001003959 NF n/a 09/01/14 3

001003963 NF n/a 09/01/14 21

001003965 NF n/a 09/01/14 13 Level Supported by 2015 Request for Revision Report

001003994 NF n/a 08/06/15 CHOW 7/31/15: Level 13 Final Requested

001003999 PHC 8 09/01/14 PHC B 5 20 Enrollment limited to level achieved on 2012 cost report

001004004 NF n/a 09/01/14 NE

001004039 RC 5 09/01/14 NE

001004040 RC 5 09/01/14 NE Terminated 8/31/14

001004042 PHC 6 09/01/14 PHC B 28 31 Level supported by 2015 Request for Revision report

001004048 RC 6 08/24/15 Terminated 7/15/15: Level NE

001004051 NF n/a 09/01/14 7 Level Supported by 2015 Request for Revision Report

001004052 NF n/a 09/01/14 7

001004054 NF n/a 09/01/14 NE

001004055 NF n/a 09/01/14 2

001004056 NF n/a 09/01/14 NE

001004063 NF n/a 09/01/14 25

001004064 PHC 11 09/01/14 PHC NP 25

001004084 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001004089 NF n/a 09/01/14 10

001004093 PHC 8 09/01/14 NE

001004099 PHC 8 09/01/14 PHC B 31 31

001004112 NF n/a 09/01/14 7

001004113 PHC 3 09/01/14 PHC B 5 31 Enrollment limited to level achieved on 2012 cost report

001004117 NF n/a 09/01/14 6

001004118 NF n/a 09/01/14 2

001004122 NF n/a 09/01/14 7 Level Supported by 2015 Request for Revision Report

001004132 PHC 11 09/01/14 PHC B 31 31

001004152 DAHS 11 09/01/14 3

001004153 DAHS 6 09/01/14 25

001004175 NF n/a 09/01/14 20

001004180 PHC 11 09/01/14 PHC B 31 31

001004226 NF n/a 09/01/14 NE

001004231 PHC 11 09/01/14 PHC B 29 29

001004232 NF n/a 02/11/15 CHOW 1/31/15: Level 10 Final Requested

001004234 NF n/a 09/01/14 NE

001004250 CBA 7 09/01/14 30 Terminated 8/31/14

001004259 NF n/a 09/01/14 7

001004260 NF n/a 09/01/14 7

001004270 NF n/a 09/01/14 2

001004277 PHC 11 09/01/14 PHC B 31 31

001004282 NF n/a 09/01/14 2

001004283 NF n/a 09/01/14 7

001004286 NF n/a 09/01/14 13

001004287 NF n/a 09/01/14 NE

001004288 NF n/a 09/01/14 4

001004293 PHC 11 09/01/14 PHC NP 27

001004295 NF n/a 09/01/14 2

001004298 CBA 2 09/01/14 NE Terminated 8/31/14

001004327 DAHS 11 09/01/14 20

001004349 NF n/a 01/07/15 Terminated 12/18/14: Level 11 Final Requested

001004350 NF n/a 09/01/14 NE

001004353 NF n/a 09/01/14 2

001004357 RC 1 09/01/14 NE Terminated 8/31/14

001004365 PHC 6 09/01/14 PHC B 31 31

001004368 PHC 6 09/01/14 PHC B 20 20

001004384 PHC 3 09/01/14 23 0

001004387 PHC 6 09/01/14 23 0

001004391 PHC 3 09/01/14 PHC B 31 31

001004395 PHC 3 09/01/14 PHC B 22 21

001004401 NF n/a 09/01/14 NE

001004408 PHC 3 09/01/14 PHC NP 29

001004411 NF n/a 09/01/14 NE

001004414 PHC 11 09/01/14 PHC B 20 29

001004428 NF n/a 06/10/15 CHOW 5/31/15: Level 10 Final Requested

001004430 NF n/a 09/01/14 7

001004432 NF n/a 09/01/14 7

001004434 PHC 8 09/01/14 PHC B 31 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001004439 NF n/a 09/01/14 13

001004440 NF n/a 09/01/14 13

001004442 NF n/a 09/01/14 7

001004443 NF n/a 12/16/14 CHOW 11/30/14: Level 7 Final Requested

001004444 NF n/a 09/01/14 18

001004445 NF n/a 09/01/14 8

001004448 NF n/a 09/01/14 13

001004449 NF n/a 09/01/14 13

001004450 NF n/a 09/01/14 18

001004452 NF n/a 09/01/14 18

001004453 NF n/a 09/01/14 13

001004468 NF n/a 09/01/14 7 Level Supported by 2015 Request for Revision Report

001004469 NF n/a 09/01/14 NE

001004482 NF n/a 09/01/14 2

001004487 NF n/a 09/01/14 2

001004488 NF n/a 09/01/14 NE

001004489 NF n/a 09/01/14 2

001004490 NF n/a 09/01/14 10

001004504 PHC 9 09/01/14 NE

001004515 NF n/a 09/01/14 NE

001004520 NF n/a 09/01/14 7

001004521 NF n/a 09/01/14 NE

001004523 DAHS 11 09/01/14 31

001004526 NF n/a 09/01/14 6

001004530 NF n/a 08/19/15 CHOW 7/31/15: Level NE

001004533 PHC 6 09/01/14 PHC B 31 31

001004542 DAHS 8 09/01/14 23

001004545 PHC 11 09/01/14 PHC B 31 31

001004547 PHC 6 09/01/14 PHC NP 21

001004548 NF n/a 09/01/14 13

001004554 DAHS 4 09/01/14 31

001004559 PHC 6 09/01/14 PHC B 13 5

001004578 DAHS 8 09/01/14 23

001004628 PHC 4 09/01/14 PCH P 23

001004638 NF n/a 09/01/14 10

001004643 NF n/a 09/01/14 2

001004652 DAHS 11 09/01/14 18 Enrollment limited to level achieved on 2012 cost report

001004655 NF n/a 09/01/14 10

001004686 NF n/a 10/30/14 CHOW 10/17/14: Level 15 Final Requested

001004760 PHC 3 12/01/14 Terminated 10/1/13: Level NE

001004765 DAHS 8 09/01/14 25

001004778 NF n/a 09/01/14 14

001004780 PHC 6 09/01/14 PHC B 20 25

001004783 CBA 10 09/01/14 7 Terminated 8/31/14

001004786 DAHS 11 09/01/14 20

001004787 DAHS 11 09/01/14 31

001004795 NF n/a 09/01/14 23

001004797 PHC 6 09/01/14 PHC B 23 6

001004798 NF n/a 09/01/14 13

001004816 NF n/a 09/01/14 6

001004826 NF n/a 09/01/14 3

001004827 NF n/a 09/01/14 6

001004844 PHC 6 09/01/14 PHC B 31 31

001004847 NF n/a 09/01/14 2

001004849 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001004850 NF n/a 09/01/14 20 Level Supported by 2015 Request for Revision Report

001004851 NF n/a 09/01/14 NE

001004852 NF n/a 09/01/14 10 Pending outcome of Informal Review

001004854 NF n/a 09/01/14 NE

001004855 NF n/a 09/01/14 NE

001004856 PHC 3 09/01/14 PHC NP 19

001004858 NF n/a 09/01/14 7

001004859 NF n/a 09/01/14 NE

001004860 NF n/a 09/01/14 13

001004861 NF n/a 09/01/14 4

001004862 NF n/a 09/01/14 NE

001004863 NF n/a 09/01/14 NE

001004864 PHC 6 09/01/14 PHC B 31 31

001004865 NF n/a 09/01/14 2

001004868 RC 6 09/01/14 NE

001004869 NF n/a 09/01/14 NE

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001004870 PHC 11 09/01/14 PHC NP 23

001004871 NF n/a 09/01/14 3

001004873 NF n/a 09/01/14 6

001004874 NF n/a 09/01/14 8 Pending outcome of Informal Review

001004875 NF n/a 09/01/14 3

001004876 NF n/a 09/01/14 NE

001004877 NF n/a 09/01/14 2

001004879 NF n/a 09/01/14 4

001004880 NF n/a 09/01/14 2

001004882 NF n/a 03/09/15 CHOW 2/26/15: Level 27 Final Requested

001004889 PHC 7 09/01/14 PHC B 31 31

001007560 NF n/a 09/01/14 7

001012007 NF n/a 09/01/14 13

001012012 PHC 3 09/01/14 PHC NP 13

001012021 PHC 3 09/01/14 PHC NP 23

001012023 PHC 11 09/01/14 PHC B 31 31

001012024 RC 7 09/01/14 NE

001012026 PHC 8 09/01/14 PHC B 31 31

001012035 PHC 8 09/01/14 NE

001012043 PHC 6 09/01/14 PHC B 31 31

001012062 PHC 5 09/01/14 PHC NP 18

001012068 NF n/a 09/01/14 NE

001012071 NF n/a 09/01/14 7

001012079 NF n/a 09/01/14 13

001012080 DAHS 6 09/01/14 NE

001012089 RC 3 09/01/14 NE Terminated 8/31/14

001012092 PHC 3 09/01/14 PHC B 23 23

001012093 CBA 3 09/01/14 31 Terminated 8/31/14

001012112 DAHS 7 09/01/14 NE

001012121 DAHS 11 09/01/14 NE

001012142 NF n/a 09/01/14 9

001012149 PHC 6 09/01/14 PHC NP 13

001012164 NF n/a 09/01/14 10

001012175 NF n/a 09/01/14 7

001012181 RC 3 09/01/14 NE

001012183 PHC 3 09/01/14 NE Enrollment limited to level achieved on 2012 cost report

001012195 PHC 3 09/01/14 NE

001012202 NF n/a 09/01/14 3

001012208 PHC 6 09/01/14 PHC P 23

001012218 NF n/a 09/01/14 27

001012222 RC 6 09/01/14 NE

001012224 RC 4 09/01/14 31 Terminated 8/31/14

001012229 NF n/a 09/01/14 NE

001012235 NF n/a 09/01/14 4

001012240 DAHS 11 09/01/14 NE

001012256 DAHS 8 09/01/14 31

001012267 NF n/a 09/01/14 27

001012272 PHC 6 09/01/14 PHC NP 17

001012287 PHC 11 09/01/14 PHC B 31 31

001012308 NF n/a 09/01/14 27

001012329 DAHS 11 09/01/14 31

001012331 RC 3 09/01/14 NE

001012353 PHC 3 09/01/14 PHC B 31 31

001012355 PHC 3 09/01/14 PHC NP 29

001012374 PHC 6 09/01/14 PHC B 23 11

001012386 PHC 11 09/01/14 PHC B 25 25

001012395 PHC 8 09/01/14 PHC B 31 31

001012397 PHC 11 09/01/14 PHC B 31 31

001012417 DAHS 10 09/01/14 9

001012427 PHC 6 09/01/14 PHC B 31 31

001012429 PHC 7 09/01/14 PHC B 31 31

001012436 PHC 6 09/01/14 PHC B 20 29

001012439 RC 1 09/01/14 2 Terminated 8/31/14

001012460 PHC 7 09/01/14 PHC B 31 31

001012462 PHC 11 09/01/14 PHC NP 25

001012468 PHC 8 09/01/14 PHC NP 31

001012471 NF n/a 09/01/14 7

001012485 DAHS 2 09/01/14 NE

001012508 DAHS 11 09/01/14 27

001012527 PHC 3 09/01/14 PHC B 6 23

001012533 DAHS 11 09/01/14 2

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001012535 DAHS 8 09/01/14 NE

001012540 PHC 11 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001012541 PHC 6 09/01/14 PHC B 31 31

001012552 PHC 11 09/01/14 PHC B 31 31

001012576 PHC 8 09/01/14 PHC NP 29

001012612 DAHS 11 09/01/14 NE

001012616 DAHS 3 09/01/14 NE

001012623 PHC 3 09/01/14 PHC NP 20 Level supported by 2015 Request for Revision report

001012625 DAHS 10 09/01/14 10

001012637 DAHS 11 09/01/14 15 Level supported by Informal Review request

001012642 DAHS 8 09/01/14 17

001012650 PHC 11 09/01/14 PHC B 31 31

001012651 NF n/a 09/01/14 16

001012662 PHC 11 09/01/14 PHC B 31 31

001012665 NF n/a 09/01/14 NE

001012666 PHC 3 09/01/14 PHC B 29 24 Level supported by 2015 Request for Revision report

001012685 PHC 6 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001012689 DAHS 11 09/01/14 31

001012714 PHC 3 09/01/14 PHC B 25 25

001012741 PHC 6 09/01/14 NE

001012751 DAHS 11 09/01/14 31

001012764 PHC 6 09/01/14 NE

001012792 PHC 6 09/01/14 PHC B 29 29

001012813 PHC 11 09/01/14 PHC NP 31

001012814 PHC 6 09/01/14 PHC B 30 30

001012869 NF n/a 09/01/14 14

001012874 NF n/a 09/01/14 6

001012877 DAHS 11 09/01/14 20 Limited to increase as per 1 TAC §355.112(f)(4)

001012879 PHC 6 09/01/14 NE

001012894 PHC 11 09/01/14 PHC B 31 31

001012896 NF n/a 09/01/14 7

001012900 NF n/a 03/09/15 CHOW 2/27/15: Level 6 Final Requested

001012902 NF n/a 08/05/15 CHOW 7/30/15: Level 6 Final Requested

001012905 NF n/a 03/09/15 CHOW 2/27/15: Level 13 Final Requested

001012908 NF n/a 09/01/14 7

001012919 NF n/a 10/30/14 CHOW 9/29/14: Level 7 Final Requested

001012920 NF n/a 03/09/15 CHOW 2/27/15: Level 7 Final Requested

001012921 NF n/a 09/01/14 25

001012923 NF n/a 10/31/14 CHOW 9/29/14: Level 7 Final Requested

001012924 NF n/a 03/09/15 CHOW 2/27/15: Level 6 Final Requested

001012926 PHC 6 09/01/14 NE

001012928 NF n/a 09/01/14 7

001012930 NF n/a 09/01/14 13

001012931 NF n/a 06/02/15 CHOW 5/31/15: level 3 Final Requested

001012932 NF n/a 09/01/14 11

001012939 PHC 6 09/01/14 PHC B 3 21

001012947 PHC 6 09/01/14 PHC B 31 31

001012953 NF n/a 09/01/14 20 Level Supported by 2015 Request for Revision Report

001012954 NF n/a 09/01/14 23

001012976 NF n/a 05/08/15 CHOW 4/30/15 to 001026850: Level 7 Final Requested

001012991 DAHS 11 10/10/14 Terminated 10/6/14: Level 11 Final Requested

001013027 NF n/a 02/11/15 CHOW 1/31/15: Level 3 Final Requested

001013030 NF n/a 09/01/14 23

001013031 NF n/a 09/01/14 17

001013032 DAHS 11 09/01/14 31

001013033 NF n/a 09/01/14 25 Level Supported by 2015 Request for Revision Report

001013036 NF n/a 09/01/14 27

001013038 NF n/a 09/01/14 27

001013049 PHC 6 09/01/14 PHC B 31 31

001013055 DAHS 8 09/01/14 31

001013066 PHC 6 09/01/14 PHC B 20 19

001013070 PHC 6 06/17/15 Terminated 10/31/14: Level 10/31 Final Requested

001013073 PHC 3 09/01/14 PHC B 31 31

001013075 PHC 6 04/15/15 Terminated 3/2/15: Level NE

001013077 PHC 3 09/01/14 PHC NP 25 Enrollment limited to level achieved on 2012 cost report

001013096 RC 4 09/01/14 23 Terminated 8/31/14

001013098 RC 9 09/01/14 NE Terminated 8/31/14

001013104 RC 2 09/01/14 23 Terminated 8/31/14

001013108 RC 9 09/01/14 23 Terminated 8/31/14

001013118 PHC 3 09/01/14 PHC B 31 31

001013122 PHC 6 09/01/14 PHC B 31 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001013128 DAHS 11 09/01/14 31

001013129 PHC 11 09/01/14 PHC B 20 31 Level supported by 2015 Request for Revision report

001013140 RC 3 09/01/14 NE

001013143 DAHS 11 09/01/14 CA to 001026426 eff 1/31/15: Level 23 Final Requested

001013150 RC 2 09/01/14 NE Terminated 8/31/14

001013155 PHC 3 09/01/14 PHC NP 29

001013158 DAHS 11 09/01/14 25 Limited to increase as per 1 TAC §355.112(f)(4)

001013166 PHC 3 09/01/14 PHC B 29 29

001013167 CBA 3 09/01/14 16 Terminated 8/31/14

001013181 PHC 6 09/01/14 PHC B 30 30

001013188 NF n/a 09/01/14 21

001013204 DAHS 11 09/01/14 3 Limited to increase as per 1 TAC §355.112(f)(4)

001013205 PHC 3 09/01/14 PHC B 31 31

001013209 DAHS 11 09/01/14 NE

001013211 DAHS 4 09/01/14 23

001013226 DAHS 11 09/01/14 NE

001013231 RC 7 09/01/14 23 Terminated 8/31/14

001013249 PHC 6 09/01/14 PHC B 31 31

001013251 PHC 3 09/01/14 PHC B 5 31 Enrollment limited to level achieved on 2012 cost report

001013262 NF n/a 09/01/14 6

001013278 PHC 6 09/01/14 PHC NP 15

001013287 CBA 3 09/01/14 NE Terminated 8/31/14

001013288 CBA 4 09/01/14 NE Terminated 8/31/14

001013292 DAHS 8 09/01/14 31

001013298 PHC 3 09/01/14 PHC NP 19

001013301 PHC 6 09/01/14 PHC B 3 21

001013304 PHC 11 09/01/14 PHC B 31 31

001013313 PHC 6 09/01/14 NE

001013318 PHC 6 09/01/14 PHC B 31 31

001013320 PHC 9 09/01/14 PHC NP 29 Prority Limited to level achieved on 2012 Cost Report

001013340 NF n/a 06/02/15 CHOW 5/31/15: level 6 Final Requested

001013341 NF n/a 08/05/15 CHOW 7/30/15: Level 7 Final Requested

001013342 NF n/a 03/09/15 CHOW 2/27/15: Level 27 Final Requested

001013344 NF n/a 03/09/15 CHOW 2/27/15: Level 6 Final Requested

001013345 NF n/a 09/01/14 7

001013347 NF n/a 09/01/14 6

001013349 NF n/a 09/01/14 7

001013350 NF n/a 03/09/15 CHOW 2/27/15: Level 12 Final Requested

001013351 NF n/a 06/02/15 CHOW 5/31/15: Level 3 Final Requested

001013353 NF n/a 09/01/14 13

001013354 NF n/a 09/01/14 27

001013355 NF n/a 09/01/14 7

001013358 NF n/a 09/01/14 3

001013373 NF n/a 10/30/14 CHOW 9/29/14: Level 7 Final Requested

001013374 NF n/a 03/09/15 CHOW 2/27/15: Level 27 Final Requested

001013375 DAHS 3 05/21/15 Terminated 1/10/13 - Level 23 Final Requested

001013378 DAHS 11 09/01/14 25

001013381 NF n/a 03/09/15 CHOW 2/27/15: Level 13 Final Requested

001013382 NF n/a 03/09/15 CHOW 2/27/15: Level 7 Final Requested

001013383 NF n/a 03/09/15 CHOW 2/27/15: Level 13 Final Requested

001013388 NF n/a 09/01/14 3

001013389 PHC 3 09/01/14 PHC B 31 31

001013391 NF n/a 03/09/15 CHOW 2/27/15: Level 15 Final Requested

001013395 NF n/a 03/06/15 CHOW 2/27/15: Level 6 Final Requested

001013396 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001013398 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001013399 PHC 6 09/01/14 NE

001013401 NF n/a 09/01/14 21

001013402 NF n/a 09/01/14 13

001013407 NF n/a 09/01/14 7

001013408 NF n/a 09/01/14 18

001013409 DAHS 3 09/01/14 31

001013410 NF n/a 09/01/14 27

001013431 DAHS 11 09/01/14 4 Enrollment limited to level achieved on 2012 cost report

001013454 NF n/a 09/01/14 7

001013455 NF n/a 09/01/14 7

001013456 NF n/a 09/01/14 7

001013457 NF n/a 09/01/14 7

001013458 NF n/a 09/01/14 13

001013461 NF n/a 10/30/14 CHOW 9/29/14: Level 7 Final Requested

001013462 NF n/a 09/01/14 15

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001013475 PHC 6 09/01/14 PHC B 31 31

001013483 PHC 3 09/01/14 PHC NP 17

001013485 NF n/a 10/30/14 CHOW 9/29/14: Level 13 Final Requested

001013488 PHC 6 09/01/14 PHC B 29 29

001013490 PHC 6 09/01/14 NE

001013496 NF n/a 11/05/14 CHOW 9/30/14: Level 7 Final Requested

001013502 DAHS 11 09/01/14 23

001013506 PHC 6 09/01/14 PHC B 31 31

001013514 NF n/a 09/01/14 NE

001013528 NF n/a 09/01/14 7

001013529 NF n/a 09/01/14 23

001013530 NF n/a 09/01/14 13

001013535 NF n/a 09/01/14 7

001013536 NF n/a 09/01/14 7

001013537 NF n/a 09/01/14 21

001013538 NF n/a 09/01/14 7

001013540 NF n/a 09/01/14 6

001013541 PHC 6 09/01/14 PHC B 31 31

001013545 PHC 10 09/01/14 PHC NP 21

001013561 PHC 6 09/01/14 PHC B 20 18

001013562 NF n/a 09/01/14 9 Level Supported by 2015 Request for Revision Report

001013564 NF n/a 09/01/14 7

001013566 NF n/a 10/13/14 Terminated 9/6/14: Level 15 Final Requested

001013568 NF n/a 09/01/14 6

001013569 NF n/a 09/01/14 7

001013577 PHC 3 09/01/14 PHC B 3 30

001013589 DAHS 11 09/01/14 31

001013599 PHC 6 09/01/14 PHC B 25 25

001013604 PHC 11 09/01/14 PHC B 31 31

001013606 PHC 11 09/01/14 PHC B 20 20

001013621 PHC 8 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001013639 NF n/a 09/01/14 7

001013649 RC 4 09/01/14 NE Terminated 8/31/14

001013650 RC 4 09/01/14 NE Terminated 8/31/14

001013652 RC 4 09/01/14 NE Terminated 8/31/14

001013661 PHC 7 09/01/14 PHC B 31 31

001013662 CBA 7 09/01/14 31 Terminated 8/31/14

001013684 NF n/a 09/01/14 7

001013701 DAHS 11 09/01/14 NE

001013704 DAHS 11 09/01/14 NE

001013707 DAHS 11 09/01/14 NE Enrollment limited to level achieved on 2012 cost report

001013717 NF n/a 09/01/14 9 Enrollment Limited to level achieved in 2012

001013736 RC 4 09/01/14 22 Terminated 8/31/14

001013737 RC 4 09/01/14 NE

001013738 NF n/a 09/01/14 3

001013739 PHC 3 09/01/14 PHC B 31 31

001013742 PHC 11 09/01/14 PHC B 31 31

001013743 PHC 3 09/01/14 NE

001013766 NF n/a 09/01/14 NE

001013784 DAHS 11 09/01/14 13

001013790 RC 4 09/01/14 NE Terminated 8/31/14

001013801 PHC 3 09/01/14 PHC B 31 31

001013808 PHC 3 09/01/14 PHC B 31 31

001013809 PHC 6 09/01/14 PHC NP 14

001013820 PHC 3 09/01/14 PHC B 3 22

001013829 PHC 6 09/01/14 PHC B 31 31

001013836 DAHS 11 09/01/14 NE

001013842 PHC 6 09/01/14 PHCB 6 15

001013849 PHC 11 09/01/14 PHC B 29 29

001013853 NF n/a 09/01/14 10

001013854 NF n/a 09/01/14 NE

001013873 NF n/a 09/01/14 16

001013877 PHC 8 09/01/14 PHC B 25 25

001013899 PHC 8 09/01/14 PHC B 10 28

001013905 NF n/a 09/01/14 27

001013906 PHC 3 09/01/14 PHC B 31 31

001013913 NF n/a 08/18/15 CHOW 7/31/15: Level 7 Final Requested

001013915 NF n/a 10/15/14 CHOW 8/22/14: Level 7 Final Requested

001013916 NF n/a 10/30/14 CHOW 10/17/14: Level 13 Final Requested

001013927 NF n/a 02/13/15 CHOW 1/31/15: Level 16 Final Requested

001013930 NF n/a 09/24/14 CHOW 8/30/14: Level 7 Final Requested

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001013931 NF n/a 09/01/14 11

001013942 PHC 3 09/01/14 PHC B 31 31

001013943 PHC 3 09/01/14 PHC B 29 29

001013958 PHC 3 09/01/14 PHC B 29 29

001013968 PHC 11 09/01/14 PHC B 31 31

001013979 NF n/a 09/01/14 14

001013980 NF n/a 09/01/14 3

001014027 NF n/a 09/01/14 18

001014031 PHC 8 09/01/14 PHC B 31 31

001014032 RC 2 09/01/14 NE Terminated 8/31/14

001014036 PHC 6 09/01/14 PHC B 31 31

001014049 PHC 6 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001014054 PHC 3 09/01/14 PHC B 31 31

001014059 PHC 3 09/01/14 PHC B 19 31 Level supported by 2015 Request for Revision report

001014061 RC 6 09/01/14 NE

001014062 NF n/a 09/01/14 27

001014071 NF n/a 09/01/14 13

001014082 NF n/a 01/09/15 CHOW 11/30/14: Level 13 Final Requested

001014087 NF n/a 09/01/14 13

001014088 NF n/a 09/01/14 20

001014092 PHC 3 09/01/14 PHC NP 31

001014094 DAHS 3 09/01/14 29

001014099 RC 7 09/01/14 30 Terminated 8/31/14

001014103 RC 2 09/01/14 NE Terminated 8/31/14

001014109 PHC 3 09/01/14 PHC B 31 31

001014116 PHC 1 09/01/14 PHC B 30 30

001014118 PHC 9 09/01/14 PHC B 30 30

001014123 PHC 6 09/01/14 PHC B 31 31

001014143 NF n/a 09/01/14 22 Level Supported by 2015 Request for Revision Report

001014146 PHC 8 09/01/14 PHC B 31 31

001014152 PHC 3 09/01/14 PHC B 31 31

001014154 PHC 3 09/01/14 NE

001014165 PHC 8 09/01/14 PHC B 31 31

001014167 PHC 11 09/01/14 PHC B 31 31

001014184 RC 1 09/01/14 31 Terminated 8/31/14

001014197 PHC 3 09/01/14 PHC B 31 31

001014204 PHC 6 09/01/14 PHC B 31 31

001014208 NF n/a 09/01/14 6

001014209 DAHS 11 09/01/14 NE

001014214 PHC 3 09/01/14 PHC B 2 20

001014223 NF n/a 09/06/15 CHOW 7/31/15: Level 21 Final Requested

001014224 NF n/a 05/08/15 CHOW 4/30/15: Level 6 Final Requested

001014225 PHC 9 09/01/14 NE

001014242 NF n/a 09/01/14 17 Enrollment Limited to level achieved in 2012

001014243 NF n/a 09/01/14 16

001014246 DAHS 11 09/01/14 31

001014247 NF n/a 09/01/14 13 Level Supported by 2015 Request for Revision Report

001014248 NF n/a 01/16/15 CHOW 12/31/14: Level 7 Final Requested

001014258 PHC 11 09/01/14 PHC B 23 23

001014259 PHC 1 12/02/14 CA to 001026062 eff 11/30/14: Level 31/9 Final Requested

001014260 CBA 1 09/01/14 NE Terminated 8/31/14

001014270 DAHS 10 09/01/14 8

001014274 PHC 3 09/01/14 PHC NP 13

001014279 PHC 6 09/01/14 PHC B 31 31

001014281 PHC 6 09/01/14 PHC B 29 29

001014284 DAHS 11 09/01/14 25

001014286 NF n/a 03/24/15 CHOW 02/07/15: Level NE

001014300 NF n/a 09/01/14 15

001014306 RC 11 09/01/14 31

001014307 NF n/a 09/01/14 27

001014313 PHC 11 09/01/14 PHC B 31 31

001014316 PHC 6 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001014327 DAHS 11 09/01/14 31

001014329 DAHS 11 09/01/14 31

001014336 NF n/a 08/17/15 CHOW 7/31/15: Level NE

001014337 NF n/a 08/17/15 CHOW 8/31/15: Level NE

001014340 NF n/a 03/09/15 CHOW 2/27/15: Level 7 Final Requested

001014344 NF n/a 09/01/14 7

001014345 NF n/a 09/01/14 7

001014346 NF n/a 09/01/14 7

001014349 NF n/a 09/01/14 9

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001014368 NF n/a 09/01/14 7

001014377 NF n/a 09/01/14 7

001014378 NF n/a 09/01/14 7

001014379 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001014380 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001014386 PHC 8 09/01/14 PHC NP 29 Enrollment limited to level achieved on 2012 cost report

001014413 PHC 6 09/01/14 PHC B 5 9

001014425 NF n/a 09/01/14 1

001014428 NF n/a 09/01/14 7

001014458 NF n/a 09/01/14 3

001014465 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001014473 PHC 3 09/01/14 PHC B 21 14

001014474 PHC 10 09/01/14 PHC B 10 10

001014475 PHC 6 09/01/14 PHC B 31 31

001014479 NF n/a 09/01/14 13

001014485 NF n/a 09/01/14 6

001014491 NF n/a 12/16/14 CHOW 11/5/14: Level 6 Final Requested

001014494 NF n/a 09/01/14 7 Level Supported by 2015 Request for Revision Report

001014497 DAHS 11 09/01/14 31

001014503 PHC 11 09/01/14 PHC B 31 31

001014519 NF n/a 09/01/14 7

001014520 PHC 6 09/01/14 PHC B 31 31

001014524 RC 3 09/01/14 1

001014538 NF n/a 03/24/15 CHOW 2/27/15: Level NE

001014539 PHC 3 09/01/14 PHC B 31 31

001014542 PHC 6 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001014544 RC 9 09/01/14 NE Terminated 8/31/14

001014558 PHC 6 09/01/14 PHC B 31 31

001014559 NF n/a 09/01/14 6

001014571 PHC 10 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001014576 PHC 11 04/16/15 Terminated 3/1/15: Level NP 15: Final Requested

001014580 DAHS 11 09/01/14 31

001014581 PHC 6 09/01/14 PHC B 29 29

001014583 PHC 3 09/01/14 PHC NP 23

001014590 RC 2 09/01/14 NE Terminated 8/31/14

001014594 PHC 6 09/01/14 NE

001014598 NF n/a 09/01/14 27 Level Supported by 2015 Request for Revision Report

001014602 NF n/a 09/01/14 18

001014603 NF n/a 09/01/14 7

001014607 NF n/a 09/01/14 27

001014608 PHC 6 09/01/14 PHC B 31 31

001014613 NF n/a 09/01/14 2 Enrollment Limited to level achieved in 2012

001014615 NF n/a 09/01/14 10

001014616 NF n/a 09/01/14 23

001014617 NF n/a 09/01/14 7

001014618 PHC 9 09/01/14 PHC B 31 31

001014622 DAHS 11 10/10/14 CA to 001026048 eff 10/8/14: Level NE

001014628 PHC 3 09/01/14 NE

001014629 PHC 11 09/01/14 PHC NP 31

001014632 PHC 3 09/01/14 NE

001014646 NF n/a 09/01/14 NE

001014647 NF n/a 09/01/14 13

001014648 NF n/a 09/01/14 7

001014658 DAHS 11 09/01/14 22

001014663 PHC 3 09/01/14 PHC B 29 29

001014666 DAHS 11 09/01/14 NE

001014669 PHC 6 09/01/14 NE

001014670 DAHS 8 09/01/14 31

001014674 PHC 11 09/01/14 PHC NP 31

001014678 PHC 11 09/01/14 PHC B 23 29

001014681 PHC 6 09/01/14 NE

001014682 DAHS 11 09/01/14 31

001014685 PHC 6 09/01/14 PHC B 31 31

001014686 PHC 3 09/01/14 PHC B 31 31

001014693 PHC 6 09/01/14 NE

001014699 NF n/a 09/01/14 7

001014716 NF n/a 09/01/14 7

001014728 RC 4 09/01/14 NE

001014732 NF n/a 09/03/15 CHOW 8/31/15: Level NE

001014734 NF n/a 09/01/14 6

001014736 NF n/a 09/01/14 24

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001014737 NF n/a 09/01/14 NE

001014738 NF n/a 10/09/14 CHOW 9/15/14: Level 6 Final Requested

001014739 RC 4 09/01/14 NE Terminated 8/31/14

001014740 RC 4 09/01/14 NE

001014741 NF n/a 09/01/14 1

001014755 PHC 6 09/01/14 PHC NP 29

001014756 DAHS 8 09/01/14 31

001014758 PHC 3 09/01/14 PHC B 31 31

001014774 NF n/a 09/01/14 7

001014775 PHC 6 06/10/15 Terminated 5/18/15: Level P 20 Final Rquested

001014777 NF n/a 03/06/15 CHOW 2/27/15: Level NE

001014787 NF n/a 09/01/14 27

001014790 CLASS 3 09/01/14 31 Level supported by 2015 Request for Revision Report

001014798 PHC 3 09/01/14 PHC B 31 31

001014802 DAHS 11 09/01/14 31

001014804 DAHS 3 06/01/15 NE WP eff 5/31/15: Level 20 Final Requested

001014807 PHC 3 09/01/14 PHC B 31 31

001014815 NF n/a 09/01/14 27

001014816 NF n/a 09/01/14 23

001014820 PHC 6 09/01/14 PHC NP 2

001014828 PHC 6 09/01/14 PHC B 31 31

001014839 DAHS 11 09/01/14 NE Enrollment limited to level achieved on 2012 cost report

001014843 PHC 11 09/01/14 PHC B 31 31

001014859 PHC 6 09/01/14 PHC P 23

001014860 PHC 7 09/01/14 NE

001014871 RC 4 09/01/14 31 Terminated 8/31/14

001014879 CBA 8 09/01/14 31 Terminated 8/31/14

001014880 PHC 5 09/01/14 PHC B 31 31

001014881 CBA 5 09/01/14 31 Terminated 8/31/14

001014903 NF n/a 03/03/15 CHOW 2/19/15: Level 4 Final Requested

001014911 NF n/a 09/01/14 1 Enrollment Limited to level achieved in 2012

001014913 DAHS 3 09/01/14 25

001014921 PHC 6 09/01/14 NE

001014924 DAHS 11 12/02/14 CA to 001026236 eff 12/1/14: Level 31 Final Requested

001014932 DAHS 10 09/01/14 31

001014939 NF n/a 02/11/15 CHOW 1/31/15: Level 6 Final Requested

001014940 NF n/a 02/11/15 CHOW 1/31/15: Level 6 Final Requested

001014941 NF n/a 03/17/15 CHOW 1/31/15: Level 6 Final Requested

001014943 NF n/a 03/10/15 CHOW 1/31/15: Level 6 Final Requested

001014949 NF n/a 09/01/14 7

001014952 NF n/a 09/01/14 6

001014955 NF n/a 09/01/14 7

001014963 PHC 7 09/01/14 PHC B 31 31

001014972 PHC 11 09/01/14 PHC B 31 31

001014973 NF n/a 02/11/15 CHOW 1/31/15: Level 6 Final Requested

001014979 PHC 11 09/01/14 PHC B 31 31

001014981 NF n/a 03/10/15 CHOW 1/31/15: Level 6 Final Requested

001014982 NF n/a 04/02/15 CHOW 1/31/15: Level 6 Final Requested

001014983 NF n/a 02/11/15 CHOW 1/31/15: Level 6 Final Requested

001014992 NF n/a 09/01/14 3

001014994 NF n/a 09/01/14 6

001014995 PHC 11 09/01/14 PHC B 31 31

001015013 DAHS 11 09/01/14 25

001015021 NF n/a 09/01/14 7

001015028 PHC 3 09/01/14 PHC NP 29

001015041 PHC 3 09/01/14 PHC B 29 15

001015050 NF n/a 09/01/14 7

001015051 NF n/a 12/13/14 CHOW 11/30/14: Level 27 Final Requested

001015052 NF n/a 09/01/14 19

001015053 RC 2 09/01/14 NE Terminated 8/31/14

001015058 NF n/a 03/19/15 CHOW 2/27/15: Level 5 Final Requested

001015066 PHC 3 09/01/14 NE

001015091 PHC 11 09/01/14 PHC B 31 31

001015092 PHC 11 09/01/14 PHC B 31 31

001015097 PHC 3 09/01/14 PHC B 22 31 Enrollment limited to level achieved on 2012 cost report

001015099 DAHS 11 09/01/14 25

001015107 DAHS 11 09/01/14 NE

001015108 NF n/a 10/13/14 CHOW 8/30/14: Level 7 Final Requested

001015110 NF n/a 02/23/15 CHOW 1/31/15: Level 7 Final Requested

001015112 DAHS 11 09/01/14 5

001015113 PHC 11 09/01/14 PHC P 25

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001015115 NF n/a 11/19/14 CHOW 10/31/14: Level 6 Final Requested

001015116 NF n/a 09/01/14 7

001015117 NF n/a 11/19/14 CHOW 10/31/14: Level 3 Final Requested

001015118 NF n/a 09/01/14 NE

001015119 NF n/a 11/19/14 CHOW 10/31/14: Level 6 Final Requested

001015120 NF n/a 11/19/14 CHOW 10/31/14: Level 3 Final Requested

001015121 NF n/a 11/19/14 CHOW 10/31/14: Level 6 Final Requested

001015122 PHC 11 09/01/14 PHC B 31 31

001015123 NF n/a 11/19/14 CHOW 10/31/14: Level 6 Final Requested

001015125 NF n/a 09/01/14 7

001015130 PHC 6 09/01/14 NE

001015135 NF n/a 09/01/14 13

001015146 PHC 11 09/01/14 PHC B 31 31

001015147 NF n/a 09/01/14 13 Level Supported by 2015 Request for Revision Report

001015148 NF n/a 09/01/14 13

001015186 NF n/a 09/01/14 13

001015187 NF n/a 09/01/14 13

001015188 NF n/a 09/01/14 27

001015191 PHC 6 09/01/14 PHC NP 9

001015193 NF n/a 09/01/14 23

001015194 NF n/a 09/01/14 16

001015195 NF n/a 09/01/14 13

001015196 NF n/a 09/01/14 27

001015197 NF n/a 09/01/14 27 Level Supported by 2015 Request for Revision Report

001015200 NF n/a 09/01/14 17

001015201 NF n/a 12/16/14 CHOW 11/30/14: Level 10 Final Requested

001015205 DAHS 11 09/01/14 21

001015207 NF n/a 09/01/14 6

001015208 NF n/a 09/01/14 25

001015211 PHC 3 09/01/14 PHC B 5 20

001015212 NF n/a 09/01/14 17

001015214 DAHS 8 09/01/14 23

001015215 NF n/a 09/01/14 14

001015228 NF n/a 09/01/14 13

001015229 NF n/a 09/01/14 13

001015230 NF n/a 09/01/14 13

001015231 NF n/a 09/01/14 27

001015232 PHC 6 09/01/14 PHC B 31 31

001015247 DAHS 11 09/01/14 NE

001015251 RC 4 09/01/14 23 Terminated 8/31/14

001015252 RC 4 09/01/14 23

001015253 RC 4 09/01/14 23 Terminated 8/31/14

001015254 RC 4 09/01/14 23

001015255 RC 4 09/01/14 23 Terminated 8/31/14

001015256 RC 4 09/01/14 23

001015257 RC 4 09/01/14 23 Terminated 8/31/14

001015258 RC 4 09/01/14 23

001015259 NF n/a 10/09/14 CHOW 9/22/14: Level 7 Final Requested

001015261 PHC 4 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001015263 PHC 7 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001015265 PHC 9 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001015279 PHC 11 09/01/14 PHC NP 23

001015285 PHC 2 09/01/14 PHC B 31 31 Terminated 8/31/15: Level 31/31 Final Requested

001015286 CBA 2 09/01/14 22 Terminated 8/31/14

001015287 PHC 3 09/01/14 PHC B 31 31 Terminated 9/30/15: Level 31/31 Final Requested

001015288 CBA 3 09/01/14 22 Terminated 8/31/14

001015290 RC 11 09/01/14 10 Terminated 8/31/14

001015294 PHC 11 09/01/14 PHC B 31 31

001015296 NF n/a 09/01/14 7

001015299 PHC 6 09/01/14 PHC B 31 28 Level supported by 2015 Request for Revision report

001015307 PHC 11 09/01/14 PHC B 31 31

001015317 PHC 3 09/01/14 PHC B 8 3

001015321 PHC 11 09/01/14 PHC NP 31

001015325 PHC 6 09/01/14 PHC B 31 31

001015326 PHC 11 09/01/14 PHC B 31 31

001015335 DAHS 11 09/01/14 18 Enrollment limited to level achieved on 2012 cost report

001015340 NF n/a 09/01/14 6 Enrollment Limited to level achieved in 2012

001015346 PHC 11 09/01/14 PHC B 31 31

001015347 DAHS 3 09/01/14 31

001015356 PHC 11 09/01/14 PHC B 31 31

001015363 PHC 6 09/01/14 PHC B 23 7

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001015365 PHC 6 09/01/14 PHC B 31 31

001015370 DAHS 3 09/01/14 NE

001015371 NF n/a 09/01/14 10

001015372 NF n/a 09/01/14 27

001015375 PHC 11 09/01/14 PHC NP 17

001015376 NF n/a 09/01/14 7

001015377 NF n/a 09/01/14 13

001015378 NF n/a 09/01/14 13

001015380 NF n/a 09/01/14 27

001015382 NF n/a 09/01/14 13

001015383 PHC 8 09/01/14 PHC B 29 21

001015385 NF n/a 09/01/14 13

001015387 NF n/a 09/01/14 27

001015390 NF n/a 09/01/14 7

001015392 NF n/a 09/01/14 27

001015393 PHC 11 09/01/14 PHC B 31 31

001015394 NF n/a 09/01/14 27

001015396 NF n/a 09/01/14 13

001015398 NF n/a 09/01/14 25

001015399 NF n/a 09/01/14 13

001015400 NF n/a 09/01/14 27

001015403 PHC 11 09/01/14 PHC B 31 31

001015416 NF n/a 02/13/15 CHOW 1/31/15: Level 3 Final Requested

001015421 DAHS 11 09/01/14 20

001015427 PHC 6 09/01/14 NE

001015428 NF n/a 01/07/15 CHOW 11/14/14: Level 13 Final Requested

001015430 DAHS 10 09/01/14 31

001015433 PHC 11 09/01/14 PHC B 31 31

001015436 PHC 6 09/01/14 PHC B 10 23 Enrollment limited to level achieved on 2012 cost report

001015440 PHC 11 09/01/14 PHC B 29 29

001015557 PHC 8 09/01/14 PHC B 14 31 Enrollment limited to level achieved on 2012 cost report

001015558 CBA 8 09/01/14 NE Terminated 8/31/14

001015563 NF n/a 09/01/14 NE

001015664 PHC 11 09/01/14 PHC B 31 31

001015682 NF n/a 09/01/14 3

001015690 NF n/a 09/01/14 3

001015714 PHC 6 09/01/14 PHC B 31 31

001015726 NF n/a 11/19/14 CHOW 09/30/14: Level 13 Final Requested

001015727 PHC 3 09/01/14 PHC B 31 31

001015739 RC 4 09/01/14 12 Terminated 8/31/14

001015748 RC 1 09/01/14 NE Terminated 8/31/14

001015749 RC 1 09/01/14 NE Terminated 8/31/14

001015750 RC 1 09/01/14 NE Terminated 8/31/14

001015751 RC 1 09/01/14 NE Terminated 8/31/14

001015752 RC 1 09/01/14 NE Terminated 8/31/14

001015753 RC 1 09/01/14 NE

001015812 PHC 11 09/01/14 PHC B 31 31

001015815 PHC 6 09/01/14 PHC B 29 29

001015819 DAHS 11 09/01/14 3

001015833 CLASS 1 09/01/14 31

001015834 CLASS 2 09/01/14 31

001015835 CLASS 3 05/01/15 Terminated 4/8/15: Level 31 Final Requested

001015836 CLASS 3 09/01/14 31

001015837 CLASS 9 09/01/14 31

001015839 CLASS 2 09/01/14 31

001015842 CLASS 11 09/01/14 31

001015843 CLASS 8 09/01/14 31

001015845 CLASS 7 09/01/14 31

001015846 CLASS 3 09/01/14 31

001015847 CLASS 11 09/01/14 31

001015848 CLASS 3 09/01/14 31

001015849 CLASS 4 09/01/14 31

001015850 CLASS 5 09/01/14 31

001015851 CLASS 9 09/01/14 31

001015852 CLASS 8 09/01/14 31

001015853 CLASS 7 09/01/14 31

001015857 CLASS 6 09/01/14 31

001015862 RC 4 09/01/14 NE

001015863 RC 4 09/01/14 NE Terminated 8/31/14

001015868 NF n/a 09/01/14 13

001015874 NF n/a 09/01/14 6

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001015876 CLASS 6 09/01/14 31

001015877 DAHS 11 09/01/14 31

001015878 CLASS 1 09/01/14 21 Level supported by Informal Review request

001015879 CLASS 1 09/01/14 21 Level supported by Informal Review request

001015881 CLASS 6 09/01/14 31

001015882 CLASS 1 09/01/14 31

001015883 CLASS 8 09/01/14 31

001015884 DAHS 11 09/01/14 31

001015895 CLASS 7 09/01/14 31

001015903 RC 6 09/01/14 29

001015908 PHC 8 09/01/14 PHC B 23 31

001015911 PHC 11 09/01/14 PHC B 23 31

001015915 PHC 6 09/01/14 PHC B 31 31

001015916 NF n/a 03/07/15 CHOW 2/20/15: Level 7 Final Requested

001015917 NF n/a 09/01/14 7

001015922 PHC 6 09/01/14 PHC B 23 7

001015923 CLASS 6 09/01/14 29

001015924 CLASS 8 09/01/14 29

001015928 CLASS 11 09/01/14 31

001015929 CLASS 3 09/01/14 31

001015932 PHC 6 09/01/14 PHC B 29 29

001015933 DAHS 11 09/01/14 3

001015939 CLASS 11 09/01/14 31

001015950 PHC 3 09/01/14 PHC NP 21

001015958 NF n/a 02/11/15 CHOW 1/31/15: Level 13 Final Requested

001015963 NF n/a 09/01/14 27

001015965 PHC 11 09/01/14 PHC B 31 31

001015975 PHC 6 09/01/14 PHC B 25 25

001015998 NF n/a 09/01/14 6

001016005 PHC 6 09/01/14 PHC B 31 31

001016006 NF n/a 09/01/14 6

001016012 PHC 11 09/01/14 PHC B 25 25

001016043 NF n/a 09/01/14 21 Enrollment Limited to level achieved in 2012

001016048 RC 3 09/01/14 NE

001016057 DAHS 11 09/01/14 31

001016066 DAHS 11 09/01/14 31

001016069 NF n/a 09/01/14 13

001016085 NF n/a 09/01/14 7

001016092 PHC 11 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001016094 PHC 11 09/01/14 PHC B 23 23

001016103 NF n/a 09/01/14 7

001016106 DAHS 11 09/01/14 31

001016107 PHC 6 09/01/14 PHC B 30 30

001016116 NF n/a 09/09/15 CHOW

001016117 NF n/a 09/01/14 6

001016119 NF n/a 09/01/14 7

001016121 CLASS 6 09/01/14 27

001016124 PHC 6 09/01/14 PHC NP 31

001016127 NF n/a 09/01/14 NE

001016131 RC 4 05/07/15 Terminated 7/14/14: Level NE

001016149 PHC 11 09/01/14 PHC B 31 31

001016152 NF n/a 09/01/14 7

001016153 PHC 11 09/01/14 PHC B 31 31

001016156 NF n/a 09/01/14 7

001016157 NF n/a 09/01/14 6

001016158 NF n/a 03/09/15 CHOW 2/17/15: Level 6 Final Requested

001016172 RC 3 09/01/14 NE

001016175 RC 4 09/01/14 23

001016182 PHC 11 09/01/14 PHC B 31 31

001016187 PHC 6 09/01/14 PHC B 31 31

001016188 CLASS 1 09/01/14 31

001016193 CBA 4 09/01/14 14 Terminated 8/31/14

001016197 RC 7 09/01/14 NE

001016198 RC 7 09/01/14 NE Terminated 8/31/14

001016199 NF n/a 09/01/14 10 Enrollment Limited to level achieved in 2012

001016216 PHC 11 09/01/14 PHC B 31 31

001016217 NF n/a 09/01/14 7

001016218 RC 2 09/01/14 31 Terminated 8/31/14

001016219 DAHS 11 09/01/14 31

001016225 PHC 6 09/01/14 PHC B 23 23

001016231 PHC 1 09/01/14 PHC B 31 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001016233 PHC 2 09/01/14 PHC B 31 31

001016234 CBA 2 09/01/14 31 Terminated 8/31/14

001016235 PHC 3 09/01/14 PHC B 31 31

001016237 PHC 4 09/01/14 PHC B 31 31

001016238 CBA 4 09/01/14 31 Terminated 8/31/14

001016239 PHC 5 09/01/14 PHC B 31 31

001016241 PHC 6 09/01/14 PHC B 31 31

001016243 PHC 7 09/01/14 PHC B 31 31

001016244 CBA 7 09/01/14 31 Terminated 8/31/14

001016245 PHC 8 09/01/14 PHC B 31 31

001016247 PHC 9 09/01/14 PHC B 31 31

001016248 CBA 9 09/01/14 31 Terminated 8/31/14

001016249 PHC 10 09/01/14 PHC B 31 31

001016251 PHC 11 09/01/14 PHC B 31 31

001016260 PHC 9 09/01/14 PHC B 31 31

001016265 NF n/a 09/01/14 7

001016266 PHC 3 09/01/14 PHC NP 16

001016270 DAHS 11 09/01/14 31

001016271 DAHS 3 09/01/14 31

001016272 RC 2 09/01/14 16 Terminated 8/31/14

001016273 RC 2 09/01/14 16

001016289 DAHS 11 09/01/14 31

001016290 NF n/a 09/01/14 7

001016297 NF n/a 09/01/14 7

001016298 PHC 11 09/01/14 PHC P 25

001016299 PHC 11 09/01/14 PHC B 23 23

001016302 NF n/a 09/01/14 6

001016307 PHC 11 09/01/14 PHC B 1 31

001016311 PHC 3 09/01/14 PHC NP 31

001016318 PHC 11 09/01/14 PHC NP 29

001016320 DAHS 11 09/01/14 31

001016329 PHC 6 09/01/14 PHC B 16 16

001016334 PHC 11 09/01/14 PHC B 31 31

001016341 PHC 11 09/01/14 PHC B 31 31

001016349 NF n/a 01/23/15 CHOW 12/31/14: Level 11 Final Requested

001016350 NF n/a 09/01/14 NE

001016351 NF n/a 09/01/14 5

001016356 DAHS 11 09/01/14 15 Level supported by 2015 Request for Revision Report

001016357 RC 4 09/01/14 23 Terminated 8/31/14

001016360 DAHS 11 09/01/14 31

001016369 PHC 6 09/01/14 PHC NP 16

001016370 NF n/a 09/01/14 6

001016371 NF n/a 09/01/14 NE

001016372 PHC 6 09/01/14 PHC B 27 27

001016374 DB_MD 4 09/01/14 NE

001016375 DB_MD 4 11/18/14 Terminated 11/3/14: Level NE

001016376 DAHS 11 09/01/14 23

001016378 PHC 3 09/01/14 PHC B 31 31

001016382 NF n/a 01/07/15 CHOW 12/31/14: Level 7 Final Requested

001016387 PHC 6 09/01/14 PHC P 16

001016389 DAHS 7 09/01/14 29

001016415 DAHS 11 09/01/14 23

001016426 CLASS 11 09/01/14 31

001016429 NF n/a 09/01/14 NE

001016433 DAHS 11 09/01/14 31

001016444 NF n/a 09/01/14 NE

001016445 DB_MD 8 09/01/14 NE

001016446 DB_MD 8 09/01/14 31

001016447 DB_MD 8 09/01/14 31

001016448 DB_MD 8 09/01/14 31

001016449 DB_MD 8 09/01/14 31

001016450 DB_MD 8 09/01/14 31

001016451 DB_MD 8 09/01/14 31

001016452 DB_MD 8 09/01/14 31

001016455 DAHS 11 09/01/14 31

001016457 PHC 10 09/01/14 PHC B 31 31

001016458 NF n/a 09/01/14 27

001016466 PHC 11 09/01/14 PHC B 31 31

001016467 RC 3 09/01/14 29

001016470 DAHS 11 09/01/14 31

001016472 DAHS 11 09/01/14 19 Level supported by 2015 Request for Revision Report

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001016473 RC 9 09/01/14 NE Terminated 8/31/14

001016475 RC 6 09/01/14 NE

001016477 NF n/a 09/01/14 6

001016484 PHC 6 04/15/15 Terminated 3/2/15: Level NE

001016491 DAHS 11 09/01/14 31

001016497 PHC 8 09/01/14 PHC B 23 23

001016506 NF n/a 03/02/15 CHOW 12/31/14: to 001026494: Level 7 Final Requested

001016507 PHC 8 09/01/14 PHC NP 29 Prority Limited to level achieved on 2012 Cost Report

001016509 NF n/a 04/01/14 CHOW 1/31/15 to 001026731: Level 6 Final Requested

001016512 PHC 3 09/01/14 PHC B 20 13

001016514 NF n/a 09/01/14 6

001016515 PHC 11 09/01/14 PHC B 25 25

001016534 DB_MD 3 09/01/14 NE

001016535 DAHS 11 09/01/14 31

001016537 CLASS 6 09/01/14 15

001016540 DB_MD 1 09/01/14 31

001016541 DB_MD 6 09/01/14 31

001016542 DB_MD 6 09/01/14 31

001016543 DAHS 11 09/01/14 3

001016546 CLASS 11 09/01/14 31

001016547 RC 3 09/01/14 31 Level supported by 2015 Request for Revision Report

001016554 RC 3 09/01/14 NE

001016564 DB_MD 3 09/01/14 23

001016565 DB_MD 3 09/01/14 23

001016566 DB_MD 3 09/01/14 23

001016567 DB_MD 3 09/01/14 23

001016571 PHC 6 09/01/14 PHC NP 11 Enrollment limited to level achieved on 2012 cost report

001016576 CLASS 11 09/01/14 31

001016577 NF n/a 09/01/14 NE

001016583 NF n/a 02/19/15 CHOW 12/31/14: Level NE

001016587 DB_MD 7 09/01/14 NE

001016594 PHC 11 09/01/14 PHC B 27 27

001016604 RC 6 09/01/14 31

001016605 NF n/a 02/23/15 CHOW 1/31/15: Level 6 Final Requested

001016606 PHC 11 09/01/14 PHC B 31 31

001016638 NF n/a 02/13/15 CHOW 1/31/15: Level 10 Final Requested

001016641 NF n/a 03/04/15 CHOW 2/19/15: Leve NE

001016642 NF n/a 09/01/14 3

001016646 RC 3 12/16/14 Terminated 11/30/14: Level NE

001016648 PHC 3 09/01/14 PHC B 29 17

001016653 NF n/a 09/01/14 12

001016658 PHC 7 12/02/14 Terminated 11/24/14: Level 31/31 Final Requested

001016667 NF n/a 09/01/14 3

001016669 PHC 9 12/02/14 Terminated 10/31/14: Level 29/29 Final Requested

001016670 PHC 6 09/01/14 PHC B 31 31

001016678 NF n/a 09/01/14 1

001016679 NF n/a 09/01/14 3

001016680 NF n/a 09/01/14 3

001016706 NF n/a 09/01/14 6

001016708 PHC 3 09/01/14 PHC B 30 30

001016710 DAHS 11 09/01/14 31 Level supported by 2015 Request for Revision Report

001016711 DB_MD 1 09/01/14 NE

001016712 DB_MD 2 09/01/14 NE

001016713 DB_MD 3 09/01/14 NE

001016714 DB_MD 7 09/01/14 NE

001016716 DB_MD 1 09/01/14 NE

001016717 DB_MD 3 09/01/14 NE

001016718 PHC 10 09/01/14 PHC B 29 29

001016719 NF n/a 09/01/14 7

001016724 NF n/a 11/19/14 CHOW 10/31/14: Level 7 Final Requested

001016725 PHC 6 09/01/14 PHC B 28 31 Level supported by 2015 Request for Revision report

001016727 NF n/a 09/01/14 7

001016728 NF n/a 09/01/14 7

001016732 NF n/a 03/09/15 CHOW 2/27/15: Level 7 Final Requested

001016810 DB_MD 6 09/01/14 NE

001016823 DAHS 11 09/01/14 15

001016837 PHC 3 09/01/14 PHC B 31 31

001016839 PHC 6 09/01/14 PHC B 14 22 Enrollment limited to level achieved on 2012 cost report

001016843 PHC 3 09/01/14 PHC B 13 13

001016844 NF n/a 09/01/14 NE

001016855 PHC 3 09/01/14 PHC B 31 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001016861 PHC 11 09/01/14 PHC NP 25 Enrollment limited to level achieved on 2012 cost report

001016868 CLASS 6 09/01/14 31

001016883 DAHS 11 09/01/14 31

001016898 CLASS 1 09/01/14 31

001016904 DAHS 11 09/01/14 18 Enrollment limited to level achieved on 2012 cost report

001016908 NF n/a 09/01/14 27

001016910 DAHS 3 09/01/14 29

001016916 DAHS 11 09/01/14 31

001016926 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001016927 DAHS 11 09/01/14 23

001016938 NF n/a 09/01/14 11

001016939 NF n/a 09/01/14 4

001016941 NF n/a 09/01/14 5

001016942 NF n/a 09/01/14 3

001016943 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001016944 NF n/a 09/01/14 8

001016945 NF n/a 09/01/14 7

001016955 NF n/a 09/01/14 15

001016956 NF n/a 09/01/14 3

001016957 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001016963 PHC 6 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001016965 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001016966 NF n/a 09/01/14 6

001016967 NF n/a 09/01/14 7

001016969 PHC 11 09/01/14 PHC B 31 31

001016970 DAHS 11 09/01/14 22

001016971 NF n/a 03/02/15 CHOW 1/31/15: Level 7 Final Requested

001016973 PHC 9 09/01/14 PHC B 31 31

001016975 NF n/a 09/18/14 CHOW 8/30/14: Level 26 Final Requested

001016978 PHC 3 09/01/14 PHC NP 23

001016992 PHC 11 09/01/14 PHC B 31 31

001016995 DAHS 11 09/01/14 31

001017004 PHC 6 09/01/14 PHC B 22 22

001017009 NF n/a 09/01/14 13

001017010 NF n/a 09/01/14 7

001017021 DAHS 11 12/02/14 Terminated 11/19/14: Level 2 Final Requested

001017022 NF n/a 09/01/14 13

001017027 PHC 11 09/01/14 PHC B 31 31

001017030 DAHS 4 09/01/14 NE Enrollment limited to level achieved on 2012 cost report

001017031 PHC 6 09/01/14 PHC B 31 31

001017033 DAHS 11 09/01/14 16 Enrollment limited to level achieved on 2012 cost report

001017035 PHC 3 05/22/15 Terminated 5/7/15: Level 22/22 Final Requested

001017037 CLASS 6 09/01/14 26

001017038 PHC 3 09/01/14 PHC B 5 22

001017041 PHC 6 09/01/14 PHC NP 29

001017045 DAHS 11 09/01/14 31

001017060 PHC 3 09/01/14 NE

001017061 NF n/a 03/09/15 CHOW 2/25/15: Level 7 Final Requested

001017078 DAHS 7 09/01/14 29

001017097 NF n/a 09/01/14 7

001017103 NF n/a 09/01/14 13

001017106 PHC 6 09/01/14 PHC B 22 15

001017107 CLASS 6 09/01/14 31

001017108 DAHS 11 09/01/14 29

001017110 DAHS 11 09/01/14 NE

001017133 PHC 6 09/01/14 PHC B 20 25

001017139 PHC 3 09/01/14 PHC B 31 13 Level supported by 2015 Request for Revision report

001017142 PHC 3 09/01/14 PHC B 23 7

001017145 NF n/a 09/01/14 13

001017161 PHC 3 09/01/14 PHC B 23 16

001017166 CLASS 3 08/04/15 Terminated 4/17/15: Level 3 Final Requested

001017171 DAHS 11 09/01/14 31

001017174 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017180 NF n/a 09/01/14 7

001017181 PHC 3 09/01/14 PHC B 23 23

001017182 CLASS 7 09/01/14 23

001017183 PHC 4 09/01/14 PHC B 31 31

001017184 CBA 4 09/01/14 29 Terminated 8/31/14

001017186 NF n/a 09/01/14 6

001017190 PHC 11 09/01/14 PHC B 4 29 Enrollment limited to level achieved on 2012 cost report

001017193 DAHS 11 09/01/14 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001017197 PHC 11 09/01/14 PHC B 31 31

001017199 DAHS 11 09/01/14 31

001017206 PHC 6 09/01/14 PHC B 18 25

001017207 PHC 3 09/01/14 PHC B 23 20

001017208 NF n/a 09/01/14 7

001017210 DAHS 6 09/01/14 31

001017211 PHC 6 09/01/14 PHC B 24 24

001017217 DAHS 11 09/01/14 31

001017218 RC 4 09/01/14 NE Terminated 8/31/14

001017220 PHC 6 09/01/14 PHC B 31 31

001017222 CLASS 6 09/01/14 6

001017224 PHC 6 09/01/14 PHC B 29 29

001017225 PHC 11 09/01/14 PHC B 31 31

001017227 NF n/a 08/05/15 Chow 7/31/15: Level 4 Final Requested

001017249 PHC 3 09/01/14 PHC P 29

001017367 PHC 3 09/01/14 PHC B 23 12

001017369 PHC 6 09/01/14 PHC B 23 8

001017479 DAHS 11 09/01/14 31

001017487 PHC 11 09/01/14 PHC B 3 29

001017529 CLASS 3 09/01/14 31

001017530 DB_MD 3 09/01/14 29

001017541 PHC 11 09/01/14 PHC B 29 29

001017559 DAHS 3 09/01/14 29

001017568 PHC 6 09/01/14 PHC B 31 31

001017574 PHC 11 09/01/14 PHC NP 23 Enrollment limited to level achieved on 2012 cost report

001017582 PHC 6 09/01/14 PHC B 29 29

001017585 CLASS 8 09/01/14 31

001017595 DAHS 11 09/01/14 31

001017598 DAHS 11 09/01/14 31

001017600 PHC 6 09/01/14 PHC B 16 23 Enrollment limited to level achieved on 2012 cost report

001017605 PHC 3 09/01/14 PHC NP 25

001017609 CLASS 3 09/01/14 Terminated 9/29/14: Level 23 Final Requested

001017615 PHC 6 09/01/14 PHC B 31 31

001017618 PHC 11 09/01/14 PHC B 31 31

001017622 NF n/a 08/24/15 CHOW 7/31/15: Level 7 Final Requested

001017625 NF n/a 09/01/14 7

001017638 PHC 3 09/01/14 PHC B 30 30

001017662 NF n/a 03/19/15 CHOW 2/27/15: Level 3 Final Requested

001017664 PHC 6 06/03/15 Terminated 8/31/12: Level 31/31- Zero units

001017665 CLASS 11 09/01/14 31 Level supported by 2015 Request for Revision Report

001017667 PHC 6 12/23/14 Terminated 10/31/12: Level 23/23 Final Requested

001017668 PHC 6 12/23/14 Terminated 10/31/12: Level 23/23 Final Requested

001017671 CBA 3 09/01/14 NE Terminated 8/31/14

001017696 DAHS 11 09/01/14 31

001017698 NF n/a 09/01/14 13

001017701 PHC 11 09/01/14 PHC B 31 31

001017704 DAHS 11 09/01/14 31

001017710 PHC 3 09/01/14 PHC B 25 25

001017722 RC 6 09/01/14 NE

001017724 NF n/a 04/28/15 CHOW 2/28/15 to 001026855: Level 6 Final Requested

001017737 PHC 11 09/01/14 PHC B 8 20

001017739 PHC 11 09/01/14 22 0

001017743 NF n/a 09/01/14 3

001017749 DB_MD 3 09/01/14 29

001017750 CLASS 3 09/01/14 29

001017751 PHC 6 12/13/14 Terminated 4/30/13: Level NP 23 Final Requested

001017753 CLASS 11 09/01/14 31

001017757 RC 8 09/01/14 29

001017758 PHC 3 09/01/14 PHC P 25

001017776 PHC 6 09/01/14 PHC B 31 31

001017790 DB_MD 11 09/01/14 31

001017791 NF n/a 09/01/14 17

001017792 NF n/a 09/01/14 27

001017795 PHC 3 09/01/14 PHC NP 29

001017816 NF n/a 09/01/14 7

001017818 PHC 6 09/01/14 PHC B 31 31

001017819 DAHS 11 09/01/14 31

001017825 NF n/a 09/01/14 19 Enrollment Limited to level achieved in 2012

001017827 NF n/a 09/01/14 13

001017829 PHC 3 01/09/15 Terminated 12/31/14: Level 29/29 Final Requested

001017842 DAHS 10 09/01/14 19

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001017843 NF n/a 10/30/14 CHOW 9/30/14: Level 6 Final Requested

001017847 NF n/a 09/01/14 6

001017848 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017849 NF n/a 10/30/14 CHOW 9/30/14: Level 7 Final Requested

001017850 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017851 NF n/a 10/17/14 CHOW 8/31/14: Level 3 Final Requested

001017853 PHC 3 09/01/14 PHC B 31 12 Level supported by 2015 Request for Revision report

001017858 NF n/a 10/30/14 CHOW 9/30/14: Level 6 Final Requested

001017859 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017861 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017862 NF n/a 10/14/14 CHOW 8/31/14: Level 5 Final Requested

001017863 NF n/a 09/01/14 NE

001017864 NF n/a 09/01/14 NE

001017865 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017866 NF n/a 09/01/14 2 Enrollment Limited to level achieved in 2012

001017867 NF n/a 09/01/14 6

001017868 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017869 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017870 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017871 NF n/a 10/29/14 CHOW 9/30/14: Level NE

001017872 NF n/a 09/01/14 7

001017873 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017874 NF n/a 10/17/14 CHOW 9/30/14: Level NE

001017875 NF n/a 10/29/14 CHOW 9/30/14 to 001026285: Level NE

001017876 NF n/a 10/30/14 CHOW 9/30/14: Level 6 Final Requested

001017877 NF n/a 10/30/14 1 CHOW 9/30/14: Level 1 Final Requested

001017878 NF n/a 10/30/14 CHOW 9/30/14: Level 6 Final Requested

001017879 DAHS 3 09/01/14 31

001017880 NF n/a 10/13/14 CHOW 8/31/14: Level 3 Final Requested

001017884 NF n/a 09/01/14 6

001017885 PHC 3 09/01/14 PHC NP 18

001017889 NF n/a 09/01/14 7

001017890 PHC 3 09/01/14 PHC B 31 31

001017893 NF n/a 09/01/14 7

001017899 PHC 11 09/01/14 PHC B 23 23

001017900 PHC 3 09/01/14 PHC B 20 20

001017902 NF n/a 10/30/14 CHOW 9/30/14: Level 7 Final Requested

001017903 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017905 PHC 6 09/01/14 PHC B 30 31

001017907 CLASS 10 09/01/14 10

001017908 NF n/a 09/01/14 NE

001017910 PHC 3 09/01/14 PHC B 23 12

001017912 NF n/a 09/01/14 NE

001017914 DAHS 11 09/01/14 23

001017924 NF n/a 09/01/14 NE

001017926 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001017934 PHC 3 09/01/14 PHC NP 17

001017938 NF n/a 03/09/15 CHOW 2/27/15: Level 27 Final Requested

001017939 NF n/a 08/05/15 CHOW 6/30/15: Level 7 Final Requested

001017950 PHC 11 09/01/14 PHC B 31 31

001017952 PHC 3 09/01/14 PHC NP 23

001017955 DAHS 11 09/01/14 31

001017956 PHC 3 09/01/15 PHC B 21 24

001017961 PHC 11 09/01/14 PHC B 31 31

001017971 PHC 3 09/01/14 PHC NP 30

001017980 PHC 6 09/01/14 PHC B 25 25

001017982 CLASS 6 09/01/14 25

001017987 DAHS 8 09/01/14 13 Enrollment limited to level achieved on 2012 cost report

001017993 DAHS 11 09/01/14 31

001017994 NF n/a 09/01/14 7

001018003 PHC 3 09/01/14 PHC NP 20 Level supported by 2015 Request for Revision report

001018004 NF n/a 09/01/14 7

001018006 NF n/a 09/01/14 4

001018030 RC 3 09/01/14 NE Terminated 8/31/14

001018031 NF n/a 02/11/15 CHOW 1/31/15: Level 7 Final Requested

001018032 PHC 8 09/01/14 PHC B 25 25

001018033 PHC 11 09/01/14 PHC B 25 25

001018048 CLASS 10 09/01/14 31

001018069 NF n/a 04/03/15 CHOW 1/31/15: Level NE

001018072 PHC 3 04/16/15 Terminated 3/31/15: Level NP 21 Final Requested

001018076 CLASS 3 09/01/14 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001018095 PHC 6 09/15/15 Terminated 9/8/15: Level 23/20 Final Requested

001018107 DAHS 10 09/01/14 31

001018117 PHC 3 09/01/14 PHC NP 31

001018127 NF n/a 09/01/14 7

001018128 NF n/a 09/01/14 23

001018129 NF n/a 09/01/14 7

001018130 NF n/a 09/01/14 7

001018132 NF n/a 09/01/14 20

001018147 PHC 3 09/01/14 PHC B 23 3

001018158 PHC 3 09/01/14 PHC B 31 31

001018170 PHC 3 09/01/14 PHC B 22 22

001018177 PHC 3 09/01/14 NE

001018198 PHC 6 09/01/14 NE

001018204 PHC 3 09/01/14 PHC B 23 11

001018217 PHC 3 09/01/14 PHC B 8 22

001018220 DAHS 11 02/10/15 Terminated 2/17/13: Level NE

001018226 PHC 11 09/01/14 PHC NP 23

001018254 NF n/a 09/01/14 6

001018255 PHC 3 09/01/14 PHC B 31 31

001018265 PHC 6 09/01/14 NE

001018275 NF n/a 09/01/14 4 Enrollment Limited to level achieved in 2012

001018281 CLASS 8 09/01/14 1

001018283 DAHS 11 09/01/14 3 Enrollment limited to level achieved on 2012 cost report

001018285 CLASS 3 10/10/14 Terminated 9/29/14: Level 3 Final Requested

001018294 DAHS 11 12/02/14 Terminated 11/3/14: Level 22 Final Requested

001018303 DB_MD 10 09/01/14 23

001018314 PHC 6 09/01/14 PHC B 31 31

001018315 NF n/a 09/01/14 12

001018337 DAHS 11 09/01/14 31

001018339 PHC 3 09/01/14 PHC B 29 29

001018346 PHC 8 09/01/14 PHC NP 31

001018347 CLASS 6 09/01/14 31

001018365 RC 4 09/01/14 3

001018367 RC 4 09/01/14 3 Terminated 8/31/14

001018369 NF n/a 09/01/14 27

001018370 DAHS 11 09/01/14 31

001018372 NF n/a 09/01/14 13

001018373 NF n/a 03/06/15 CHOW 2/22/15: Level 9 Final Requested

001018376 PHC 4 05/08/15 Terminated 4/30/15: Level NP 17 Final Requested

001018378 DAHS 11 09/01/14 31

001018379 PHC 11 09/01/14 PHC NP 30

001018381 PHC 3 09/01/14 PHC B 31 31

001018383 PHC 3 09/01/14 PHC NP 28

001018399 PHC 3 09/01/14 PHC B 29 29

001018406 PHC 3 09/01/14 PHC B 27 27

001018411 PHC 6 09/01/14 NE

001018412 PHC 6 09/01/14 PHC B 25 25

001018413 DAHS 11 10/30/14 Terminated 9/5/14: Level NE

001018415 PHC 3 09/01/14 NE

001018419 DAHS 10 09/01/14 20 Level supported by 2015 Request for Revision Report

001018421 NF n/a 06/10/15 CHOW 6/01/15: Level 6 Final Requested

001018429 PHC 6 09/01/14 NE

001018433 NF n/a 09/01/14 NE

001018441 PHC 3 09/01/14 PHC B 13 13

001018445 NF n/a 03/02/15 CHOW 2/25/15 to 001026676: Level 6 Final Requested

001018446 NF n/a 09/01/14 5

001018452 DAHS 8 09/01/14 29

001018454 PHC 3 09/01/14 PHC P 25

001018457 NF n/a 01/14/15 CHOW 12/31/14: Level 7 Final Requested

001018458 DAHS 3 09/01/14 NE

001018459 DAHS 11 09/01/14 31

001018466 PHC 11 09/01/14 PHC B 22 31 Enrollment limited to level achieved on 2012 cost report

001018470 CLASS 11 09/01/14 31 Level supported by 2015 Request for Revision Report

001018472 NF n/a 09/01/14 7

001018473 DAHS 11 09/01/14 NE

001018475 PHC 11 09/01/14 PHC B 31 31

001018505 NF n/a 09/01/14 13

001018515 NF n/a 03/10/15 CHOW 1/31/15: Level 3 Final Requested

001018522 NF n/a 09/01/14 6

001018546 NF n/a 09/01/14 6

001018555 PHC 3 09/01/14 PHC B 1 1

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001018569 PHC 3 09/01/14 PHC B 31 31

001018570 CBA 3 09/01/14 NE Terminated 8/31/14

001018579 CLASS 6 09/01/14 8 Enrollment limited to level achieved on 2012 cost report

001018592 PHC 6 09/01/14 PHC B 31 31

001018594 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001018596 NF n/a 09/01/14 7

001018597 NF n/a 09/01/14 7

001018598 DAHS 11 09/01/14 23

001018600 NF n/a 09/01/14 7

001018601 NF n/a 09/01/14 6

001018605 PHC 3 09/01/14 PHC B 31 31

001018609 PHC 11 09/01/14 PHC B 31 31

001018631 PHC 3 09/01/14 PHC B 23 23

001018636 PHC 3 11/04/15 CA to 001026866 eff 7/1/15: Level NP 29 Final Requested

001018655 PHC 3 09/01/14 PHC B 29 29

001018662 DAHS 11 09/01/14 31

001018663 CLASS 11 09/01/14 10 Enrollment limited to level achieved on 2012 cost report

001018668 PHC 11 09/01/14 PHC B 22 22

001018675 NF n/a 09/01/14 13

001018678 PHC 3 09/01/14 NE

001018679 DAHS 11 09/01/14 31

001018687 RC 3 09/01/14 2

001018692 NF n/a 09/01/14 6

001018693 PHC 6 09/01/14 PHC B 31 31

001018697 PHC 3 09/01/14 PHC NP 10

001018698 CLASS 3 08/18/15 Terminated 8/13/15: Level 17 Final Requested

001018699 DAHS 5 09/01/14 13 Enrollment limited to level achieved on 2012 cost report

001018703 NF n/a 09/01/14 7

001018704 PHC 6 09/01/14 PHC B 31 31

001018708 NF n/a 09/01/14 7

001018717 PHC 3 09/02/15 Terminated 8/31/15: Level 31/31 Final Requested

001018726 PHC 10 09/01/14 PHC B 31 31

001018733 PHC 3 09/01/14 PHC B 29 3

001018741 NF n/a 09/01/14 7 Level Supported by 2015 Request for Revision Report

001018751 PHC 6 09/01/14 PHC B 25 25

001018753 CLASS 11 09/01/14 25

001018754 PHC 3 09/01/14 PHC NP 30

001018755 PHC 4 09/08/15 Terminated 8/31/15: Level 31/31 Final Requested

001018756 CBA 4 09/01/14 22 Terminated 8/31/14

001018757 PHC 6 09/01/14 PHC NP 20

001018773 RC 3 09/01/14 NE

001018774 NF n/a 09/01/14 13

001018793 PHC 6 09/01/14 PHC B 31 31

001018803 PHC 3 09/01/14 PHC B 31 22

001018810 NF n/a 09/01/14 13

001018812 PHC 6 09/01/14 PHC B 31 31

001018813 NF n/a 12/16/14 CHOW 12/01/14 to 001026410: Level 6 Final Requested

001018814 PHC 3 09/01/14 PHC B 10 12

001018829 NF n/a 09/01/14 13

001018832 PHC 3 09/01/14 PHC B 31 31

001018834 PHC 3 09/01/14 PHC NP 29

001018839 PHC 3 09/01/14 PHC B 31 31

001018853 NF n/a 09/01/14 13

001018855 NF n/a 09/01/14 9

001018859 DAHS 10 09/01/14 31

001018861 PHC 11 09/01/14 PHC B 31 31

001018864 CBA 3 09/01/14 23 Terminated 8/31/14

001018866 PHC 3 09/01/14 PHC B 31 31

001018867 PHC 10 09/01/14 PHC B 31 31

001018875 CLASS 11 09/01/14 31

001018877 PHC 3 09/01/14 PHC NP 31

001018880 DAHS 4 10/17/14 Terminated 10/17/14: Level 13 Final Requested

001018882 DAHS 11 09/01/14 21

001018883 NF n/a 09/01/14 23

001018900 PHC 3 09/01/14 PHC B 22 22

001018903 PHC 3 09/01/14 PHC NP 26

001018909 DAHS 11 09/01/14 NE

001018911 NF n/a 09/01/14 7

001018913 NF n/a 12/16/14 CHOW 11/30/14: Level 7 Final Requested

001018914 PHC 6 01/09/15 Terminated 12/17/14:Leve NE

001018916 NF n/a 12/16/14 CHOW 11/30/14 to 001026318: Level 7 Final Requested

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001018917 NF n/a 12/16/14 CHOW 11/30/14: Level 7 Final Requested

001018918 PHC 6 09/01/14 PHC B 31 23

001018923 PHC 3 09/01/14 PHC B 22 15

001018927 DAHS 11 09/01/14 21

001018928 DAHS 11 09/01/14 31

001018929 DAHS 11 09/01/14 31

001018931 PHC 11 09/01/14 PHC B 31 31

001018940 DAHS 11 09/01/14 23

001018941 PHC 6 09/01/14 PHC NP 25 Enrollment limited to level achieved on 2012 cost report

001018942 PHC 3 09/01/14 PHC B 31 31

001018943 NF n/a 09/01/14 18

001018944 NF n/a 09/01/14 24

001018947 NF n/a 09/01/14 13

001018948 NF n/a 09/01/14 18 Level Supported by 2015 Request for Revision Report

001018949 NF n/a 09/01/14 7

001018951 DAHS 10 09/01/14 23

001018954 PHC 10 09/01/14 PHC NP 28 Enrollment limited to level achieved on 2012 cost report

001018956 PHC 3 09/01/14 PHC B 27 27

001018959 PHC 3 09/01/14 PHC B 31 31

001018970 NF n/a 09/01/14 6 Enrollment Limited to level achieved in 2012

001018971 NF n/a 09/01/14 5

001018974 NF n/a 09/01/14 10

001018982 DAHS 11 09/01/14 31 Level supported by 2015 Request for Revision Report

001018983 PHC 3 09/01/14 NE

001018984 PHC 6 09/01/14 PHC NP 25

001018987 PHC 6 09/01/14 PHC NP 29

001018994 DAHS 11 09/01/14 29

001018997 NF n/a 01/07/15 CHOW 11/30/14: Level 7 Final Requested

001018999 PHC 6 09/01/14 PHC B 29 7

001019000 NF n/a 09/01/14 7

001019001 NF n/a 09/01/14 3

001019005 PHC 11 09/01/14 PHC B 31 31

001019022 PHC 6 09/01/14 PHC B 31 31

001019032 DAHS 10 09/01/14 10

001019034 PHC 3 09/01/14 PHC B 31 31

001019070 PHC 3 09/01/14 PHC B 30 30

001019091 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001019092 PHC 11 09/01/14 PHC P 25

001019093 PHC 11 09/01/14 PHC B 31 31

001019104 PHC 11 09/01/14 PHC NP 26

001019105 DAHS 11 09/01/14 25

001019113 RC 3 09/01/14 NE Terminated 8/31/14

001019114 PHC 6 09/01/14 PHC NP 31 Level supported by 2015 Request for Revision report

001019131 NF n/a 09/01/14 7

001019134 PHC 4 09/01/14 PHC NP 31 Pending result of Informal Review request

001019138 PHC 3 09/01/14 PHC B 30 30

001019156 NF n/a 09/01/14 7

001019157 NF n/a 09/01/14 11 Level Supported by 2015 Request for Revision Report

001019159 NF n/a 09/01/14 7

001019160 PHC 10 09/01/14 PHC B 31 31

001019166 PHC 3 09/01/14 PHC NP 28

001019167 PHC 11 09/01/14 PHC P 22

001019171 DAHS 8 09/01/14 22

001019172 PHC 3 09/01/14 PHC B 31 18 Level supported by 2015 Request for Revision report

001019188 DAHS 11 09/01/14 NE

001019191 PHC 3 09/01/14 PHC B 31 31

001019196 DAHS 11 09/01/14 31

001019199 NF n/a 02/13/15 CHOW 1/31/15: Level 13 Final Requested

001019200 NF n/a 09/01/14 7

001019201 NF n/a 09/01/14 10

001019202 NF n/a 03/09/15 CHOW 2/28/15: Level 26 Final Requested

001019205 PHC 10 09/01/14 PHC B 4 31 Enrollment limited to level achieved on 2012 cost report

001019212 PHC 3 09/01/14 PHC B 23 31 Pending result of Informal Review request

001019214 NF n/a 09/01/14 7

001019215 NF n/a 09/01/14 27

001019216 NF n/a 09/01/14 7

001019244 PHC 3 09/01/14 PHC NP 31

001019259 PHC 11 09/01/14 PHC B 31 31

001019261 PHC 3 09/01/14 NE

001019262 DAHS 11 09/01/14 31

001019264 PHC 3 09/01/14 PHC NP 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001019270 DAHS 11 09/01/14 31

001019283 DAHS 11 09/01/14 31

001019284 DAHS 11 09/01/14 22

001019285 DAHS 11 09/01/14 NE Enrollment limited to level achieved on 2012 cost report

001019287 PHC 3 09/01/14 PHC B 23 22

001019295 DAHS 10 09/01/14 22

001019296 NF n/a 09/01/14 13

001019298 PHC 6 09/01/14 PHC B 31 31

001019309 NF n/a 09/01/14 6

001019310 NF n/a 09/01/14 7

001019311 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001019317 DAHS 11 09/01/14 18 Enrollment limited to level achieved on 2012 cost report

001019318 NF n/a 09/01/14 6

001019323 NF n/a 09/01/14 6

001019324 PHC 11 07/24/15 Terminated 7/15/15: Level NE

001019335 DB_MD 6 09/01/14 NE

001019340 NF n/a 09/01/14 6

001019344 PHC 11 09/01/14 PHC B 31 31

001019351 DAHS 4 09/01/14 NE

001019354 PHC 3 09/01/14 PHC B 31 31 Level supported by 2015 Request for Revision report

001019357 PHC 10 09/01/14 PHC B 22 22

001019361 NF n/a 09/01/14 6

001019364 PHC 3 09/01/14 PHC B 31 31

001019366 PHC 3 09/01/14 PHC B 31 31

001019380 PHC 3 09/01/14 PHC B 25 25

001019381 NF n/a 08/05/15 CHOW 6/30/15: Level 7 Final Requested

001019393 NF n/a 02/23/15 CHOW 1/31/15: Level 7 Final Requested

001019397 PHC 11 09/01/14 PHC B 31 31

001019398 PHC 5 09/01/14 PHC B 31 31

001019417 PHC 3 09/01/14 PHC B 29 29

001019421 PHC 11 09/01/14 PHC B 31 31

001019424 NF n/a 09/01/14 27

001019425 PHC 3 09/01/14 PHC NP 5

001019433 PHC 8 09/01/14 PHC B 31 31

001019441 NF n/a 09/01/14 NE

001019443 NF n/a 09/01/14 NE

001019467 PHC 6 09/01/14 NE

001019474 PHC 8 09/01/14 NE

001019476 PHC 11 09/01/14 PHC B 26 31

001019481 PHC 3 09/01/14 NE

001019484 NF n/a 09/01/14 7

001019486 NF n/a 09/01/14 27

001019487 PHC 6 09/01/14 NE

001019492 PHC 3 05/07/15 Terminated 4/30/15: Level NE

001019493 PHC 4 05/07/15 Terminated 4/30/15: Level NE

001019498 PHC 3 09/01/14 PHC B 31 31

001019504 PHC 3 09/01/14 NE

001019514 PHC 6 06/03/15 Terminated 3/1/12: Level NE

001019518 PHC 10 09/01/14 PHC NP 21 Enrollment limited to level achieved on 2012 cost report

001019540 RC 11 09/01/14 31

001019541 PHC 3 06/03/15 Terminated 2/15/12: Level NE

001019546 PHC 6 09/01/14 PHC B 20 22 Enrollment limited to level achieved on 2012 cost report

001019547 CLASS 6 09/01/14 23

001019548 DAHS 1 09/01/14 31

001019555 PHC 3 09/01/14 PHC B 31 31

001019556 PHC 6 09/01/14 PHC NP 29

001019559 DAHS 11 09/01/14 31

001019560 DAHS 11 09/01/14 29

001019566 NF n/a 09/01/14 27

001019572 PHC 8 09/01/14 PHC B 23 21

001019579 DAHS 4 09/01/14 NE

001019582 PHC 8 09/01/14 PHC B 31 3

001019587 DAHS 11 09/01/14 21

001019589 DAHS 11 09/01/14 31

001019591 NF n/a 10/30/14 CHOW 10/17/14 to 001026123: Level 7 Final Requested

001019641 DAHS 11 09/01/14 29

001019642 CLASS 11 08/24/15 Terminated 7/15/15: Level 31 Final Requested

001019643 DAHS 11 10/31/14 Termnated 9/10/14: Level 31 Final Requested

001019644 DAHS 11 09/01/14 28

001019649 DAHS 10 09/01/14 22

001019651 PHC 3 09/01/14 PHC NP 25

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001019655 PHC 6 09/01/14 PHC B 31 31

001019665 DAHS 11 09/01/14 25

001019684 PHC 6 09/01/14 PHC B 31 31

001019687 NF n/a 09/01/14 10

001019688 PHC 11 09/01/14 PHC B 31 31

001019707 PHC 6 09/01/14 PHC B 29 29

001019708 PHC 6 09/01/14 PHC B 29 29

001019711 NF n/a 09/16/14 CHOW 8/30/14 to 001026028: Level 25 Final Requested

001019714 PHC 3 09/01/14 PHC NP 31

001019719 NF n/a 03/06/15 CHOW 2/19/15: Level 6 Final Requested

001019722 NF n/a 09/01/14 6

001019724 PHC 3 09/01/14 PHC B 31 31

001019730 NF n/a 09/01/14 NE

001019731 PHC 6 09/01/14 PHC NP 2

001019732 DAHS 11 09/01/14 31

001019734 DAHS 3 09/01/14 31

001019736 NF n/a 09/01/14 6

001019739 NF n/a 09/01/14 7

001019741 DAHS 11 09/01/14 22

001019742 PHC 11 09/01/14 PHC B 31 31

001019744 PHC 3 09/01/14 PHC B 31 31

001019746 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001019749 PHC 3 09/01/14 PHC B 22 22

001019751 PHC 3 08/04/15 Treminated 6/30/15: Level 25/17 Final Requested

001019755 DAHS 11 09/01/14 NE Enrollment limited to level achieved on 2012 cost report

001019756 PHC 11 09/01/14 PHC B 31 31

001019759 PHC 3 09/01/14 PHC B 29 11

001019760 PHC 3 09/01/14 PHC B 29 29

001019762 PHC 11 09/01/14 PHC B 31 31

001019766 DAHS 6 09/01/14 NE

001019767 PHC 3 09/01/14 PHC B 29 14

001019772 PHC 3 09/01/14 PHC B 31 31

001019773 CBA 3 09/01/14 31 Terminated 8/31/14

001019786 PHC 11 09/01/14 PHC B 25 31

001019794 PHC 3 09/01/14 PHC B 31 31

001019804 NF n/a 08/13/15 CHOW 2/20/15 changed 4/30/15: Level 18 Final Requested

001019806 PHC 3 09/01/14 PHC NP 31

001019813 PHC 3 09/01/14 PHC B 22 16

001019815 PHC 3 09/01/14 PHC B 31 31

001019820 DAHS 11 09/01/14 NE

001019826 PHC 11 09/01/14 PHC B 31 31

001019828 PHC 3 09/01/14 PHC P 20

001019830 PHC 3 09/01/14 PHC B 15 15

001019831 PHC 3 09/01/14 NE

001019834 DAHS 11 11/03/14 CA to 001026052 eff 10/1/14: Level NE

001019838 PHC 6 09/01/14 PHC B 31 31

001019843 RC 11 09/01/14 20

001019844 RC 11 09/01/14 20 Terminated 8/31/14

001019853 PHC 3 09/01/14 PHC B 29 1

001019862 NF n/a 09/01/14 6

001019880 NF n/a 09/01/14 7

001019881 NF n/a 09/01/14 7

001019884 NF n/a 09/01/14 7

001019885 NF n/a 09/01/14 6

001019887 PHC 3 09/01/14 PHC B 23 23

001019888 NF n/a 09/01/14 10

001019889 NF n/a 09/01/14 6

001019890 DAHS 3 09/01/14 29

001019892 NF n/a 09/01/14 7

001019897 NF n/a 09/01/14 27

001019899 PHC 6 10/31/14 Terminated 10/15/14: Level 15/18 Final Requested

001019900 RC 3 09/01/14 NE

001019902 PHC 11 09/01/14 PHC B 31 31

001019903 NF n/a 08/06/15 CHOW 7/31/15: Level 7 Final Requested

001019908 PHC 6 09/01/14 NE

001019921 DAHS 11 09/01/14 31

001019930 PHC 3 09/01/14 PHC B 29 29

001019935 PHC 3 09/01/14 PHC B 11 11

001019936 DAHS 11 09/01/14 NE Enrollment limited to level achieved on 2012 cost report

001019938 RC 8 09/01/14 12

001019939 DAHS 11 09/01/14 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001019945 NF n/a 09/01/14 15

001019947 RC 6 09/01/14 22

001019948 RC 6 09/01/14 22

001019949 NF n/a 04/02/15 CHOW 2/28/15: Level 6 Final Requested

001019962 PHC 6 09/01/14 PHC B 31 31

001019963 NF n/a 02/11/15 CHOW 1/31/15 to 001026585: Level 6 Final Requested

001019964 PHC 3 09/01/14 PHC P 25

001019977 PHC 3 10/17/14 Terminated 10/9/14: Level NE

001019994 DAHS 11 09/01/14 NE

001019997 PHC 4 09/01/14 NE

001020006 PHC 11 09/01/14 PHC NP 29

001020007 PHC 6 09/01/14 PHC B 20 20

001020014 PHC 3 09/01/14 PHC B 31 31

001020017 NF n/a 08/18/15 CHOW 7/31/15: Level 7 Final Requested

001020018 NF n/a 08/17/15 CHOW 7/31/15: Level 13 Final Requested

001020028 PHC 11 09/01/14 NE

001020029 PHC 10 09/01/14 NE

001020037 DAHS 11 09/01/14 NE

001020043 DAHS 11 09/01/14 31

001020047 PHC 3 11/18/14 Termnated 10/31/14: Level NE

001020051 PHC 3 09/01/14 PHC P 22

001020053 PHC 6 09/01/14 PHC B 31 31

001020063 NF n/a 09/01/14 6

001020066 PHC 3 09/01/14 PHC NP 25

001020078 PHC 11 09/01/14 PHC B 31 31

001020081 PHC 3 09/01/14 NE

001020082 NF n/a 09/01/14 8

001020093 PHC 11 09/01/14 PHC B 25 25

001020094 NF n/a 03/09/15 CHOW 2/27/15: Level 27 Final Requested

001020102 PHC 3 09/01/14 PHC B 31 31

001020117 PHC 3 09/01/14 NE

001020119 NF n/a 10/14/14 CHOW 8/31/14: Level 27 Final Requested

001020120 PHC 3 01/09/15 Terminated 12/29/14: Level 29/29 Final Requested

001020121 NF n/a 09/01/14 7

001020122 PHC 11 09/01/14 PHC B 30 30

001020128 PHC 6 09/01/14 PHC B 31 31

001020136 PHC 6 09/01/14 PHC B 31 31

001020137 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001020138 NF n/a 09/01/14 18

001020139 NF n/a 09/01/14 7

001020140 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001020141 NF n/a 09/01/14 7

001020142 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001020143 NF n/a 09/01/14 7

001020144 PHC 11 09/01/14 PHC B 31 31

001020145 PHC 11 09/01/14 PHC B 25 25

001020158 DAHS 11 09/01/14 31

001020162 PHC 11 09/01/14 PHC B 30 30

001020163 PHC 3 09/01/14 PHC B 22 10

001020166 NF n/a 09/01/14 7

001020172 NF n/a 10/30/14 CHOW 10/17/14: Level 6 Final Requested

001020173 NF n/a 02/11/15 CHOW 1/31/15: Level 6 Final Requested

001020181 NF n/a 09/01/14 7

001020185 PHC 6 09/01/14 NE

001020188 PHC 6 10/10/14 Terminated 10/3/14: Level NE

001020200 PHC 11 09/01/14 PHC B 22 3

001020204 PHC 3 09/01/14 PHC B 31 31

001020210 PHC 5 09/01/14 PHC B 29 7

001020213 PHC 6 03/09/15 Terminated 2/28/15: Level 31/31 Final Requested

001020218 DAHS 11 09/01/14 29

001020228 PHC 3 09/01/14 NE

001020229 PHC 3 09/01/14 PHC B 31 31

001020231 DAHS 11 09/01/14 31

001020233 PHC 6 09/01/14 PHC B 29 18

001020237 NF n/a 09/01/14 3

001020244 NF n/a 10/09/14 CHOW 8/31/14: Level 21 Final Requested

001020245 DAHS 3 09/01/14 22

001020248 NF n/a 09/01/14 25

001020249 NF n/a 09/01/14 11

001020250 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001020251 PHC 3 01/08/15 Terminated 12/15/14: Level 31/31 Final Requested

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001020253 NF n/a 09/01/14 3

001020256 PHC 3 09/01/14 PHC B 31 31

001020257 NF n/a 09/01/14 3

001020260 PHC 3 09/01/14 PHC NP 31

001020261 NF n/a 09/01/14 6

001020265 NF n/a 04/01/15 CHOW 1/31/15: Level 13 Final Requested

001020266 PHC 11 04/16/15 Terminated 3/31/15: Level 31/31 Final Requested

001020268 NF n/a 09/01/14 3

001020269 RC 7 09/01/14 31 Terminated 8/31/14

001020273 PHC 3 09/01/14 NE

001020274 PHC 3 09/01/14 NE

001020279 NF n/a 03/31/15 CHOW 1/31/15: Level 27 Final Requested

001020285 PHC 6 04/16/15 Terminated 3/31/15: Level 31/31 Final Requested

001020292 PHC 3 09/01/14 PHC B 31 31

001020300 NF n/a 03/17/15 CHOW 1/31/15: Level 27 Final Requested

001020301 PHC 3 09/01/14 PHC B 31 31

001020302 PHC 3 09/01/14 PHC B 29 29

001020304 PHC 3 09/01/14 NE

001020306 PHC 10 09/01/14 PHC B 24 24

001020315 PHC 10 09/01/14 PHC B 29 29

001020317 PHC 3 09/01/14 PHC B 29 29

001020321 DAHS 10 09/01/14 1

001020322 PHC 10 09/01/14 PHC B 23 23

001020323 PHC 3 09/01/14 PHC B 29 29

001020325 RC 4 09/01/14 NE

001020339 DAHS 8 09/01/14 30

001020340 NF n/a 01/27/15 CHOW 12/31/14: Level 7 Final Requested

001020341 PHC 3 09/01/14 PHC B 31 31

001020343 PHC 11 09/01/14 PHC B 31 31

001020348 NF n/a 10/30/14 CHOW 9/30/14: Level 6 Final Requested

001020349 PHC 3 09/01/14 NE

001020351 RC 6 09/01/14 22 Terminated 8/31/14

001020356 RC 10 09/01/14 31

001020361 NF n/a 09/01/14 25

001020372 PHC 3 09/01/14 PHC B 6 31

001020376 NF n/a 03/17/15 CHOW 2/28/15: Level 7 Final Requested

001020378 NF n/a 09/01/14 7

001020381 DAHS 11 09/01/14 NE

001020384 PHC 3 09/01/14 PHC B 31 31

001020386 DB_MD 5 09/01/14 NE

001020387 DB_MD 6 09/01/14 NE

001020388 PHC 11 09/01/14 PHC B 31 31

001020400 PHC 3 09/01/14 PHC B 31 31

001020411 NF n/a 01/07/15 CHOW 12/31/14: Level 8 Final Requested

001020418 PHC 6 09/01/14 PHC B 22 22

001020420 PHC 11 09/01/14 PHC B 31 31

001020423 PHC 6 06/10/15 Terminated 5/31/15: Level 31/31 Final Requested

001020424 PHC 11 09/01/14 PHC B 31 31

001020425 NF n/a 10/30/14 CHOW 9/30/14: Level 3 Final Requested

001020427 PHC 3 06/10/15 Terminated 5/31/15: Level NP 22 Final Requested

001020429 RC 3 01/07/15 Terminated 1/6/15: Level NE

001020430 RC 3 09/01/14 22 Terminated 8/31/14

001020431 DAHS 5 09/01/14 NE

001020432 DAHS 11 09/01/14 NE

001020433 PHC 10 09/01/14 PHC B 22 22

001020434 PHC 10 09/01/14 PHC B 22 22

001020444 PHC 6 09/01/14 PHC P 5

001020447 PHC 6 09/01/14 PHC B 31 28

001020448 PHC 3 09/01/14 PHC B 31 31

001020452 NF n/a 02/23/15 CHOW 1/31/15: Level 6 Final Requested

001020456 PHC 6 07/24/15 NE Terminated 6/30/15 : Level NE

001020457 NF n/a 03/06/15 CHOW 1/31/15: Level 7 Final Requested

001020458 PHC 6 09/01/14 NE

001020459 DAHS 8 09/01/14 29

001020460 DAHS 11 09/01/14 31

001020463 NF n/a 04/13/15 CHOW 2/22/15: Level 10 Final Requested

001020464 NF n/a 09/01/14 7

001020466 NF n/a 03/09/15 CHOW 2/27/15: Level 6 Final Requested

001020468 PHC 3 09/01/14 PHC B 31 31

001020469 PHC 6 04/01/15 PHC B 31 31

001020471 PHC 11 09/01/14 PHC B 31 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001020474 DAHS 11 09/01/14 31

001020475 PHC 7 09/01/14 PHC B 23 31

001020476 CBA 7 09/01/14 31 Terminated 8/31/14

001020478 PHC 3 04/13/15 Terminated 7/31/13: Level 29/29 Final Requested

001020480 PHC 10 07/24/15 NE Terminated 6/30/15 : Level NE

001020481 PHC 11 09/01/14 PHC B 31 31

001020482 NF n/a 09/01/14 NE Enrollment Limited to level achieved in 2012

001020487 PHC 9 06/03/15 Terminated 2/15/13: Level NE

001020489 PHC 3 09/01/14 PHC NP 31

001020507 NF n/a 02/11/15 CHOW 1/14/15: Level 7 Final Requested

001020509 PHC 3 09/01/14 PHC B 22 22

001020512 PHC 11 09/01/14 PHC B 31 31

001020513 PHC 10 09/01/14 NE

001020514 PHC 6 09/01/14 PHC B 31 31

001020518 CLASS 6 09/01/14 31

001020522 NF n/a 08/17/15 CHOW 7/9/15: Level NE

001020523 PHC 6 08/04/15 Terminated 7/31/15: Level NE

001020529 NF n/a 09/01/14 6

001020530 DAHS 11 09/01/14 29

001020533 PHC 3 09/01/14 NE

001020535 PHC 7 09/01/14 PHC B 31 30

001020538 PHC 6 09/01/14 NE

001020541 PHC 6 09/01/14 NE

001020553 DAHS 11 09/01/14 NE

001020554 NF n/a 09/01/14 6

001020555 DAHS 11 09/01/14 6 Enrollment limited to level achieved on 2012 cost report

001020557 PHC 6 12/13/14 CA to 001026291 eff 11/30/14: Level NE

001020564 PHC 3 09/01/14 PHC B 31 31

001020571 PHC 6 09/08/15 Terminated 8/31/15: Level 20/13 Final Requested

001020574 PHC 6 09/01/14 PHC B 31 31

001020579 PHC 3 09/08/15 Terminated 8/31/15: Level 29/29 Final Requested

001020581 PHC 6 09/01/14 PHC NP 20

001020582 NF n/a 06/10/15 CHOW 5/19/15: Level 3 Final Requested

001020586 NF n/a 05/11/15 CHOW 3/31/15: Level NE

001020590 PHC 3 09/01/14 PHC B 31 31

001020595 PHC 6 09/08/15 Terminated 8/31/15: Level 25/29 Final Rquested

001020601 PHC 3 09/01/14 PHC B 16 24

001020619 PHC 8 09/01/14 PHC B 30 30

001020624 PHC 3 09/01/14 PHC B 31 31

001020627 DAHS 11 11/03/14 CA to 001026051 eff 10/1/14: Level NE

001020630 PHC 6 09/01/14 PHC B 25 25

001020633 DAHS 10 09/01/14 22

001020635 PHC 3 09/01/14 PHC B 31 31

001020649 PHC 6 09/01/14 PHC B 31 31

001020650 PHC 6 09/01/14 PHC B 31 31

001020653 PHC 8 09/01/14 PHC B 31 31

001020654 NF n/a 09/01/14 NE

001020655 PHC 8 09/01/14 PHC B 31 31

001020658 PHC 6 09/01/14 PHC B 31 31

001020667 DAHS 11 09/01/14 31

001020668 RC 2 09/01/14 NE Terminated 8/31/14

001020669 RC 2 09/01/14 NE

001020670 RC 2 09/01/14 NE Terminated 8/31/14

001020671 RC 2 09/01/14 NE

001020672 NF n/a 02/11/15 CHOW 1/31/15 to 001026584: Level 6 Final Requested

001020675 PHC 3 09/01/14 PHC P 31

001020677 CLASS 3 09/01/14 31

001020680 DAHS 11 09/01/14 31

001020689 CLASS 3 09/01/14 NE

001020690 PHC 3 09/01/14 NE

001020691 NF n/a 09/01/14 20

001020692 PHC 11 09/01/14 PHC B 31 31

001020694 PHC 3 09/01/14 PHC B 31 31

001020697 PHC 6 09/01/14 PHC B 25 25

001020701 CLASS 3 09/01/14 31

001020702 CLASS 3 09/01/14 31

001020703 CLASS 3 09/01/14 31

001020707 PHC 3 09/01/14 PHC B 20 20

001020708 PHC 3 09/01/14 NE

001020717 CLASS 7 09/01/14 31

001020725 PHC 3 09/01/14 NE

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001020728 PHC 6 09/01/14 PHC B 31 31

001020729 PHC 3 09/01/14 PHC B 25 25

001020733 CBA 3 09/01/14 31 Terminated 8/31/14

001020735 NF n/a 09/01/14 9

001020738 NF n/a 02/13/15 CHOW 1/31/15: Level 13 Final Requested

001020741 CBA 9 09/01/14 NE Terminated 8/31/14

001020754 PHC 3 09/01/14 NE

001020756 DAHS 11 09/01/14 NE

001020759 NF n/a 09/01/14 7

001020769 PHC 3 09/01/14 PHC B 31 31

001020778 NF n/a 09/01/14 18

001020781 NF n/a 09/01/14 13

001020783 NF n/a 09/01/14 2

001020785 NF n/a 09/01/14 6

001020789 PHC 6 09/01/14 PHC B 31 31

001020792 PHC 6 09/01/14 PHC B 15 15

001020793 DAHS 11 09/01/14 NE

001020794 PHC 11 09/01/14 PHC B 31 31

001020796 NF n/a 02/23/15 CHOW 1/31/15: Level 6 Final Requested

001020799 PHC 6 09/01/14 PHC B 31 31

001020801 PHC 6 09/01/14 PHC B 31 31

001020805 NF n/a 09/01/14 NE

001020806 PHC 11 09/01/14 PHC B 31 31

001020808 PHC 3 09/01/14 PHC B 22 22

001020809 PHC 11 09/01/14 PHC B 31 31

001020828 NF n/a 09/01/14 6

001020829 NF n/a 09/01/14 7

001020830 PHC 3 09/01/14 NE

001020831 NF n/a 09/01/14 7

001020834 PHC 3 09/01/14 PHC B 25 20

001020838 PHC 3 09/01/14 PHC B 31 31

001020841 NF n/a 09/01/14 6

001020844 NF n/a 02/13/15 CHOW 1/31/15: Level 10 Final Requested

001020845 PHC 3 09/01/14 PHC B 30 30

001020848 RC 4 09/01/14 3 Terminated 8/31/14

001020849 RC 4 09/01/14 3 Terminated 8/31/14

001020850 PHC 3 09/01/14 PHC B 31 31

001020856 NF n/a 09/01/14 6

001020860 NF n/a 09/01/14 NE

001020861 PHC 3 09/01/14 PHC B 22 22

001020865 PHC 6 09/01/14 PHC B 31 31

001020867 NF n/a 09/01/14 6

001020870 NF n/a 09/01/14 13

001020871 NF n/a 06/10/15 CHOW03/31/15: Level 14 Final Requested

001020872 NF n/a 04/23/15 27 CHOW 2/28/15: Level 27 Final Requested

001020874 NF n/a 09/01/14 7

001020875 NF n/a 05/06/15 CHOW 2/28/15: Level 13 Final Requested

001020876 PHC 11 09/01/14 PHC B 25 25

001020877 NF n/a 09/01/14 6

001020878 NF n/a 09/01/14 27

001020879 NF n/a 06/10/15 CHOW 3/31/15: Level 27 Final Requested

001020881 NF n/a 03/17/15 CHOW 2/28/15: Level 27 Final Requested

001020882 PHC 6 04/28/15 Terminated 1/31/14: Level NP 1 Final Requested

001020883 DAHS 3 09/01/14 29

001020884 NF n/a 09/01/14 13

001020885 PHC 6 09/01/14 PHC B 29 29

001020887 PHC 6 09/01/14 PHC B 31 31

001020888 PHC 3 09/01/14 PHC NP 31

001020889 NF n/a 09/01/14 23

001020892 PHC 5 09/01/14 PHC B 31 31

001020899 PHC 10 09/01/14 PHC B 31 31

001020900 DAHS 11 09/01/14 23

001020903 RC 7 09/01/14 NE Terminated 8/31/14

001020904 PHC 6 09/01/14 NE

001020905 PHC 8 09/01/14 PHC B 23 23

001020907 PHC 11 09/01/14 PHC B 23 23

001020909 NF n/a 09/01/14 7

001020911 CLASS 6 12/01/14 31

001020914 NF n/a 09/01/14 20

001020917 RC 3 09/01/14 NE Terminated 8/31/14

001020918 PHC 3 09/01/14 PHC NP 25

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001020922 RC 3 09/01/14 NE

001020923 PHC 3 09/01/14 PHC P 27

001020926 PHC 6 9/1/14 PHC B 28 28

001020927 PHC 6 09/01/14 PHC B 31 31

001020928 PHC 6 09/01/14 PHC B 31 31

001020929 PHC 6 09/01/14 PHC B 31 31

001020931 PHC 5 09/01/14 PHC P 31

001020948 NF n/a 03/01/15 NE

001020949 PHC 6 09/01/14 PHC B 31 31

001020950 PHC 6 09/01/14 PHC B 31 31

001020953 PHC 6 09/01/14 PHC P 29

001020958 NF n/a 09/01/14 7

001020961 NF n/a 09/01/14 10

001020964 PHC 6 09/01/14 PHC B 31 31

001020965 NF n/a 04/13/15 CHOW 2/28/15: Level 6 Final Requested

001020966 PHC 6 09/01/14 PHC B 31 30

001020967 DAHS 11 09/01/14 NE

001020970 CLASS 6 09/01/14 NE

001020975 CLASS 6 09/01/14 NE

001020978 PHC 6 02/11/15 Terminated 1/31/15 - Level NE

001020981 PHC 7 09/01/14 PHC B 29 29

001020982 CBA 7 09/01/14 29 Terminated 8/31/14

001020983 CLASS 3 09/01/14 NE

001020998 PHC 3 09/01/14 PHC B 31 31

001021002 PHC 3 07/27/15 Terminated 7/6/15: Level NE

001021004 PHC 3 09/01/14 PHC 31 31

001021006 NF n/a 09/01/14 26

001021007 PHC 3 09/01/14 PHC B 30 30

001021008 PHC 11 09/01/14 PHC B 31 31

001021009 NF n/a 09/01/14 6

001021010 PHC 6 09/01/14 PHC B 31 31

001021012 DAHS 5 09/01/14 31

001021015 PHC 10 09/01/14 NE

001021016 NF n/a 09/01/14 6

001021023 NF n/a 03/09/15 CHOW 2/28/15: Level 13 Final Requested

001021025 DAHS 3 09/01/14 NE

001021026 PHC 3 09/01/14 PHC NP 31

001021028 NF n/a 09/01/14 6

001021038 PHC 6 12/13/14 Terminated 12/3/14: Level 31/31 Final Requested

001021045 RC 2 09/01/14 29 Terminated 8/31/14

001021048 NF n/a 09/01/14 3

001021055 PHC 8 09/01/14 PHC NP 29

001021056 RC 4 10/15/15 Terminated 8/31/14: Level NE

001021057 PHC 3 09/01/14 PHC B 15 25

001021058 NF n/a 09/01/14 7

001021063 NF n/a 09/01/14 25

001021066 DAHS 8 09/01/14 31

001021067 DAHS 11 09/01/14 31

001021070 PHC 6 09/01/14 PHC B 30 30

001021076 NF n/a 12/16/14 CHOW 11/30/14: Level 10 Final Requested

001021078 PHC 4 09/01/14 NE

001021079 PHC 7 09/01/14 NE

001021084 DB_MD 3 09/01/14 NE

001021085 NF n/a 09/01/14 13

001021087 PHC 3 07/27/15 Terminated 7/8/15: Level NE

001021091 PHC 6 09/01/14 NE

001021092 NF n/a 09/01/14 7

001021093 NF n/a 03/09/15 CHOW 2/26/15: Level 7 Final Requested

001021094 PHC 6 09/01/14 PHC P 18

001021097 NF n/a 01/27/15 CHOW 12/31/14: Level 7 Final Requested

001021106 NF n/a 09/01/14 27

001021107 PHC 3 09/01/14 PHC P 31

001021109 NF n/a 09/01/14 7

001021113 RC 4 09/01/14 10

001021114 PHC 11 09/01/14 PHC B 29 29

001021124 PHC 11 09/01/14 PHC B 31 31

001021125 PHC 11 09/01/14 PHC B 31 31

001021130 RC 3 09/01/14 31

001021131 NF n/a 09/01/14 7

001021132 NF n/a 09/01/14 7

001021138 NF n/a 09/01/14 3

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001021139 PHC 3 09/01/14 NE

001021140 PHC 3 09/01/14 NE

001021142 PHC 3 09/01/14 PHC B 29 29

001021144 PHC 3 09/01/14 PHC B 29 29

001021145 CBA 4 09/01/14 29 Terminated 8/31/14

001021146 NF n/a 10/30/14 CHOW 9/30/14: Level 19 Final Requested

001021147 NF n/a 10/09/14 CHOW 8/31/14: Level 10 Final Requested

001021148 NF n/a 10/30/14 CHOW 9/30/14: Level 8 Final Requested

001021149 RC 10 12/16/14 Terminated 11/21/14: Level NE

001021151 NF n/a 02/01/15 NE WP from RE eff 2/1/15: Level 1 Final Requested

001021153 PHC 5 09/01/14 PHC B 29 29

001021154 CBA 5 09/01/14 29 Terminated 8/31/14

001021157 PHC 6 09/01/14 PHC B 29 29

001021159 NF n/a 02/11/15 CHOW 1/31/15 to 001026587: Level 6 Final Requested

001021160 PHC 6 09/01/14 NE

001021164 PHC 6 09/01/14 NE

001021167 CLASS 6 09/01/14 NE

001021182 PHC 3 05/01/15 NE WP eff 4/30/15: Level 30/31 Final Requested

001021190 PHC 11 09/01/14 PHC B 31 31

001021191 NF n/a 09/01/14 NE

001021193 CLASS 3 09/01/14 NE

001021197 PHC 3 09/01/14 PHC B 31 31

001021200 NF n/a 09/01/14 7

001021201 RC 3 09/01/14 NE Terminated 8/31/14

001021212 CBA 4 09/01/14 10 Terminated 8/31/14

001021213 PHC 4 09/01/14 PHC B 29 1

001021216 NF n/a 09/01/14 7

001021217 PHC 6 09/01/14 NE

001021224 PHC 5 09/01/14 PHC NP 25

001021225 NF n/a 09/01/14 10

001021226 PHC 6 11/18/14 Terminated 10/31/14: Level NE

001021228 DAHS 11 08/24/15 Terminateed 7/20/15: Level 31 Final Requested

001021230 NF n/a 09/01/14 13

001021232 NF n/a 09/01/14 7

001021235 NF n/a 10/30/14 CHOW 9/30/14: Level 6 Final Requested

001021236 NF n/a 10/30/14 CHOW 9/30/14: Level 7 Final Requested

001021237 DAHS 11 09/01/14 31

001021238 DB_MD 7 08/17/15 Terminated 8/14/15: Level NE

001021240 NF n/a 10/30/14 CHOW 9/30/14: Level 7 Final Requested

001021241 NF n/a 11/05/14 CHOW 9/30/14: Level 7 Final Requested

001021243 PHC 3 09/01/14 PHC P 27

001021247 NF n/a 09/01/14 9

001021248 NF n/a 03/09/15 CHOW 2/27/15: Level NE

001021250 NF n/a 09/01/14 27

001021251 DAHS 8 05/07/15 Terminated 4/30/15: Level NE

001021252 NF n/a 03/17/15 CHOW 2/27/15: Level NE

001021253 NF n/a 08/18/15 CHOW 7/3/15: Level 6 Final Requested

001021254 NF n/a 09/01/14 10

001021255 NF n/a 09/01/14 6

001021258 PHC 4 09/01/14 PHC B 29 29

001021259 CBA 4 09/01/14 29 Terminated 8/31/14

001021261 PHC 5 09/01/14 PHC B 29 29

001021262 CBA 5 09/01/14 29 Terminated 8/31/14

001021263 NF n/a 02/13/15 CHOW 1/14/15: Level 13 Final Requested

001021264 PHC 6 09/01/14 NE

001021265 PHC 3 09/01/14 PHC B 29 29

001021274 PHC 11 09/01/14 NE

001021281 NF n/a 09/01/14 6

001021284 PHC 4 09/01/14 PHC B 31 31

001021289 PHC 3 09/01/14 PHC B 31 31

001021291 DAHS 11 09/01/14 31

001021292 PHC 11 09/01/14 PHC B 31 31

001021301 CLASS 2 09/01/14 29

001021302 CLASS 11 09/01/14 29

001021303 CLASS 4 09/01/14 29

001021304 CLASS 1 09/01/14 29

001021305 CLASS 9 09/01/14 29

001021306 CBA 7 09/01/14 25 Terminated 8/31/14

001021307 CBA 7 09/01/14 25 Terminated 8/31/14

001021308 PHC 11 09/01/14 PHC B 31 31

001021309 CLASS 11 09/01/14 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001021313 PHC 3 09/01/14 NE

001021314 NF n/a 03/09/15 CHOW 2/26/15: Level 7 Final Requested

001021316 NF n/a 03/09/15 CHOW 2/26/15: Level 7 Final Requested

001021317 NF n/a 09/01/14 6

001021318 PHC 3 09/01/14 PHC B 31 31

001021319 PHC 3 09/01/14 PHC B 29 29

001021322 NF n/a 09/01/14 12

001021323 NF n/a 03/09/15 CHOW 2/26/15: Level 7 Final Requested

001021324 NF n/a 09/01/14 10

001021325 NF n/a 09/01/14 7

001021327 PHC 6 11/18/14 Terminated 10/31/14: Level NE

001021329 NF n/a 09/01/14 7

001021330 PHC 11 09/01/14 PHC B 29 29

001021331 PHC 6 09/01/14 NE

001021332 NF n/a 09/01/14 6

001021337 NF n/a 09/01/14 7

001021338 PHC 3 09/01/14 PHC B 23 23

001021339 PHC 6 11/18/14 Terminated 10/31/14: Level NE

001021340 PHC 3 09/01/14 PHC B 31 31

001021342 PHC 5 09/01/14 PHC B 31 31

001021344 CLASS 3 09/01/14 31

001021364 PHC 3 09/01/14 NE

001021365 PHC 4 09/01/14 NE

001021366 PHC 6 01/09/15 Terminated 12/29/14: Level NP 25 Final Requested

001021367 RC 3 09/01/14 31

001021369 PHC 3 09/01/14 PHC B 27 27

001021370 NF n/a 09/01/14 5

001021371 CLASS 3 09/01/14 NE

001021375 CLASS 2 09/01/14 NE

001025381 NF n/a 09/01/14 6

001025385 NF n/a 09/01/14 6

001025387 RC 6 09/01/14 NE Terminated 8/31/14

001025390 NF n/a 09/01/14 NE

001025393 NF n/a 09/01/14 7

001025397 NF n/a 01/27/15 CHOW 12/31/14: Level 13 Final Requested

001025398 NF n/a 09/01/14 NE

001025399 PHC 5 10/31/14 Terminated 10/14/14: Level 31/31 Final Requested

001025400 NF n/a 03/09/15 CHOW 2/26/15: Level 7 Final Requested

001025401 PHC 3 08/17/15 Terminated 8/14/15: Level NE

001025403 DAHS 8 09/01/14 NE

001025404 PHC 11 09/01/14 PHC NP 31

001025405 PHC 11 09/01/14 PHC B 31 31

001025407 PHC 6 09/01/14 NE

001025408 NF n/a 03/17/15 CHOW 2/26/15: Level 7 Final Requested

001025410 NF n/a 03/09/15 CHOW 2/26/15: Level 7 Final Requested

001025411 PHC 11 09/01/14 PHC B 31 31

001025412 CBA 4 09/01/14 NE Terminated 8/31/14

001025413 NF n/a 02/13/15 CHOW 1/31/15: Level 27 Final Requested

001025414 NF n/a 09/01/14 6

001025421 PHC 6 09/01/14 PHC B 29 29

001025423 PHC 6 09/01/14 PHC B 31 31

001025425 PHC 6 09/01/14 PHC B 31 31

001025429 PHC 6 09/01/14 PHC B 25 25

001025431 RC 3 09/01/14 NE

001025432 PHC 6 10/14/14 Terminated 9/24/14: level NE

001025433 RC 8 10/14/14 Terminated 8/31/14: Level NE

001025434 RC 8 09/01/14 NE

001025437 PHC 4 08/17/15 Terminated 8/14/15: Level NE

001025439 NF n/a 09/01/14 12

001025440 NF n/a 09/01/14 6

001025441 CLASS 6 01/16/15 Terminated 12/15/14: Level 20 Final Requested

001025442 PHC 6 09/01/14 PHC B 30 30

001025448 NF n/a 09/01/14 13

001025450 PHC 3 01/08/15 Terminated 12/31/14: Level NE

001025451 CBA 3 09/01/14 NE Terminated 8/31/14

001025453 PHC 6 10/10/14 Terminated 9/29/14: Level NE

001025454 PHC 11 09/01/14 PHC B 31 31

001025456 PHC 11 09/01/14 NE

001025459 NF n/a 09/01/14 7

001025461 PHC 3 09/01/14 PHC B 31 31

001025475 RC 4 09/01/14 NE Terminated 8/31/14

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001025476 NF n/a 09/01/14 15

001025478 CLASS 7 09/01/14 NE

001025479 PHC 6 12/02/14 Terminated 11/30/14: Level NP15 Final Requested

001025481 CBA 7 09/01/14 29 Terminated 8/31/14

001025483 NF n/a 09/01/14 27

001025484 NF n/a 03/19/15 CHOW 2/20/15: Level 11 Final Requested

001025486 PHC 11 12/02/14 Terminated 11/30/14: Level NP 29 Final Requested

001025487 NF n/a 03/09/15 CHOW 2/26/15: Level 6 Final Requested

001025488 NF n/a 09/01/14 NE

001025489 NF n/a 07/27/15 3 CHOW from 001019923

001025490 NF n/a 09/01/14 13

001025492 NF n/a 09/01/14 23

001025494 CBA 2 09/01/14 31 Terminated 8/31/14

001025495 CBA 4 09/01/14 31 Terminated 8/31/14

001025496 CBA 9 09/01/14 31 Terminated 8/31/14

001025506 NF n/a 09/01/14 6

001025518 NF n/a 09/01/14 3

001025519 PHC 3 08/17/15 Terminated 8/15/15: Level NE

001025520 PHC 3 09/01/14 PHC B 31 31

001025524 NF n/a 02/11/15 CHOW 1/31/15: Level 6 Final Requested

001025525 PHC 6 07/24/15 NE Terminated 6/10/15 : Level NE

001025526 NF n/a 02/13/15 CHOW 1/22/15: Level 27 Final Requested

001025531 DAHS 10 09/01/14 6

001025532 NF n/a 09/01/14 NE

001025533 PHC 6 10/10/14 Terminated 10/3/14: Level NE

001025535 DB_MD 3 09/01/14 29

001025536 PHC 3 09/01/14 NE

001025540 PHC 6 09/01/14 PHC NP 31

001025542 DAHS 8 09/01/14 31

001025543 NF n/a 01/27/15 CHOW 12/31/14: Level 13 Final Requested

001025544 PHC 3 09/01/14 PHC B 31 31

001025545 RC 2 09/01/14 NE Terminated 8/31/14

001025552 NF n/a 09/01/14 7

001025553 NF n/a 09/01/14 7

001025554 PHC 6 01/09/15 Terminated 12/31/14: Level NE

001025555 CBA 6 09/01/14 NE Terminated 8/31/14

001025561 RC 4 09/01/14 NE Terminated 8/31/14

001025562 RC 4 09/01/14 NE

001025563 NF n/a 09/01/14 27

001025565 PHC 3 09/01/14 PHC B 29 29

001025566 CBA 3 09/01/14 29 Terminated 8/31/14

001025568 PHC 6 12/16/14 Terminated 12/4/14:Level NP 29 Final Requested

001025569 NF n/a 09/01/14 6

001025570 PHC 3 05/07/15 Terminated 4/30/15: Level NE

001025573 NF n/a 09/01/14 3

001025579 NF n/a 09/01/14 6

001025580 NF n/a 09/01/14 3

001025581 PHC 3 02/11/15 Terminated 1/3/15: Level NP 21 Final Requested

001025583 NF n/a 09/01/14 17

001025584 NF n/a 09/01/14 13

001025585 NF n/a 09/01/14 7

001025586 NF n/a 09/01/14 27

001025592 NF n/a 02/23/15 CHOW 1/31/15: Level 3 Final Requested

001025595 CBA 6 09/01/14 29 Terminated 8/31/14

001025601 RC 8 05/28/15 Terminated 3/31/15: Level NE

001025605 DAHS 3 09/01/14 6

001025606 PHC 5 05/07/15 Terminated 4/30/15: Level NE

001025607 PHC 6 10/10/14 Terminated 9/25/14: Level NP 20 Final Requested

001025608 CLASS 11 09/01/14 31

001025610 PHC 3 09/01/14 NE

001025615 NF n/a 09/01/14 13

001025617 NF n/a 09/01/14 7

001025618 PHC 6 09/01/14 NE

001025623 PHC 3 09/01/14 PHC B 29 29

001025625 CBA 6 09/01/14 NE Terminated 8/31/14

001025626 NF n/a 09/01/14 7

001025627 NF n/a 04/16/15 CHOW 3/31/15: Level 27 Final Requested

001025629 PHC 5 04/16/15 Terminated 3/31/15: Level NE

001025631 NF n/a 09/01/14 21

001025632 NF n/a 09/01/14 6

001025633 RC 3 10/01/14 NE

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001025634 NF n/a 09/01/14 27

001025635 NF n/a 09/01/14 7

001025636 NF n/a 03/09/15 CHOW 2/26/15: Level 6 Final Requested

001025637 PHC 3 09/01/14 PHC B 31 31

001025642 PHC 3 12/13/14 Terminated 12/4/14: Level NE

001025643 CBA 3 09/01/14 NE Terminated 8/31/14

001025645 NF n/a 09/01/14 7

001025646 NF n/a 09/01/14 6

001025647 PHC 11 09/01/14 PHC B 31 31

001025656 NF n/a 09/01/14 27

001025657 NF n/a 09/01/14 7

001025660 NF n/a 09/01/14 27

001025661 NF n/a 09/01/14 27

001025662 NF n/a 09/01/14 13

001025663 CLASS 6 09/01/14 31

001025665 PHC 8 09/01/14 PHC B 31 31

001025666 NF n/a 09/01/14 7

001025667 NF n/a 09/01/14 13

001025668 NF n/a 09/01/14 27

001025669 NF n/a 09/01/14 14

001025675 PHC 3 09/01/14 PHC B 29 29

001025679 PHC 3 09/01/14 PHC B 22 22

001025680 PHC 3 09/01/14 PHC B 31 31

001025681 PHC 3 09/01/14 PHC NP 21

001025685 RC 2 09/01/14 NE Terminated 8/31/14

001025686 NF n/a 09/01/14 5

001025687 NF n/a 09/01/14 7

001025692 NF n/a 01/01/15 NE

001025694 PHC 8 04/16/15 Terminated 3/31/15: Level NE

001025696 PHC 10 04/16/15 Terminated 3/31/15: Level 31/31

001025697 NF n/a 09/01/14 3

001025699 PHC 11 09/01/14 PHC NP 31

001025701 NF n/a 09/01/14 3

001025706 NF n/a 09/01/14 6

001025708 PHC 4 09/01/14 PHC B 31 31

001025709 NF n/a 09/01/14 27

001025710 NF n/a 09/01/14 3

001025711 NF n/a 09/01/14 9

001025712 DAHS 11 01/23/15 Terminated 12/26/14: Level 29 Final Requested

001025715 NF n/a 09/01/14 27

001025716 PHC 3 09/01/14 PHC B 29 29

001025718 CBA 3 09/01/14 29 Terminated 8/31/14

001025720 PHC 6 09/01/14 NE

001025721 CLASS 6 09/01/14 NE

001025722 NF n/a 01/09/15 CHOW 11/30/14: Level 7 Final Requested

001025726 PHC 3 09/01/14 NE

001025742 PHC 6 09/01/14 PHC B 31 31

001025743 PHC 3 04/30/15 Terminated 5/1/14: Level NE

001025746 DAHS 10 09/01/14 NE

001025747 PHC 3 09/01/14 NE

001025754 NF n/a 09/01/14 NE

001025755 PHC 6 04/16/15 Terminated 3/31/15: Level 26/26 Final Requested

001025756 NF n/a 09/01/14 1

001025761 PHC 6 08/04/15 Terminated 7/31/15: Level NE

001025763 PHC 6 09/01/14 PHC B 31 31

001025764 DB_MD 6 06/10/15 Terminated 5/30/15: Level 31 Zero units

001025765 NF n/a 09/01/14 3

001025767 PHC 11 09/01/14 PHC B 31 31

001025768 NF n/a 09/01/14 6

001025769 NF n/a 03/06/15 CHOW 2/27/15: level NE

001025770 CLASS 8 09/01/14 31

001025771 NF n/a 09/01/14 5

001025772 NF n/a 09/01/14 7

001025773 NF n/a 09/01/14 NE

001025774 DB_MD 6 09/01/14 31

001025777 CLASS 8 09/01/14 31

001025779 NF n/a 09/01/14 3

001025788 NF n/a 09/01/14 NE

001025789 PHC 6 09/01/14 NE

001025790 PHC 6 03/10/15 Terminated 3/6/15: Level NE

001025791 DAHS 6 08/18/15 Terminated 8/17/15: Level 29 Final Requested

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001025795 PHC 11 09/01/14 PHC B 31 31

001025796 PHC 1 09/01/14 NE

001025797 NF n/a 09/01/14 12

001025799 CBA 6 09/01/14 NE Terminated 8/31/14

001025800 PHC 6 09/01/14 PHC B 29 29

001025802 PHC 6 09/01/14 PHC B 29 29

001025803 NF n/a 03/09/15 CHOW 2/27/15: Level NE

001025810 PHC 6 09/01/14 PHC B 31 31

001025811 NF n/a 09/01/14 6

001025812 NF n/a 09/01/14 7

001025813 RC 4 09/01/14 NE Terminated 8/31/14

001025814 PHC 6 09/01/14 NE

001025815 PHC 11 09/01/14 PHC B 31 31

001025818 PHC 11 09/01/14 NE

001025819 PHC 5 06/10/15 Terminated 5/31/15: Level 31/31 Final Requested

001025820 NF n/a 04/23/15 CHOW 2/27/15: Level 3 Final Requested

001025824 NF n/a 09/01/14 23

001025826 DAHS 11 12/02/14 Terminated 11/5/14: Level NE

001025827 DB_MD 6 10/29/14 Terminated 9/20/14: Level NE

001025829 NF n/a 09/01/14 17

001025830 NF n/a 09/01/14 3

001025831 RC 1 09/01/14 NE Terminated 8/31/14

001025835 PHC 3 09/01/14 NE

001025836 NF n/a 09/01/14 7

001025837 NF n/a 10/01/14 6

001025840 NF n/a 09/01/14 10

001025841 NF n/a 09/01/14 17

001025842 PHC 3 06/10/15 Terminated 5/31/15: Level NE

001025843 NF n/a 09/01/14 6

001025844 PHC 3 09/01/14 NE

001025845 PHC 6 09/18/15 Terminated 8/31/15: Level NE

001025846 PHC 3 09/01/14 NE

001025848 PHC 11 09/01/14 PHC B 31 31

001025849 NF n/a 09/01/14 6

001025850 PHC 5 01/30/15 Terminated 1/9/15: Level NE

001025851 PHC 6 09/01/14 NE

001025852 NF n/a 04/13/15 CHOW 2/28/15: Level 7 Final Requested

001025853 CBA 3 09/01/14 NE Terminated 8/31/14

001025854 CBA 4 09/01/14 NE Terminated 8/31/14

001025855 DB_MD 6 09/01/14 31

001025857 PHC 6 09/01/14 PHC B 31 31 Back active as of 6/22/15

001025861 PHC 5 06/10/15 Terminated 5/31/15: Level 31/31 Final Requested

001025864 PHC 7 06/10/15 Terminated 5/31/15: Level 31/31 Final Requested

001025865 PHC 3 09/01/14 NE

001025866 NF n/a 07/22/15 CHOW 6/29/15: Level NE

001025868 PHC 6 09/01/14 NE

001025869 NF n/a 09/01/14 7

001025870 NF n/a 09/01/14 7

001025871 NF n/a 03/09/15 CHOW 2/27/15: Level 7 Final Requested

001025873 DAHS 6 09/01/14 31

001025875 NF n/a 03/09/15 CHOW 2/27/15: Level 6 Final Requested

001025877 DB_MD 6 09/01/14 31

001025880 PHC 3 09/01/14 PHC P 27

001025881 NF n/a 09/01/14 13

001025883 NF n/a 11/01/14 6

001025888 PHC 5 07/24/15 NE Terminated 6/30/15 : Level NE

001025890 PHC 3 10/01/14 NE

001025891 NF n/a 09/01/14 10

001025894 PHC 6 07/24/15 NE Terminated 6/30/15 : Level NE

001025895 PHC 6 09/01/14 PHC B 31 31 CA from 000016000

001025896 DAHS 6 10/01/14 NE

001025899 PHC 6 09/01/14 NE

001025904 NF n/a 09/01/14 10

001025905 DAHS 1 09/01/14 31

001025909 PHC 11 11/05/14 Terminated 10/20/14: Level NE

001025911 NF n/a 09/01/14 7

001025912 NF n/a 09/01/14 27

001025913 NF n/a 09/01/14 27

001025914 NF n/a 09/01/14 27

001025915 NF n/a 09/01/14 27

001025916 NF n/a 09/01/14 7

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001025917 NF n/a 09/01/14 27

001025918 NF n/a 09/01/14 3

001025919 NF n/a 09/01/14 11

001025920 PHC 6 09/01/14 PHC B 31 31

001025923 PHC 11 09/01/14 PHC B 31 31

001025924 PHC 7 12/01/14 NE

001025925 PHC 6 10/01/14 NE

001025928 NF n/a 02/10/15 CHOW 1/31/15: Level NE

001025929 NF n/a 09/01/14 23

001025930 NF n/a 06/02/15 CHOW 5/31/15: Level 6 Final Requested

001025934 NF n/a 11/01/14 6

001025935 NF n/a 09/16/14 CHOW 08/28/14 to 001026094: Level 6 Final Requested

001025943 NF n/a 09/01/14 7

001025944 DAHS 11 11/01/14 NE

001025945 NF n/a 09/01/14 6 CHOW from 001013925

001025946 DB_MD 6 09/01/14 NE

001025949 PHC 3 09/29/15 NE

001025950 DB_MD 6 10/01/14 NE

001025952 NF n/a 12/16/14 CHOW 11/30/14: Level 27 Final Requested

001025953 NF n/a 09/01/14 27

001025954 NF n/a 09/01/14 27

001025957 NF n/a 09/01/14 27

001025959 NF n/a 09/01/14 7

001025960 PHC 11 09/01/14 PHC B 31 31

001025961 NF n/a 01/01/14 6

001025965 NF n/a 09/01/14 14

001025967 NF n/a 09/01/14 7 CHOW from 001014695

001025969 NF n/a 09/01/14 11

001025970 NF n/a 09/01/14 7

001025974 DAHS 11 09/01/14 31

001025975 NF n/a 09/01/14 13 CHOW from 001013935

001025976 NF n/a 09/01/14 13 CHOW from 001013924

001025977 NF n/a 09/01/14 6

001025978 PHC 6 09/28/15 NE

001025979 NF n/a 09/01/14 NE CHOW from 001001093

001025983 PHC 3 04/24/15 Terminated 04/21/15: Level NE

001025984 NF n/a 09/01/14 6 CHOW from 001013928

001025986 PHC 11 10/1/14 PHC B 31 31

001025990 DAHS 11 12/01/14 NE

001025996 PHC 6 09/01/14 NE

001025998 PHC 6 10/01/14 NE

001026000 PHC 6 10/01/14 NE

001026003 PHC 11 11/1/14 PHC B 31 31

001026004 CLASS 1 09/01/14 31

001026005 NF n/a 09/01/14 27

001026006 NF n/a 09/01/14 7

001026007 PHC 6 11/01/14 PHC B 31 31

001026008 PHC 7 11/01/14 PHC B 31 31

001026014 CLASS 11 11/01/14 31

001026015 CLASS 11 11/01/14 31

001026016 CLASS 11 11/01/14 31

001026017 CLASS 11 09/01/14 NE

001026020 DB_MD 1 11/01/14 31

001026022 PHC 3 12/01/14 NE

001026023 NF n/a 09/01/14 6 CHOW from 001018398

001026024 NF n/a 09/01/14 13 CHOW from 001003644

001026026 PHC 8 11/01/14 PHC B 31 31

001026028 NF n/a 09/01/14 25 CHOW from 001019711

001026029 NF n/a 09/01/14 7 CHOW from 001013926

001026030 NF n/a 09/01/14 7 CHOW from 001013932

001026033 PHC 11 11/01/14 PHC B 31 31

001026034 PHC 3 11/01/14 PHC B 31 31

001026035 NF n/a 09/01/14 NE

001026037 CLASS 6 01/01/15 NE

001026038 PHC 3 11/01/14 PHC B 31 31

001026040 PHC 6 12/01/14 NE

001026041 PHC 3 04/24/15 Terminated 4/13/15: Level NE

001026042 DAHS 11 11/01/14 31

001026043 DAHS 11 11/01/14 31

001026044 NF n/a 09/01/14 10 CHOW from 000481506

001026046 NF n/a 09/01/14 6 CHOW from 00064506

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026048 DAHS 11 10/08/14 NE CA from 001014622

001026049 NF n/a 09/01/14 16 CHOW from 001018325

001026050 NF n/a 09/01/14 27 CHOW from 001020280

001026051 DAHS 11 10/01/14 NE

001026051 DAHS 11 10/01/14 NE CA from 001020627

001026052 DAHS 11 10/01/14 NE CA from 001019834

001026056 NF n/a 08/31/14 13 CHOW from 001013916

001026058 DAHS 11 10/01/14 31

001026059 CLASS 6 10/01/14 NE

001026060 PHC 6 12/01/14 NE

001026062 PHC 1 11/01/14 PHC B 31 9 CA from 001014259

001026065 NF n/a 09/01/14 NE CHOW from 000438404

001026067 NF n/a 08/31/14 9 CHOW from 000504406

001026068 NF n/a 08/11/14 13 CHOW from 001013929

001026070 PHC 3 11/01/14 NE

001026073 PHC 6 12/01/14 PHC B 29 29

001026076 NF n/a 04/01/15 3

001026080 NF n/a 09/24/14 27 CHOW from 001001699

001026081 NF n/a 08/14/14 13 CHOW from 001013918

001026084 NF n/a 09/01/14 10 CHOW from 001021147

001026085 NF n/a 09/24/14 27

001026090 NF n/a 09/01/14 17 CHOW from 001021256

001026091 PHC 10 12/01/14 PHC B 31 31

001026094 NF n/a 09/01/14 6 CHOW from 001025935

001026095 PHC 6 12/01/14 NE

001026099 PHC 6 01/01/15 NE

001026102 NF n/a 10/01/14 8 CHOW from 001014216

001026104 NF n/a 08/31/14 19 CHOW from 001013920

001026106 PHC 11 12/01/14 PHC B 31 31

001026108 NF n/a 09/01/14 7 CHOW from 001013915

001026121 PHC 6 01/01/15 NE

001026122 NF n/a 10/18/14 6 CHOW from 001020172

001026123 NF n/a 10/18/14 7 CHOW from 001019591

001026124 PHC 3 11/01/14 PHC B 31 31

001026126 PHC 3 12/01/14 PHC B 30 30

001026127 PHC 6 11/01/14 PHC NP 31

001026128 DB_MD 6 08/17/15 Terminated 8/14/15: Level NE

001026129 NF n/a 12/01/14 NE

001026130 NF n/a 09/30/14 10 CHOW from 000462606

001026133 NF n/a 08/31/14 NE CHOW from 000513304

001026136 NF n/a 10/01/14 7 CHOW from 001021241

001026137 NF n/a 10/01/14 NE CHOW from 000487002

001026138 NF n/a 09/01/14 26

001026139 PHC 3 01/01/15 PHC B 31 31

001026141 PHC 5 01/01/15 NE

001026143 PHC 6 01/01/15 NE

001026144 NF n/a 10/01/14 13 CHOW from 001015726

001026147 PHC 6 01/01/15 NE

001026148 PHC 3 01/01/15 NE

001026152 NF n/a 09/01/14 7

001026153 PHC 6 01/01/15 NE

001026154 CLASS 6 03/01/15 NE

001026156 PHC 3 12/01/14 PHC B 8 8

001026157 PHC 6 01/01/15 NE

001026158 PHC 11 01/01/15 NE

001026159 PHC 3 12/01/14 PHC NP 31

001026161 NF n/a 10/01/14 13 CHOW from 001003645

001026162 NF n/a 10/01/14 15 CHOW from 001004686

001026164 PHC 8 01/01/15 PHC B 31 31

001026165 PHC 6 01/01/15 NE

001026166 PHC 7 07/24/15 NE Terminated 6/28/15 : Level NE

001026167 NF n/a 03/02/15 CHOW to 001026672: Level NE

001026169 NF n/a 09/23/14 7 CHOW from 001015259

001026171 PHC 6 02/01/15 NE

001026173 NF n/a 09/16/14 6 CHOW from 001014738

001026174 DB_MD 6 01/01/15 31

001026179 CLASS 6 03/01/15 31

001026182 DAHS 3 03/01/15 NE

001026184 NF n/a 10/01/14 15 CHOW from 001001787

001026185 PHC 11 01/01/15 PHC B 31 31

001026186 NF n/a 10/01/14 23 CHOW from 001001762

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026187 NF n/a 10/01/14 15 CHOW from 001001789

001026188 NF n/a 10/01/14 7 CHOW from 001001785

001026189 PHC 10 01/01/15 NE

001026191 NF n/a 10/01/14 15 CHOW from 001001788

001026192 NF n/a 08/31/14 7 CHOW from 001015108

001026193 NF n/a 08/31/14 21 CHOW from 001020244

001026194 PHC 9 12/01/14 PHC B 31 31

001026197 NF n/a 08/31/14 7 CHOW from 000504906

001026198 NF n/a 11/01/14 21 CHOW from 000474806

001026204 NF n/a 05/01/15 NE

001026205 PHC 6 01/01/15 NE

001026206 NF n/a 09/30/14 8 CHOW from 000504006

001026208 PHC 6 12/01/14 PHC B 31 31

001026211 NF n/a 05/01/15 NE

001026213 NF n/a 09/01/14 3 CHOW from 001017880

001026214 NF n/a 09/01/14 5 CHOW from 001017862

001026215 NF n/a 09/01/14 27 CHOW from 001020119

001026216 PHC 3 01/01/15 NE

001026217 PHC 6 01/01/15 PHC B 31 31

001026219 DB_MD 3 03/01/15 NE

001026225 PHC 6 12/01/14 PHC B 31 31

001026226 PHC 6 12/01/14 PHC P 27

001026227 NF n/a 09/30/14 16 CHOW from 000456406

001026228 PHC 6 01/01/15 PHC B 25 25

001026230 PHC 3 01/01/15 NE

001026234 NF n/a 09/01/14 27 CHOW from 000483703

001026235 NF n/a 09/01/14 NE CHOW from 001017851

001026236 DAHS 11 12/01/14 31 CA from 001014924

001026237 PHC 6 02/01/15 PHC B 31 31

001026239 NF n/a 10/01/14 NE CHOW from 001017874

001026240 NF n/a 10/01/14 1 CHOW from 001017877

001026241 NF n/a 09/01/14 7 CHOW from 001000427

001026242 NF n/a 10/01/14 NE CHOW from 001017878

001026243 NF n/a 10/01/14 NE CHOW from 001017871

001026244 PHC 6 01/01/15 NE

001026245 NF n/a 09/30/14 13 CHOW from 001013485

001026246 NF n/a 09/30/14 7 CHOW from 001012919

001026247 NF n/a 09/30/14 7 CHOW from 001013461

001026248 NF n/a 11/01/14 7 CHOW from 000489607

001026249 PHC 11 12/01/14 PHC B 31 31

001026250 DB_MD 6 02/01/15 NE

001026252 NF n/a 09/30/14 7 CHOW from 001013373

001026254 NF n/a 09/30/14 7 CHOW from 000488807

001026260 NF n/a 10/01/14 7 CHOW from 001021236

001026261 PHC 4 01/01/15 NE

001026262 PHC 5 07/24/15 Terminated 7/23/15: Level NE

001026263 PHC 7 07/24/15 Terminated 7/23/15: Level NE

001026264 PHC 9 07/24/15 NE Terminated 7/23/15: Level NE

001026265 PHC 3 01/01/15 PHC B 29 29

001026266 NF n/a 09/30/14 13 CHOW from 001013402

001026267 NF n/a 09/30/14 7 CHOW from 001012923

001026268 NF n/a 09/30/14 7 CHOW from 001013496

001026269 PHC 4 01/01/15 NE

001026270 PHC 5 07/24/15 NE Terminated 7/17/15: Level NE

001026271 PHC 7 07/24/15 NE Terminated 7/17/15: Level NE

001026272 PHC 9 07/24/15 NE Terminated 7/17/15: Level NE

001026274 NF n/a 10/01/14 6 CHOW from 001017876

001026275 NF n/a 10/01/14 7 CHOW from 001021240

001026276 NF n/a 10/01/14 19 CHOW from 001021146

001026277 NF n/a 10/01/14 3 CHOW from 001020425

001026278 NF n/a 11/07/14 19 CHOW from 0004439904

001026279 NF n/a 10/01/14 7 CHOW from 001017849

001026280 NF n/a 11/01/14 NE CHOW from 000477606

001026281 NF n/a 10/01/14 6 CHOW from 001021235

001026283 NF n/a 10/01/14 7 CHOW from 001017902

001026284 NF n/a 10/01/14 6 CHOW from 001017858

001026285 NF n/a 10/01/14 NE CHOW from 001017875

001026286 NF n/a 10/01/14 6 CHOW from 001017843

001026287 NF n/a 10/01/14 6 CHOW from 001020348

001026289 PHC 6 01/01/15 NE

001026291 PHC 6 12/01/14 NE CA from 001020557

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026294 CLASS 3 03/01/15 NE

001026295 NF n/a 11/27/14 7 CHOW from 000467206

001026296 NF n/a 11/01/14 3 CHOW from 001015120

001026297 PHC 11 01/01/15 NE

001026298 NF n/a 11/01/14 3 CHOW from 001015117

001026299 PHC 8 01/01/15 NE

001026300 PHC 3 01/01/15 NE

001026301 NF n/a 12/01/14 27 CHOW from 000484204

001026302 PHC 3 12/18/15 PHC B 31 31

001026304 NF n/a 08/17/15 CHOW 7/31/15: Level NE

001026305 PHC 3 03/01/15 NE

001026307 PHC 8 08/04/15 Terminated 7/31/15: Level NE

001026308 NF n/a 12/01/14 27 CHOW from 001015051

001026309 PHC 3 02/25/15 Terminated 2/23/15: Level NE

001026312 PHC 8 02/01/15 PHC B 29 29

001026313 NF n/a 12/01/14 7 CHOW from 001018913

001026314 NF n/a 12/01/14 13 CHOW from 001014082

001026315 NF n/a 12/01/14 12 CHOW from 000441305

001026316 NF n/a 11/01/14 6 CHOW from 001015123

001026317 NF n/a 11/27/14 9 CHOW from 000459806

001026318 NF n/a 12/01/14 7 CHOW from 001018916

001026319 NF n/a 11/26/14 13 CHOW from 000444706

001026320 NF n/a 11/01/14 6 CHOW from 001015115

001026322 PHC 3 03/01/15 NE

001026323 NF n/a 05/20/15 CHOW 3/27/15: Level 6 Final Requested

001026324 PHC 11 01/01/15 PHC P 31

001026329 PHC 6 03/01/15 NE

001026346 NF n/a 04/01/15 CHOW 2/27/15: Level 6 Final Requested

001026347 PHC 6 06/01/15 NE EPC CLOSED

001026350 PHC 10 03/01/15 NE

001026351 PHC 3 02/01/15 PHC B 31 31

001026352 NF n/a 12/01/14 10 CHOW from 001015201

001026353 PHC 3 02/01/15 PHC B 31 31

001026354 NF n/a 06/01/15 6

001026355 PHC 6 03/01/15 NE

001026357 NF n/a 12/01/14 27 CHOW from 001025952

001026358 NF n/a 03/24/15 CHOW 1/31/15: Level 7 Final Requested

001026359 PHC 6 03/01/15 PHC B 31 31

001026361 CLASS 6 03/01/15 31

001026362 DAHS 11 03/01/15 NE

001026363 PHC 6 03/01/15 NE

001026365 PHC 6 02/01/15 PHC B 31 31

001026369 PHC 6 02/01/15 PHC B 31 31

001026371 DAHS 6 03/01/15 NE

001026372 PHC 10 02/01/15 PHC B 31 31

001026374 PHC 3 03/01/15 PHC B 31 31

001026384 DAHS 3 02/01/15 20

001026390 PHC 3 03/01/15 PHC B 25 25

001026391 PHC 5 02/01/15 PHC B 31 31

001026392 PHC 6 02/01/15 PHC B 31 31

001026393 PHC 7 02/01/15 PHC B 31 31

001026394 PHC 6 02/01/15 PHC B 30 30

001026401 NF n/a 01/01/15 NE CHOW from 000502206

001026403 PHC 3 03/01/15 NE

001026405 NF n/a 07/01/15 6

001026407 PHC 7 03/01/15 PHC B 25 25

001026410 NF n/a 12/01/14 6 CHOW from 001018813

001026411 PHC 3 03/01/15 PHC B 26 26

001026412 NF n/a 01/01/15 7 CHOW from 001016382

001026413 NF n/a 01/01/15 6 CHOW from 001016605

001026414 NF n/a 01/01/15 NE CHOW from 001016583

001026415 NF n/a 01/01/15 7 CHOW from 000513905

001026416 NF n/a 12/05/14 15 CHOW from 000491006

001026417 NF n/a 12/01/14 10 CHOW from 001021076

001026418 NF n/a 12/01/14 7 CHOW from 001018917

001026419 NF n/a 01/01/15 7 CHOW from 001014248

001026420 DAHS 11 03/01/15 NE

001026421 NF n/a 12/01/14 12 CHOW from 000402605

001026422 PHC 6 06/01/15 PHC B 31 31

001026423 PHC 3 03/01/15 PHC B 31 31

001026425 CLASS 3 03/01/15 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026426 DAHS 11 02/01/15 23 CA from 001013143

001026427 NF n/a 01/01/15 11 CHOW from 001016349

001026429 PHC 11 06/10/15 Terminated 2/1/15: Level NE

001026432 NF n/a 01/01/15 27 CHOW from 000443701

001026433 NF n/a 06/01/15 3

001026434 NF n/a 06/24/15 NE EPC CLOSED

001026435 CLASS 3 02/01/15 31

001026436 PHC 7 03/01/15 PHC B 30 30

001026437 PHC 8 03/01/15 PHC B 31 31

001026439 PHC 11 03/01/15 PHC B 23 21

001026442 PHC 10 03/01/15 NE

001026446 PHC 6 03/01/15 NE

001026447 PHC 5 03/01/15 NE

001026448 PHC 3 03/01/15 NE

001026448 PHC 6 03/01/15 NE

001026450 PHC 10 03/01/15 NE

001026453 PHC 6 03/01/15 NE

001026455 NF n/a 01/15/15 7 CHOW from 001020507

001026457 NF n/a 02/01/15 7 CHOW from 001004443

001026475 DB_MD 6 03/01/15 NE

001026479 PHC 7 03/01/15 NE

001026481 NF n/a 02/01/15 7 CHOW from 001018997

001026482 PHC 3 03/01/15 NE

001026483 NF n/a 01/01/15 NE CHOW from 001000653

001026484 NF n/a 01/01/15 7 CHOW from 001020411

001026485 PHC 6 03/01/15 PHC B 31 31

001026486 NF n/a 02/01/15 27 CHOW from 001025413

001026487 NF n/a 12/01/14 7 CHOW from 001025722

001026488 PHC 6 02/01/15 NE

001026489 NF n/a 01/01/15 27 CHOW from 001003887

001026490 NF n/a 02/04/15 7 CHOW from 000458410

001026491 NF n/a 02/04/15 13 CHOW from 000431906

001026492 NF n/a 02/04/15 7 CHOW from 000492706

001026493 NF n/a 02/04/15 7 CHOW from 000499607

001026494 NF n/a 01/01/15 7 CHOW from 001016506

001026495 PHC 1 05/01/15 NE

001026504 NF n/a 01/01/15 13 CHOW from 001025543

001026509 NF n/a 02/04/15 6 CHOW from 000483606

001026513 NF n/a 01/01/15 7 CHOW from 001018457

001026514 NF n/a 02/01/15 7 CHOW from 001016971

001026515 NF n/a 02/01/15 6 CHOW from 000446604

001026516 NF n/a 02/01/15 3 CHOW from 001013027

001026517 NF n/a 02/01/15 6 CHOW from 001025524

001026518 NF n/a 02/01/15 10 CHOW from 001004232

001026522 PHC 3 04/01/15 NE

001026523 NF n/a 01/01/15 13 CHOW from 001025397

001026524 NF n/a 02/01/15 3 CHOW from 001025592

001026525 NF n/a 02/01/15 11 CHOW from 000465204

001026529 PHC 6 06/01/15 NE EPC CLOSED

001026530 NF n/a 03/01/15 13 CHOW from 001020884

001026531 NF n/a 06/01/15 6

001026533 NF n/a 02/01/15 13 CHOW from 001015958

001026534 PHC 6 04/01/15 NE

001026535 PHC 6 06/01/15 NE EPC CLOSED

001026536 NF n/a 03/01/15 27 CHOW from 001020881

001026537 NF n/a 01/01/15 7 CHOW from 001021097

001026538 NF n/a 02/01/15 6 CHOW from 001014940

001026539 NF n/a 02/01/15 6 CHOW from 001014939

001026540 NF n/a 02/01/15 6 CHOW from 001020173

001026541 NF n/a 01/01/15 7 CHOW from 001020340

001026542 PHC 6 05/01/15 NE

001026544 PHC 3 05/01/15 NE

001026546 NF n/a 02/15/15 7 CHOW from 001014368

001026547 NF n/a 02/15/15 NE CHOW from 001014646

001026548 PHC 11 04/01/15 NE

001026550 PHC 6 04/01/15 NE

001026551 NF n/a 02/20/15 13 CHOW from 001017698

001026554 NF n/a 02/01/15 7 CHOW from 001020457

001026555 DAHS 6 05/01/15 NE

001026556 PHC 3 04/01/15 NE

001026558 NF n/a 02/01/15 6 CHOW from 001020796

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026559 PHC 11 06/01/15 PHC B 31 31

001026560 NF n/a 02/01/15 6 CHOW from 001014981

001026561 NF n/a 02/20/15 7 CHOW from 001021058

001026562 NF n/a 02/01/15 6 CHOW from 001014943

001026563 NF n/a 02/01/15 13 CHOW from 001020265

001026565 NF n/a 02/15/15 8 CHOW from 000403504

001026566 NF n/a 02/01/15 7 CHOW from 001004259

001026567 PHC 6 07/01/15 NE EPC CLOSED

001026568 NF n/a 02/01/15 7 CHOW from 001016290

001026569 NF n/a 02/28/15 6 CHOW from 001012924

001026571 NF n/a 02/01/15 6 CHOW from 001014983

001026572 NF n/a 02/21/15 11 CHOW from 001025484

001026573 NF n/a 02/16/15 10 CHOW from 000442609

001026574 NF n/a 02/18/15 6 CHOW from 001016158

001026577 NF n/a 02/28/15 6 CHOW from 001013395

001026578 NF n/a 02/28/15 13 CHOW from 001012905

001026582 NF n/a 02/28/15 6 CHOW from 001012900

001026583 NF n/a 02/28/15 6 CHOW from 001020466

001026584 NF n/a 02/01/15 6 CHOW from 001020672

001026585 NF n/a 02/01/15 6 CHOW from 001019963

001026586 NF n/a 02/01/15 NE CHOW from 001025928

001026587 NF n/a 02/01/15 6 CHOW from 001021159

001026590 NF n/a 02/01/15 7 CHOW from 001018031

001026594 PHC 11 06/01/15 PHC B 31 31

001026595 NF n/a 02/28/15 13 CHOW from 001013381

001026597 NF n/a 02/28/15 NE CHOW from 001014538

001026598 NF n/a 02/28/15 6 CHOW from 001025875

001026599 NF n/a 02/27/15 7 CHOW from 001025400

001026600 PHC 3 06/01/15 NE EPC CLOSED

001026602 NF n/a 01/23/15 27 CHOW from 001025526

001026604 NF n/a 02/01/15 10 CHOW from 001016638

001026605 NF n/a 02/01/15 13 CHOW from 001019199

001026606 NF n/a 02/01/15 8 CHOW from 000465504

001026607 NF n/a 02/28/15 NE CHOW from 001014777

001026609 NF n/a 02/04/15 15 CHOW from 000436907

001026610 NF n/a 02/28/15 27 CHOW from 000426606

001026611 NF n/a 02/01/15 3 CHOW from 001015416

001026612 NF n/a 02/01/15 3 CHOW from 001018515

001026614 NF n/a 02/01/15 10 CHOW from 001020844

001026615 PHC 11 06/01/15 PHC B 31 29

001026616 NF n/a 02/04/15 7 CHOW from 000458606

001026617 NF n/a 02/01/15 7 CHOW from 001019393

001026618 NF n/a 02/23/15 7 CHOW from 001025943

001026619 PHC 11 06/01/15 PHC B 30 31

001026627 NF n/a 01/15/15 13 CHOW from 001021263

001026628 NF n/a 02/28/15 7 CHOW from 001016732

001026629 PHC 1 08/17/15 Terminated 8/13/15: Level NE

001026630 PHC 2 06/01/15 NE

001026631 PHC 3 06/01/15 NE

001026632 PHC 4 06/01/15 NE

001026633 PHC 5 06/01/15 NE

001026634 PHC 6 06/01/15 NE

001026635 PHC 7 06/01/15 NE

001026636 PHC 8 06/01/15 NE

001026637 PHC 9 06/01/15 NE

001026638 PHC 10 08/17/15 Terminated 8/13/15: Level NE

001026639 NF n/a 02/21/15 7 CHOW from 001015916

001026641 NF n/a 02/28/15 7 CHOW from 001013382

001026642 NF n/a 02/28/15 7 CHOW from 001025871

001026643 NF n/a 02/27/15 6 CHOW from 001025636

001026644 NF n/a 02/28/15 19 CHOW from 000493307

001026645 NF n/a 02/01/15 6 CHOW from 001014973

001026646 NF n/a 02/23/15 6 CHOW from 001014559

001026647 NF n/a 03/01/15 27 CHOW from 000411803

001026651 PHC 7 05/01/15 NE

001026653 NF n/a 03/01/15 7 CHOW from 001020376

001026654 NF n/a 02/23/15 9 CHOW from 001018373

001026655 PHC 3 05/01/15 NE

001026657 NF n/a 02/28/15 NE CHOW from 001025769

001026658 NF n/a 06/01/15 3 CHOW from 001012931

001026660 NF n/a 02/27/15 7 CHOW from 001021316

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026661 NF n/a 02/27/15 27 CHOW from 001004882

001026664 NF n/a 06/01/15 3 CHOW from 001013351

001026665 NF n/a 02/28/15 7 CHOW from 001014340

001026666 NF n/a 02/28/15 27 CHOW from 001013374

001026667 NF n/a 02/27/15 13 CHOW from 001003369

001026669 NF n/a 02/28/15 3 CHOW from 000474302

001026670 NF n/a 02/28/15 3 CHOW from 001017662

001026671 NF n/a 02/28/15 5 CHOW from 001015058

001026672 NF n/a 02/26/15 NE CHOW from 001026167

001026673 NF n/a 02/28/15 6 CHOW from 001026346

001026675 NF n/a 02/15/15 13 CHOW from 000409807

001026676 NF n/a 02/26/15 6 CHOW from 001018445

001026677 NF n/a 02/20/15 6 CHOW from 001019719

001026678 NF n/a 02/28/15 6 CHOW from 001013344

001026679 NF n/a 02/28/15 13 CHOW from 000518303

001026680 NF n/a 02/28/15 7 CHOW from 000478107

001026681 NF n/a 02/01/15 10 CHOW from 000470504

001026683 NF n/a 05/01/15 NE CHOW from 001016641

001026684 NF n/a 05/01/15 6 CHOW from 001014224

001026685 NF n/a 02/28/15 12 CHOW from 001013350

001026686 NF n/a 02/28/15 7 CHOW from 001012920

001026687 NF n/a 02/27/15 7 CHOW from 001021093

001026688 PHC 3 04/01/15 NE

001026689 NF n/a 02/27/15 7 CHOW from 001025408

001026693 NF n/a 02/28/15 NE CHOW from 001021252

001026694 NF n/a 02/28/15 NE CHOW from 001021248

001026695 NF n/a 02/28/15 27 CHOW from 000524303

001026698 NF n/a 06/01/15 6 CHOW from 001013340

001026699 NF n/a 02/15/15 7 CHOW from 001015110

001026700 NF n/a 02/28/15 15 CHOW from 001013391

001026701 NF n/a 02/28/15 27 CHOW from 001013342

001026702 NF n/a 02/28/15 27 CHOW from 001020094

001026703 NF n/a 02/28/15 13 CHOW from 001013383

001026704 NF n/a 02/28/15 27 CHOW from 001017938

001026705 NF n/a 05/01/15 18 CHOW from 001019804

001026706 NF n/a 03/01/15 26 CHOW from 001019202

001026707 NF n/a 03/01/15 13 CHOW from 001021023

001026709 NF n/a 03/01/15 27 CHOW from 000512607

001026711 NF n/a 02/27/15 7 CHOW from 001021323

001026712 NF n/a 02/27/15 6 CHOW from 001025487

001026715 NF n/a 02/26/15 13 CHOW from 000433505

001026716 NF n/a 03/01/15 6 CHOW from 001019949

001026718 NF n/a 02/28/15 9 CHOW from 000522102

001026719 NF n/a 03/01/15 27 CHOW from 001001513

001026721 NF n/a 02/20/15 4 CHOW from 001014903

001026722 NF n/a 02/26/15 7 CHOW from 001017061

001026723 NF n/a 02/27/15 7 CHOW from 001025410

001026724 NF n/a 02/27/15 7 CHOW from 001021314

001026727 NF n/a 02/28/15 NE CHOW from 001025803

001026731 NF n/a 02/01/15 6 CHOW from 001016509

001026732 PHC 3 05/01/15 NE

001026733 NF n/a 02/01/15 6 CHOW from 001014982

001026737 PHC 2 06/01/15 PHC B 31 31

001026739 PHC 3 05/01/15 NE

001026741 DB_MD 3 06/01/15 31

001026742 PHC 4 05/01/15 NE

001026745 PHC 6 06/01/15 PHC B 31 31

001026747 NF n/a 02/26/15 13 CHOW from 000434404

001026749 PHC 5 04/01/15 NE

001026750 PHC 7 04/01/15 NE

001026751 NF n/a 02/15/15 10 CHOW from 001004490

001026754 PHC 11 06/01/15 PHC B 31 31

001026755 PHC 3 06/01/15 NE EPC CLOSED

001026756 PHC 8 05/01/15 NE

001026759 PHC 11 06/01/15 PHC B 31 31

001026762 PHC 8 05/01/15 NE

001026765 PHC 6 06/01/15 PHC B 29 29

001026766 PHC 7 06/01/15 PHC B 29 29

001026768 PHC 6 06/01/15 PHC B 31 31

001026769 PHC 3 05/01/15 NE

001026771 PHC 3 06/01/15 PHC B 31 31

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026773 PHC 6 05/01/15 NE

001026774 DAHS 11 06/01/15 29

001026776 PHC 6 06/01/15 PHC B 31 31

001026777 PHC 11 05/01/15 NE

001026779 PHC 11 06/01/15 PHC B 31 31

001026780 PHC 6 06/01/15 PHC B 25 31

001026781 PHC 11 06/01/15 NE

001026782 PHC 3 05/01/15 NE

001026783 NF n/a 04/01/15 14 CHOW from 001020871

001026785 PHC 7 06/01/15 PHC B 29 29

001026789 PHC 3 06/01/15 PHC B 31 31

001026791 PHC 3 06/01/15 PHC B 31 31

001026799 PHC 11 06/01/15 NE EPC CLOSED

001026801 PHC 8 06/01/15 NE EPC CLOSED

001026802 NF n/a 05/12/15 NE

001026803 PHC 6 06/01/15 PHC B 30 25

001026804 DB_MD 6 09/01/15 NE See EN 2016

001026805 PHC 3 06/01/15 PHC B 31 31

001026806 NF n/a 02/01/15 NE CHOW from 001018069

001026807 NF n/a 06/01/15 6 CHOW from 001025930

001026809 NF n/a 02/01/15 7 CHOW from 001017180

001026810 PHC 10 06/01/15 NE EPC CLOSED

001026811 PHC 3 06/01/15 NE

001026812 PHC 3 06/01/15 NE EPC CLOSED

001026813 NF n/a 04/01/15 27 CHOW from 001020879

001026814 PHC 3 05/01/15 NE

001026815 PHC 3 06/01/15 NE EPC CLOSED

001026816 PHC 3 06/01/15 NE EPC CLOSED

001026820 NF n/a 04/01/15 9 CHOW from 000516506

001026822 PHC 3 06/01/15 NE EPC CLOSED

001026826 PHC 6 06/01/15 NE EPC CLOSED

001026826 PHC 6 06/01/15 NE EPC CLOSED

001026828 PHC 10 07/01/15 NE EPC CLOSED

001026829 PHC 3 06/01/15 NE EPC CLOSED

001026832 NF n/a 07/29/15 NE EPC CLOSED

001026833 PHC 3 07/01/15 NE

001026835 DB_MD 5 06/01/15 NE EPC CLOSED

001026836 PHC 3 06/01/15 NE EPC CLOSED

001026839 PHC 3 06/01/15 NE EPC CLOSED

001026842 PHC 3 06/01/15 NE

001026844 NF n/a 05/01/15 10 CHOW from 000527702

001026846 PHC 6 07/01/15 NE EPC CLOSED

001026848 CLASS 6 07/01/15 NE EPC CLOSED

001026850 NF n/a 04/30/15 7 CHOW from 001012976

001026851 CLASS 11 06/01/15 NE EPC CLOSED

001026853 PHC 11 06/01/15 NE EPC CLOSED

001026854 NF n/a 05/20/15 3 CHOW from 001020582

001026855 NF n/a 03/01/15 6 CHOW from 001017724

001026856 PHC 3 06/01/15 NE EPC CLOSED

001026859 PHC 3 07/01/15 PHC B 25 17 CA from 001019751

001026860 NF n/a 06/01/15 20 CHOW from 001001090

001026861 PHC 6 06/01/15 NE EPC CLOSED

001026862 PHC 8 06/01/15 NE EPC CLOSED

001026863 PHC 11 07/01/15 NE

001026863 PHC 11 06/01/15 NE EPC CLOSED

001026866 PHC 3 07/01/15 PHC NP 29 CA from 001018636

001026871 NF n/a 05/01/15 13 CHOW from 001003643

001026876 PHC 3 06/01/15 NE EPC CLOSED

001026878 NF n/a 03/01/15 13 CHOW from 001020875

001026879 PHC 10 08/01/15 NE EPC CLOSED

001026880 PHC 6 08/01/15 NE EPC CLOSED

001026885 PHC 6 07/01/15 NE EPC CLOSED

001026886 PHC 3 07/01/15 NE EPC CLOSED

001026887 PHC 11 07/01/15 NE EPC CLOSED

001026888 PHC 11 07/01/15 NE EPC CLOSED

001026889 PHC 8 08/01/15 NE EPC CLOSED

001026890 CLASS 3 08/01/15 NE EPC CLOSED

001026891 NF n/a 06/01/15 10 CHOW from 001004428

001026892 PHC 6 07/01/15 NE EPC CLOSED

001026893 CLASS 6 07/01/15 NE EPC CLOSED

001026894 DAHS 6 06/01/15 NE EPC CLOSED

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001026895 PHC 6 08/01/15 NE EPC CLOSED

001026897 PHC 8 07/01/15 NE EPC CLOSED

001026898 PHC 5 08/01/15 NE EPC CLOSED

001026899 PHC 6 08/01/15 NE EPC CLOSED

001026903 NF n/a 07/16/15 NE EPC CLOSED

001026904 PHC 3 07/01/15 NE EPC CLOSED

001026905 PHC 3 07/01/15 NE EPC CLOSED

001026906 NF n/a 06/01/15 13 CHOW from 000526303

001026907 PHC 3 07/01/15 NE EPC CLOSED

001026908 PHC 6 07/01/15 NE EPC CLOSED

001026909 PHC 7 07/01/15 NE EPC CLOSED

001026910 PHC 8 07/01/15 NE EPC CLOSED

001026911 NF n/a 05/01/15 13 CHOW from 001003642

001026912 NF n/a 02/01/15 27 CHOW from 001020300

001026914 PHC 6 07/01/15 NE EPC CLOSED

001026919 PHC 6 07/01/15 NE EPC CLOSED

001026921 PHC 3 08/01/15 NE EPC CLOSED

001026922 PHC 7 08/01/15 NE EPC CLOSED

001026923 PHC 8 08/01/15 NE

001026924 PHC 11 08/01/15 NE

001026925 NF 7 08/25/15 15 CHOW from 000458101

001026926 NF n/a 08/03/15 NE EPC CLOSED

001026929 PHC 6 07/01/15 NE EPC CLOSED

001026931 PHC 3 08/01/15 NE EPC CLOSED

001026932 PHC 10 08/01/15 NE

001026934 PHC 3 08/01/15 NE EPC CLOSED

001026935 PHC 6 08/01/15 NE EPC CLOSED

001026936 PHC 10 08/01/15 NE EPC CLOSED

001026937 PHC 11 08/01/15 NE EPC CLOSED

001026939 PHC 6 08/01/15 NE

001026940 PHC 3 08/01/15 NE EPC CLOSED

001026943 PHC 6 08/01/15 NE EPC CLOSED

001026946 PHC 3 08/01/15 NE EPC CLOSED

001026947 NF n/a 05/29/15 NE EPC CLOSED

001026948 PHC 11 08/01/15 NE

001026949 PHC 3 08/01/15 NE EPC CLOSED

001026951 NF n/a 07/01/15 NE CHOW from 001020759

001026952 NF n/a 07/01/15 NE CHOW from 001012142

001026952 NF n/a 07/01/15 9 CHOW from 001012142

001026953 PHC 3 08/01/15 PHC NP 31 CA from 000031800 eff 8/1/15

001026955 PHC 3 09/01/15 PHC B 14 13

001026956 NF n/a 07/01/15 10 CHOW from 000521303

001026959 PHC 3 08/01/15 NE EPC CLOSED

001026961 NF n/a 07/01/15 NE CHOW from 000500206

001026964 NF n/a 06/30/15 7 CHOW from 001020759

001026965 PHC 3 09/01/15 NE EPC CLOSED

001026965 PHC 3 09/01/15 NE EPC CLOSED

001026967 PHC 5 08/01/15 NE EPC CLOSED

001026969 PHC 6 08/01/15 NE EPC CLOSED

001026971 CLASS 3 08/01/15 NE EPC CLOSED

001026975 PHC 6 08/01/15 NE EPC CLOSED

001026976 PHC 6 08/01/15 NE EPC CLOSED

001026977 NF n/a 07/08/15 27 CHOW from 000530801

001026978 PHC 10 08/01/15 NE EPC CLOSED

001026979 PHC 10 08/01/15 NE EPC CLOSED

001026980 PHC 5 08/01/15 NE

001026981 PHC 6 08/01/15 NE

001026983 PHC 6 09/01/15 NE EPC CLOSED

001026984 DAHS 11 08/01/15 NE EPC CLOSED

001026985 PHC 3 08/01/15 NE EPC CLOSED

001026987 PHC 4 08/01/15 NE EPC CLOSED

001026990 PHC 3 08/01/15 NE EPC CLOSED

001026994 NF n/a 07/01/15 13 CHOW from 001014087

001026995 PHC 3 09/01/15 PHC B 31 31 CA from 001018717

001026996 NF n/a 06/01/15 10 CHOW from 000521201

001026997 PHC 3 09/01/15 PHC B 31 31

001026999 NF n/a 07/01/15 NE CHOW from 001020874

001027000 PHC 6 09/01/15 NE EPC CLOSED

001027005 PHC 3 09/01/15 NE EPC CLOSED

001027008 NF n/a 07/30/15 7 CHOW from 001013341

001027009 NF 6 08/01/15 13 CHOW from 000443003

PHC

Contract Program DADS Non - PHC

# Type Region Effective Level Level P NP Comments

001027010 NF 7 08/01/15 7 CHOW from 001020017

001027026 PHC 3 09/01/15 PHC B 26 26

001027031 NF n/a 07/01/15 7 CHOW from 001019381

001027032 PHC 5 09/01/15 NE EPC CLOSED

001027034 NF n/a 07/01/15 7 CHOW from 001017939

001027041 NF n/a 09/01/15 NE CHOW from 001014337

001027044 NF n/a 09/01/15 13 CHOW from 001001652

001027060 NF n/a 07/30/15 6 CHOW from 001012902

001027061 NF n/a 08/01/15 7 CHOW from 001013913

001027069 NF n/a 08/01/15 4 CHOW from 001017227

001027071 NF n/a 08/01/15 21 CHOW from 001014223

001027072 NF n/a 08/01/15 13 CHOW from 001003994

001027073 NF n/a 08/01/15 7 CHOW from 001019903

001027098 NF n/a 09/01/15 NE CHOW from 001014732

001027103 NF n/a 09/01/15 NE CHOW from 001018433

001027104 NF 2 08/01/15 NE CHOW from 001014336

001027110 NF n/a 09/01/15 NE CHOW from 001016116

001027111 NF n/a 08/01/15 16 CHOW from 001001711

001027113 NF n/a 08/01/15 NE CHOW from 001001928

001027114 NF n/a 08/01/15 14 CHOW from 001000512

001027117 NF n/a 08/01/15 NE CHOW from 001004530

001027118 NF n/a 08/01/15 NE CHOW from 001026304

001027119 NF 1 09/01/15 24 CHOW from 000407202

001027120 NF n/a 08/01/15 6 CHOW from 001021253

001027122 NF n/a 08/01/15 13 CHOW from 001020018

001027148 PHC 11 07/01/15 NE EPC CLOSED

001027149 PHC 3 08/01/15 NE EPC CLOSED