| Entity Name: | MAGELLAN MEDICAID ADMINISTRATION, INC. |
| Jurisdiction: | Connecticut |
| Legal type: | Stock |
| Citizenship: | Foreign |
| Status: | Withdrawn |
| Sub status: | Annual report past due |
| Date Formed: | 24 Jan 1986 |
| Business ALEI: | 0179279 |
| Annual report due: | 30 Jan 2023 |
| NAICS code: | 624190 - Other Individual and Family Services |
| Business address: | 11013 W. BROAD STREET, STE 500, GLEN ALLEN, VA, 23060, United States |
| Mailing address: | 2900 AMES CROSSING ROAD, EAGAN, MN, 55121 |
| Place of Formation: | VIRGINIA |
| E-Mail: | chappellm@magellanhealth.com |
| Name | Role | Business address |
|---|---|---|
| Secretary of State | Agent | 165 Capitol Ave., P.O. BOX 150470, Hartford, CT, 06115-0470, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| VICTOR HADDOCK | Officer | 14100 MAGELLAN PLAZA, MARYLAND HEIGHTS, MO, 63043, United States | 14100 MAGELLAN PLAZA, MARYLAND HEIGHTS, MO, 63043, United States |
| MOSTAFA KAMAL | Officer | 15950 N. 76TH STREET, STE. 200, SCOTTSDALE, AZ, 85260, United States | 2 - 2ND STREET, UNIT 1705, JERSEY CITY, NJ, 07302, United States |
| MARGIE M. SMITH | Officer | 125 PLANTATION CENTRE DRIVE, BLDG. 500-D, MACON, GA, 31210, United States | 125 PLANTATION CENTRE DRIVE, BLDG. 500-D, MACON, GA, 31210, United States |
| MEREDITH DELK | Officer | 816 CONGRESS AVENUE, SUITE 370, AUSTIN, TX, 78701, United States | 816 CONGRESS AVENUE, SUITE 370, AUSTIN, TX, 78701, United States |
| TERESA ALCORN | Officer | 4801 EAST WASHINGTON STREET, PHOENIX, AZ, 85034, United States | 123 BAR HARBOR BLVD., MEDINA, OH, 44256, United States |
| Name | Role | Business address | Residence address |
|---|---|---|---|
| KENNETH J. FASOLA | Director | FIVE COWBOYS WAY, SUITE 300, FRISCO, TX, 75034, United States | FIVE COWBOYS WAY, SUITE 300, FRISCO, TX, 75034, United States |
| Type | Old value | New value | Date of change |
|---|---|---|---|
| Name change | FIRST HEALTH SERVICES CORPORATION | MAGELLAN MEDICAID ADMINISTRATION, INC. | 2010-06-15 |
| Name change | COMPUTER COMPANY THE | FIRST HEALTH SERVICES CORPORATION | 1991-12-23 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0011518630 | 2022-12-08 | 2022-12-08 | Withdrawal | Certificate of Withdrawal | No data |
| BF-0010176431 | 2022-01-31 | No data | Annual Report | Annual Report | 2022 |
| BF-0010456048 | 2022-01-14 | 2022-01-14 | Mass Agent Change � Address | Agent Address Change | No data |
| 0007074493 | 2021-01-21 | No data | Annual Report | Annual Report | 2021 |
| 0006950703 | 2020-07-06 | 2020-07-06 | Change of Agent Address | Agent Address Change | No data |
| 0006943532 | 2020-07-06 | 2020-07-06 | Change of Agent Address | Agent Address Change | No data |
| 0006739715 | 2020-02-03 | No data | Annual Report | Annual Report | 2020 |
| 0006335903 | 2019-01-24 | No data | Annual Report | Annual Report | 2019 |
| 0006014215 | 2018-01-17 | No data | Annual Report | Annual Report | 2018 |
| 0005745558 | 2017-01-19 | No data | Annual Report | Annual Report | 2017 |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
