| | 200508!506530!9700!H94002!TRICARE SUPPORT OFFICE !MDA90690D0003 !A!N! !Y! !P00034!20050506!19960131!078760071!078760071!078760071!N!DELTA DENTAL PLAN OF CALIFORNI!100 1ST ST STE 400 !SAN FRANCISCO !CA!94105!64000!067!06!SACRAMENTO !SACRAMENTO !CALIFORNIA!-000000070932!N!N!000000000000!Q201!GENERAL HEALTH CARE SERVICES !S1 !SERVICES !000 !* !524114!E! !3!A!S!C! ! !20200930!B! ! !A! !A!U!A!2!002!B! !Z!N!Z! ! !N!C!N! ! ! !A!A!A!A!000!A!C!N! ! ! ! ! ! !0001! ! | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q201MEDICAL- GENERAL HEALTH CARE | May 6, 2005 | May 6, 2005 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | 524114Direct Health and Medical Insurance Carriers | Q503MEDICAL- DENTISTRY | Aug 20, 2002 | Aug 20, 2002 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q201MEDICAL- GENERAL HEALTH CARE | Sep 29, 1999 | Sep 29, 1999 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q201MEDICAL- GENERAL HEALTH CARE | Sep 17, 1999 | Sep 17, 1999 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q503MEDICAL- DENTISTRY | Dec 28, 1998 | Dec 28, 1998 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q503MEDICAL- DENTISTRY | Sep 14, 1998 | Sep 14, 1998 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q503MEDICAL- DENTISTRY | Apr 2, 1998 | Apr 2, 1998 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q503MEDICAL- DENTISTRY | Mar 9, 1998 | Mar 9, 1998 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | TRICARE MANAGEMENT ACTIVITY (TMA) | TRICARE MANAGEMENT ACTIVITY (TMA) | — | — | Q503MEDICAL- DENTISTRY | Jan 27, 1998 | Jan 27, 1998 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Jan 20, 1997 | Jan 20, 1997 | — |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Sep 15, 1996 | Sep 15, 1996 | Sep 15, 1996 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Oct 15, 1994 | Oct 15, 1994 | Jun 15, 1996 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Sep 15, 1994 | Sep 15, 1994 | Jul 15, 1995 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Aug 15, 1994 | Aug 15, 1994 | Jul 15, 1995 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Jun 15, 1994 | Jun 15, 1994 | Nov 15, 1994 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Apr 15, 1994 | Apr 15, 1994 | Dec 15, 1994 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Mar 15, 1994 | Mar 15, 1994 | Apr 15, 1994 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Mar 15, 1994 | Mar 15, 1994 | Dec 15, 1994 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Feb 15, 1994 | Feb 15, 1994 | Apr 15, 1995 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Jan 15, 1994 | Jan 15, 1994 | Jul 15, 1995 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Dec 15, 1993 | Dec 15, 1993 | Dec 15, 1993 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Dec 15, 1993 | Dec 15, 1993 | Jan 15, 1994 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Nov 15, 1993 | Nov 15, 1993 | Nov 15, 1993 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Oct 15, 1993 | Oct 15, 1993 | Oct 15, 1993 |
| | — | DELTA DENTAL PLAN OF CALIFORNI | $0 | OFFICE OF THE CIVILIAN HEALTH AND MEDICAL PROGRAM | — | — | — | G007SOCIAL- GOVERNMENT HEALTH INSURANCE PROGRAMS | Sep 15, 1993 | Sep 15, 1993 | Sep 15, 1993 |