Date Submitted: 2/18/2015 3:19:52 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Dr. First Name Michael Middle/Maiden Roger Last Name Busatto Email Address mbusatto@humana.com Cell Phone 305-343-4773 Race Caucasian Gender Male Fax 305-370-6249 Disability Addresses Speficy the preferred mailing address: Business 2- Residence Address Line 1 9386 SW 21 St Address Line 2 City Miami State Florida County Miami-Dade Zip / Postal Code 33165 Phone Number 3- Business Address Line 1 3401 SW 160 Ave 3rd Floor Address Line 2 City Miramar State Florida Zip / Postal Code Phone Number Other Residences 4-A. List all your places of residence for the last ten (10) years. Address City & State Start Date End Date 7/28/2015 3:12:06 PM 1 of 6

Date Submitted: 2/18/2015 3:19:52 PM 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth 01/05/1957 Place of Birth Toronto, Canada 6- Driver License # B230556570050 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 8/2/1972 10- Since what year have you been a continuous resident of Florida? 1961 11- Vote Are you a registered Florida voter? Yes County of registration Miami-Dade Current Party Affiliation Republican Education 12-A. High School Miami Central High School Year Graduated 1975 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received University of Miami 1975 1979 BS Biology University of Florida 1981 1984 BS Pharmacy va Southeastern University 1994 2001 Pharm.D. Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component 7/28/2015 3:12:06 PM 2 of 6

Date Submitted: 2/18/2015 3:19:52 PM C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Humana 3401 SW 160 Ave Miramar Florida 33027 Managed care Clinical Pharmacist Pharmacy manager Start Date End Date 1994 2015 YTD 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Extensive experience in the managed care setting and formulary management. C. Have you received any awards or recognitions relating to the subject matter of this appointment? D. Identify all association memberships and association offices held by you that relate to this appointment Academy of Managed Care Pharmacy 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? 7/28/2015 3:12:06 PM 3 of 6

Date Submitted: 2/18/2015 3:19:52 PM Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented 7/28/2015 3:12:06 PM 4 of 6

Date Submitted: 2/18/2015 3:19:52 PM Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business Your Relationship to Business Business Relationship to Agency Humana Inc Employee Humana has contracts with the Agency for Health Care Administration. B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business References & Affiliations Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency Mercy Hospital Spouse Employee Mercy Hospital treats Humana Family Medicaid patients. 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Dr. Jill Sumfest 3501 SW 160 Ave 4th Floor Miramar, Fl 33027 3056265597 Alaina Gibson Pharm.D. 4030 Boy Scout Blvd Suite 1000 Tampa, Fl 33607 8132886354 Dr. Hector Fernandez 7150 W 20 Ave Suite 202 Hialeah, Fl 33016 3058228229 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Academy of Managed Care Pharmacy 100 rth Pitt Street Suite 400 Alexandria, Va 22314 ne #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 7/28/2015 3:12:06 PM 5 of 6

Date Submitted: 2/18/2015 3:19:52 PM 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter 465. 2 Governor appoints 5 pharmacists who are licensed under Chapter 465. 8 Governor appoints 5 pharmacists who are licensed under Chapter 465. 9 Governor appoints 5 pharmacists who are licensed under Chapter 465. 10 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:12:06 PM 6 of 6

Date Submitted: 1/29/2015 6:03:24 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Ms. First Name Eunice Middle/Maiden Nuekie Last Name Cofie Email Address eunicecofie@hotmail.com Cell Phone 850-766-7695 Race African-American Gender Female Fax Disability Addresses Speficy the preferred mailing address: Business 2- Residence Address Line 1 1323 Conservancy Drive East Address Line 2 City Tallahassee State Florida County Leon Zip / Postal Code 32312 Phone Number 3- Business Address Line 1 P.O. Box 7018 Address Line 2 City Tallahassee State Florida Zip / Postal Code Other Residences 32314 Phone Number 4-A. List all your places of residence for the last ten (10) years. Address City & State Start Date End Date 7/28/2015 3:54:02 PM 1 of 6

Date Submitted: 1/29/2015 6:03:24 PM 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth 07/28/1980 Place of Birth Lexington, KY 6- Driver License # C100214807680 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1984 11- Vote Are you a registered Florida voter? Yes County of registration Leon Current Party Affiliation Party Affiliation Education 12-A. High School Leon High School Year Graduated 1998 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Florida Agricultural and Mechanical University, Tallahassee, FL University of South Florida, Tampa, FL Harvard Kennedy School of Government Executive Education Program, Boston, MA Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service 8/1998 12/2004 B.S. in Chemistry 8/2008 12/2010 ne 4/2013 4/2013 Global Leadership and Public Policy for the 21st Century Certificate 7/28/2015 3:54:02 PM 2 of 6

Date Submitted: 1/29/2015 6:03:24 PM C. Date & Type of Discharge B. Branch or component 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Nuekie, Inc., 3000 Commonwealth Blvd., Tallahassee, FL 32303 Institute for African American Health, Tallahassee, FL Health and Beauty products Start Date End Date President 11/2003 Current n Profit Assistant Coordinator 11/2007 12/2010 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Yes Position Employing Agency Start Date End Date Program Assistant Florida State University 12/2010 8/2013 Program Assistant Florida Agricultural and Mechanical University 01/2005 08/2005 Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I have trained cosmetologists and estheticians at national conferences on the topic of skin health conditions in people of color. So, I have experience in developing curriculum. I also am the founder of an innovative health and beauty product company for people of color called Nuekie. I am an expert in cosmetic science and I have conducted research, written articles, and spoken on the topic to professional organizations and academic institutions. C. Have you received any awards or recognitions relating to the subject matter of this appointment? Yes B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes I have a B.S. degree in Chemistry/Molecular Biology. I have completed two entrepreneurship programs and obtained a certificate from Harvard Kennedy School of Government in Global Leadership. D. Identify all association memberships and association offices held by you that relate to this appointment Society of Cosmetic Chemists Cosmetic Executive Women Skin of Color Society 7/28/2015 3:54:02 PM 3 of 6

Date Submitted: 1/29/2015 6:03:24 PM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:54:02 PM 4 of 6

Date Submitted: 1/29/2015 6:03:24 PM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Yes Name of Business Your Relationship to Business Business Relationship to Agency Nuekie, Inc. President Florida Department of Health B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Dr. Paa Kofi Obeng 800 Benevita Place, Apt. 402, Hampton, VA Dr. Alisha Jones 3400 S. Sara Rd., Apt. 1106, Bloomington, IN Dr. Candrice Heath 10 Amsterdam Ave., Apt. 906, New York, New York 23666 2405937559 47401 2408932978 10023 8043707676 7/28/2015 3:54:02 PM 5 of 6

29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Society of Cosmetic Chemists Skin of Color Society Cosmetic Executive Women 120 Wall Street, Suite 2400, NY, NY 10005 303 West State Street, Geneva, Illnois 60134 286 Madison Avenue, 19th Floor, NY, NY 10017 GOVERNOR'S OFFICE Date Submitted: 1/29/2015 6:03:24 PM ne 12/31/2013 ne 02/28/2014 ne 12/31/2013 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Board Name Seat Seat Qualification Reappointment DBPR Board of Cosmetology 6 Lay Members Medical & Health Medicaid Pharmaceutical and Therapeutics Committee 11 Governor appoints 1 member who is a consumer representative. 7/28/2015 3:54:02 PM 6 of 6

Date Submitted: 4/8/2015 9:57:12 AM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Erin Middle/Maiden Chistine Last Name Duffy Email Address Duffy.PharmD@gmail.com Cell Phone s. 119 071(4)(d), F.S. Race Caucasian Gender Female Fax 813-675-2817 Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s. 119.071(4)(d), F.S. Address Line 2 City s. 119.071(4)(d), F.S. State s. 119.071(4)(d), F County s. 119.071(4)(d), F.S Zip / Postal Code s. 119.071(4)(d) Phone Number s. 119.071(4)(d), F.S. 3- Business Address Line 1 4110 George Rd Address Line 2 City Tampa State Florida Zip / Postal Code 33634 Phone Number 813-206-7232 Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:18:08 PM 1 of 6

Date Submitted: 4/8/2015 9:57:12 AM Address City & State Start Date End Date s. 119.071(4)(d), F.S. s. 119.071(4)(d), F.S. 09/01/1997 Present 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s. 119.071(4)(d), F.S. Place of Birth Bethpage, NY 6- Driver License # D100203847010 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1997 11- Vote Are you a registered Florida voter? Yes County of registration Pinellas Current Party Affiliation Party Affiliation Education 12-A. High School Palm Harbor University High School B. List all postsecondary educational institutions attended Year Graduated 2002 Name & Location Start Date End Date Certificates / Degrees Received Saint Petersburg College 01/01/2001 05/01/2005 Associates of Arts University of South Florida 01/01/2004 05/01/2007 Bachelor of Science Touro College of Pharmacy 09/01/2008 06/01/2012 Doctorate of Pharmacy Employment 13- Are you or have you ever been a member of the armed forces of the United States? 7/28/2015 3:18:08 PM 2 of 6

A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title WellCare Health Plans 4110 Geroge Rd Tampa, FL 33634 Walgreens Pharmacy 353 West 57th St New York, New York 10019 Walgreens Pharmacy 1160 3rd Avenue New York, NY 10065 WellCare Health Plans 8725 Henderson Rd Tampa, FL 33634 Walgreens Pharmacy 1701 McMullen Booth Rd Clearwater, FL 33761 GOVERNOR'S OFFICE Managed Care Manager of Pharmacy Operations Start Date End Date 01/06/201 4 Retail Pharmacy Floater Pharmacist 07/01/201 2 Retail Pharmacy Pharmacy Intern 10/01/201 0 Managed Care Retail Pharmacy Date Submitted: 4/8/2015 9:57:12 AM Certified Pharmacy Technician Certified Pharmacy Technician 06/01/200 7 01/30/200 3 Present 01/06/2014 07/01/2012 09/01/2008 06/01/2007 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? I have almost three years of experience in the managed care field where I can see the direct effects of a formulary and have also worked with the formulary team within my company in helping to decide when to add or remove an item from the formulary. C. Have you received any awards or recognitions relating to the subject matter of this appointment? D. Identify all association memberships and association offices held by you that relate to this appointment ne 7/28/2015 3:18:08 PM 3 of 6

Date Submitted: 4/8/2015 9:57:12 AM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:18:08 PM 4 of 6

Date Submitted: 4/8/2015 9:57:12 AM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Philip Stalas 4110 George Rd Suite 300 Tampa, FL 33634 7274215544 Ryan Nimtz 1124 Moody Ave Tampa, FL 33629 8152225735 Elizabeth Dawson 301 east 75th st Apt 2G 10021 2244360334 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) 7/28/2015 3:18:08 PM 5 of 6

Name Mailing Address Office(s) Held & Term Date of Membership National association of specialty Pharmacy 1765 Duke St, Alexandira, VA 22314 GOVERNOR'S OFFICE Date Submitted: 4/8/2015 9:57:12 AM Member #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter 465. 2 Governor appoints 5 pharmacists who are licensed under Chapter 465. 8 Governor appoints 5 pharmacists who are licensed under Chapter 465. 9 Governor appoints 5 pharmacists who are licensed under Chapter 465. 10 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:18:08 PM 6 of 6

Date Submitted: 2/18/2015 9:30:17 AM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Jodi Middle/Maiden Ellen Last Name Fredericks Email Address jodib99@yahoo.com Cell Phone s. 119 071(4)(d), F.S. Race Caucasian Gender Female Fax 954-846-9501 Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s. 119.071(4)(d), F.S. Address Line 2 City s. 119.071(4)(d State s. 119.071(4)(d), F County s. 119.071(4)(d), F.S. Zip / Postal Code s. 119.071(4)(d) Phone Number s. 119.071(4)(d), F.S. 3- Business Address Line 1 1643 Harrison Parkway Address Line 2 City Sunrise State Building H, Suite 200 Florida Zip / Postal Code 33323 Phone Number 954-276-4327 Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:10:35 PM 1 of 6

Date Submitted: 2/18/2015 9:30:17 AM Address City & State Start Date End Date s. 119.071(4)(d), F.S. s. 119.071(4)(d), F.S. s. 119.071(4)(d), F.S. s. 119.071(4)(d), F.S. March 2010 present Sept 2007 2010 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s. 119.071(4)(d), F.S. Place of Birth Falmouth, MA 6- Driver License # F636425746810 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? Yes Jodi Ellen Beck (Maiden Name) 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1982 11- Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Republican Education 12-A. High School University School of va University B. List all postsecondary educational institutions attended Year Graduated 1992 Name & Location Start Date End Date Certificates / Degrees Received va Southeastern University College of Pharmacy, Fort Lauderdale, FL va Southeastern University Huizenga School of Business, Fort Lauderdale, FL Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA August 1995 May 1999 Doctor of Pharmacy Jan. 2004 Oct. 2005 Masters in Business Administration with a concentration in Health Services Administration July 1999 June 2000 Residency in AMbulatory Care Pharmacotherapy 7/28/2015 3:10:35 PM 2 of 6

Date Submitted: 2/18/2015 9:30:17 AM University of Florida, Gainesville, FL Aug.1992 May 1995 Associates of Arts Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title South Florida Community Care Network, 1643 Harrison Parkway, Bldg. H, Suite 200, Sunrise, FL 33323 Memorial Healthcare System, 1131 N. 35 Ave, Hollywood, FL 33021 Memorial Healthcare System, 2900 Corporate Way, Suite C, Miramar, FL 33025 Provider Service Network Health Plan Healthcare System Healthcare System Director of Pharmacy Services Pharmacy Safety and Medication Officer Director of Pharmacy Contracting Start Date End Date July 2014 present Aug. 2006 July 2014 Oct. 2003 July 2006 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I chaired Memorial Healthcare System's District Formulary Committee for eight years and was responsible for new drug requests, drug evaluation, automatic substitutions, and deletions and/or additions to the formulary. In addition, as Director of Pharmacy Contracting for Memorial Healthcare System, I analyzed contracts and drug pricing to present cost savings to the system and analyze safety, efficacy, rebates, cost savings/impact, etc. C. Have you received any awards or recognitions relating to the subject matter of this appointment? B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes Doctor of Pharmacy (Pharm.D.), Masters in Business Administration (MBA) with a concentration in Health Services Administration (HSA). D. Identify all association memberships and association offices held by you that relate to this appointment 7/28/2015 3:10:35 PM 3 of 6

Date Submitted: 2/18/2015 9:30:17 AM Academy of Managed Care Pharmacy (AMCP)- member 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:10:35 PM 4 of 6

Date Submitted: 2/18/2015 9:30:17 AM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number John Benz 1643 Harrison Parkway, Bldg H, Suite 200, Sunrise, FL 33323 9542762369 Dr. Stanley Marks 1131 N. 35 Ave, 3rd Floor, Hollywood, FL 33021 9542655936 7/28/2015 3:10:35 PM 5 of 6

Date Submitted: 2/18/2015 9:30:17 AM Dr. Keith Fricker 2900 Corporate Way, Suite C, Miramar, FL 33025 9542765491 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership Academy of Managed Care Pharmacy 100 rth Pitt Street, Suite 400, Alexandria, VA 22314 member 07/31/2014 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter 465. 2 Governor appoints 5 pharmacists who are licensed under Chapter 465. 8 Governor appoints 5 pharmacists who are licensed under Chapter 465. 9 Governor appoints 5 pharmacists who are licensed under Chapter 465. 10 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:10:35 PM 6 of 6

Date Submitted: 4/6/2015 12:01:45 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Holly Middle/Maiden Neal Last Name Moreau Email Address drhneal@aol.com Cell Phone s. 119 071(4)(d), F.S. Race African-American Gender Female Fax Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s. 119.071(4)(d), F.S. Address Line 2 City s. 119.071(4)(d), F.S State s. 119.071(4)(d), F County s. 119.071(4)(d), F.S. Zip / Postal Code s. 119.071(4)(d) Phone Number s. 119.071(4)(d), F.S. 3- Business Address Line 1 3100 SW 145th Ave Address Line 2 City Miramar State Florida Zip / Postal Code 33027 Phone Number 954-364-0704 Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:17:36 PM 1 of 6

Date Submitted: 4/6/2015 12:01:45 PM Address City & State Start Date End Date s. 119.071(4)(d), F.S. s. 119.071(4)(d), F.S. Aug 2002 present 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s. 119.071(4)(d), F.S. Place of Birth tampa 6- Driver License # M60033471942 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 11- Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Democrat Education 12-A. High School King High school Year Graduated 1989 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge 7/28/2015 3:17:36 PM 2 of 6

14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title United Healthcare Managed Care organization Sunshine Health Managed Care organization Molina Health care of FL Managed Care organization GOVERNOR'S OFFICE Date Submitted: 4/6/2015 12:01:45 PM Pharmacy Manager Start Date End Date April 2014 present Pharmacy Director Oct 2013 Jan 2014 Pharmacy Director Dec 2008 Oct 2013 CVS Caremark PBM Pharmacy Supervisor Oct 2001 Dec 2008 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment I have over 12 years of experience in Managed Care and about 6 years of experience working with Managed Care Organizations that manage the Prescription benefit for Medicaid, Florida Healthy Kids and Medicare membership. In addition, I have almost 5 years of previous experience as a Plan Pharmacy Director for Molina Healthcare of FL. Combining my background and experience in Managed Care along with my diverse background in Pharmacy would make me a great candidate for this appointment. C. Have you received any awards or recognitions relating to the subject matter of this appointment? B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes Doctor of Pharmacy degree D. Identify all association memberships and association offices held by you that relate to this appointment 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 7/28/2015 3:17:36 PM 3 of 6

Date Submitted: 4/6/2015 12:01:45 PM 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes 7/28/2015 3:17:36 PM 4 of 6

Error: Subreport could not be shown. GOVERNOR'S OFFICE Date Submitted: 4/6/2015 12:01:45 PM 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Mark Bloom, MD Benjamin Schatzman, PharmD 8300 NW 33rd Street, Suite 400 Doral, Florida 200 Oceangate, Suite 100 Long Beach, CA Tina Lamaa, PharmD 200 Oceangate, Suite 100 Long Beach, CA 33122 3055288424 90802 5624773718 90802 3106632824 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership 7/28/2015 3:17:36 PM 5 of 6

Date Submitted: 4/6/2015 12:01:45 PM 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter 465. 2 Governor appoints 5 pharmacists who are licensed under Chapter 465. 8 Governor appoints 5 pharmacists who are licensed under Chapter 465. 9 Governor appoints 5 pharmacists who are licensed under Chapter 465. 10 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:17:36 PM 6 of 6

Date Submitted: 4/14/2015 12:16:27 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Dr. First Name Reina Middle/Maiden Last Name Natero Email Address rnatero@gmail.com Cell Phone Race Hispanic-American Gender Female Fax Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 2681 N Flamingo Address Line 2 Unit 2004S City Sunrise State Florida County Broward Zip / Postal Code 33323 Phone Number 3- Business Address Line 1 1301 International Parkway Address Line 2 City Sunrise State Suite 400 Florida Zip / Postal Code Other Residences Phone Number 954-377-8524 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:19:08 PM 1 of 7

Date Submitted: 4/14/2015 12:16:27 PM Address City & State Start Date End Date 2115 3RD S ST SAINT PETERSBURG, FL 33705-2776 242 MATEO NE WAY SAINT PETERSBURG,FL 33704-3622 724 4TH S AVE APT7 ST PETERSBURG,FL 33701-4473 August 2005 July 2008 July 2011 July 2014 August 2008 June 2011 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date 113 EDGECOMB ST HAMDEN,CT 06517-2615 May 1998 September 2002 140 MILL ST APT18141 EAST HAVEN,CT 06512-1087 416 WAVERLEY ST APT1 MENLO PARK,CA 94025-3719 Personal Information June 1997 May 1998 September 2002 July 2005 5- Date of Birth 12/29/1968 Place of Birth Buenos Aires, Argentina 6- Driver License # n360720689690 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 9/8/1996 10- Since what year have you been a continuous resident of Florida? 2005 11- Vote Are you a registered Florida voter? Yes County of registration Broward Current Party Affiliation Democrat Education 12-A. High School GED Year Graduated 7/28/2015 3:19:08 PM 2 of 7

B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received University of Florida 2006 2010 Doctor of Pharmacy. Florida International University. Miami, Florida Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge GOVERNOR'S OFFICE Date Submitted: 4/14/2015 12:16:27 PM 1991 1997 BS Chemistry 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Sunshine Health Managed Care Director, Clinical Pharmacy Services Start Date End Date 8/4/2014 current WellCare Health Plans Managed Care PGY1 Resident, Clinical Implementation Project Manager, Director of SP Pharmacy 6/28/2010 7/23/2014 Amgen Biothechnology Senior Associate Scientist CV Therapeutics Biothechnology Senior Research Associate Bayer Pharmaceuticals Associate Scientist I to Associate Scientist vember 2004 Septembe r 2002 June 1997 July 2005 October 2004 September 2002 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes 7/28/2015 3:19:08 PM 3 of 7

Date Submitted: 4/14/2015 12:16:27 PM o Utilized clinical expertise to plan, develop and present supporting materials to Medical Oversight and P&T Committees at WellCare and Sunshine Health o Driven clinical pharmacy outreach initiatives at the health plan and specialty pharmacy level for Medicare and Medicaid members o Worked within a Medicare and Medicaid Health Plans to insure fiscally responsible access to Specialty Medications (Operations, Quality and PBM Relations) o Clinically monitored and counseled patients through telephonic delivered disease therapy management (DTM) and MTM o Given the opportunity, I would strive to motivate and work with the DUR committee to analyze data trends to make sound decisions C. Have you received any awards or recognitions relating to the subject matter of this appointment? PharmD, RPh. PGY1 in Managed Care D. Identify all association memberships and association offices held by you that relate to this appointment AMCP: Academy of Managed Care Pharmacy since 2009 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence 7/28/2015 3:19:08 PM 4 of 7

Date Submitted: 4/14/2015 12:16:27 PM Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency 7/28/2015 3:19:08 PM 5 of 7

Date Submitted: 4/14/2015 12:16:27 PM B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:19:08 PM 6 of 7

Date Submitted: 4/14/2015 12:16:27 PM Medical & Health Medicaid Pharmaceutical and Therapeutics Committee 2 Governor appoints 5 pharmacists who are licensed under Chapter 465. Medical & Health Medicaid Pharmaceutical and Therapeutics Committee 8 Governor appoints 5 pharmacists who are licensed under Chapter 465. Medical & Health Medicaid Pharmaceutical and Therapeutics Committee 9 Governor appoints 5 pharmacists who are licensed under Chapter 465. Medical & Health Medicaid Pharmaceutical and Therapeutics Committee 10 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:19:08 PM 7 of 7

Date Submitted: 4/3/2015 12:01:39 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Alfred Middle/Maiden Last Name Romay Email Address alfred.romay@molinahealthcar e.com Cell Phone s. 119 071(4)(d), F.S. Race Hispanic-American Gender Male Fax 866-472-9512 Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s. 119.071(4)(d), F.S. Address Line 2 City s. 119.071(4)(d State s. 119.071(4)(d), F County s. 119 071(4)(d), F.S. Zip / Postal Code s. 119.071(4)(d) Phone Number s. 119.071(4)(d), F.S. 3- Business Address Line 1 8300 NW 33 Street Address Line 2 City Doral State Florida Zip / Postal Code 33122 Phone Number 305-714-3416 Other Residences 4-A. List all your places of residence for the last ten (10) years. Address City & State Start Date End Date 7/28/2015 3:16:49 PM 1 of 6

Date Submitted: 4/3/2015 12:01:39 PM 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s. 119.071(4)(d), F.S. Place of Birth Weehawken 6- Driver License # R500000690680 Issuing State New Jersey 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1993 11- Vote Are you a registered Florida voter? Yes County of registration Miami-Dade Current Party Affiliation Republican Education 12-A. High School Union Hill High School Year Graduated 1986 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received St. Johns University 1986 1991 BS Pharmacy Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge 7/28/2015 3:16:49 PM 2 of 6

Date Submitted: 4/3/2015 12:01:39 PM 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Molina Healthcare of Florida Health Plan Pharmacist, Director, Pharmacy Services Catamaran PBM Pharmacist, Utilization Review CVS Caremark PBM Pharmacist, Clincal Operations Supervisor Start Date End Date 12/2013 Present 6/2009 11/2013 11/2004 6/2009 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? With my extensive knowledge base of disease states, I am able to make linically sound decisions in regards to evaluating drug medication classes. I have prior experience with running the P&T committee at our health plan. C. Have you received any awards or recognitions relating to the subject matter of this appointment? D. Identify all association memberships and association offices held by you that relate to this appointment 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 7/28/2015 3:16:49 PM 3 of 6

Date Submitted: 4/3/2015 12:01:39 PM 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? 7/28/2015 3:16:49 PM 4 of 6

Date Submitted: 4/3/2015 12:01:39 PM B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Maritza Aguayo 9400 NW 104 ST, Miami, Florida 33142 7862000150 Albert Garcia 9400 NW 104 ST, Miami, Florida 33142 3056367779 Lorna Cameron 730 Briarwood Terrace, Davie, Florida 33325 9544759719 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) Name Mailing Address Office(s) Held & Term Date of Membership 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 7/28/2015 3:16:49 PM 5 of 6

Date Submitted: 4/3/2015 12:01:39 PM 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter 465. 2 Governor appoints 5 pharmacists who are licensed under Chapter 465. 8 Governor appoints 5 pharmacists who are licensed under Chapter 465. 9 Governor appoints 5 pharmacists who are licensed under Chapter 465. 10 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:16:49 PM 6 of 6

Date Submitted: 2/19/2015 11:24:14 AM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Luis Middle/Maiden Last Name Saenz Email Address luis.saenz@aidshealth.org Cell Phone s. 119 071(4)(d), F.S. Race Hispanic-American Gender Male Fax 888-974-9948 Disability Addresses Speficy the preferred mailing address: Business 2- Residence Address Line 1 s. 119.071(4)(d), F.S. Address Line 2 s. 119.071(4)(d), F.S. City s. 119.071(4)(d), F.S. State s. 119.071(4)(d), F County s. 119.071(4)(d), F.S. Zip / Postal Code s. 119.071(4)(d) Phone Number s. 119.071(4)(d), F.S. 3- Business Address Line 1 Address Line 2 City Zip / Postal Code Other Residences State Phone Number Please select 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:52:41 PM 1 of 6

Address City & State Start Date End Date s. 119.071(4)(d), F.S. GOVERNOR'S OFFICE Date Submitted: 2/19/2015 11:24:14 AM s. 119.071(4)(d), F.S. 2005 present 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s. 119.071(4)(d), F.S. Place of Birth Nicaragua 6- Driver License # S520521713320 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 3/28/2002 1:00:00 AM 10- Since what year have you been a continuous resident of Florida? 1983 11- Vote Are you a registered Florida voter? Yes County of registration Miami-Dade Current Party Affiliation Democrat Education 12-A. High School Coral Gables Year Graduated 1991 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received Florida International University, Miami, FL vasoutheastern University, Fort Lauderdale, FL Employment 1991 1995 Bachelors Science Physical Therapy 1998 2002 Doctor of Osteopathy 13- Are you or have you ever been a member of the armed forces of the United States? 7/28/2015 3:52:41 PM 2 of 6

A. Date of Service B. Branch or component C. Date & Type of Discharge GOVERNOR'S OFFICE Date Submitted: 2/19/2015 11:24:14 AM 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title Aids HealthCare Foundation Borinquen Health Center Care Resource Doris Ison Community Health Center of South Dade, INC Dr. Karen Raben MD, PA Rosie Lee Wesley Clinic Managed Care Insurance Community Health Center Community Health Center Community Health Center Private Practice Medical Community Helth Center Medical Director Southern Bureau Medical Director Family Medicine Physician Family and HIV Medicine Per Diem Physician Urgent Care Center Family and HIV medicine Physician Family Medicine Physician Start Date End Date 10/2014 present 01/2013 10/2014 05/2008 10/2013 01/2008 present 05/2006 12/2007 07/2005 04/2006 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? I am currently a member of the Ryan White Medical Subcommittee in Miami-Dade County. We deal with several issues related to drugs which should be in formulary. I am currently chair of that committee C. Have you received any awards or recognitions relating to the subject matter of this appointment? D. Identify all association memberships and association offices held by you that relate to this appointment American Academy of HIV Medicine HIV Specialist Certification 7/28/2015 3:52:41 PM 3 of 6

Date Submitted: 2/19/2015 11:24:14 AM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled every fourth Friday of the month 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence for last 6 years none na Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:52:41 PM 4 of 6

Date Submitted: 2/19/2015 11:24:14 AM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Marivi Navarro 2625 Collins Avenue Apt. 1706, Miami Beach, FL 33140 7863484618 Dr. Arnold Oper 10300 SW 216th Street, Cutler Bay, FL 33190 3053431630 Dr. Edgardo Nunez 810 W Mowry Dr, Homestead, FL 33030 3059628693 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) 7/28/2015 3:52:41 PM 5 of 6

Date Submitted: 2/19/2015 11:24:14 AM Name Mailing Address Office(s) Held & Term Date of Membership 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee 7 Governor appoints 1 physician who is licensed under Chapter 459. 7/28/2015 3:52:41 PM 6 of 6

Date Submitted: 3/29/2015 10:18:49 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Alan Middle/Maiden Richard Last Name Smith Email Address alan.smith@wellcare.com Cell Phone s. 119 071(4)(d), F.S. Race Caucasian Gender Male Fax 813-262-2943 Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 s. 119.071(4)(d), F.S. Address Line 2 City s. 119.071(4)(d), F State s. 119.071(4)(d), F County s. 119.071(4)(d), F.S. Zip / Postal Code s. 119.071(4)(d) Phone Number s. 119.071(4)(d), F.S. 3- Business Address Line 1 3031 N. Rocky Point Drive, Address Line 2 West City Tampa State Florida Zip / Postal Code 33607 Phone Number 813-206-3687 Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:51:59 PM 1 of 6

Date Submitted: 3/29/2015 10:18:49 PM Address City & State Start Date End Date s. 119.071(4)(d), F.S. s. 119.071(4)(d), F.S. May 2003 present 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date s. 119.071(4)(d), F.S. s. 119.071(4)(d), F.S. July 1978 August 1979 Personal Information 5- Date of Birth s. 119.071(4)(d), F.S. Place of Birth Chicago, IL 6- Driver License # S530016493850 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1979 11- Vote Are you a registered Florida voter? Yes County of registration Hillsborough Current Party Affiliation Republican Education 12-A. High School Roger C. Sullivan Year Graduated 1967 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received The College of the University of Chicago University of Chicago Pritzker School of Medicine University of Chicago Hospitals and Clinics September 1967 June 1971 Bachelor of Science September 1971 June 1975 MD July 1975 June 1978 Completed Internship Residency in Internal Medicine 7/28/2015 3:51:59 PM 2 of 6

Date Submitted: 3/29/2015 10:18:49 PM Employment 13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title WellCare Health Plans Manged Care Medicaid and Medicare Health Insurance Physician Medical Director Start Date End Date February 2003 present 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Faculty position at the University of Chicago Pritzker School of Medicine and practiced inner city medicine in Chicago, IL and Gary, Indiana before moving to Florida in 1979. Practiced primary care in rural Pasco County from 1979-1993. Worked in managed care at Aetna and WellCare from 1993 to present, with Pharmacy P&T participation and Chair of P&T at both companies. Spent 7 years at WellCare as Senior Medical Director of Pharmacy. Have extensive experience in all aspects of the P&T process, as well as clinical practice experience with private practice prescribing processes in the great State of Florida. C. Have you received any awards or recognitions relating to the subject matter of this appointment? D. Identify all association memberships and association offices held by you that relate to this appointment 7/28/2015 3:51:59 PM 3 of 6

Date Submitted: 3/29/2015 10:18:49 PM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:51:59 PM 4 of 6

Date Submitted: 3/29/2015 10:18:49 PM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) 7/28/2015 3:51:59 PM 5 of 6

Name Mailing Address Office(s) Held & Term Date of Membership American Board of Quality Assurance and Utilization Review Physicians 6640 Congress St, New Port Richey, FL 34653 GOVERNOR'S OFFICE Date Submitted: 3/29/2015 10:18:49 PM Fellow #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 3 Governor appoints 4 physicians who are licensed under Chapter 458. 4 Governor appoints 4 physicians who are licensed under Chapter 458. 5 Governor appoints 4 physicians who are licensed under Chapter 458. 6 Governor appoints 4 physicians who are licensed under Chapter 458. 7/28/2015 3:51:59 PM 6 of 6

Date Submitted: 5/12/2015 2:26:10 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Contact 1- General Title Dr. First Name Patrizia Middle/Maiden Last Name Taddei Allen Email Address ptaddei-allen@welldynerx.com Cell Phone 813-758-3317 Race Hispanic-American Gender Female Fax Disability Addresses Speficy the preferred mailing address: Residential 2- Residence Address Line 1 1183 Shipwatch Circle Address Line 2 City Tampa State Florida County Hillsborough Zip / Postal Code 33602 Phone Number 3- Business Address Line 1 500 Eagles Landing Drive Address Line 2 City Lakeland State Florida Zip / Postal Code 33810 Phone Number 888-479-2000 Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:37:52 PM 1 of 6

Date Submitted: 5/12/2015 2:26:10 PM Address City & State Start Date End Date 1183 Shipwatch Circle Tampa, FL 11/26/2012 Current 4444 Summer Oak Dr Tampa, FL 02/17/2005 11/26/2012 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date ne none none none Personal Information 5- Date of Birth 05/15/1981 Place of Birth Caracas, Venezuela 6- Driver License # T345660816750 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? Yes Patrizia Taddei 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 11/30/2006 10- Since what year have you been a continuous resident of Florida? 1986 11- Vote Are you a registered Florida voter? Yes County of registration Hillsborough Current Party Affiliation Democrat Education 12-A. High School Tampa Bay Technical High School B. List all postsecondary educational institutions attended Year Graduated 1999 Name & Location Start Date End Date Certificates / Degrees Received University of South Florida August 1999 May 2003 B.S. University of Florida August 2003 May 2007 PharmD Employment 7/28/2015 3:37:52 PM 2 of 6

13- Are you or have you ever been a member of the armed forces of the United States? A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title WellDyne 500 Eagles Landing Dr Lakeland, FL 33810 University of Florida College of Pharmacy 1225 Center Drive HPCP 3302 Gainesville, FL 32610 CVS Pharmacy 1 CVS Drive Woonsocket, RI 02895 GOVERNOR'S OFFICE Pharmacy Benefit Manager Date Submitted: 5/12/2015 2:26:10 PM Academic Institution Start Date End Date Clinical Pharmacist 10/1/2013 Current Clinical Assistant Professor, Regional Coordinator Tampa 11/15/201 1 Current Pharmacy Pharmacist 4/24/2004 August 2014 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment At WellDyne, I am involved with development and review of clinical criteria used to make coverage determinations, as well as evaluating prior authorization requests. I am a nationally Board Certified Ambulatory Care Pharmacist (BCACP). I serve on the Editorial Advisory Board for the Journal of Managed Care Pharmacy (JMCP) and am also a peer-reviewer for submitted manuscripts and poster abstracts. I am an assistant professor at UF College of Pharmacy and am involved with pharmacy education. C. Have you received any awards or recognitions relating to the subject matter of this appointment? Yes Silver Medal for Professional Poster submitted at the 27th Annual Academy of Managed Care Pharmacy (AMCP) National Conference. B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes PharmD, BCACP, APhA MTM Certified Pharmacist, APhA Certified Immunizer D. Identify all association memberships and association offices held by you that relate to this appointment Editorial Advisory Board Committee for Journal of Managed Care Pharmacy at Academy of Managed Care Pharmacy (AMCP); APhA. 7/28/2015 3:37:52 PM 3 of 6

Date Submitted: 5/12/2015 2:26:10 PM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 23- Have you ever been refused a fidelity, surety, performance, or other bond? 7/28/2015 3:37:52 PM 4 of 6

Date Submitted: 5/12/2015 2:26:10 PM Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number Bob Parrado 7922 Flowerfield Dr Tampa, FL 33615 8133610491 William Schnell 190 Broadway St Atp 502 Asheville, NC 22801 8138439640 Stacey Curtis P.O. Box 100486 Gainesville, FL 32610 3522811865 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) 7/28/2015 3:37:52 PM 5 of 6

Name Mailing Address Office(s) Held & Term Date of Membership AMCP 100 rth Pitt Street Suite 400 Alexandria, VA 22314 GOVERNOR'S OFFICE Date Submitted: 5/12/2015 2:26:10 PM Editorial Advisory Board Committee Member April 2015 through April 2018 #Error 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 1 Governor appoints 5 pharmacists who are licensed under Chapter 465. 2 Governor appoints 5 pharmacists who are licensed under Chapter 465. 8 Governor appoints 5 pharmacists who are licensed under Chapter 465. 9 Governor appoints 5 pharmacists who are licensed under Chapter 465. 10 Governor appoints 5 pharmacists who are licensed under Chapter 465. 7/28/2015 3:37:52 PM 6 of 6

Date Submitted: 3/16/2015 3:02:31 PM As a general matter, applications for all positions within state Government are public records, which may be viewed by anyone upon request. However, there are some exemptions from the public records law for identifying information relating to past and present law enforcement officers and their families, victims of certain crimes, etc. If you believe an exemption from the public records law applies to portions of your application, please check this box. Yes Contact 1- General Title Dr. First Name Michael Middle/Maiden Last Name Wohlfeiler Email Address michael.wohlfeiler@aidshealth. org Cell Phone s. 119 071(4)(d), F.S. Race Caucasian Gender Male Fax Disability Addresses Speficy the preferred mailing address: Business 2- Residence Address Line 1 s. 119.071(4)(d), F.S. Address Line 2 City s. 119.071(4)(d State s. 119.071(4)(d), F County s. 119 071(4)(d), F.S. Zip / Postal Code s. 119.071(4)(d) Phone Number s. 119.071(4)(d), F.S. 3- Business Address Line 1 1613 Alton Road Address Line 2 City Miami Beach State Florida Zip / Postal Code 33139 Phone Number 305-538-1400 Other Residences 4-A. List all your places of residence for the last ten (10) years. 7/28/2015 3:50:39 PM 1 of 6

Address City & State Start Date End Date s. 119.071(4)(d), F.S. GOVERNOR'S OFFICE Date Submitted: 3/16/2015 3:02:31 PM s. 119.071(4)(d), F.S. 1992 2015 4-B. List all your former and current residences outside of Florida that you have maintained at any time during adulthood. Address City & State Start Date End Date Personal Information 5- Date of Birth s. 119.071(4)(d), F.S. Place of Birth Tucson, AZ 6- Driver License # W414542540540 Issuing State Florida 7- Social Security # s. 119 071(5)(a), F.S. 8- Have you ever used or been known by any other legal name? 9- A. Are you a United States citizen? Yes B. If you are a naturalized citizen, date of naturalization 10- Since what year have you been a continuous resident of Florida? 1987 11- Vote Are you a registered Florida voter? Yes County of registration Miami-Dade Current Party Affiliation Democrat Education 12-A. High School Rincon High School Year Graduated 1972 B. List all postsecondary educational institutions attended Name & Location Start Date End Date Certificates / Degrees Received University of Arizona, Tucson, AZ 1972 1976 BA University of Arizona College of Law, Tucson, AZ 1977 1980 JD Rush University College of Medicine 1983 1987 MD Employment 13- Are you or have you ever been a member of the armed forces of the United States? 7/28/2015 3:50:39 PM 2 of 6

A. Date of Service B. Branch or component C. Date & Type of Discharge 14- Concerning your current employer and for all of your employment during the last ten years, list your employer s name, business address, type of business, occupation or job title, and period(s) of employment. Employer's Name & Address Type of Business Occupation / Job Title AIDS Healthcare Foundation AIDS Healthcare Foundation AIDS Healthcare Foundation Wohlfeiler, Piperato Associates GOVERNOR'S OFFICE nprofit provider of medical care nprofit provider of medical care nprofit provider of medical care Private medical practice Date Submitted: 3/16/2015 3:02:31 PM Start Date End Date Chief of Medicine 08/2013 Current Regional Medical Director 08/2012 08/2013 Medical Provider 09/2011 08/2012 Medical Director 1997 09/2011 15- Have you ever been employed by any state, district, or local governmental agency in Florida? Position Employing Agency Start Date End Date Appointments 16- A. State your experiences and interests or elements of your personal history that qualify you for this appointment 25 years work in HIV/AIDS. 10 years as Medical Director of Mercy Hospital's Special Immunology Services program. 10 years serving on M-DC's Ryan White Medical Care Subcommittee. First President of the Florida Academy of HIV Medicine. Former member of the National Board of Directors of the American Academy of HIV Medicine. Currently Chief of Medicine of AIDS Healthcare Foundation (largest provider of HIV care in the world). C. Have you received any awards or recognitions relating to the subject matter of this appointment? Yes B. Have you received any degree(s), professional certification(s), or designations(s) related to the subject matter of this appointment? Yes M.D., J.D., AAHIVMS (American Academy of HIV Medicine Specialist) D. Identify all association memberships and association offices held by you that relate to this appointment Member, Florida ADAP Advisory Work Group International AIDS Society 7/28/2015 3:50:39 PM 3 of 6

Recipient, Twelve Good Men Award, Ronald McDonald House, 2002Red Ribbon Hero Award, CAEAR (Communities Advocating Emergency AIDS Relief) Coalition, January 9, 2012 Selected for inclusion in The Best Doctors in America, 1996-1997, 2001-2014. Woodward/White, Inc. GOVERNOR'S OFFICE Date Submitted: 3/16/2015 3:02:31 PM 17- Do you currently hold an office or position (appointive, civil service, or other) with the federal or any foreign government? 18- Have you previously been appointed to any office that required confirmation by the Florida Senate? Title of Office Term of Appointment Confirmation Result 19- A. Have you ever been elected or appointed to any public office in this state? Office Title Date of Election or Appointment Term of Office Level of Government (city, county, district, state, federal) B. If your service was on an appointed board(s), committee(s), or council(s) 1- How frequently were meetings scheduled 2- If you missed any of the regularly scheduled meetings, state the number of meetings you attended, the number you missed, and the reasons(s) for your absence(s) Meetings Attended Meetings Missed Reason for Absence Violation 20- Have you ever been arrested, charged, or indicted for violation of any federal, state, county, or municipal law, regulation, or ordinance? (Exclude traffic violations for which a fine or civil penalty of $150 or less was paid.) Date Place Nature Disposition 21- Has probable cause ever been found that you were in violation of the Code of Ethics for Public Officers and Employees, Part III, Chapter 112, F.S.? Date Nature of Violation Disposition 22- Have you ever been suspended from any office by the Governor of the State of Florida? Title of Office Reason of Suspension Date of Suspension Result Please Select 7/28/2015 3:50:39 PM 4 of 6

Date Submitted: 3/16/2015 3:02:31 PM 23- Have you ever been refused a fidelity, surety, performance, or other bond? Certifications 24- Have you held or do you hold an occupational or professional license or certificate in the State of Florida? Yes Error: Subreport could not be shown. 25- Have you ever been a registered lobbyist or have you lobbied at any level of government at any time during the past five (5) years? A. Did you receive any compensation other than reimbursement for expenses? B. Name of agency or entity you lobbied and the principal(s) you represented Agency Lobbies Principal Represented Disclosures 26- If required by law or administrative rule, will you file financial disclosure statements? Yes 27- A. Have you, or businesses of which you have been an owner, officer, or employee, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Your Relationship to Business Business Relationship to Agency B. Have members of your immediate family (spouse, child, parents(s), siblings(s)), or businesses of which members of your immediate family have been owners, officers, or employees, held any contractual or other direct dealings during the last four (4) years with any state or local governmental agency in Florida, including the office or agency to which you have been appointed or are seeking appointment? Name of Business Family Member's Relationship to You Family Member's Relationship to Business Business Relationship to Agency References & Affiliations 28- List three persons who have known you well within the past five (5) years. Include a current, complete address and telephone number. Exclude your relatives and members of the Florida Senate. Name Mailing Address Zip Code Phone Number 29- Name any business, professional, occupational, civic, or fraternal organizations(s) of which you are now a member, or of which you have been a member during the past five (5) years, the organization address(es), and date(s) of your membership(s) 7/28/2015 3:50:39 PM 5 of 6

Date Submitted: 3/16/2015 3:02:31 PM Name Mailing Address Office(s) Held & Term Date of Membership 30- Do you know of any reason why you will not be able to attend fully to the duties of the office or position to which you have been or will be appointed? 31- Are you now, or in the past three years have you been, a member of any club or organization that, to your knowledge, in practice or policy, restricts membership or restricted membership during the time that you belonged on the basis of race, religion, national origin, or gender? If so, detail the name and nature of the club(s) or organization(s), relevant policies and practices, and state whether you intend to continue as a member if you appointed by the Governor? Boards of Interest Functional Category Medical & Health Medical & Health Medical & Health Medical & Health Board Name Seat Seat Qualification Reappointment Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee Medicaid Pharmaceutical and Therapeutics Committee 3 Governor appoints 4 physicians who are licensed under Chapter 458. 4 Governor appoints 4 physicians who are licensed under Chapter 458. 5 Governor appoints 4 physicians who are licensed under Chapter 458. 6 Governor appoints 4 physicians who are licensed under Chapter 458. 7/28/2015 3:50:39 PM 6 of 6