MAGELLAN MEDICAID ADMINISTRATION, INC.

Company Details

Name:	MAGELLAN MEDICAID ADMINISTRATION, INC.
Jurisdiction:	Rhode Island
Entity type:	Foreign Corporation
Status:	Conversion
Date of Organization in Rhode Island:	14 Feb 2008 (17 years ago)
Date of Dissolution:	20 Dec 2022 (2 years ago)
Date of Status Change:	20 Dec 2022 (2 years ago)
Identification Number:	000308615
Place of Formation:	VIRGINIA
Purpose:	PHARMACY BENEFITS ADMINISTRATION
Historical names:	First Health Services Corporation
Principal Address:	11013 W. BROAD STREET SUITE 500, GLEN ALLEN, VA, 23060, USA

Industry & Business Activity

NAICS

624190 Other Individual and Family Services

This industry comprises establishments primarily engaged in providing nonresidential individual and family social assistance services (except those specifically directed toward children, the elderly, persons diagnosed with intellectual and developmental disabilities, or persons with disabilities). Learn more at the U.S. Census Bureau

Agent

Name	Role	Address
CORPORATION SERVICE COMPANY	Agent	222 JEFFERSON BOULEVARD SUITE 200, WARWICK, RI, 02888, USA

PRESIDENT

Name	Role	Address
MOSTAFA KAMAL	PRESIDENT	11013 W. BROAD STREET GLEN ALLEN, VA 23060 USA

TREASURER

Name	Role	Address
DERRICK DUKE	TREASURER	8621 ROBERT FULTON DRIVE COLUMBIA, MD 21046 USA

SECRETARY

Name	Role	Address
MICHAEL MCQUILLEN	SECRETARY	8621 ROBERT FULTON DR COLUMBIA, MD 21046 USA

SVP & GENERAL MANAGER

Name	Role	Address
MEREDITH DELK	SVP & GENERAL MANAGER	816 CONGRESS AVE., STE. 370 AUSTIN, TX 78701 USA

DIRECTOR

Name	Role	Address
KENNETH J. FASOLA	DIRECTOR	FIVE COWBOYS WAY, STE. 300 FRISCO, TX 75034 USA
MICHAEL MCQUILLEN	DIRECTOR	8621 ROBERT FULTON DRIVE COLUMBIA, MD 21046 USA
DERRICK DUKE	DIRECTOR	8621 ROBERT FULTON DRIVE COLUMBIA, MD 21046 USA

Events

Type	Date	Old Value	New Value
Conversion	2022-12-20	MAGELLAN MEDICAID ADMINISTRATION, INC.	Prime Therapeutics State Government Solutions LLC on 12-20-2022
Name Change	2010-06-11	First Health Services Corporation	MAGELLAN MEDICAID ADMINISTRATION, INC.

Filings

Number	Name	File Date
202216332540	Annual Report	2022-04-29
202193365980	Annual Report	2021-03-01
202036003220	Annual Report	2020-03-06
201987874080	Annual Report	2019-02-28
201858465070	Annual Report	2018-02-16

Date of last update: 09 May 2025

Sources: Rhode Island Department of State