MGCRB FFY 2022 Individual Decisions Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0001 Reid Health (15-0048) Primary Request 15 34620 Approved Secondary Request 15 34620 Dismissed Tertiary Request 15 17140 Dismissed 22C0003 Beaumont Hospital Dearborn (23-0020) Primary Request 19804 47664 Approved Secondary Request 19804 11460 Dismissed Tertiary Request 19804 19804 Dismissed 22C0004 Saint Thomas DeKalb Hospital (44-0148) Primary Request 44 34980 Approved 22C0005 Saint Thomas River Park Hospital (44-0151) Primary Request 44 34980 Approved 22C0006 Lake Charles Memorial Hospital (19-0060) Primary Request 29340 13140 Approved 22C0008 Bayhealth Hospital, Sussex Campus (08-0009) Primary Request 41540 20100 Approved 22C0009 Robert Wood Johnson University Hospital (31-0038) Primary Request 35154 35614 Approved 22C0010 Texoma Medical Center (45-0324) Primary Request 43300 19124 Approved Secondary Request 43300 43300 Dismissed 22C0011 Memorial Hospital (36-0156) Primary Request 36 45780 Approved 22C0012 Northeast Alabama Regional Medical Center (01-0078) Primary Request 11500 12060 Approved Secondary Request 11500 13820 Dismissed 22C0013 Scripps Mercy Hospital (05-0077) Primary Request 41740 41740 Approved 22C0014 Scripps Green Hospital (05-0424) Primary Request 41740 41740 Approved 22C0018 Reid Health (15-0048) Primary Request 15 17140 Withdrawn (Pre-Decision) 22C0019 Onslow Memorial Hospital (34-0042) Primary Request 27340 48900 Approved Secondary Request 27340 35100 Dismissed 22C0020 Lenoir Memorial Hospital, Inc. (34-0027) Primary Request 34 24780 Approved 22C0021 OSF St. James John Albrecht Medical Center (14-0161) Primary Request 14 16984 Approved 22C0022 Cleveland Clinic Hospital (10-0289) Primary Request 22744 22744 Approved 22C0023 OSF Sacred Heart Medical Center (14-0093) Primary Request 19180 29200 Approved 22C0024 Saint Anthony Medical Center (14-0233) Primary Request 40420 20994 Approved 22C0025 Little Company of Mary Hospital (14-0179) Primary Request 16984 29404 Approved Secondary Request 16984 20994 Denied 22C0026 Northwestern Lake Forest Hospital (14-0130) Primary Request 29404 16984 Approved 22C0027 OSF Saint Mary Medical Center (14-0064) Primary Request 14 37900 Approved Secondary Request 14 19340 Dismissed

Page 1 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0028 Hospital of Univ of Pennsylvania (39-0111) Primary Request 37964 47220 Withdrawn (Pre-Decision) Secondary Request 37964 12100 Withdrawn (Pre-Decision) Tertiary Request 37964 37964 Withdrawn (Pre-Decision) Fourth Request 37964 47220 Withdrawn (Pre-Decision) 22C0029 St. Luke's Hospital (39-0049) Primary Request 10900 35084 Approved Secondary Request 10900 33874 Dismissed 22C0030 Chester County Hospital (39-0179) Primary Request 33874 37964 Approved 22C0031 Penn Presbyterian Medical Center (39-0223) Primary Request 37964 47220 Approved Secondary Request 37964 12100 Denied Tertiary Request 37964 37964 Denied 22C0032 Pennsylvania Hospital (39-0226) Primary Request 37964 47220 Approved Secondary Request 37964 12100 Dismissed Tertiary Request 37964 37964 Dismissed 22C0033 Hospital of Univ of Pennsylvania (39-0111) Primary Request 37964 47220 Approved Secondary Request 37964 12100 Dismissed Tertiary Request 37964 37964 Dismissed 22C0034 Indian River Memorial Hospital, Inc. (10-0105) Primary Request 42680 37340 Approved 22C0035 Jackson County Memorial Hospital (37-0022) Primary Request 37 45 Approved 22C0036 Ronald Reagan UCLA Medical Center (05-0262) Primary Request 31084 37100 Approved Secondary Request 31084 31084 Dismissed 22C0037 Santa Monica UCLA Medical Center (05-0112) Primary Request 31084 37100 Approved Secondary Request 31084 31084 Dismissed 22C0038 University Health System (45-0213) Primary Request 41700 12420 Approved Secondary Request 41700 41700 Dismissed 22C0039 DCH Regional Medical Center (01-0092) Primary Request 46220 13820 Approved 22C0040 Weirton Medical Center (51-0023) Primary Request 48260 38300 Approved Secondary Request 48260 48260 Dismissed 22C0041 Eastern Idaho Regional Medical Center (13-0018) Primary Request 26820 38540 Approved Secondary Request 26820 38540 Dismissed Tertiary Request 26820 38540 Dismissed Fourth Request 26820 53 Dismissed 22C0043 Mercy Medical Center Clinton (16-0080) Primary Request 16 19340 Approved 22C0044 Mercy Medical Center North Iowa (16-0064) Primary Request 16 24 Approved 22C0045 Huntsville Hospital (01-0039) Primary Request 26620 26620 Approved 22C0046 Decatur Morgan Hospital Decatur Campus (01-0085) Primary Request 19460 26620 Approved

Page 2 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0047 Tuscon Medical Center (03-0006) Primary Request 46060 38060 Approved 22C0048 Terrebonne General Medical Center (19-0008) Primary Request 26380 12940 Approved 22C0049 Hillsdale Hospital (23-0037) Primary Request 23 27100 Approved 22C0050 Froedtert Memorial Lutheran Hospital (52-0177) Primary Request 33340 29404 Approved Secondary Request 33340 33340 Dismissed 22C0051 Firelands Regional Medical Center (36-0025) Primary Request 36 17460 Approved Secondary Request 36 45780 Dismissed 22C0052 Main Line Hospital Paoli (39-0153) Primary Request 33874 37964 Approved 22C0053 Main Line Hospital Bryn Mawr Campus (39-0139) Primary Request 33874 37964 Approved 22C0054 Main Line Hospital Lankenau (39-0195) Primary Request 33874 37964 Approved 22C0055 McLaren Central Michigan (23-0080) Primary Request 23 13020 Approved 22C0056 Karmanos Cancer Hospital (23-0297) Primary Request 19804 47664 Approved 22C0057 MidMichigan Medical Center Gratiot (23-0030) Primary Request 23 24340 Approved 22C0058 MidMichigan Medical Center-Midland (23-0222) Primary Request 33220 33220 Approved 22C0059 Good Samaritan Regional Medical Center (38-0014) Primary Request 18700 21660 Approved 22C0060 Samaritan Albany General Hospital (38-0022) Primary Request 10540 21660 Approved 22C0061 SSM Health Saint Mary's Hospital Janesville (52-0208) Primary Request 27500 31540 Approved 22C0062 Phoenixville Hospital (39-0127) Primary Request 33874 37964 Approved Secondary Request 33874 15804 Dismissed 22C0063 UnityPoint Health Marshalltown (16-0001) Primary Request 16 19780 Approved 22C0064 Middlesex Hospital (07-0020) Primary Request 25540 14860 Approved Secondary Request 25540 25540 Dismissed 22C0066 Warren General Hospital (39-0146) Primary Request 39 33 Approved 22C0068 University of Tennessee Medical Center (44-0015) Primary Request 28940 28940 Approved 22C0069 Saint Mary's Health Care (23-0059) Primary Request 24340 24340 Approved 22C0070 Providence Holy Family Hospital (50-0077) Primary Request 44060 44060 Approved 22C0071 Providence Sacred Heart Medical Center (50-0054) Primary Request 44060 44060 Approved 22C0072 Baptist Memorial Hospital Desoto (25-0141) Primary Request 32820 32820 Approved 22C0073 Baptist Memorial Hospital Union City (44-0130) Primary Request 44 18 Approved 22C0074 Munson Healthcare Manistee Hospital (23-0303) Primary Request 23 34740 Approved 22C0075 Hollywood Presbyterian Medical Center (05-0063) Primary Request 31084 37100 Approved Secondary Request 31084 31084 Dismissed 22C0076 Memorial Satilla Health (11-0003) Primary Request 11 15260 Approved 22C0077 Tampa General Hospital (10-0128) Primary Request 45300 45300 Approved 22C0078 Baptist Medical Center Jacksonville (10-0088) Primary Request 27260 27260 Approved 22C0079 Cedars Sinai Medical Center (05-0625) Primary Request 31084 37100 Approved

Page 3 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0080 Cayuga Medical Center at Ithaca (33-0307) Primary Request 27060 27060 Approved 22C0081 Cooper University Hospital (31-0014) Primary Request 15804 37964 Approved 22C0082 Gundersen Lutheran Medical Center (52-0087) Primary Request 29100 29100 Approved 22C0084 St. Barnabas Hospital (33-0399) Primary Request 35614 35614 Approved Secondary Request 35614 35004 Dismissed Tertiary Request 35614 35614 Dismissed 22C0085 Hillcrest Medical Center (37-0001) Primary Request 46140 36420 Approved Secondary Request 46140 46140 Dismissed 22C0086 Mercy Medical Center Sioux City (16-0153) Primary Request 43580 36540 Approved Secondary Request 43580 43580 Dismissed 22C0087 St. Mary Mercy Hospital (23-0002) Primary Request 19804 47664 Approved 22C0088 Saint Alphonsus Medical Center Nampa (13-0013) Primary Request 14260 38 Approved Secondary Request 14260 14260 Dismissed 22C0089 Saint Alphonsus Regional Medical Center (13-0007) Primary Request 14260 38 Approved Secondary Request 14260 14260 Dismissed 22C0090 Samaritan Hospital (33-0180) Primary Request 10580 47 Approved Secondary Request 10580 10580 Dismissed 22C0091 St. Joseph's Hospital Health Center (33-0140) Primary Request 45060 45060 Approved 22C0092 Reid Health (15-0048) Primary Request 15 34620 Not Considered Secondary Request 15 17140 Not Considered 22C0093 Maury Regional Hospital (44-0073) Primary Request 34980 34980 Approved 22C0094 Lovelace Medical Center Downtown (32-0009) Primary Request 10740 42140 Approved Secondary Request 10740 10740 Dismissed 22C0095 Baptist St. Anthony's Hospital (45-0231) Primary Request 11100 32 Approved Secondary Request 11100 31180 Dismissed Tertiary Request 11100 11100 Dismissed 22C0097 Montefiore Hospital Moses Campus (33-0059) Primary Request 35614 35614 Approved Secondary Request 35614 35004 Dismissed Tertiary Request 35614 35614 Dismissed 22C0098 White Plains Hospital Center (33-0304) Primary Request 35614 35614 Approved Secondary Request 35614 35004 Dismissed Tertiary Request 35614 35614 Dismissed 22C0099 Montefiore New Rochelle Hospital (33-0184) Primary Request 35614 35614 Approved Secondary Request 35614 35004 Dismissed Tertiary Request 35614 35614 Dismissed

Page 4 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0100 Shannon Medical Center (45-0571) Primary Request 41660 10180 Approved Secondary Request 41660 41660 Dismissed 22C0101 Harrison Medical Center (50-0039) Primary Request 14740 45104 Approved 22C0102 Community Health Center of Branch County (23-0022) Primary Request 23 29620 Approved 22C0103 McLaren Flint (23-0141) Primary Request 22420 22420 Approved 22C0104 Memorial Medical Center Livingston (45-0395) Primary Request 45 26420 Approved Secondary Request 45 13140 Dismissed 22C0105 Iowa Methodist Medical Center (16-0082) Primary Request 19780 11180 Approved Secondary Request 19780 19780 Dismissed 22C0106 Pipeline Weiss Memorial Hospital (14-0082) Primary Request 16984 20994 Approved 22C0107 St. Cloud Hospital (24-0036) Primary Request 41060 33460 Approved 22C0108 San Juan Regional Medical Center (32-0005) Primary Request 22140 06 Approved 22C0109 TRMC of Orangeburg & Calhoun Counties (42-0068) Primary Request 42 16700 Approved 22C0110 Holy Family Memorial (52-0107) Primary Request 52 43100 Approved 22C0111 Danbury Hospital dba New Milford Hospital (07-B033) Primary Request 07 14860 Approved 22C0112 Westchester Medical Center (33-0234) Primary Request 35614 35614 Approved 22C0113 Heart of Florida Regional Medical Center (10-0137) Primary Request 29460 45300 Approved Secondary Request 29460 36740 Dismissed 22C0114 Providence Health Center (45-0042) Primary Request 47380 47380 Approved 22C0115 Columbia St. Mary's Hospital Milwaukee (52-0051) Primary Request 33340 29404 Approved Secondary Request 33340 33340 Dismissed 22C0116 Wheaton Franciscan Healthcare All Saints (52-0096) Primary Request 39540 16984 Approved 22C0117 St. Luke's Regional Medical Center (16-0146) Primary Request 43580 36540 Denied Secondary Request 43580 28 Approved Tertiary Request 43580 43580 Dismissed 22C0118 Henry Ford Hospital (23-0053) Primary Request 19804 47664 Dismissed Secondary Request 19804 11460 Approved 22C0119 Henry Ford Wyandotte Hospital (23-0146) Primary Request 19804 47664 Approved 22C0120 Henry Ford Allegiance Health (23-0092) Primary Request 27100 29620 Withdrawn (Pre-Decision) Secondary Request 27100 11460 Approved 22C0121 Baton Rouge General Medical Center (19-0065) Primary Request 12940 35380 Approved 22C0123 Lakeland Regional Medical Center (10-0157) Primary Request 29460 35840 Approved 22C0124 Boston Medical Center Corporation (22-0031) Primary Request 14454 14454 Approved 22C0126 Lake Regional Health System (26-0186) Primary Request 26 44180 Approved 22C0127 St. Vincent Hospital (39-0009) Primary Request 21500 33 Approved

Page 5 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0128 Swedish Medical Center - Cherry Hill (50-0025) Primary Request 42644 45104 Approved Secondary Request 42644 14740 Dismissed Tertiary Request 42644 42644 Dismissed 22C0129 Swedish Medical Center (50-0027) Primary Request 42644 45104 Approved Secondary Request 42644 14740 Dismissed Tertiary Request 42644 42644 Dismissed 22C0130 Providence St. Mary Medical Center (50-0002) Primary Request 47460 47460 Approved 22C0132 University of Utah Hospitals and Clinics (46-0009) Primary Request 41620 41620 Approved 22C0134 Danbury Hospital (07-0033) Primary Request 14860 35614 Dismissed 22C0135 Norwalk Hospital Association (07-0034) Primary Request 14860 35614 Dismissed 22C0136 Swedish American Hospital (14-0228) Primary Request 40420 20994 Approved 22C0137 Parkland Health and Hospital System (45-0015) Primary Request 19124 19124 Approved 22C0138 St. John's Episcopal Hospital at South Shore (33-0395) Primary Request 35614 35004 Dismissed Secondary Request 35614 35614 Approved 22C0139 Jamaica Hospital Medical Center (33-0014) Primary Request 35614 35004 Dismissed Secondary Request 35614 35614 Approved 22C0140 Flushing Hospital Medical Center (33-0193) Primary Request 35614 35004 Dismissed Secondary Request 35614 35614 Approved 22C0141 Hanover Hospital (39-0233) Primary Request 49620 23900 Approved 22C0142 Pinnacle Health Hospitals (39-0067) Primary Request 25420 39740 Approved 22C0143 John Dempsey Hospital (07-0036) Primary Request 25540 14860 Denied Secondary Request 25540 35980 Approved 22C0144 Charleston Area Medical Center (51-0022) Primary Request 16620 26580 Approved 22C0145 Carilion New River Valley Medical Center (49-0042) Primary Request 13980 40220 Approved 22C0146 Genesis Medical Center - Davenport (16-0033) Primary Request 19340 26980 Denied 22C0147 Southeast Health (26-0110) Primary Request 16020 16060 Approved 22C0148 Beloit Memorial Hospital (52-0100) Primary Request 27500 31540 Approved 22C0149 Christus St. Vincent Regional Medical Center (32-0002) Primary Request 42140 42140 Approved 22C0150 Davis Medical Center (51-0030) Primary Request 51 34060 Approved 22C0151 St. John Medical Center (37-0114) Primary Request 46140 36420 Approved 22C0152 Beth Israel Deaconess Hospital - Plymouth (22-0060) Primary Request 14454 14454 Approved 22C0153 New England Baptist Hospital (22-0088) Primary Request 14454 14454 Approved 22C0154 Beth Israel Deaconess Medical Center (22-0086) Primary Request 14454 14454 Approved 22C0155 Providence Park Hospital Southfield (23-0019) Primary Request 47664 47664 Approved

Page 6 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0156 Crittenton Hospital Medical Center (23-0254) Primary Request 47664 47664 Approved 22C0157 Washington Hospital (05-0195) Primary Request 36084 42100 Approved Secondary Request 36084 41940 Dismissed Tertiary Request 36084 36084 Dismissed 22C0158 Geisinger Medical Center (39-0006) Primary Request 14100 44300 Approved Secondary Request 14100 25420 Dismissed 22C0159 Orange Regional Medical Center (33-0126) Primary Request 39100 35614 Dismissed 22C0160 Rio Grande Regional Hospital (45-0711) Primary Request 32580 15180 Approved 22C0161 Kings County Hospital Center (33-0202) Primary Request 35614 35614 Approved 22C0162 Mount Sinai Beth Israel (33-0169) Primary Request 35614 35614 Approved 22C0163 Mount Sinai West (33-0046) Primary Request 35614 35614 Approved 22C0164 Lenox Hill Hospital (33-0119) Primary Request 35614 35614 Approved 22C0165 Hospital for Special Surgery (33-0270) Primary Request 35614 35614 Approved 22C0166 Mercy Hospital Fort Smith (04-0062) Primary Request 22900 22900 Approved 22C0167 Capital Health Medical Center Hopewell (31-0044) Primary Request 45940 15804 Approved 22C0168 West Virginia University Hospitals, Inc. (51-0001) Primary Request 34060 38300 Approved 22C0169 Methodist Hospital (45-0388) Primary Request 41700 12420 Approved Secondary Request 41700 41700 Dismissed 22C0170 Community Hospital South (15-0128) Primary Request 26900 26900 Approved 22C0171 Community Hospital East (15-0074) Primary Request 26900 26900 Approved 22C0172 Indiana University Health Ball Memorial Hospital (15-0089) Primary Request 34620 26900 Approved 22C0173 Southeast Alabama Medical Center (01-0001) Primary Request 20020 18880 Approved 22C0174 FisherTitus Medical Center (36-0065) Primary Request 36 45780 Approved 22C0175 Advocate Bromenn Medical Center (14-0127) Primary Request 14010 14010 Approved 22C0176 Mercy Health System Corp (52-0066) Primary Request 27500 16984 Denied Secondary Request 27500 33340 Approved 22C0177 Sanford Medical Center Fargo (35-0011) Primary Request 22020 24 Approved 22C0178 Adirondack Medical Center (33-0079) Primary Request 33 15540 Approved 22C0179 Advocate Lutheran General Hospital (14-0223) Primary Request 16984 20994 Approved 22C0180 Advocate South Suburban Hospital (14-0250) Primary Request 16984 20994 Approved 22C0181 Aurora Sheboygan Memorial Medical Center (52-0035) Primary Request 43100 33340 Approved 22C0182 Aurora Memorial Hospital Burlington (52-0059) Primary Request 39540 29404 Approved 22C0183 Aurora Lakeland Medical Center (52-0102) Primary Request 52 29404 Approved 22C0184 Aurora St. Luke's Medical Center (52-0138) Primary Request 33340 29404 Approved Secondary Request 33340 33340 Dismissed

Page 7 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0185 Aurora Medical Center Oshkosh (52-0198) Primary Request 36780 24580 Approved 22C0186 Aurora Medical Center (52-0206) Primary Request 33340 31540 Approved 22C0187 Glens Falls Hospital (33-0191) Primary Request 24020 24020 Approved 22C0188 Saratoga Hospital (33-0222) Primary Request 10580 10580 Approved 22C0189 Walker Baptist Medical Center (01-0089) Primary Request 01 46220 Approved 22C0190 IU Health Bloomington Hospital (15-0051) Primary Request 14020 26900 Approved 22C0191 Mary Imogene Bassett Hospital d/b/a Bassett Medical Center Primary Request 33 45060 Approved (33-0136) 22C0192 Duke University Hospital (34-0030) Primary Request 20500 20500 Approved 22C0193 Duke Regional Hospital (34-0155) Primary Request 20500 20500 Approved 22C0194 Lakeland Medical Center St. Joseph (23-0021) Primary Request 35660 43780 Approved 22C0195 Citizens Baptist Medical Center (01-0101) Primary Request 01 11500 Approved 22C0196 Providence Saint John's Health Center (05-0290) Primary Request 31084 37100 Approved 22C0197 Abrazo Central Campus (03-0030) Primary Request 38060 38060 Approved 22C0198 Abrazo Arrowhead Campus (03-0094) Primary Request 38060 38060 Approved 22C0199 The Hospitals of Providence Transmountain Campus (67-0120) Primary Request 21340 29740 Approved

22C0200 Southside Community Hospital (49-0090) Primary Request 49 40060 Approved 22C0201 Mayo Clinic (10-0151) Primary Request 27260 23540 Denied Secondary Request 27260 27260 Approved 22C0202 Geisinger Lewistown Hospital (39-0048) Primary Request 39 44300 Approved 22C0203 Clay County Medical Corporation d/b/a North Mississippi Primary Request 25 46220 Approved Medical Center West Point (25-0067) 22C0204 Penn State Health Milton S. Hershey Medical Center (39-0256) Primary Request 25420 23900 Approved

22C0205 El Paso Healthcare System LTD (45-0107) Primary Request 21340 29740 Approved 22C0206 Marion Regional Medical Center (01-0044) Primary Request 01 25 Approved 22C0207 Forrest County General Hospital (25-0078) Primary Request 25620 25060 Approved 22C0208 Anderson Regional Medical Center (25-0104) Primary Request 25 46220 Approved 22C0209 Webster Health Services, Inc. d/b/a North Mississippi Medical Primary Request 25 27140 Approved Center Eupora (25-0020) 22C0210 Great River Medical Center (04-0069) Primary Request 04 26 Approved 22C0211 Christus Health Shreveport - Bossier (19-0041) Primary Request 43340 30980 Approved 22C0212 Christus Good Shepherd Medical Center Marshall (45-0032) Primary Request 30980 46340 Approved Secondary Request 30980 30980 Dismissed

Page 8 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0213 Lehigh Valley Hospital (39-0133) Primary Request 10900 35084 Approved 22C0214 Christus Mother Frances Hospital (45-0102) Primary Request 46340 46340 Approved 22C0215 CHRISTUS St. Michael Medical Center (45-0801) Primary Request 45500 45500 Approved 22C0216 Freeman Health System (26-0137) Primary Request 27900 22220 Approved 22C0217 Mercy St. Vincent Medical Center (36-0112) Primary Request 45780 33780 Dismissed Secondary Request 45780 11460 Approved 22C0218 Lewis Gale Hospital Alleghany (49-0126) Primary Request 49 40220 Approved 22C0219 New York Presbyterian Hospital (33-0101) Primary Request 35614 35614 Approved 22C0220 New York Presbyterian/Queens (33-0055) Primary Request 35614 35614 Approved 22C0221 New York-Presbyterian Brooklyn Methodist Hospital (33-0236) Primary Request 35614 35614 Approved

22C0222 Deer Valley Medical Center (03-0092) Primary Request 38060 39150 Approved 22C0223 Scottsdale Shea Medical Center (03-0087) Primary Request 38060 39150 Approved 22C0224 Scottsdale Osborn Medical Center (03-0038) Primary Request 38060 39150 Approved 22C0225 John C. Lincoln Medical Center (03-0014) Primary Request 38060 39150 Approved 22C0226 Brandon Regional Hospital (10-0243) Primary Request 10 45300 Withdrawn (Pre-Decision) 22C0227 Northside Hospital (10-0238) Primary Request 10 45300 Withdrawn (Pre-Decision) 22C0228 Providence Saint Joseph Medical Center (05-0235) Primary Request 31084 37100 Approved 22C0229 Providence Holy Cross Medical Center (05-0278) Primary Request 31084 37100 Approved 22C0230 Providence Medford Medical Center (38-0075) Primary Request 32780 05 Approved 22C0231 Floyd Medical Center (11-0054) Primary Request 40660 12060 Approved 22C0232 Meadows Regional Medical Center (11-0128) Primary Request 11 42340 Approved 22C0233 Citrus Memorial Hospital (10-0023) Primary Request 26140 23540 Denied 22C0234 Northside Hospital (10-0238) Primary Request 45300 45300 Approved 22C0235 Brandon Regional Hospital (10-0243) Primary Request 45300 45300 Approved 22C0236 SSM Health St. Clare Hospital Baraboo (52-0057) Primary Request 52 31540 Approved 22C0238 Santa Barbara Cottage Hospital (05-0396) Primary Request 42200 37100 Approved Secondary Request 42200 42200 Not Considered 22C0239 Banner University Medical Center Tucson (03-0064) Primary Request 46060 38060 Approved 22C0240 Banner Casa Grande Medical Center (03-0016) Primary Request 38060 38060 Approved 22C0241 Banner Baywood Medical Center (03-0088) Primary Request 38060 39150 Approved Secondary Request 38060 38060 Dismissed 22C0242 Banner Gateway Medical Center (03-0122) Primary Request 38060 39150 Approved Secondary Request 38060 38060 Dismissed 22C0243 Baptist Health Madisonville (18-0093) Primary Request 18 21780 Approved

Page 9 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0244 Baptist Health Paducah (18-0104) Primary Request 18 14 Approved 22C0245 Columbia Memorial Hospital (33-0094) Primary Request 33 07 Dismissed Secondary Request 33 38340 Approved 22C0246 Caldwell Memorial Hospital (19-0190) Primary Request 19 10780 Approved 22C0247 Citizens Medical Center (19-0184) Primary Request 19 10780 Approved 22C0248 Camden-Clark Memorial Hospital (51-0058) Primary Request 37620 16620 Approved Secondary Request 37620 36 Dismissed 22C0249 University of Virginia Medical Center (49-0009) Primary Request 16820 47894 Approved 22C0250 FirstHealth Moore Regional Hospital (34-0115) Primary Request 34 20500 Approved 22C0251 FirstHealth Moore Regional Hospital - Hoke Campus (34-B115) Primary Request 22180 39580 Approved

22C0252 Alamance Regional Medical Center (34-0070) Primary Request 15500 20500 Approved 22C0253 Catawba Velley Medical Center (34-0143) Primary Request 25860 16740 Approved 22C0254 Berkshire Medical Center Inc. (22-0046) Primary Request 38340 38340 Approved 22C0256 Sacred Heart Hospital on the Emerald Coast (10-0292) Primary Request 18880 18880 Approved 22C0257 Sentara RMH Medical Center (49-0004) Primary Request 25500 47894 Approved 22C0258 Presbyterian Hospital (32-0021) Primary Request 10740 42140 Approved 22C0259 Scotland Memorial Hospital (34-0008) Primary Request 34 16740 Approved 22C0260 Peterson Regional Medical Center (45-0007) Primary Request 45 41700 Approved 22C0261 Huntington Hospital (05-0438) Primary Request 31084 37100 Approved 22C0262 Franciscan St. James Health (14-0172) Primary Request 16984 20994 Approved 22C0263 Franciscan St. Anthony Health Michigan City (15-0015) Primary Request 33140 16984 Denied Secondary Request 33140 43780 Approved 22C0264 Franciscan Health Crawfordsville (15-0022) Primary Request 15 26900 Dismissed Secondary Request 15 29200 Approved 22C0265 Teche Regional Medical Center (19-0014) Primary Request 19 12940 Approved 22C0266 Flowers Hospital (01-0055) Primary Request 20020 37460 Approved 22C0267 Bayfront Health Port Charlotte (10-0077) Primary Request 39460 35840 Approved 22C0268 IU Health LaPorte Hospital (15-0006) Primary Request 33140 43780 Approved 22C0269 Kosciusko Community Hospital (15-0133) Primary Request 15 23060 Approved 22C0270 Merit Health River Region (25-0031) Primary Request 25 27140 Approved 22C0271 Northeast Regional Medical Center (26-0022) Primary Request 26 16 Approved 22C0272 Moberly Regional Medical Center (26-0074) Primary Request 26 27620 Approved 22C0273 Poplar Bluff Regional Medical Center (26-0119) Primary Request 26 16020 Approved 22C0274 Alliance Health Woodward (37-0002) Primary Request 37 21420 Approved

Page 10 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0275 Alliance Health Ponca City (37-0006) Primary Request 37 21420 Approved 22C0276 AllianceHealth Durant (37-0014) Primary Request 37 43300 Approved 22C0277 WilkesBarre General Hospital (39-0137) Primary Request 42540 42540 Approved 22C0278 Tennova Healthcare - Clarksville (44-0035) Primary Request 17300 34980 Approved 22C0279 Tennova Healthcare Shelbyville (44-0137) Primary Request 44 34980 Approved 22C0280 Tennova Healthcare Harton (44-0144) Primary Request 44 16860 Approved 22C0281 Laredo Medical Center (45-0029) Primary Request 29700 41700 Approved 22C0282 Detar Healthcare System (45-0147) Primary Request 47020 18580 Approved 22C0283 Greenbrier Valley Medical Center (51-0002) Primary Request 51 13220 Approved Secondary Request 51 49 Dismissed 22C0285 Robert Packer Hospital (39-0079) Primary Request 39 27060 Approved 22C0286 Princeton Community Hospital (51-0046) Primary Request 51 13980 Approved 22C0287 Bay Park Community Hospital (36-0259) Primary Request 45780 45780 Approved 22C0288 Southeastern Regional Medical Center (34-0050) Primary Request 34 34820 Approved 22C0289 Jefferson Regional Medical Center (04-0071) Primary Request 38220 30780 Approved 22C0290 T.J. Samson Community Hospital (18-0017) Primary Request 18 34980 Approved 22C0291 Singing River Health System (25-0040) Primary Request 25060 25060 Approved 22C0292 Rush University Medical Center (14-0119) Primary Request 16984 20994 Approved Secondary Request 16984 16984 Dismissed 22C0293 Geisinger Wyoming Valley Medical Center (39-0270) Primary Request 42540 10900 Approved Secondary Request 42540 42540 Dismissed 22C0294 Via Christi Hospital Pittsburg (17-0006) Primary Request 17 27900 Denied 22C0295 Fort Sanders Regional Medical Center (44-0125) Primary Request 28940 28940 Approved 22C0296 Beebe Medical Center, Inc. (08-0007) Primary Request 41540 36140 Approved 22C0297 High Point Regional Hospital (34-0004) Primary Request 24660 20500 Approved 22C0298 Sampson Regional Medical Center (34-0024) Primary Request 34 22180 Denied 22C0299 University of Illinois Hospital (14-0150) Primary Request 16984 29404 Approved Secondary Request 16984 20994 Not Considered 22C0300 St. Mary's of Michigan Saginaw (23-0077) Primary Request 40980 47664 Approved 22C0301 Bronson Battle Creek Hospital (23-0075) Primary Request 12980 29620 Denied 22C0302 St. John Hospital & Medical Center (23-0165) Primary Request 19804 47664 Approved 22C0303 Samaritan Medical Center (33-0157) Primary Request 48060 48060 Approved 22C0304 Lima Memorial Health System (36-0009) Primary Request 30620 18140 Approved 22C0305 Temple University Hospital (39-0027) Primary Request 37964 47220 Approved Secondary Request 37964 12100 Dismissed Tertiary Request 37964 37964 Dismissed

Page 11 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0306 University of Chicago Medical Center (14-0088) Primary Request 16984 29404 Approved Secondary Request 16984 20994 Not Considered 22C0307 Essentia Health St. Mary's Medical Center (24-0002) Primary Request 20260 33460 Approved Secondary Request 20260 20260 Dismissed 22C0308 Providence St. Vincent Medical Center (38-0004) Primary Request 38900 38900 Withdrawn (Pre-Decision) 22C0309 Santa Rosa Healthcare (45-0237) Primary Request 41700 12420 Approved 22C0310 Yavapai Regional Medical Center (03-0012) Primary Request 39150 39150 Approved 22C0312 Augusta Medical Center (49-0018) Primary Request 44420 44420 Approved 22C0313 Northern Louisiana Medical Center (19-0086) Primary Request 19 33740 Approved 22C0314 Byrd Regional Hospital (19-0164) Primary Request 19 10780 Approved 22C0315 Mercy Regional Medical Center (19-0167) Primary Request 19 10780 Approved 22C0316 Spectrum Health Butterworth Campus (23-0038) Primary Request 24340 24340 Approved 22C0317 Henry Ford Allegiance Health (23-0092) Primary Request 27100 11460 Not Considered Secondary Request 27100 29620 Not Considered 22C0318 South Shore Hospital (22-0100) Primary Request 14454 14454 Approved 22C0319 Barnes Jewish Hospital (26-0032) Primary Request 41180 41180 Approved 22C0320 Jackson Madison County General Hospital (44-0002) Primary Request 27180 32820 Approved 22C0321 St. Joseph Warren Hospital (36-0161) Primary Request 49660 10420 Approved 22C0322 Springfield Regional Medical Center (36-0086) Primary Request 44220 17140 Approved 22C0323 Lourdes Hospital (18-0102) Primary Request 18 14 Approved 22C0324 Covenant Medical Center (23-0070) Primary Request 40980 22420 Approved Secondary Request 40980 47664 Dismissed Tertiary Request 40980 13020 Dismissed Fourth Request 40980 40980 Dismissed 22C0325 Hartford Hospital (07-0025) Primary Request 25540 49340 Approved 22C0326 The Hospital of Central Connecticut (07-0035) Primary Request 25540 14860 Approved 22C0327 Highlands Medical Center (01-0061) Primary Request 01 26620 Approved 22C0328 Salinas Valley Memorial Hospital (05-0334) Primary Request 41500 42100 Approved Secondary Request 41500 41940 Dismissed Tertiary Request 41500 41500 Dismissed 22C0329 Northwestern Medical Center, Inc. (47-0024) Primary Request 15540 15540 Denied 22C0330 Halifax Medical Center (10-0017) Primary Request 19660 37340 Approved 22C0331 Tufts Medical Center (22-0116) Primary Request 14454 14454 Approved 22C0332 Loyola University Medical Center (14-0276) Primary Request 16984 29404 Approved Secondary Request 16984 20994 Not Considered

Page 12 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0333 Gottlieb Memorial Hospital (14-0008) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0334 MacNeal Hospital (14-0054) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0335 Maine Coast Memorial Hospital (20-0050) Primary Request 20 12620 Approved 22C0337 Presence St. Joseph Hospital (14-0224) Primary Request 16984 29404 Approved Secondary Request 16984 20994 Denied Tertiary Request 16984 16984 Denied 22C0338 Adventist La Grange Memorial Hospital (14-0065) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0339 St. Alexius Medical Center (14-0290) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0340 Alexian Brothers Medical Center (14-0258) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0341 Presence Saints Mary & Elizabeth Hospital (14-0180) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0342 Presence Resurrection Medical Center (14-0117) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0343 Presence St. Francis Hospital (14-0080) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0344 West Florida Hospital (10-0231) Primary Request 37860 18880 Approved 22C0345 Palmetto Health Richland (42-0018) Primary Request 17900 17900 Approved 22C0346 Northwestern Memorial Hospital (14-0281) Primary Request 16984 29404 Denied Secondary Request 16984 20994 Approved 22C0347 University of North Carolina Hospital (34-0061) Primary Request 20500 20500 Approved 22C0348 Ocala Regional Medical Center (10-0212) Primary Request 36100 23540 Approved 22C0349 Memorial Hospital and Health Care Center (15-0115) Primary Request 15 21780 Approved 22C0350 Eliza Coffee Memorial Hospital (01-0006) Primary Request 22520 25 Approved 22C0351 Andalusia Regional Hospital (01-0036) Primary Request 01 18880 Approved 22C0352 Vaughn Regional Medical Center Parkway Campus (01-0118) Primary Request 01 46220 Approved 22C0353 Shoals Hospital (01-0157) Primary Request 22520 25 Approved Secondary Request 22520 19460 Dismissed 22C0354 Jackson Purchase Medical Center (18-0116) Primary Request 18 14 Approved 22C0355 UP Health System Marquette (23-0054) Primary Request 23 24580 Approved 22C0356 Bolivar Medical Center (25-0093) Primary Request 25 32820 Denied

Page 13 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0357 Los Alamos Medical Center (32-0033) Primary Request 32 10740 Approved 22C0358 Rutherford Regional Medical Center (34-0013) Primary Request 34 24860 Approved 22C0359 Central Carolina Hospital (34-0020) Primary Request 34 39580 Approved 22C0360 Wilson Medical Center (34-0126) Primary Request 34 24140 Approved 22C0361 Southwestern Medical Center (37-0097) Primary Request 30020 36420 Approved 22C0362 Providence Hospital (42-0026) Primary Request 17900 17900 Approved 22C0363 Southern Tennessee Regional Health System Pulaski (44-0020) Primary Request 44 34980 Approved

22C0364 Southern Tennessee Regional Health System Winchester (44- Primary Request 44 26620 Approved 0058) 22C0365 Livingston Regional Hospital (44-0187) Primary Request 44 34980 Approved 22C0366 Parkview Regional Hospital (45-0400) Primary Request 45 17780 Approved 22C0367 Danville Regional Medical Center (49-0075) Primary Request 49 40220 Approved 22C0368 St. Mary's Regional Medical Center (04-0041) Primary Request 04 22900 Approved 22C0369 Bourbon Community Hospital (18-0046) Primary Request 30460 17140 Approved 22C0370 Georgetown Community Hospital (18-0101) Primary Request 30460 17140 Approved 22C0372 St. John Medical Center (50-0041) Primary Request 31020 38900 Approved 22C0373 Wentworth-Douglass Hospital (30-0018) Primary Request 40484 15764 Approved 22C0374 The Cooley Dickinson Hospital, Inc. (22-0015) Primary Request 44140 49340 Approved 22C0375 Brigham and Women's Faulkner Hospital (22-0119) Primary Request 14454 14454 Approved 22C0376 Banner Boswell Medical Center (03-0061) Primary Request 38060 39150 Approved Secondary Request 38060 38060 Dismissed 22C0377 Banner Del E. Webb Medical Center (03-0093) Primary Request 38060 39150 Approved Secondary Request 38060 38060 Dismissed 22C0378 Banner Heart Hospital (03-0105) Primary Request 38060 39150 Approved Secondary Request 38060 38060 Dismissed 22C0379 NYU Langone Hospitals (33-0214) Primary Request 35614 35614 Approved 22C0380 NYU Winthrop Hospital (33-B214) Primary Request 35004 35004 Denied 22C0381 Long Island Jewish Medical Center (33-0195) Primary Request 35614 35614 Approved 22C0382 Long Island Jewish Valley Stream (33-B195) Primary Request 35004 35004 Approved 22C0383 Blanchard Valley Hospital (36-0095) Primary Request 36 30620 Approved 22C0384 Yuma Regional Medical Center (03-0013) Primary Request 49740 49740 Approved 22C0385 East Carroll Parish Hospital (19-0208) Primary Request 19 04 Approved 22C0386 Grandview Hospital (36-0133) Primary Request 19430 19430 Approved 22C0387 Joint Township District Memorial Hospital (36-0032) Primary Request 36 30620 Approved

Page 14 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0388 Kettering Medical Center (36-0079) Primary Request 19430 19430 Approved 22C0389 Miami Valley Hospital (36-0051) Primary Request 19430 19430 Approved 22C0390 Metropolitan Hospital (23-0236) Primary Request 24340 24340 Approved 22C0391 University of Toledo Medical Center (36-0048) Primary Request 45780 45780 Approved 22C0392 Van Wert County Hospital (36-0071) Primary Request 36 30620 Approved 22C0393 Wooster Community Hospital (36-0036) Primary Request 36 31900 Approved 22C0394 Sycamore Medical Center (36-0239) Primary Request 19430 19430 Approved 22C0395 UF Health Jacksonville (10-0001) Primary Request 27260 23540 Approved Secondary Request 27260 27260 Dismissed 22C0396 Soin Medical Center (36-0360) Primary Request 19430 19430 Approved 22C0397 Marietta Memorial Hospital (36-0147) Primary Request 36 16620 Approved 22C0398 Lock Haven Hospital (39-0071) Primary Request 39 44300 Approved 22C0399 University of Pittsburgh Medical Center Hamot (39-0063) Primary Request 21500 33 Approved 22C0400 Williamsport Regional Medical Center (39-0045) Primary Request 48700 44300 Approved 22C0401 Largo Medical Center (10-0248) Primary Request 45300 45300 Approved 22C0402 Raulerson Hospital (10-0252) Primary Request 10 38940 Approved 22C0403 MUSC Medical Center (42-0004) Primary Request 16700 16700 Approved 22C0404 Mary Rutan Hospital (36-0197) Primary Request 36 18140 Approved 22C0405 Wilson Memorial Hospital (36-0013) Primary Request 36 30620 Approved 22C0406 Elkhart General Hospital (15-0018) Primary Request 21140 21140 Approved 22C0407 Lawrence General Hospital (22-0010) Primary Request 15764 49340 Approved 22C0408 Salem Community Hospital (36-0185) Primary Request 36 38300 Approved Secondary Request 36 10420 Dismissed Tertiary Request 36 15940 Dismissed 22C0409 Winter Haven Hospital (10-0052) Primary Request 29460 45300 Approved 22C0410 Community Hospital of the Monterey Peninsula (05-0145) Primary Request 41500 42100 Approved Secondary Request 41500 41940 Denied 22C0411 Overlook Medical Center (31-0051) Primary Request 35084 35614 Approved 22C0412 St. Joseph's Medical Center (24-0075) Primary Request 24 41060 Denied Secondary Request 24 41060 Denied 22C0413 York Hospital (39-0046) Primary Request 49620 23900 Approved 22C0414 Maimonides Medical Center (33-0194) Primary Request 35614 35614 Approved 22C0415 St. John's Riverside Hospital (33-0208) Primary Request 35614 35614 Approved 22C0416 Evangelical Community Hospital (39-0013) Primary Request 39 25420 Approved 22C0417 White River Medical Center (04-0119) Primary Request 04 27860 Approved

Page 15 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0418 Baptist Health Medical Center Stuttgart (04-0072) Primary Request 04 30780 Approved 22C0419 North Arkansas Regional Medical Center (04-0017) Primary Request 04 22220 Approved 22C0420 Queen of the Valley Medical Center (05-0009) Primary Request 34900 42034 Dismissed Secondary Request 34900 36084 Approved Tertiary Request 34900 46700 Dismissed 22C0421 Santa Rosa Memorial Hospital (05-0174) Primary Request 42220 42034 Approved 22C0422 Sutter Amador Hospital (05-0014) Primary Request 05 40900 Approved 22C0423 Memorial Medical Center (05-0557) Primary Request 33700 44700 Approved 22C0424 Capital Region Medical Center (26-0047) Primary Request 27620 17860 Approved 22C0425 Putnam Community Medical Center (10-0232) Primary Request 10 23540 Approved 22C0426 Sky Lakes Medical Center (38-0050) Primary Request 38 05 Denied 22C0428 Schneck Medical Center (15-0065) Primary Request 15 18020 Approved 22C0429 Riverside County Regional Medical Center (05-0292) Primary Request 40140 40140 Approved 22C0431 Nanticoke Memorial Hospital, Inc. (08-0006) Primary Request 41540 20100 Approved 22C0432 Mercy Hospital Ada (37-0020) Primary Request 37 36420 Approved 22C0433 Franciscan Health Indianapolis (15-0162) Primary Request 26900 18020 Approved 22C0434 Waynesboro Hospital (39-0138) Primary Request 16540 16540 Approved Secondary Request 16540 47894 Dismissed 22C0435 Midland Memorial Hospital (45-0133) Primary Request 33260 36220 Denied 22C0436 West Valley Medical Center (13-0014) Primary Request 14260 38 Denied Secondary Request 14260 14260 Denied 22C0437 St. Mark's Hospital (46-0047) Primary Request 41620 41620 Denied Secondary Request 41620 53 Denied 22C0438 Willis Knighton Medical Center (19-0111) Primary Request 43340 43340 Approved 22C0439 Banner University Medical Center Phoenix (03-0002) Primary Request 38060 38060 Approved Secondary Request 38060 39150 Dismissed 22C0440 University Hospital of Brooklyn (33-0350) Primary Request 35614 35004 Withdrawn (Pre-Decision) Secondary Request 35614 35614 Withdrawn (Pre-Decision) 22C0441 Eastern Idaho Regional Medical Center (13-0018) Primary Request 26820 38540 Not Considered Secondary Request 26820 53 Not Considered 22C0442 The Queens Medical Center (12-0001) Primary Request 46520 27980 Approved 22C0443 Titus Regional Medical Center (45-0080) Primary Request 45 45500 Approved 22C0445 Great River Medical Center (16-0057) Primary Request 16 19340 Approved 22C0446 Dell Seton Medical Center at the University of TX (45-0124) Primary Request 12420 12420 Approved

Page 16 of 17 Case Provider's Home Requested CBSA Number Case Name Priority CBSA Code Code Request Status 22C0447 University Medical Center (45-0686) Primary Request 31180 33260 Dismissed Secondary Request 31180 32 Approved 22C0448 Harper Hutzel Hospital (23-0104) Primary Request 19804 47664 Approved 22C0449 Sinai Grace Hospital (23-0024) Primary Request 19804 11460 Approved 22C0450 KFH San Francisco (05-0076) Primary Request 41884 41884 Approved 22C0451 Atrium Health Lincoln (34-0145) Primary Request 16740 16740 Approved 22C0452 St. Luke's Medical Center (03-0037) Primary Request 38060 39150 Approved 22C0453 Sebastian River Medical Center (10-0217) Primary Request 42680 37340 Approved 22C0454 Glenwood Regional Medical Center (19-0160) Primary Request 33740 10780 Withdrawn (Pre-Decision) 22C0455 Sharon Regional Health System (39-0211) Primary Request 49660 17460 Approved Secondary Request 49660 38300 Dismissed 22C0456 Wadley Regional Medical Center (45-0200) Primary Request 45500 45500 Approved 22C0457 Scenic Mountain Medical Center (45-0653) Primary Request 45 33260 Approved 22C0458 Southwest General Hospital (45-0697) Primary Request 41700 12420 Withdrawn (Pre-Decision) 22C0459 King's Daughters' Hospital & Health Services (15-0069) Primary Request 15 17140 Approved 22C0460 Arkansas Methodist Medical Center (04-0039) Primary Request 04 26 Approved 22C0461 St. Vincent Hospital (52-0075) Primary Request 24580 11540 Denied 22C0462 Missouri Delta Medical Center (26-0113) Primary Request 26 14 Approved 22C0463 University of Kansas Hospital (17-0040) Primary Request 28140 41140 Approved Secondary Request 28140 28140 Dismissed 22C0464 Beaver Dam Community Hospital (52-0076) Primary Request 52 33340 Denied 22C0465 Memorial Hospital at Gulfport (25-0019) Primary Request 25060 35380 Approved Secondary Request 25060 25060 Dismissed 22C0466 Stanford Health Care (05-0441) Primary Request 41940 41940 Approved 22C0467 Stanford Health Care - Valleycare (05-0283) Primary Request 36084 41940 Approved Secondary Request 36084 41884 Dismissed Tertiary Request 36084 36084 Dismissed 22C0468 St. Joseph's Hospital & Medical Center (03-0024) Primary Request 38060 39150 Approved 22C0469 Chandler Regional Medical Center (03-0036) Primary Request 38060 39150 Approved 22C0470 Mercy Gilbert Medical Center (03-0119) Primary Request 38060 39150 Approved 22C0471 Highland Park Hospital (14-B010) Primary Request 29404 16984 Approved 22C0472 Evanston Northwestern Healthcare (14-0010) Primary Request 16984 29404 Denied 22C0473 Riverside Tappahannock (49-0084) Primary Request 49 40060 Approved 22C0474 Riverside Shore Memorial Hospital (49-0037) Primary Request 49 41540 Denied 22C0475 Thomas Hospital (01-0100) Primary Request 19300 37860 Denied

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