DIRECTORY Pharmacy. Toll-Free , TTY 711

Transcription

1 2017 Pharmacy DIRECTORY This directory is a list of network pharmacies near you. This directory is for Nebraska. Changes to our pharmacy network may occur during the benefit year. An updated list of pharmacies is located on our website. For more information, please call Customer Service at: Toll-Free , TTY a.m. - 8 p.m. local time, Monday - Friday Y0066_160817_111646_NM Last updated January 6, 2017

2 About this PHARMACY DIRECTORY This directory is a partial list of the plan s network pharmacies. It lists pharmacies in your area based on your State. Pharmacies are listed in alphabetical order. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed may no longer be in our network, or there may be newer pharmacies in our network that are not listed. It is current as of the date printed on the cover of this directory. Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website. For the most current list of our network pharmacies, please see the cover of this directory for information on how to call us. Network pharmacies A network pharmacy is a pharmacy where you get prescription drug benefits provided by your plan. We call the pharmacies in this directory our network pharmacies because we have made arrangements with them to provide prescription drugs to our plan members. In most cases, your prescriptions are covered under the plan only if they are filled at one of our network pharmacies or through a mail service pharmacy. We have a large service area with many pharmacies where you may fill your prescription drugs. This directory lists network pharmacies in your area. For information about additional network pharmacies, please contact us using the information on the cover of this directory. You do not have to use the same network pharmacy every time you fill your prescription drugs. You may use any of our network pharmacies. In certain situations, we may cover prescriptions filled at pharmacies outside of the network. Please see your plan s Evidence of Coverage for more information. For a complete description of your prescription drug coverage, including how to fill your prescriptions, please see your plan s Evidence of Coverage and Drug List (Formulary). If you have questions about any of the above, including instructions on how to submit claims for prescriptions that you had to fill at a non-network pharmacy, please see the cover of this directory for information on how to call us. Pharmacy Saver Pharmacy Saver is a cost savings prescription drug program available to you as a plan member. 1 The plan has worked with many of our network pharmacies to offer even lower prices on many common prescription drugs. To learn more about Pharmacy Saver or to see the full list of participating pharmacies, visit Pharmacies included in the Pharmacy Saver program are indicated by a pharmacy listings on the following pages. symbol in the

3 Mail service pharmacies A network mail service pharmacy is where members can get their prescription drugs delivered to their mailbox. You may go to any of the plan s network mail service pharmacies to get your covered prescription drugs. You can use one of the plan s mail service pharmacies in our network, OptumRx home delivery. You are not required to use OptumRx to obtain a 90-day supply of your maintenance medications, but you may pay more out-of-pocket compared to using OptumRx, your plan s mail service pharmacy. 2 Prescription orders sent directly to OptumRx from your doctor must have your approval before OptumRx can send your medications. This includes new prescriptions and prescription refills. OptumRx will contact you, by phone, to get your approval. At that time you may also tell OptumRx to automatically fill any future prescriptions they receive directly from your doctor(s) for up to one year. If OptumRx is unable to reach you for approval your prescription will not be sent to you. New prescriptions should arrive within ten business days from the date the completed order is received by the mail service pharmacy. Completed refill orders should arrive in about seven business days. OptumRx will contact you if there will be an extended delay in the delivery of your medications. To refill your home delivery prescriptions, please call us before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. If you do not receive your prescription drugs or need to contact us, please call OptumRx toll-free at , TTY 711, 24 hours, 7 days a week. Refunds may be available for prescriptions you did not approve and did not want. You may request a refund or cancel your approval by calling OptumRx toll-free at , TTY 711, 24 hours, 7 days a week. You can find more information about mail service pharmacies by calling OptumRx at the number listed in the Mail service pharmacies section of this directory. Mail service pharmacies are indicated by a symbol in the pharmacy listings on the following pages. 90-day supply from retail pharmacies You do not have to use a mail service pharmacy to get a 90-day supply of your prescription drugs. Some of the retail pharmacies in the plan s network also offer 90-day supply of prescription drugs. If you fill a 90-day supply at a retail pharmacy, you may pay more. Retail pharmacies in the network that fill 90-day supply of prescription drugs are indicated by a symbol in the pharmacy listings on the following pages.

4 E-prescribing Some of our network pharmacies use electronic prescribing, or e-prescribing. The pharmacy receives your prescriptions electronically, directly from your doctor. Your prescription may be sent before you even leave your doctor s office. E-prescribing can be a safe and efficient way for network pharmacies to get your prescriptions. It may help the pharmacy avoid reading mistakes and may alert your doctor to drugs that should not be taken together. Network pharmacies that use e-prescribing are indicated by an on the following pages. symbol in the pharmacy listings

5 Pharmacy retail chains Below are some of the retail chains in the plan s pharmacy network. For locations and phone numbers of stores in your area, call the numbers shown below. Albertsons & Affiliates ACME Albertsons Amigo Carrs Haggens Jewel-Osco Market Street Pavilions Randalls Safeway Shaws Tom Thumb United Vons CVS Duane Reade Food Lion Giant Giant Food Stores Hannaford H-E-B Hy-Vee Kroger & Affiliates Baker s City Market Dillons Fred Meyer Fry s Harris Teeter King Soopers Kroger QFC Ralphs Smith s Martins Publix Rite Aid Sam s Club Stop & Shop Thrifty White TTY Walmart Wegmans Kmart This list may change. For a list of other retail pharmacy chains in the network or to check for a pharmacy not listed in this directory, call us at the number located on the cover of this directory. TTY users should call 711, unless a different phone number is listed.

6 Retail pharmacies, including chain pharmacies near you Below are some of the retail and chain pharmacies in your area. Other pharmacies are available in our network. Note: Pharmacies may have closed or moved locations since this directory was printed. Adams Allens Discount Pharmacy 1115 W 2nd St Hastings, NE , TTY: 711 Berts Pharmacy 1021 W 14th St Hastings, NE , TTY: 711 Berts Pharmacy 700 W 2nd St Hastings, NE , TTY: 711 Crosier Park Pharmacy 405 East 14th Street Hastings, NE , TTY: 711 Keiths Drive In Drug 500 N Hastings Hastings, NE , TTY: 711 Keiths Medical Park Pharmacy 2115 N Kansas Ave Hastings, NE , TTY: 711 Redline Pharmacy 401 W 33rd St # 100 Hastings, NE , TTY: 711 Russ's Market Pharmacy 611 N Burlington Ave Hastings, NE , TTY: 711 Village Pharmacy Inc 300 S 1st Ave Hastings, NE , TTY: N Burlington Ave Hastings, NE , TTY: Osborne Drive West Hastings, NE , TTY: 711 Antelope Elgin Pharmacy 112 S. 2nd Street Elgin, NE , TTY: 711

7 Hilltop Drugs Etc 108 W 11th St Neligh, NE , TTY: 711 Wanek Pharmacy 410 Main Street Neligh, NE , TTY: 711 Boone Good Life Pharmacy 124 S 4th St Albion, NE , TTY: 711 Wells Healthmart Drug 113 S 4th St Albion, NE , TTY: 711 Box Butte Dave's Pharmacy 508 Niobrara Ave Hemingford, NE , TTY: 711 Brown 1511 East 4th Anisworth, NE , TTY: 711 Buffalo ABC Drug 2123 Central Ave Kearney, NE , TTY: rd Ave Kearney, NE , TTY: 711 Family Fresh Market Pharmacy nd Avenue Kearney, NE , TTY: 711 Haeberle's Grand Central Pharmac 7 W 25th St Kearney, NE , TTY: 711 Safeway Pharmacy 500 E. Third Street Alliance, NE , TTY: 711 Hy-Vee Pharmacy () rd Avenue Kearney, NE , TTY: Flack Ave Alliance, NE , TTY: 711

8 Medicap Pharmacy nd Ave Ste A Kearney, NE , TTY: 711 Butler David City Discount Pharmacy 422 5th St David City, NE , TTY: 711 Svanda Pharmacy 314 Grand Ave Ravenna, NE , TTY: 711 E Street Discount Pharmacy 470 E Street David City, NE , TTY: 711 Valley Pharmacy Inc 211 W 33rd St Kearney, NE , TTY: nd Ave Kearney, NE , TTY: N. Second Avenue Kearney, NE , TTY: 711 Burt Corner Drug 301 N Oakland Avenue Oakland, NE , TTY: 711 Tekamah Drug Company 410 So 13th Street Tekamah, NE , TTY: 711 Cass Blake's Pharmacy 213 Main St Louisville, NE , TTY: 711 Hy-Vee Pharmacy () Westside Drive Plattsmouth, NE , TTY: S 23rd St Plattsmouth, NE , TTY: 711 Cedar Main St Apothecary 201 E 2nd St Laurel, NE , TTY: 711

9 Steffen Drug 214 North Broadway Hartington, NE , TTY: 711 Western Drug 806 Illinios Sidney, NE , TTY: 711 Chase Adams Drug Company Inc 513 Broadway Imperial, NE , TTY: 711 Clay Sutton Pharmacy 210 N Saunders Ave Sutton, NE , TTY: 711 Cherry Heart City Drug 265 N Main St Valentine, NE , TTY: 711 Colfax Schuyler Pharmacy 122 W. 16th Street Schuyler, NE , TTY: E Highway 20 Valentine, NE , TTY: 711 Cheyenne Safeway Pharmacy 1944 Illinois St Sidney, NE , TTY: 711 Cuming 500 W Plaza Dr West Point, NE , TTY: 711 Toms Rexall Drug 124 N Main St West Point, NE , TTY: Silverberg Drive Sidney, NE , TTY: 711 Wisner Apothecary 1024 Avenue E Ste 100 Wisner, NE , TTY: 711

10 Custer Holcomb Pharmacy Pc 540 S 8th Ave Broken Bow, NE , TTY: 711 Dawes Petersen Drug 302 Main St Chadron, NE , TTY: 711 Seven Valleys Health Mart 200 E Pacific St Callaway, NE , TTY: 711 Safeway Pharmacy 230 Morehead Chadron, NE , TTY: South E Broken Bow, NE , TTY: Linden Street Chadron, NE , TTY: 711 Varney Health Mart 744 South E St Broken Bow, NE , TTY: 711 Dakota Hy-Vee Pharmacy () 2501 Cornhusker Plaza South Sioux City, NE , TTY: 711 Dawson Barmore Drug Store Inc 600 N Washington Lexington, NE , TTY: 711 Gothenburg Discount Pharmacy 902 Avenue D Gothenburg, NE , TTY: W 21st St South Sioux City, NE , TTY: 711 Plum Creek Long Term Care Pharma 109 East 6th Lexington, NE , TTY: Cornhuskers Drive South Sioux City, NE , TTY: 711 Service Drug Store 133 E 8th St Cozad, NE , TTY: 711

11 718 4th Street Gothenburg, NE , TTY: 711 U Save Pharmacy Cozad 312 W 8th St Cozad, NE , TTY: 711 USAve Pharmacy Lex 603 N Washington Lexington, NE , TTY: Frontier Street Lexington, NE , TTY: 711 Deuel Western Drug of Chappell 650 2nd St Chappell, NE , TTY: 711 Dodge A & A Drug Company 1612 N Bell Fremont, NE , TTY: 711 Bakers Pharmacy 1531 N Bell St Fremont, NE , TTY: 711 Famcare Pharmacy 450 E 23rd St Fremont, NE , TTY: 711 Hy-Vee Pharmacy () 840 East 23rd Street Fremont, NE , TTY: 711 Kubat Pharmacy Inc 350 West 23rd Street Fremont, NE , TTY: 711 Dixon Keller Pharmacy 119 E 3rd St Ponca, NE , TTY: 711 Medicine Man Pharmacy 748 Main St North Bend, NE , TTY: 711 Miller Pharmacy Specialties 1900 E Military Ste 216 Fremont, NE , TTY: 711

12 Scribner Pharmacy 416 Main St Scribner, NE , TTY: 711 Bakers Pharmacy W Maple Rd Omaha, NE , TTY: E 23 St Fremont, NE , TTY: 711 Bakers Pharmacy 888 Saddlecreek Rd Omaha, NE , TTY: E 23rd Ave N Fremont, NE , TTY: 711 Bakers Pharmacy Lakeside Hills Plaza Omaha, NE , TTY: 711 Douglas Affinity Biotech, Inc N 203rd St Omaha, NE , TTY: 711 Alixarx Ne Hub Davenport St Ste 104A Omaha, NE , TTY: 711 Baker's Pharmacy 7312 N 30th St Omaha, NE , TTY: 711 Bakers Pharmacy 5555 N 90th St Omaha, NE , TTY: 711 Bakers Pharmacy 505 N 155th Plaza Omaha, NE , TTY: 711 Bakers Pharmacy 4405 N 72nd St Omaha, NE , TTY: 711 Bakers Pharmacy W Center Rd Omaha, NE , TTY: 711 Brooksiderx LLC Q Street Omaha, NE , TTY: 711

13 12500 K Plaza Omaha, NE , TTY: Fort St Omaha, NE , TTY: N 132nd St Omaha, NE , TTY: U St Omaha, NE , TTY: Dodge St Omaha, NE , TTY: Dodge St Omaha, NE , TTY: W Center Rd Omaha, NE , TTY: S 132nd St Omaha, NE , TTY: N 73rd Plz Omaha, NE , TTY: N 90th St Omaha, NE , TTY: Evans Plaza Omaha, NE , TTY: W Center Rd Omaha, NE , TTY: W Maple Rd Omaha, NE , TTY: 711 Chi Health Pharmacy Bergan Mer 7710 Mercy Rd Ste 110 Omaha, NE , TTY: 711

14 Chi Health Pharmacy Florence 8613 N 30th St Omaha, NE , TTY: 711 Chi Health Specialty Pharmacy 7710 Mercy Rd Ste 102 Omaha, NE , TTY: 711 Chi Health Pharmacy Immanuel 6901 N 72nd St Omaha, NE , TTY: 711 Costco Pharmacy W Dodge Rd Omaha, NE , TTY: 711 Chi Health Pharmacy Lakeside Lakeside Hills Ct Ste 107 Omaha, NE , TTY: 711 Creighton University Medical Cen 601 N 30th St Cumc Clinic Pharmacy Omaha, NE , TTY: 711 Chi Health Pharmacy Nd and W Center Rd Omaha, NE , TTY: 711 Chi Health Pharmacy Nd and L 4220 L St Omaha, NE , TTY: 711 Chi Health Pharmacy St and Evans Street Suite 101 Omaha, NE , TTY: 711 Depot Drug 1400 Douglas St Stop 0050 Omaha, NE , TTY: 711 Diabetes Supply Center of The Mi 2910 S 84th St Omaha, NE , TTY: 711 Douglas County Health Center Pha 4102 Woolworth Omaha, NE , TTY: 711 Chi Health Pharmacy Th and F 310 S. 15th Street Omaha, NE , TTY: 711 Eds Rexall 2701 S 10th St Omaha, NE , TTY: 711

15 Elmwood Pharmacy 808 So 52nd Omaha, NE , TTY: 711 Hy-Vee Drugstore () 8404 N 30th Street Omaha, NE , TTY: 711 Family Fare Pharmacy 1221 South 203rd Street Omaha, NE , TTY: 711 Fred Leroy Health and Wellness C 2602 J St Omaha, NE , TTY: 711 Genoa, A QOL Healthcare Company, 4001 Leavenworth St Ste 150A Omaha, NE , TTY: 711 Gerimed Inc 7915 N 30th St Omaha, NE , TTY: 711 Health Mart Pharmacy C W Hadan Dr Bennington, NE , TTY: 711 Hematology & Oncology Consultant 6901 N 72nd St Ste 2244 Omaha, NE , TTY: 711 Hy-Vee Drugstore LTC () 8404 N. 30th Suite 100 Omaha, NE , TTY: 711 Hy-Vee Pharmacy () 5150 Center Omaha, NE , TTY: 711 Hy-Vee Pharmacy () 747 North 132nd Street Omaha, NE , TTY: 711 Hy-Vee Pharmacy () 9707 Q Street Omaha, NE , TTY: 711 Hy-Vee Pharmacy () Fort Street Omaha, NE , TTY: 711 Hy-Vee Pharmacy () Stony Brook Blvd. Omaha, NE , TTY: 711

16 Hy-Vee Pharmacy () 7910 Cass Street Omaha, NE , TTY: 711 Kohlls Pharmacy 3427 S 84th St Omaha, NE , TTY: 711 Hy-Vee Pharmacy () 8809 W Center Road Omaha, NE , TTY: 711 Kohlls Pharmacy 2923 Leavenworth St Omaha, NE , TTY: 711 Hy-Vee Pharmacy () Welch Plaza Omaha, NE , TTY: 711 Kohlls Pharmacy 622 N 114th St Omaha, NE , TTY: 711 Hy-Vee Pharmacy () 3410 North 156th Street Omaha, NE , TTY: 711 Kohlls Pharmacy Q St Omaha, NE , TTY: 711 Hy-Vee Pharmacy () 1000 South 178th Street Omaha, NE , TTY: 711 Kohlls Pharmacy 5000 Dodge St Omaha, NE , TTY: 711 Infuscience 8710 F St Ste 118 Omaha, NE , TTY: 711 Kmart Pharmacy 5000 &Quot;L&Quot; Street Omaha, NE , TTY: 711 Kubat Custom Health Care Inc 4924 Center Street Suite A Omaha, NE , TTY: 711 Kubat Pharmacy 4924 Center St Omaha, NE , TTY: 711

17 Kubat Pharmacy 2401 N St Omaha, NE , TTY: 711 Medicine Man Pharmacy 715 N 132nd St Omaha, NE , TTY: 711 Midwest Surgical Hosptial Pharma 7915 Farnam Dr Omaha, NE , TTY: 711 Ncs Outpatient Pharmacy Wright St Ste 203 Omaha, NE , TTY: 711 Oneworld Pharmacy 4920 S 30th St Ste 105 Omaha, NE , TTY: 711 Pharmacy Express In Tower Plaza 349 N 78th Street Omaha, NE , TTY: 711 Pharmerica 6528 S 118th St Omaha, NE , TTY: 711 Quantum Med Pharmacy 3744 S 132nd St Omaha, NE , TTY: 711 Nebraska Orthopaedic Hospital Re 2725 S 144th St Ste 111 Omaha, NE , TTY: 711 Sams Pharmacy L Street Omaha, NE , TTY: 711 Neighborhood LTC Pharmacy 5115 S 111th St Omaha, NE , TTY: S 84th St Omaha, NE , TTY: 711 Oak Creek Rx, LLC 8607 F St Omaha, NE , TTY: N 90th St Omaha, NE , TTY: 711

18 14445 W Center Rd Omaha, NE , TTY: 711 Steier Pharmacy 6828 N 72nd St Ste 2160 Omaha, NE , TTY: 711 U Save Pharmacy Maple 2728 N 108th St Ste 105 Omaha, NE , TTY: 711 U-Save Pharmacy Qst 5011 S 108th St Omaha, NE , TTY: 711 Super Saver Pharmacy 5710 S 144th St Omaha, NE , TTY: 711 Unimed Pharmacy 7915 N 30th St Omaha, NE , TTY: 711 The Nebraska Medical Center Clin NEbraska Medical Center Omaha, NE , TTY: 711 Valley Long Term Care Pharmacy 123 1/2 E Gardiner St Valley, NE , TTY: 711 Think Aksarben Pharmacy 7100 W Center Rd Omaha, NE , TTY: 711 Valley Pharmacy 123 E Gardiner St Valley, NE , TTY: 711 U Save Pharmacy 940 N. 204th Ave Ste 270 Elkhorn, NE , TTY: 711 Viarx 825 N 90th St Omaha, NE , TTY: 711 Vna Home Infusion Therapy Co W Center Rd Ste 100 Omaha, NE , TTY: 711

19 7151 Cass St Omaha, NE , TTY: S 24th St Omaha, NE , TTY: N 60th St Omaha, NE , TTY: Center St Omaha, NE , TTY: N Saddle Creek Rd Omaha, NE , TTY: Q St Omaha, NE , TTY: W Center Rd Omaha, NE , TTY: North 132nd St Omaha, NE , TTY: Blondo Street Omaha, NE , TTY: North 30th St Omaha, NE , TTY: W Center Rd Omaha, NE , TTY: Lake St Omaha, NE , TTY: Ames Ave Omaha, NE , TTY: S 155th St Omaha, NE , TTY: 711

20 2323 L Street Omaha, NE , TTY: N 90th St Omaha, NE , TTY: Fort St Omaha, NE , TTY: Manderson St Omaha, NE , TTY: S 171st St Omaha, NE , TTY: N 72nd St Omaha, NE , TTY: Dodge St Omaha, NE , TTY: Burke St Omaha, NE , TTY: W Dodge Rd Omaha, NE , TTY: S 77th St Omaha, NE , TTY: Spaulding Plaza Omaha, NE , TTY: North 99th Street Omaha, NE , TTY: R Plaza Omaha, NE , TTY: Wright St. Omaha, NE , TTY: 711

21 12850 L Street Omaha, NE , TTY: N 90th St Omaha, NE , TTY: West Maple Road Omaha, NE , TTY: N Saddle Creek Rd Omaha, NE , TTY: South 72nd Street Omaha, NE , TTY: Birch Dr Omaha, NE , TTY: S 167th St Omaha, NE , TTY: L St Omaha, NE , TTY: Ames Ave Omaha, NE , TTY: 711 Dundy Benkelman Pharmacy 509 S Chief Benkelman, NE , TTY: 711 Fillmore Weaver Pharmacy 1014 G St Geneva, NE , TTY: 711 Furnas Arapahoe Pharmacy 507 NEbraska Ave Arapahoe, NE , TTY: 711 Marks Pharmacy Cambridge 624 Patterson St Cambridge, NE , TTY: 711

22 Gage Arbor State Pharmacy 203 S 7th St Ste B Wymore, NE , TTY: 711 Clabaugh Pharmacy 501 Court St Beatrice, NE , TTY: North 6th Street Beatrice, NE , TTY: 711 Garden Campbell Drug 311 Main St Oshkosh, NE , TTY: 711 Deines Pharmacy 910 E Court St Beatrice, NE , TTY: 711 Lake Crest Pharmacy 620 Main Street Ste B Adams, NE , TTY: 711 Nebraska Long Term Care LLC 910 Court St Ste D Beatrice, NE , TTY: 711 Poling Drug 711 E Court St Beatrice, NE , TTY: N 24th St Beatrice, NE , TTY: 711 Garfield Burwell Pharmacy 137 Grand Ave Burwell, NE , TTY: 711 Greeley Spalding Pharmacy 230 W St Joseph Spalding, NE , TTY: 711 Hall 1710 W 2nd St Grand Island, NE , TTY: 711 Doniphan Pharmacy 2011 W Clarice St Doniphan, NE , TTY: 711

23 Gi Village Pharmacy 4075 Timberline Street Grand Island, NE , TTY: 711 U Save Pharmacy South 2105 S Locust St Grand Island, NE , TTY: 711 Hy-Vee Pharmacy () 115 Wilmar Ave Grand Island, NE , TTY: 711 U Save Pharmacy Th Street St 423 W 4th St Grand Island, NE , TTY: 711 Midwest LTC Pharmacy 3003 Frontage Road Ste 2 Grand Island, NE , TTY: N Webb Rd Grand Island, NE , TTY: 711 U-Save Pharmacy Nw 3224 W 13th St Grand Island, NE , TTY: W 2nd St Grand Island, NE , TTY: 711 Super Saver Pharmacy 1602 W 2nd St Grand Island, NE , TTY: N Diers Ave Grand Island, NE , TTY: 711 Super Saver Pharmacy 710 West State St Grand Island, NE , TTY: N Webb St Grand Island, NE , TTY: 711 U Save Pharmacy Gi Clinic 2444 W Faidley Ave Grand Island, NE , TTY: No. Diers Ave Grand Island, NE , TTY: 711

24 3501 South Locust Street Grand Island, NE , TTY: 711 Hamilton Jims U Save Pharmacy 219 Q Street Aurora, NE , TTY: 711 Harlan Hays Pharmacy 706 W Main Alma, NE , TTY: 711 Holt O'neill Family Pharmacy 317 E Douglas Street Oneill, NE , TTY: E Hwy 20 Oneill, NE , TTY: 711 West Holt Pharmacy 313 W Pearl Atkinson, NE , TTY: 711 Howard Brehm Drug 608 Howard Ave Saint Paul, NE , TTY: 711 Jefferson Globe Rexall Drug 424 E St Fairbury, NE , TTY: 711 Jefferson Community Health Cente 2200 North H St Fairbury, NE , TTY: 711 Korbel Drug 405 5th St Fairbury, NE , TTY: Hwy 15 Fairbury, NE , TTY: 711 Johnson Chief Drug 123 South 3rd St Tecumseh, NE , TTY: 711 Hasselbalch Pharmacy 143 S 3rd St Tecumseh, NE , TTY: 711

25 Kearney Lt Pedley Drug 419 N Colorado Minden, NE , TTY: 711 Knox Bloomfield Pharmacy 105 S Broadway St Ste 1 Bloomfield, NE , TTY: 711 Keith Safeway Pharmacy 611 N Spruce St Ogallala, NE , TTY: Texas Trail Dr Ogallala, NE , TTY: 711 U Save Pharmacy Ogallala 23 N Spruce St Ogallala, NE , TTY: 711 Manion's Drug Store 719 Main Street Creighton, NE , TTY: 711 Santee Tribal Clinic Pharmacy 110 S Visiting Eagle St Niobrara, NE , TTY: 711 Lancaster 333 N 48th St Lincoln, NE , TTY: Pony Express Lane Ogallala, NE , TTY: O St Lincoln, NE , TTY: 711 Kimball Bemis Drug 129 S Chestnut St Kimball, NE , TTY: S 56th St Lincoln, NE , TTY: Superior Street Lincoln, NE , TTY: 711

26 2755 S 48th St Lincoln, NE , TTY: 711 Hy-Vee Pharmacy () 6001 Village Drive Lincoln, NE , TTY: S 40th St Lincoln, NE , TTY: 711 Hy-Vee Pharmacy () 5020 N 27th Street Lincoln, NE , TTY: W O St Lincoln, NE , TTY: 711 Hy-Vee Pharmacy () 7151 Stacy Lane Lincoln, NE , TTY: S 27th St Lincoln, NE , TTY: 711 Hy-Vee Pharmacy () 5010 O Street Lincoln, NE , TTY: South St L Lincoln, NE , TTY: 711 Kohll's Pharmacy & Homecare 800 N 27th St Lincoln, NE , TTY: 711 Genoa, A QOL Healthcare Company, 2301 O St Lincoln, NE , TTY: 711 Madonna Rehabilitation Hospital 5401 South St Lincoln, NE , TTY: 711 Hy-Vee Pharmacy () 1601 N 84th Street Lincoln, NE , TTY: 711 Medicap 2555 Kensington Drive Lincoln, NE , TTY: 711

27 National Pharmacy 3306 A Street Lincoln, NE , TTY: 711 Russ's Pharmacy 4400 South 33rd Street Court Lincoln, NE , TTY: 711 Nebraska LTC Pharmacy 4300 S 48th St Suite 5 Lincoln, NE , TTY: 711 Russ's Pharmacy 130 N 66th St Lincoln, NE , TTY: 711 Neighborhood LTC Pharmacy 5625 O St Ste 101 Lincoln, NE , TTY: 711 Russ's Pharmacy 1550 S Coddington Lincoln, NE , TTY: 711 Relycare LTC Lincoln 1219 North Cotner Blvd Lincoln, NE , TTY: 711 Sams Pharmacy 4900 North 27th Street Lincoln, NE , TTY: 711 Relycare Pharmacy 1221 N Cotner Blvd Ste 1 Lincoln, NE , TTY: 711 Relycare Pharmacy 1221 N Cotner Blvd Ste 1 Lincoln, NE , TTY: 711 Russ Pharmacy 1709 Washington St Lincoln, NE , TTY: 711 Sams Pharmacy 8480 Andermatt Dr Lincoln, NE , TTY: S 27th St Lincoln, NE , TTY: S 66th St Lincoln, NE , TTY: 711

28 6845 S 27th St Lincoln, NE , TTY: 711 U-Save Pharmacy Guildford St Ste D Waverly, NE , TTY: 711 Southeast Nebraska Cancer Center 201 S 68th Street Pl Ste 200 Lincoln, NE , TTY: 711 University Health Center Pharmac 1500 U St. Lincoln, NE , TTY: 711 Stockwell Pharmacy 3811 S 27th St Lincoln, NE , TTY: O Street Lincoln, NE , TTY: 711 Super Saver Pharmacy 2662 Cornhusker Hwy Lincoln, NE , TTY: O Street Lincoln, NE , TTY: 711 Super Saver Pharmacy 2525 Pine Lake Road Lincoln, NE , TTY: South 48th Street Lincoln, NE , TTY: 711 Super Saver Pharmacy 233 N 48th St Lincoln, NE , TTY: N 48th Lincoln, NE , TTY: 711 Super Saver Pharmacy 840 Fallbrook Blvd Lincoln, NE , TTY: South St Lincoln, NE , TTY: 711

29 5701 Village Blvd Lincoln, NE , TTY: Red Rock Ln Lincoln, NE , TTY: N 27th St Lincoln, NE , TTY: N 27th Street Lincoln, NE , TTY: Superior St Lincoln, NE , TTY: Andermatt Drive Lincoln, NE , TTY: Pine Lake Rd Lincoln, NE , TTY: North 85th Street Lincoln, NE , TTY: S 70th St Lincoln, NE , TTY: Grainger Parkway Lincoln, NE , TTY: Northern Lights Dr Lincoln, NE , TTY: 711 Wellness Pharmacy, Inc 4640 Champlain Dr Ste 113 Lincoln, NE , TTY: O St Lincoln, NE , TTY: 711 Lincoln Depot Drug 221 S Jeffers St Ste 2 Ste 2 North Platte, NE , TTY: 711

30 Rx Express Pharmacy 402 N Jeffers St North Platte, NE , TTY: 711 Westfield Pharmacy 1845 West A St North Platte, NE , TTY: E Philip Ave North Platte, NE , TTY: 711 Westfield Pharmacy 1845 West A North Platte, NE , TTY: 711 U Save Pharmacy 211 W Leota North Platte, NE , TTY: 711 U-Save Pavilion Pharmacy 611 W Francis St Ste 130 North Platte, NE , TTY: 711 U-Save Pharmacy 211 W. Leota North Platte, NE , TTY: E Philip Ave North Platte, NE , TTY: South Dewey St. North Platte, NE , TTY: 711 Madison 1301 West Norfolk Ave Norfolk, NE , TTY: 711 Hofmann Pharmacy 103 E 2nd Street Tilden, NE , TTY: 711 Hy-Vee Pharmacy () 120 E Norfolk Norfolk, NE , TTY: 711 Hy-Vee Pharmacy () 2107 Taylor Avenue Norfolk, NE , TTY: 711 Louderback Drug 201 S Main St Madison, NE , TTY: 711

31 Meds & More 1226 W Pasewalk Ave Norfolk, NE , TTY: Pasewalk Ave Norfolk, NE , TTY: 711 Northeast Nebraska LTC 120 N 27th St Ste 200 Norfolk, NE , TTY: 711 Ponca Hills Health and Wellness 1800 Syracuse Ave Norfolk, NE , TTY: Krenzien Dr Norfolk, NE , TTY: 711 U Save Pharmacy of Norfolk 1001 W Benjamin Avenue Norfolk, NE , TTY: 711 Vital Care Pharmacy of Norfolk 120 N 27th St Norfolk, NE , TTY: Norfolk Ave Norfolk, NE , TTY: 711 Merrick Corner Drug 401 G St Central City, NE , TTY: 711 Norms U Save Pharmacy th St Central City, NE , TTY: 711 Morrill Nein Pharmacy 1012 Main St Bridgeport, NE , TTY: 711 Sonnys Pharmacy 310 N Main Bridgeport, NE , TTY: 711 Nance Geneoa Community Pharmacy 508 Willard Ave. Geneoa, NE , TTY: 711

32 Reimer Pharmacy 312 Broadway Fullerton, NE , TTY: 711 Nemaha Cody's USAve Pharmacy 2220 J Street Auburn, NE , TTY: 711 Otoe Moser's U Save Pharmacy 1821 S 11th St Nebraska City, NE , TTY: 711 Syracuse Town and Country Phrmy 448 5th St Syracuse, NE , TTY: 711 Hyrum's Family Value Pharmacy th St Ste 201 Auburn, NE , TTY: Dahlke Ave Auburn, NE , TTY: 711 Nuckolls 1150 East 3rd St. Superior, NE , TTY: 711 Superior Pharmacy 348 N Central Ave Superior, NE , TTY: S 11th St Nebraska City, NE , TTY: S. 11th Street Nebraska City, NE , TTY: 711 Pawnee Petes Pharmacy 643 G St Pawnee City, NE , TTY: 711 Perkins Grant Pharmacy 218 Central Ave Grant, NE , TTY: 711

33 Phelps Fulmer Pharmacy 1317 Hill St Holdrege, NE , TTY: 711 Holdrege Pharmacy 516 W 14th St Suite 500 Holdrege, NE , TTY: Burlington St Holdrege, NE , TTY: 711 Pierce Osmond Pharmacy 322 State Street State St Osmond, NE , TTY: 711 Plainview Pharmacy 103 S Main Plainview, NE , TTY: 711 Platte Bobs U Save Pharmacy rd Ave Columbus, NE , TTY: rd St Columbus, NE , TTY: 711 Hy-Vee Pharmacy () rd St Columbus, NE , TTY: 711 Super Savers Pharmacy rd St Columbus, NE , TTY: 711 Tooley Drug Inc th St Columbus, NE , TTY: 711 Tooley Drug Inc Clinical Pharmac th St Columbus, NE , TTY: rd Ave Columbus, NE , TTY: East 23rd St. Columbus, NE , TTY: 711

34 Polk Tooley's Osceola Pharmacy 415 Hawkeye Street Osceola, NE , TTY: 711 Yungdahls Apothecary 309 Commercial St Stromsburg, NE , TTY: Stone St Falls City, NE , TTY: 711 Rock Rock County Pharmacy 801 S State St Bassett, NE , TTY: 711 Red Willow Farrell's Pharmacy 120 West B St Mccook, NE , TTY: 711 Saline Barnas Drug 124 W 3rd St Wilber, NE , TTY: 711 U Save Pharmacy and Medical Supp 902 N Hwy 83 Mccook, NE , TTY: 711 Johnson Pharmacy 151 Maple St Friend, NE , TTY: West B Mccook, NE , TTY: 711 Kens U Save Pharmacy 1302 Linden Ave Crete, NE , TTY: 711 Richardson Kex Rx Pharmacy & Home Care 120 E 18th St Falls City, NE , TTY: Main Ave Crete, NE , TTY: East 29th Street Crete, NE , TTY: 711

35 Sarpy Amber Pharmacy S 152nd St Ste A Omaha, NE , TTY: 711 Axelacare 8720 South 114th Street Suite 106 La Vista, NE , TTY: 711 Bakers Pharmacy 801 Galvin Rd Bellevue, NE , TTY: 711 Bakers Pharmacy 3614 Twin Creek Dr Bellevue, NE , TTY: N Washington St Papillion, NE , TTY: Galvin Rd S Bellevue, NE , TTY: S 84th St La Vista, NE , TTY: 711 Chi Health Pharmacy Bellevue 3308 Samson Way Ste 106 Bellevue, NE , TTY: 711 Chi Health Pharmacy Lavista 8248 S. 96th Street Suite 101 Lavista, NE , TTY: 711 Chi Health Pharmacy Midlands S 84th St Ste 1841 Papillion, NE , TTY: Twin Creek Dr Bellevue, NE , TTY: 711 Community Pharmacy Services Northstar Dr Gretna, NE , TTY: 711 Costco Pharmacy Portside Parkway La Vista, NE , TTY: 711

36 Hy-Vee Pharmacy () S 73rd St Papillion, NE , TTY: Galvin Rd S Bellevue, NE , TTY: 711 Hy-Vee Pharmacy Solutions S 152nd Street Suite C Omaha, NE , TTY: 711 Kohlls Pharmacy 1413 S Washington Papillion, NE , TTY: 711 Redlers LTC Pharmacy LLC Chalco Valley Pkwy Ste 101 Omaha, NE , TTY: 711 Relycare LTC Bellevue 1820 Hillcrest Drive Ste. F Bellevue, NE , TTY: 711 Rxsolutions 1225 Golden Gate Dr Papillion, NE , TTY: 711 Sam's Club Pharmacy 9851 S 71st Plaza Papillion, NE , TTY: 711 Springfield Drug 205 Main St Springfield, NE , TTY: 711 U Save Pharmacy Gretna Gna 611 N Highway 6 Gretna, NE , TTY: 711 U Save Pharmacy Harrison Audrey St Omaha, NE , TTY: Galvin Rd S Bellevue, NE , TTY: Harrison St La Vista, NE , TTY: S 36th St Bellevue, NE , TTY: 711

37 11343 S 96th St Papillion, NE , TTY: S 71st Plaza Papillion, NE , TTY: S 71st Plz Papillion, NE , TTY: South 15th Street Bellevue, NE , TTY: Wickersham Blvd Gretna, NE , TTY: Towne Center Dr Bellevue, NE , TTY: Giles Rd La Vista, NE , TTY: 711 Saunders Ashland Pharmacy, Medicine Shopp 1401 Silver St Ashland, NE , TTY: 711 Saunders Medical Center LTC Phar 1760 County Road J Wahoo, NE , TTY: 711 Wahoo Pharmacy and Gifts 526 N Linden St Wahoo, NE , TTY: 711 Scotts Bluff Community Pharmacy at Regional W 3911 Avenue B Ste M200 Scottsbluff, NE , TTY: 711 Gering Pharmacy th Street Gering, NE , TTY: 711 Safeway Pharmacy 601 Broadway Scottsbluff, NE , TTY: 711

38 205 W 27th St Scottsbluff, NE , TTY: Avenue I Scottsbluff, NE , TTY: 711 Seward Milford Pharmacy 610 1st St Milford, NE , TTY: 711 Mueri Drug 544 Seward St Seward, NE , TTY: 711 Pac N Save Discount Pharmacy 1519 W Hwy 34 Ste 1 Seward, NE , TTY: 711 Seward Family Pharmacy 250 N Columbia Ave Seward, NE , TTY: th Road Seward, NE , TTY: 711 Sheridan 301 E US Highway 20 Gordon, NE , TTY: 711 Stockmen's Drug 116 N Main St Gordon, NE , TTY: 711 Sherman Good Life Pharmacy 727 O St Loup City, NE , TTY: 711 Loup City Rx Shoppe 133 S 7th St Loup City, NE , TTY: 711 Thayer Priefert Pharmacy 428 Lincoln Ave Hebron, NE , TTY: 711 Tchs Pharmacy 120 Park Ave Hebron, NE , TTY: 711

39 Thurston Carl T Curtis Pharmacy 100 Indian Hill Dr Macy, NE , TTY: 711 The Apothecary Shop 100 Valley View Dr Ste 2 Pender, NE , TTY: 711 Winnebago IHS Hospital Pharmacy Us Highway Winnebago, NE , TTY: 711 Valley Anderson Pharmacy 1429 M St Ord, NE , TTY: 711 Good Life Long Term Care 127 S 16th St Ord, NE , TTY: 711 Good Life Pharmacy 125 S 16th St Ord, NE , TTY: 711 Washington Health Mart Pharmacy 238 S 8th St Blair, NE , TTY: Washington St Blair, NE , TTY: Holly St Blair, NE , TTY: 711 Wayne 615 Dearborn & Hwy 35 East Wayne, NE , TTY: 711 U-Save Pharmacy 216 E 7th St Wayne, NE , TTY: 711 Webster Rons Pharmacy 537 West Gage St Blue Hill, NE , TTY: 711 Village Pharmacy 317 N Webster St Red Cloud, NE , TTY: 711

40 York Charlies U Save Pharmacy 2029 N Lincoln Ave York, NE , TTY: S Lincoln Ave York, NE , TTY: East David Drive York, NE , TTY: 711 Mail service pharmacies Our mail service pharmacies will ship your prescription drugs directly to your home. For more information, please see your Evidence of Coverage. Below are the mail service pharmacies in the plan s network. OptumRx Mail Service P.O. Box 2975, Mission, KS P.O. Box 29061, Phoenix, AZ Toll-free Toll-free TTY 711 TTY Manifest Pharmacy, LLC 1018 South Batesville Road, Bldg 4-A Greer, SC Toll-free orders@manifestrx.com Home infusion pharmacies near you The plan will cover home infusion therapy if: The plan has approved your prescription drug for home infusion therapy; and You get your prescription from an authorized prescriber. For more information, please see your Evidence of Coverage. Below are some of the home infusion network pharmacies in your area.

41 Home infusion pharmacies near you (continued) Adams Redline Pharmacy 401 W 33rd St # 100 Hastings, NE Douglas Accredo Health Group Inc P St Stes 118 And 119 Omaha, NE Affinity Biotech, Inc N 203rd St Omaha, NE Chi Health at Home Hme 5428 F St Omaha, NE Coram CVS/Specialty Infusion Ser Mill Valley Rd Omaha, NE Infuscience 8710 F St Ste 118 Omaha, NE Option Care John Galt Blvd Omaha, NE Vna Home Infusion Therapy Co W Center Rd Ste 100 Omaha, NE Hall Option Care 2604 Saint Patrick Ave Suite 2 Grand Island, NE Lancaster Option Care 4401 S 70th St Ste 2 Lincoln, NE Madison Vital Care Pharmacy of Norfolk 120 N 27th St Norfolk, NE Sarpy Amber Pharmacy S 152nd St Ste A Omaha, NE Axelacare 8720 South 114th Street Suite 106 La Vista, NE

42 Long-term care pharmacies near you Residents of a long-term care facility may get their covered prescription drugs from their facility s longterm care pharmacy or another network long-term care pharmacy. For more information, please see your Evidence of Coverage. Below are some of the long-term care network pharmacies in your area. Adams Village Pharmacy Inc 300 S 1st Ave Hastings, NE Box Butte Dave's Pharmacy 508 Niobrara Ave Hemingford, NE Antelope Elgin Pharmacy 112 S. 2nd Street Elgin, NE Buffalo ABC Drug 2123 Central Ave Kearney, NE Wanek Pharmacy 410 Main Street Neligh, NE Boone Good Life Pharmacy 124 S 4th St Albion, NE Wells Healthmart Drug 113 S 4th St Albion, NE Medicap Pharmacy nd Ave Ste A Kearney, NE Svanda Pharmacy 314 Grand Ave Ravenna, NE Burt Tekamah Drug Company 410 So 13th Street Tekamah, NE

43 Long-term care pharmacies near you (continued) Butler David City Discount Pharmacy 422 5th St David City, NE Cass Blake's Pharmacy 213 Main St Louisville, NE Cedar Main St Apothecary 201 E 2nd St Laurel, NE Cheyenne Western Drug 806 Illinios Sidney, NE Clay Sutton Pharmacy 210 N Saunders Ave Sutton, NE Custer Holcomb Pharmacy Pc 540 S 8th Ave Broken Bow, NE Varney Health Mart 744 South E St Broken Bow, NE Dawes Petersen Drug 302 Main St Chadron, NE Dawson Gothenburg Discount Pharmacy 902 Avenue D Gothenburg, NE Plum Creek Long Term Care Pharma 109 East 6th Lexington, NE USAve Pharmacy Lex 603 N Washington Lexington, NE Deuel Western Drug of Chappell 650 2nd St Chappell, NE

44 Long-term care pharmacies near you (continued) Dixon Keller Pharmacy 119 E 3rd St Ponca, NE Dodge Famcare Pharmacy 450 E 23rd St Fremont, NE Miller Pharmacy Specialties 1900 E Military Ste 216 Fremont, NE Scribner Pharmacy 416 Main St Scribner, NE Douglas Alixarx Ne Hub Davenport St Ste 104A Omaha, NE Chi Health Pharmacy Immanuel 6901 N 72nd St Omaha, NE Douglas County Health Center Pha 4102 Woolworth Omaha, NE Eds Rexall 2701 S 10th St Omaha, NE Elmwood Pharmacy 808 So 52nd Omaha, NE Genoa, A QOL Healthcare Company, 4001 Leavenworth St Ste 150A Omaha, NE Gerimed Inc 7915 N 30th St Omaha, NE Health Mart Pharmacy C W Hadan Dr Bennington, NE Hematology & Oncology Consultant 6901 N 72nd St Ste 2244 Omaha, NE

45 Long-term care pharmacies near you (continued) Hy-Vee Drugstore LTC () 8404 N. 30th Suite 100 Omaha, NE Fillmore Weaver Pharmacy 1014 G St Geneva, NE Kubat Custom Health Care Inc 4924 Center Street Suite A Omaha, NE Neighborhood LTC Pharmacy 5115 S 111th St Omaha, NE Pharmerica 6528 S 118th St Omaha, NE Quantum Med Pharmacy 3744 S 132nd St Omaha, NE Valley Long Term Care Pharmacy 123 1/2 E Gardiner St Valley, NE Dundy Benkelman Pharmacy 509 S Chief Benkelman, NE Furnas Arapahoe Pharmacy 507 NEbraska Ave Arapahoe, NE Marks Pharmacy Cambridge 624 Patterson St Cambridge, NE Gage Clabaugh Pharmacy 501 Court St Beatrice, NE Lake Crest Pharmacy 620 Main Street Ste B Adams, NE Nebraska Long Term Care LLC 910 Court St Ste D Beatrice, NE

46 Long-term care pharmacies near you (continued) Garden Campbell Drug 311 Main St Oshkosh, NE Howard Brehm Drug 608 Howard Ave Saint Paul, NE Garfield Burwell Pharmacy 137 Grand Ave Burwell, NE Jefferson Globe Rexall Drug 424 E St Fairbury, NE Hall Gi Village Pharmacy 4075 Timberline Street Grand Island, NE Midwest LTC Pharmacy 3003 Frontage Road Ste 2 Grand Island, NE Hamilton Jims U Save Pharmacy 219 Q Street Aurora, NE Harlan Hays Pharmacy 706 W Main Alma, NE Jefferson Community Health Cente 2200 North H St Fairbury, NE Korbel Drug 405 5th St Fairbury, NE Kearney Lt Pedley Drug 419 N Colorado Minden, NE Kimball Bemis Drug 129 S Chestnut St Kimball, NE

47 Long-term care pharmacies near you (continued) Knox Manion's Drug Store 719 Main Street Creighton, NE Relycare Pharmacy 1221 N Cotner Blvd Ste 1 Lincoln, NE Lancaster Genoa, A QOL Healthcare Company, 2301 O St Lincoln, NE Madonna Rehabilitation Hospital 5401 South St Lincoln, NE Relycare Pharmacy 1221 N Cotner Blvd Ste 1 Lincoln, NE Lincoln U-Save Pharmacy 211 W. Leota North Platte, NE Nebraska LTC Pharmacy 4300 S 48th St Suite 5 Lincoln, NE Westfield Pharmacy 1845 West A St North Platte, NE Neighborhood LTC Pharmacy 5625 O St Ste 101 Lincoln, NE Relycare LTC Lincoln 1219 North Cotner Blvd Lincoln, NE Westfield Pharmacy 1845 West A North Platte, NE Madison Hofmann Pharmacy 103 E 2nd Street Tilden, NE

48 Long-term care pharmacies near you (continued) Louderback Drug 201 S Main St Madison, NE Meds & More 1226 W Pasewalk Ave Norfolk, NE Northeast Nebraska LTC 120 N 27th St Ste 200 Norfolk, NE Merrick Corner Drug 401 G St Central City, NE Norms U Save Pharmacy th St Central City, NE Morrill Nein Pharmacy 1012 Main St Bridgeport, NE Sonnys Pharmacy 310 N Main Bridgeport, NE Nance Geneoa Community Pharmacy 508 Willard Ave. Geneoa, NE Reimer Pharmacy 312 Broadway Fullerton, NE Nemaha Hyrum's Family Value Pharmacy th St Ste 201 Auburn, NE Nuckolls Superior Pharmacy 348 N Central Ave Superior, NE Otoe Moser's U Save Pharmacy 1821 S 11th St Nebraska City, NE Syracuse Town and Country Phrmy 448 5th St Syracuse, NE

49 Long-term care pharmacies near you (continued) Phelps Holdrege Pharmacy 516 W 14th St Suite 500 Holdrege, NE Pierce Osmond Pharmacy 322 State Street State St Osmond, NE Platte Bobs U Save Pharmacy rd Ave Columbus, NE Tooley Drug Inc th St Columbus, NE Polk Tooley's Osceola Pharmacy 415 Hawkeye Street Osceola, NE Yungdahls Apothecary 309 Commercial St Stromsburg, NE Red Willow Farrell's Pharmacy 120 West B St Mccook, NE U Save Pharmacy and Medical Supp 902 N Hwy 83 Mccook, NE Richardson Kex Rx Pharmacy & Home Care 120 E 18th St Falls City, NE Rock Rock County Pharmacy 801 S State St Bassett, NE Saline Kens U Save Pharmacy 1302 Linden Ave Crete, NE Sarpy Community Pharmacy Services Northstar Dr Gretna, NE