DIRECTORY Pharmacy. Toll-Free , TTY 711

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1 2016 Pharmacy DIRECTORY This directory is a list of network pharmacies near you. This directory is for Montana. For more information, please call Customer Service at: Toll-Free , TTY a.m. to 8 p.m. local time, Monday through Friday Y0066_150908_ Last updated September 18, 2015

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 our plan members. 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 Mail Service Pharmacy. When you use home delivery from OptumRx, you can have 90-day supplies of your maintenance medication delivered right to your door. With the mail service pharmacy, you generally have lower out-of-pocket co-pays. You may save on a 90-day supply of many of your maintenance medications compared with what you would pay at a network retail pharmacy. 2 Members may also use other mail service pharmacies to fill prescriptions. 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. 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. 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 , 24 hours, 7 days a week. 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 , 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 pages. symbol in the pharmacy listings on the following 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.

4 Some of the retail pharmacies in the plan s network also offer 90-day supplies 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. 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 National pharmacy chains Below are some of the national chains in the plan s pharmacy network. For locations and phone numbers of stores in your area, call the numbers shown below. Albertsons/Safeway & Affiliates ACME Albertsons Carrs Jewel Osco Market Street Pavilions Randalls Safeway Shaws Tom Thumb United Vons 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 Sam s Club Stop & Shop Target Thrifty White Walgreens TTY Walmart Wegmans TTY users should call 711, unless a different phone number is listed. This list may change. For a list of other national 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.

6 Retail pharmacies, including chain pharmacies near you Below are some of the retail and chain pharmacies in your area. Note: Pharmacies may have closed or moved locations since this directory was printed. Other pharmacies are available in our network. Beaverhead Safeway Pharmacy 570 N Montana St Dillon, MT , TTY: 711 Shopko Pharmacy 125 E Glendale St Dillon, MT , TTY: 711 Vans Pharmacy 110 Southside Blvd Dillon, MT , TTY: 711 Big Horn Crow Indian Hospital Pharmacy 212 Hwy And I 90 Crow Agency, MT , TTY: 711 Lodge Grass Health Center Pharma Harding Ave Lodge Grass, MT , TTY: 711 Pharmcare of Hardin Inc 901 N Center Ave Hardin, MT , TTY: 711 Pryor Health Station Pharmacy Pryor Gap Rd Pryor, MT , TTY: 711 Blaine Chinook Pharmacy 300 Indiana St Chinook, MT , TTY: 711 Fort Belknap Health Center Pharm 456 Gros Ventre Ave Harlem, MT , TTY: 711 Hays Health Center Pharmacy 123 White Crow Rd Hays, MT , TTY: 711 Milk River Pharmacy US Hwy 2 Harlem, MT , TTY: 711 Broadwater Townsend Drug 308 Broadway Townsend, MT , TTY: 711

7 Carbon Red Lodge Drug 211 North Broadway Red Lodge, MT , TTY: 711 Cascade Afp Rx th St Ste101a Great Falls, MT , TTY: 711 Anderson Family th St S Ste 101 Great Falls, MT , TTY: 711 Benefis Ambulatory Pharmacy th Ave S Ste 2 Greatfalls, MT , TTY: 711 CVS Pharmacy th Ave S Great Falls, MT , TTY: 711 Kmart Pharmacy rd Street NW Great Falls, MT , TTY: rd St NW Great Falls, MT , TTY: th Ave S Great Falls, MT , TTY: 711 Pharmerica 625 Central Ave West Suite 105 Great Falls, MT , TTY: 711 Public Drug Co 324 Central Ave Great Falls, MT , TTY: 711 Sams Pharmacy 401 Northwest Byp Great Falls, MT , TTY: 711 Shopko Pharmacy 301 Northwest Byp Great Falls, MT , TTY: 711 Smiths Pharmacy 1601 Market Place Drive Great Falls, MT , TTY: 711

8 Snyder Drugs th Ave No Great Falls, MT , TTY: 711 Wal-Mart Pharmacy 701 Smelter Ave N.E. Great Falls, MT , TTY: 711 Walgreens rd St NW Great Falls, MT , TTY: 711 Walgreens th Ave Great Falls, MT , TTY: 711 Chouteau Benton Pharmacy 1418 Front St Fort Benton, MT , TTY: 711 Holy Rosary Health Center 2600 Wilson Miles City, MT , TTY: S Haynes Miles City, MT , TTY: 711 Wal-Mart Pharmacy 3205 Stower Street Miles City, MT , TTY: 711 Daniels Service Drug Inc 119 Main St Scobey, MT , TTY: 711 Dawson F & G Pharmacy 107 N Merrill Ave Glendive, MT , TTY: 711 Big Sandy Pharmacy 158 Johannes Ave Big Sandy, MT , TTY: 711 Custer Big Sky Pharmacy 701 Main St Miles City, MT , TTY: 711 Gabert Clinic Pharmacy 107 Dilworth Glendive, MT , TTY: 711 Kmart Pharmacy 1515 W Bell St Glendive, MT , TTY: 711

9 307 N Harmon Glendive, MT , TTY: 711 Deer Lodge CVS Pharmacy 1300 E Park Ave Anaconda, MT , TTY: 711 Montana State Hospital Pharmacy 58 Garnet Way Warm Springs, MT , TTY: 711 Stokes Pharmacy Anaconda 1525 West Park Avenue Anaconda, MT , TTY: 711 Thrifty Drug 201 E Park St Anaconda, MT , TTY: 711 Fallon Baker Rexall Drug 103 S Main Baker, MT , TTY: 711 Seiden Drug Company Inc 310 Wendell Ave Ste 102 Lewistown, MT , TTY: 711 Shopko Pharmacy 825 NE Main St Lewistown, MT , TTY: 711 Flathead Alpine Apothecary 6475 Hwy 93 S Whitefish, MT , TTY: 711 Big Sky Iv Care 20 Four Mile Drive Ste 3 Kalispell, MT , TTY: 711 Bigfork Drug 8111 Mt Highway 35 Bigfork, MT , TTY: 711 Costco Pharmacy 2330 US Highway 93 N Kalispell, MT , TTY: 711 Fergus 117 W Janeaux St Lewistown, MT , TTY: 711

10 Evergreen Pharmacy 2141 Hwy 2 East Ste 300 Kalispell, MT , TTY: 711 Good Medicine Pharmacy th St W Columbia Falls, MT , TTY: 711 Kmart Pharmacy 2024 US Hwy 2 E Kalispell, MT , TTY: 711 Medical Arts Pharmacy 209 Conway Dr Kalispell, MT , TTY: 711 Montana Veterans Home 400 Veterans Drive Columbia Falls, MT , TTY: W Idaho Kalispell, MT , TTY: 711 Remedies Lakeside 206 Stoner Loop Lakeside, MT , TTY: 711 Rosauers Pharmacy 2150 US Hwy 93 S Kalispell, MT , TTY: 711 Safeway Pharmacy 6580 Highway 93 South Whitefish, MT , TTY: 711 Shopko Pharmacy 1370 US Highway 2 E Kalispell, MT , TTY: 711 Smiths Pharmacy 195 3rd Ave NE Kalispel, MT , TTY: 711 Smiths Pharmacy 419 Nucleus Ave Columbia Falls, MT , TTY: 711 Sykes Pharmacy 202 2nd Ave West Kalispell, MT , TTY: 711 The Clinical Pharmacy 200 Conway Drive Kallispell, MT , TTY: 711

11 Wal-Mart Pharmacy 170 Hutton Ranch Rd Kalispell, MT , TTY: 711 Lee and Dads Pharmacy 205 W Madison Ave Belgrade, MT , TTY: 711 Walgreens 40 W Idaho St Kalispell, MT , TTY: 711 Whitefish Discount Pharmacy 1111 Baker Ave Whitefish, MT , TTY: 711 Gallatin Bozeman Deaconess Pharmacy 36 Center Lane Ste 2 Big Sky, MT , TTY: 711 CVS Pharmacy 115 North 19th Avenue Bozeman, MT , TTY: 711 Costco Pharmacy 2505 Catron Street Bozeman, MT , TTY: 711 Highland Park Pharmacy 925 Highland Blvd Suite 2000 Bozeman, MT , TTY: 711 Medical Arts Pharmacy 300 N Willson No 1002 Bozeman, MT , TTY: S 23rd Bozeman, MT , TTY: Jackrabbit Ln Belgrade, MT , TTY: 711 Price Rite Drug 910 N 7th Ave Bozeman, MT , TTY: 711 Railway Drug 117 Main St. S A Three Forks, MT , TTY: 711 Rosauers Pharmacy 3255 Technology Blvd Bozeman, MT , TTY: 711

12 Safeway Pharmacy 1735 W Main St Bozeman, MT , TTY: 711 Heart Butte Pharmacy 81 Disney Heart Butte, MT , TTY: 711 Silvertip Pharmacy 120 N Canyon St Ste F West Yellowstone, MT , TTY: 711 Smiths Pharmacy 1400 N 19th Ave Bozeman, MT , TTY: W Main Cut Bank, MT , TTY: 711 Granite Granite Pharmacy 106 N. Montgomery St Philipsburg, MT , TTY: 711 Wal-Mart Pharmacy 1500 North 7th Avenue Bozeman, MT , TTY: 711 Western Drug of Bozeman 544 E Main St Bozeman, MT , TTY: 711 Glacier Blackfeet Community Health Hospi 760 Hospital Circle Browning, MT , TTY: 711 Drugmart Pharmacy 601 W Main Northern Village Mall Cut Bank, MT , TTY: 711 Hill Bullhook Community Health Center 521 4th St Havre, MT , TTY: 711 Health Mart 730 1st St Havre, MT , TTY: 711 Kmart Pharmacy 3180 Highway 2 West Havre, MT , TTY: 711 Northern Montana Pharmacy 20 W 13 St Havre, MT , TTY: 711

13 Rocky Boy Health Board Rr 1 Box Elder, MT , TTY: 711 Wal-Mart Pharmacy 3510 US Highway 2 W Havre, MT , TTY: 711 Western Drug Pharmacy 123 5th Ave Ste B Havre, MT , TTY: 711 Healthcare Plus 1 7th Ave East #D Polson, MT , TTY: 711 Healthcare Plus One 7th Ave E Suite C Polson, MT , TTY: 711 Mission Drug 110 N Main St Ignatius, MT , TTY: 711 Jefferson Elkhorn Pharmacy Inc 215 N Main Boulder, MT , TTY: 711 Whitehall Drug 203 W. Legion Ave. Whitehall, MT , TTY: 711 Providence Lakeshore Pharmacy 50331A US-93 Polson, MT , TTY: 711 R and R Health Care Solutions US Highway 93 Ste B Ronan, MT , TTY: 711 Lake Cs and K Tribes-Flathead Reserva 308 Mission Drive St Ignatius, MT , TTY: 711 Family Health Pharmacy US Hwy 935 Ronan, MT , TTY: 711 Safeway Pharmacy Mt Highway 35 Polson, MT , TTY: 711 St Joseph Pharmacy 6 13th Ave E Polson, MT , TTY: 711

14 Wal-Mart Pharmacy Memory Ln Polson, MT , TTY: 711 Kmart Pharmacy 1700 Cedar Street Helena, MT , TTY: 711 Walgreens Mt Highway 35 Polson, MT , TTY: N Montana Helena, MT , TTY: 711 Lewis And Clark Bergum Drugs 2600 Winne Ave Suite A Helena, MT , TTY: 711 CVS Pharmacy 526 Euclid Helena, MT , TTY: 711 CVS Pharmacy 603 N Montana Helena, MT , TTY: 711 CVS Pharmacy 3095 N Montana Ave Helena, MT , TTY: 711 Costco Pharmacy 2195 E Custer Ave Helena, MT , TTY: 711 Safeway Pharmacy 611 N Montana Ave Helena, MT , TTY: 711 Shopko Pharmacy 3101 N Montana Ave Helena, MT , TTY: 711 South Hills Pharmacy 2600 Winne Ave Suite F Helena, MT , TTY: 711 St Peter Community Pharmacy 2475 Broadway Helena, MT , TTY: 711 St Peters Pharmacy-Broadway 2550 Broadway Helena, MT , TTY: 711

15 Wal-Mart Pharmacy 2750 Prospect Avenue Helena, MT , TTY: 711 Rosauers Pharmacy 703 W 9th St Libby, MT , TTY: 711 Walgreens th Ave Helena, MT , TTY: 711 Liberty Chester Pharmacy Inc. 30 Main Street Chester, MT , TTY: 711 Madison Ennis Healthmart Pharmacy 124 Main St Ennis, MT , TTY: 711 Mac's Chc Pharmacy 317 Madison St Sheridan, MT , TTY: 711 Remedies Pharmacy & Gift 500 East Washington Ave. Chester, MT , TTY: 711 Lincoln Eureka Drug 546 US Highway 93 N Eureka, MT , TTY: 711 Granite Pharmacy Libby 1401 Minnesota Ave Libby, MT , TTY: 711 Kootenai Drug 611 E Missoula Ave Troy, MT , TTY: 711 Meagher Castle Mountain Drug 4271 US Highway 12 E White Sulphur Spring, MT , TTY: 711 Mineral Mineral Pharmacy Inc 207 River St Superior, MT , TTY: 711 Missoula Broadway Pharmacy 500 W Broadway Missoula, MT , TTY: 711

16 CVS Pharmacy 1902 Brooks St Missoula, MT , TTY: 711 Missoula Fresh Market Pharmacy 800 West Broadway St Missoula, MT , TTY: 711 Community Rx 2835 Fort Missoula Rd Missoula, MT , TTY: 711 Missoula Fresh Market Pharmacy 3801 S Reserve Street Missoula, MT , TTY: 711 Costco Pharmacy 3220 Northern Pacific Avenue Missoula, MT , TTY: 711 Granite Pharmacy Frenchtown Beckwith St Frenchtown, MT , TTY: 711 Granite Pharmacy Health Solution th Ave Ste 1 Missoula, MT , TTY: 711 Granite Pharmacy Missoula th Ave Ste 2 Missoula, MT , TTY: 711 Lolo Drug LLC 103 Glacier Drive Lolo, MT , TTY: 711 Missoula Pharmacy 1211 S Reserve St Ste 102 Missoula, MT , TTY: Oxford St Missoula, MT , TTY: N Reserve St Missoula, MT , TTY: Russell St Missoula, MT , TTY: E Broadway St Missoula, MT , TTY: 711

17 Palmers Drug 918 SW Higgins Ave Missoula, MT , TTY: 711 Village Health Care Center 2651 South Ave W Missoula, MT , TTY: 711 Pinnacle Compounding 1120 Kensington Ave Ste E Missoula, MT , TTY: 711 Wal-Mart Pharmacy 4000 Brooks St Missoula, MT , TTY: 711 Rosauers Pharmacy 2350 Reserve St Missoula, MT , TTY: 711 Wal-Mart Pharmacy 3555 Mullan Road Missoula, MT , TTY: 711 Savmor Drug 1610 S 3rd St W Suite 100 Missoula, MT , TTY: 711 Seeley Swan Pharmacy 3027 Hwy 83 Lazy Pine Mall Ste J Seeley Lake, MT , TTY: 711 Shopko Pharmacy 2510 S Reserve St Missoula, MT , TTY: 711 Target Pharmacy 2420 N Reserve St Missoula, MT , TTY: 711 Walgreens 2527 N Reserve St Missoula, MT , TTY: 711 Walgreens 2100 Brooks St Missoula, MT , TTY: 711 Musselshell Shopko Pharmacy 148 Main St Roundup, MT , TTY: 711 Park Gardiner Pharmacy 208 Park St Gardiner, MT , TTY: 711

18 Kc Western Drug Long Term Care 1313 W Park Street Ste B Livingston, MT , TTY: 711 Pondera Olson's Drug 5 4th Ave SE Conrad, MT , TTY: Park St S Livingston, MT , TTY: 711 Shopko Pharmacy 100 Washington St Livingston, MT , TTY: 711 Western Drug of Livingston 1313 W Park Street Livingston, MT , TTY: 711 Western Drug, Too 508 Miles Clyde Park, MT , TTY: 711 Phillips Valley Drug Company of Malta Inc 131 S 1st Ave E Malta, MT , TTY: 711 Village Drug 600 S Main St Suite 2 Conrad, MT , TTY: 711 Powder River Broadus Iga Pharmacy 120 S Park Broadus, MT , TTY: 711 Powell Keystone Drug Llp 407 Main St Deer Lodge, MT , TTY: 711 Safeway Pharmacy 201 N Main St Deer Lodge, MT , TTY: 711 Ravalli Bitterroot Drug Inc 211 Main St Hamilton, MT , TTY: 711

19 Corvallis Drug 1029 Main St Corvallis, MT , TTY: 711 North Ridge Healthcare 2824 Hwy 93 N. Suite B Victor, MT , TTY: 711 Family Pharmacy Inc 3804 Eastside Hwy Stevensville, MT , TTY: N First St Hamilton, MT , TTY: 711 Florence Pharmacy 5549 Old US Highway 93 Florence, MT , TTY: 711 Ridgeway Pharmacy 39 Stevensville Cutoff Rd W Stevensville, MT , TTY: 711 Hamilton Pharmacy 135 Main St Hamilton, MT , TTY: 711 Timber Ridge Pharmacy 1131 N 1st St Hamilton, MT , TTY: 711 Healthcare Providers 1900 N First St Hamilton, MT , TTY: 711 Valley Drug 301 Main St Stevensville, MT , TTY: 711 Healthcare Providers-LTC 1900 N 1st St Ste B Hamilton, MT , TTY: 711 Walgreens 901 N 1st Street Hamilton, MT , TTY: 711 Kmart Pharmacy 1235 N First St Hamilton, MT , TTY: 711 Richland Shopko Pharmacy 1159 S Central Ave Sidney, MT , TTY: 711

20 White Drug 402 East Main Sidney, MT , TTY: 711 Lame Deer Health Center Pharmacy 100 Cheyenne Ave Lame Deer, MT , TTY: 711 Roosevelt Culbertson Pharmacy Inc 115 Broadway Culbertson, MT , TTY: 711 Poplar Health Center Pharmacy 107 H St E Poplar, MT , TTY: 711 Yellowstone Pharmacy 1025 Main St Forsyth, MT , TTY: 711 Sanders Dougs Drug 1221 Main St Thompson Falls, MT , TTY: 711 Poplar Pharmacy 213 H St East Poplar, MT , TTY: 711 Plains Drug 214 Railroad St Plains, MT , TTY: 711 Wolf Point Pharmacy th Ave North Wolf Point, MT , TTY: 711 Wolf Point Health Center Pharmac 550 6th Ave N Wolf Point, MT , TTY: 711 Rosebud Colstrip Family Pharmacy 6230 Main St Ste B101 Colstrip, MT , TTY: 711 Sheridan Plentywood Drug Inc 119 N Main St Plentywood, MT , TTY: 711 Silver Bow CVS Pharmacy 1275 Harrison St Butte, MT , TTY: 711 Community Health Center Pharmacy 1145 S Montana St Butte, MT , TTY: 711

21 Driscoll Drug 327 S Excelsior Butte, MT , TTY: 711 Kmart Pharmacy 3300 Harrison Avenue Butte, MT , TTY: 711 Medical Arts Pharmacy 435 S Crystal St Ste 230 Butte, MT , TTY: 711 Safeway Pharmacy 2500 Massachusetts Ave Butte, MT , TTY: 711 Three Bears Pharmacy 45 Three Bears Dr Butte, MT , TTY: 711 Wal-Mart Pharmacy 3901 Harrison Avenue Butte, MT , TTY: 711 Walgreens 2611 Harrison Ave Butte, MT , TTY: 711 Stillwater Stillwater Family Pharmacy 133 N 5th Columbus, MT , TTY: 711 Sweet Grass Cole Drug 136 Mcleod Big Timber, MT , TTY: 711 Teton Choteau Drug 102 Main Ave Choteau, MT , TTY: 711 Fairfield Drug Inc 407 Central Ave Fairfield, MT , TTY: 711 Toole Northtown Drugs 333 Main St Shelby, MT , TTY: 711 Shopko Pharmacy 1950 Roosevelt Hwy Shelby, MT , TTY: 711

22 Valley Fifth Ave Phcy and Gift 621 3rd St S Glasgow, MT , TTY: 711 Shopko Pharmacy 804 US Highway 2 W Glasgow, MT , TTY: 711 Western Drug 537 2nd Ave S Glasgow, MT , TTY: 711 Wheatland Remedies 100 N Central Avenue Harlowton, MT , TTY: 711 Yellowstone Billings Clinic Aspen Meadows 3155 Ave C , TTY: 711 Billings Clinic atrium Pharmacy th Ave N Billings, MT , TTY: 711 Billings Health & Rehabilitation 2115 Central Ave , TTY: 711 CVS Pharmacy 2402 Grand Ave , TTY: 711 CVS Pharmacy 1311 Grand Avenue , TTY: 711 CVS Pharmacy 425 Main Street Billings, MT , TTY: 711 CVS Pharmacy 307 SE 4th Laurel, MT , TTY: 711 CVS Pharmacy 823 North 27th Street Billings, MT , TTY: 711 CVS Pharmacy 617 Central Ave , TTY: 711

23 Costco Pharmacy 2290 King Ave W , TTY: Grand Ave , TTY: 711 Ctr For Healthy Aging Phcy 3940 Rimrock Rd , TTY: N 27th St Billings, MT , TTY: 711 First Pharmacy th St W , TTY: Central , TTY: 711 Genes Pharmacy 111 E Main St Laurel, MT , TTY: Main St Billings, MT , TTY: 711 Juros United Drugs 2043 Grand Ave , TTY: Central Ave , TTY: 711 Kmart Pharmacy 2424 Central Ave , TTY: Grand Ave , TTY: 711 Omnicare of Billings 2747 Enterprise Ave Ste , TTY: 711 Pharmacy th Ave N Billings, MT , TTY: 711

24 Pharmacy LTC th Ave N Ste 110B Billings, MT , TTY: 711 Riverstonehealth Pharmacy 123 S 27th St Ste E Billings, MT , TTY: 711 Sams Pharmacy 4420 King Ave E Billings, MT , TTY: 711 Shopko Pharmacy 905 S 24th St W , TTY: 711 St Johns Pharmacy 3940 Rimrock Rd , TTY: 711 St Vincents Healthcare 1233 N 30th St Billings, MT , TTY: 711 Target Pharmacy 2601 Central Ave , TTY: 711 Wal-Mart Pharmacy 2525 King Ave West , TTY: 711 Wal-Mart Pharmacy 1649 Main Street Billings, MT , TTY: 711 Walgreens 1602 Main St Billings, MT , TTY: 711 Walgreens 3333 Grand Ave , TTY: 711 Walgreens 1330 Grand Ave , TTY: 711 Walmart Pharmacy 101 Bernhardt Rd Laurel, MT , TTY: 711

25 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 Walgreens Mail Service P.O. Box 2975 P.O. Box Mission, KS Phoenix, AZ Toll-free Toll-free TTY 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. Flathead Big Sky Iv Care 20 Four Mile Drive Ste 3 Kalispell, MT Gallatin Option Care 2304 N 7th Ave Ste H Bozeman, MT Missoula Partners Solutions 2687 Palmer St Ste B Missoula, MT Silver Bow Option Care 401 S Alabama St Ste 1 Butte, MT

26 Home infusion pharmacies near you (continued) Yellowstone Option Care 404 N 31st St Ste 401 Billings, MT Long-term care pharmacies near you Residents of a long-term care facility may get their covered prescription drugs from their facility s long-term 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. Big Horn Pharmcare of Hardin Inc 901 N Center Ave Hardin, MT Blaine Chinook Pharmacy 300 Indiana St Chinook, MT Broadwater Townsend Drug 308 Broadway Townsend, MT Cascade Afp Rx th St Ste101a Great Falls, MT Benefis Ambulatory Pharmacy th Ave S Ste 2 Greatfalls, MT Pharmerica 625 Central Ave West Suite 105 Great Falls, MT Chouteau Benton Pharmacy 1418 Front St Fort Benton, MT Big Sandy Pharmacy 158 Johannes Ave Big Sandy, MT

27 Long-term care pharmacies near you (continued) Custer Holy Rosary Health Center 2600 Wilson Miles City, MT Dawson F & G Pharmacy 107 N Merrill Ave Glendive, MT Gabert Clinic Pharmacy 107 Dilworth Glendive, MT Deer Lodge Montana State Hospital Pharmacy 58 Garnet Way Warm Springs, MT Fergus Mt Mental Health Cntr 800 Casino Creek Dr Lewistown, MT Flathead Bigfork Drug 8111 Mt Highway 35 Bigfork, MT Montana Veterans Home 400 Veterans Drive Columbia Falls, MT Sykes Pharmacy 202 2nd Ave West Kalispell, MT The Clinical Pharmacy 200 Conway Drive Kallispell, MT Gallatin Highland Park Pharmacy 925 Highland Blvd Suite 2000 Bozeman, MT Price Rite Drug 910 N 7th Ave Bozeman, MT Lake Family Health Pharmacy US Hwy 935 Ronan, MT

28 Long-term care pharmacies near you (continued) Healthcare Plus 1 7th Ave East #D Polson, MT Healthcare Plus One 7th Ave E Suite C Polson, MT R and R Health Care Solutions US Highway 93 Ste B Ronan, MT St Joseph Pharmacy 6 13th Ave E Polson, MT Lewis And Clark South Hills Pharmacy 2600 Winne Ave Suite F Helena, MT Liberty Chester Pharmacy Inc. 30 Main Street Chester, MT Madison Ennis Healthmart Pharmacy 124 Main St Ennis, MT Mac's Chc Pharmacy 317 Madison St Sheridan, MT Meagher Castle Mountain Drug 4271 US Highway 12 E White Sulphur Spring, MT Missoula Granite Pharmacy Health Solution th Ave Ste 1 Missoula, MT Village Health Care Center 2651 South Ave W Missoula, MT Park Kc Western Drug Long Term Care 1313 W Park Street Ste B Livingston, MT

29 Long-term care pharmacies near you (continued) Phillips Valley Drug Company of Malta Inc 131 S 1st Ave E Malta, MT Pondera Olson's Drug 5 4th Ave SE Conrad, MT Village Drug 600 S Main St Suite 2 Conrad, MT Powell Keystone Drug Llp 407 Main St Deer Lodge, MT Ravalli Bitterroot Drug Inc 211 Main St Hamilton, MT Corvallis Drug 1029 Main St Corvallis, MT Healthcare Providers-LTC 1900 N 1st St Ste B Hamilton, MT North Ridge Healthcare 2824 Hwy 93 N. Suite B Victor, MT Valley Drug 301 Main St Stevensville, MT Richland White Drug 402 East Main Sidney, MT Roosevelt Poplar Pharmacy 213 H St East Poplar, MT Wolf Point Pharmacy th Ave North Wolf Point, MT

30 Long-term care pharmacies near you (continued) Rosebud Yellowstone Pharmacy 1025 Main St Forsyth, MT Yellowstone Billings Clinic Aspen Meadows 3155 Ave C Sheridan Plentywood Drug Inc 119 N Main St Plentywood, MT Silver Bow Medical Arts Pharmacy 435 S Crystal St Ste 230 Butte, MT Toole Northtown Drugs 333 Main St Shelby, MT Valley Fifth Ave Phcy and Gift 621 3rd St S Glasgow, MT Billings Health & Rehabilitation 2115 Central Ave Omnicare of Billings 2747 Enterprise Ave Ste Pharmacy th Ave N Billings, MT Pharmacy LTC th Ave N Ste 110B Billings, MT St Johns Pharmacy 3940 Rimrock Rd Western Drug 537 2nd Ave S Glasgow, MT

31 Indian health service/tribal/urban Indian health program (I/T/U) pharmacies near you Only Native Americans and Alaska Natives can use I/T/U pharmacies in the Plan s pharmacy network. Other people may be able to use these pharmacies under limited circumstances (for example, emergencies). For more information, please see your Evidence of Coverage. Below are some of the I/T/U network pharmacies in your area. Big Horn Crow Indian Hospital Pharmacy 212 Hwy And I 90 Crow Agency, MT Glacier Blackfeet Community Health Hospi 760 Hospital Circle Browning, MT Lodge Grass Health Center Pharma Harding Ave Lodge Grass, MT Heart Butte Pharmacy 81 Disney Heart Butte, MT Pryor Health Station Pharmacy Pryor Gap Rd Pryor, MT Blaine Fort Belknap Health Center Pharm 456 Gros Ventre Ave Harlem, MT Hill Rocky Boy Health Board Rr 1 Box Elder, MT Lake Cs and K Tribes-Flathead Reserva 308 Mission Drive St Ignatius, MT Hays Health Center Pharmacy 123 White Crow Rd Hays, MT Roosevelt Poplar Health Center Pharmacy 107 H St E Poplar, MT

32 Indian health service/tribal/urban Indian health program (I/T/U) pharmacies near you (continued) Wolf Point Health Center Pharmac 550 6th Ave N Wolf Point, MT Rosebud Lame Deer Health Center Pharmacy 100 Cheyenne Ave Lame Deer, MT

33 This directory is a partial list of pharmacies available in the plan s pharmacy network. For more information, please call Customer Service at: Toll-Free , TTY a.m. to 8 p.m. local time, Monday through Friday 1 Other pharmacies are available in our network. Members may use any pharmacy in the network, but may not receive Pharmacy Saver pricing. Pharmacies participating in the Pharmacy Saver program may not be available in all areas. 2 Your plan sponsor may provide coverage beyond 90 days. Please refer to the Evidence of Coverage for more information. This information is available for free in other languages. Please call Customer Service number listed above. Esta información está disponible sin costo en otros idiomas. Comuníquese con el Servicio al Cliente al número indicado arriba. Other pharmacies are available in our network. The pharmacy network may change at any time. You will receive notice when necessary. OptumRx is an affiliate of UnitedHealthcare Insurance Company. Beneficiaries must use network pharmacies to access their prescription drug benefit. Formulary, pharmacy network, premium and/or co-payments/coinsurance may change each year. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan s contract renewal with Medicare. UHEX16PD _000 MT Last updated September 18, 2015

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