Blue Cross Medicare Advantage (PPO) SM. Pharmacy Directory

Transcription

1 Blue Cross Medicare Advantage (PPO) SM Pharmacy Directory For more information, please contact Blue Cross Medicare Advantage SM Customer Service, at or, for TTY/TDD users, 711, 8 a.m.- 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voic ) will be used on weekends and holidays, or visit mybluemapd.com. This Pharmacy Directory was updated on 01/01/2014. H0107_BEN_TMP_MAPHAR14 Accepted

2 Blue Cross Medicare Advantage Pharmacy Directory Introduction This booklet provides a list of Blue Cross Medicare Advantage s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Blue Cross Medicare Advantage s formulary. When this pharmacy directory refers to we, us, or our, it means Blue Cross and Blue Shield of Montana. When it refers to plan or our plan, it means Blue Cross Medicare Advantage. We call the pharmacies on this list our network pharmacies because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under Blue Cross Medicare Advantage only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. 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 here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of January For the most current list, please contact us. Our contact information appears on the front and back cover pages. You can go to all the pharmacies on this list, but your costs may be less at certain pharmacies in this list, which we have marked with PR. We call these pharmacies preferred pharmacies, and they may offer lower costsharing than other pharmacies. You will still have access to lower drug prices at non-preferred pharmacies than out-of-network pharmacies. You may go to either of these types of pharmacies to receive your covered prescription drugs. This directory is for Montana. If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact Blue Cross Medicare Advantage. This information is available for free in other languages. Please call our Customer Service number at (TTY/TDD users should call 711). We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voic ) will be used on the weekends and holidays. Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro número de Servicio al cliente al (los usuarios de TTY/TDD deben llamar al 711). Nuestro horario es de 8 a.m. a 8 p.m., hora local, los 7 días de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías alternas (por ejemplo, correo de voz).

3 KEY R = Retail. We have a nationwide network of pharmacies where you can get covered prescription drugs as a member of our plan. PR = Preferred Retail. Preferred network of pharmacies agreeing to fill 31-day and up to 90-day prescriptions at a preferred rate. EXT = Extended Supply. Extended supply pharmacies offer extended (90-day) supplies. LT = Long-term care pharmacies are pharmacies that service long-term care nursing facilities. Residents of a long-term care facility may access their prescription drugs covered under Blue Cross Medicare Advantage through the facility s long-term care pharmacy or another network long-term care pharmacy. For more information contact customer service at H = Home Infusion. Pharmacies that provide infused (IV) medicine in your home per doctor s order. For more information contact customer service at IN = Indian Health Service/Tribal/Urban Health Program (I/T/U) Pharmacies. Only Native Americans and Alaska Natives have access to Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) Pharmacies through Blue Cross Medicare Advantage s pharmacy network. Those other than Native Americans and Alaskan Natives may be able to access these pharmacies under limited circumstances (e.g., emergencies). For more information contact customer service at The key is also listed at the bottom of each Pharmacy Directory page for your reference.

4 BEAVERHEAD DILLON DILLON CROW AGENCY CROW AGENCY HARDIN HARDIN LODGE GRASS LODGE GRASS PRYOR PRYOR CHINOOK CHINOOK HARLEM HARLEM MONTANA PHARMACY LISTING MAIL ORDER Prim ...(888) (TTY Users 711), 24 hours a day, seven days a week. Or visit BEAVERHEAD Safeway...(406) N Montana St Shopko Pharmacy...(406) E Glendale St 59725, LT Vans Pharmacy...(406) Southside Blvd BIG HORN BIG HORN Crow Indian Hospital Pharmacy...(406) Hwy and I Pharmcare Pharmacy...(406) N Center Ave Lodge Grass Health Center Pharmacy...(406) Harding Ave Pryor Health Station Pharmacy...(406) Pryor Gap Rd BLAINE BLAINE Chinook Pharmacy...(406) Indiana St Fort Belknap Health Center Pharmacy...(406) Gros Ventre Ave CASCADE Milk River Pharmacy...(406) US Hwy HAYS HAYS Hays Health Center Pharmacy...(406) White Crow Rd BROADWATER BROADWATER TOWNSEND TOWNSEND Townsend Drug...(406) Broadway St 59644, PR CARBON CARBON RED LODGE RED LODGE Red Lodge Drug...(406) N Broadway Ave 59068, PR CASCADE CASCADE GREAT FALLS GREAT FALLS AFP RX...(406) th St S Ste 101A Anderson Family...(406) th St S Ste , LT Clinic Pharmacy...(406) th St S CVS Pharmacy...(406) th Ave S Kmart Pharmacy...(406) rd St NW Osco Pharmacy...(406) rd St NW Osco Pharmacy...(406) th Ave S Pharmerica...(406) Central Ave W Ste Pharmacy Type: LT Plaza United Pharmacy...(406) th Ave S Public Drug Co...(406) Central Ave 59401, LT 1

5 CASCADE CASCADE MONTANA PHARMACY LISTING FLATHEAD CASCADE (cont.) Sam s Club Pharmacy...(406) Northwest Byp Shopko Pharmacy...(406) Northwest Byp 59404, LT Smiths Pharmacy...(406) Market Pl Dr Snyder Drugs...(406) th Ave N Spectrum Pharmacy...(406) th Ave S Ste , H Spectrums Home Solutions...(406) th Ave S Pharmacy Type: H Walgreens...(406) rd St NW Walgreens...(406) th Ave S Walmart Pharmacy...(406) Smelter Ave NE CHOUTEAU CHOUTEAU BIG SANDY BIG SANDY Big Sandy Pharmacy...(406) Johannes Ave 59520, LT FORT BENTON FORT BENTON Benton Pharmacy...(406) Front St DEER LODGE DEER LODGE ANACONDA ANACONDA Community Hosp Anaconda Pharmacy...(406) Pennsylvania CVS Pharmacy...(406) E Park Ave Safeway...(406) W Park Ave Thrifty Drug...(406) E Park Ave WARM SPRINGS WARM SPRINGS Montana State Hospital Pharmacy...(406) Garnet Way 59756, LT FERGUS FERGUS LEWISTOWN LEWISTOWN Central Montana Med...(406) Wendell Ave Pharmacy Type: LT Mt Mental Health Ctr...(406) Casino Creek Dr Osco Pharmacy...(406) W Janeaux St Seiden Drug Company Inc...(406) Wendell Ave Ste Shopko Pharmacy...(406) NE Main St 59457, LT FLATHEAD BIGFORK BIGFORK COLUMBIA FALLS COLUMBIA FALLS KALISPEL KALISPEL KALISPELL KALISPELL FLATHEAD Bigfork Drug...(406) Mt Hwy , PR, LT Good Medicine Pharmacy...(406) th St W Montana Veterans Home...(406) Veterans Dr Smiths Pharmacy...(406) Nucleus Ave Smiths Pharmacy...(406) rd Ave NE Big Sky IV Care...(406) Four Mile Dr Ste Pharmacy Type: H 2

6 FLATHEAD FLATHEAD MONTANA PHARMACY LISTING GALLATIN Walgreens...(406) E 13th St Whitefish Discount Pharmacy...(406) Baker Ave 59937, LT FLATHEAD (cont.) Costco Pharmacy...(406) US Hwy 93 N Evergreen Pharmacy...(406) US Hwy 2 E Ste Glacier Ridge Pharmacy...(406) st Ave East N Kalispell Regional...(406) Sunnyview Ln Pharmacy Type: LT Kmart Pharmacy...(406) US Hwy 2 E Medical Arts Pharmacy...(406) Conway Dr Osco Pharmacy...(406) W Idaho St Rosauers Pharmacy...(406) US Hwy 93 S Shopko Pharmacy...(406) US Hwy 2 E 59901, LT Sykes Pharmacy...(406) nd Ave W 59901, LT The Clinical Pharmacy...(406) Conway Dr 59901, LT, H Walgreens...(406) W Idaho St Walmart Pharmacy...(406) Hutton Ranch Rd LAKESIDE LAKESIDE Remedies Lakeside...(406) US Hwy 93 S Unit A WHITEFISH WHITEFISH Alpine Ridge Pharmacy...(406) US Hwy 93 S Safeway...(406) US Hwy 93 S GALLATIN BELGRADE BELGRADE BIG SKY BIG SKY BOZEMAN BOZEMAN GALLATIN Lee & Dads Pharmacy...(406) W Madison Ave Osco Pharmacy...(406) Jackrabbit Ln Bozeman Deaconess Pharmacy...(406) Center Ln Ste , PR Costco Pharmacy...(406) Catron St CVS Pharmacy...(406) N 19th Ave Highland Park Pharmacy...(406) Highland Blvd Ste Kmart Pharmacy...(406) N 7th Ave Medical Arts Pharmacy...(406) N Willson Ave No MSU Student Health Service...(406) MSU Student Health Service RX 7th and Grant Osco Pharmacy...(406) S 23rd Ave Price Rite Drug...(406) N 7th Ave 59715, LT Rosauers Pharmacy...(406) Technology Blvd W Safeway...(406) W Main St

7 GALLATIN GALLATIN MONTANA PHARMACY LISTING LAKE GALLATIN (cont.) Smiths Pharmacy...(406) N 19th Ave Walgreens Infusion Services...(406) N 7th Ave Ste H Pharmacy Type: H Walmart Pharmacy...(406) N 7th Ave THREE FORKS THREE FORKS Railway Drug...(406) Main St Ste A 59752, PR, LT WEST YELLOWSTONE WEST YELLOWSTONE Silvertip Pharmacy...(406) N Canyon St Ste F 59758, PR GLACIER GLACIER BROWNING BROWNING Blackfeet Community Health Hospital Pharmacy...(406) Hospital Circle CUT BANK CUT BANK Drugmart Pharmacy...(406) W Main St Northern Villag Osco Pharmacy...(406) W Main St HEART BUTTE HEART BUTTE Heart Butte Pharmacy...(406) Disney St GRANITE GRANITE PHILIPSBURG PHILIPSBURG Granite Cnty Med Hosp Pharmacy...(406) Sansome St Granite Pharmacy...(406) N Montgomery St 59858, LT HILL BOULDER BOULDER WHITEHALL WHITEHALL POLSON POLSON HILL BOX ELDER BOX ELDER Rocky Boy Health Board...(406) RR HAVRE HAVRE Health Mart...(406) st St Kmart Pharmacy...(406) US Hwy 2 W Northern Montana Hospital...(406) th St Pharmacy Type: LT Northern Montana Pharmacy...(406) th St W Walmart Pharmacy...(406) US Hwy 2 W Western Drug Pharmacy...(406) th Ave Ste B JEFFERSON JEFFERSON Elkhorn Pharmacy Inc...(406) N Main 59632, PR Whitehall Drug...(406) W Legion St LAKE LAKE Healthcare Plus...(406) US Hwy 93 Ste A Healthcare Plus...(406) th Ave E Ste C Safeway...(406) S Shore Rte St Joseph Pharmacy...(406) th Ave E

8 LAKE LAKE MONTANA PHARMACY LISTING MADISON LAKE (cont.) St Peter Community Pharmacy...(406) E Broadway St Walmart Pharmacy...(406) Memory Ln St Peters Pharmacy-Broadway...(406) E Broadway St RONAN RONAN Family Health Pharmacy...(406) Walgreens...(406) US Hwy th Ave R & R Health Care Solutions...(406) Walmart Pharmacy...(406) US Hwy 93 Ste B 2750 Prospect Ave , LT LIBERTY SAINT IGNATIUS SAINT IGNATIUS CS & K Tribes-Flathead Reserv...(406) Mission Dr Mission Drug...(406) N Main St LEWIS AND CLARK LEWIS AND CLARK HELENA HELENA Bergum Drug...(406) Winne Ave Costco Pharmacy...(406) E Custer Ave CVS Pharmacy...(406) Euclid Ave CVS Pharmacy...(406) N Montana Ave CVS Pharmacy...(406) N Montana Ave Kmart Pharmacy...(406) Cedar St Osco Pharmacy...(406) N Montana Ave Safeway...(406) N Montana Ave Shopko Pharmacy...(406) N Montana Ave 59602, LT South Hills Pharmacy Inc...(406) Winne Ave CHESTER CHESTER LINCOLN EUREKA EUREKA LIBBY LIBBY TROY TROY ENNIS ENNIS SHERIDAN SHERIDAN LIBERTY Chester Pharmacy Inc...(406) Main St 59522, LT Remedies Pharmacy & Gift...(406) East Washington Ave 59522, PR, LT LINCOLN Eureka Drug...(406) US Hwy 93 N 59917, PR, LT Granite Pharmacy Libby...(406) Minnesota Ave Rosauers Pharmacy...(406) W 9th St Kootenai Drug...(406) E Missoula Ave 59935, PR MADISON MADISON Ennis Healthmart Pharmacy...(406) Main St Mac s CHC Pharmacy...(406) Madison St 59749, LT 5

9 MEAGHER MEAGHER MONTANA PHARMACY LISTING MISSOULA WHITE SULPHUR SPRINGS WHITE SULPHUR SPRINGS SUPERIOR SUPERIOR FRENCHTOWN FRENCHTOWN LOLO LOLO MISSOULA MISSOULA MEAGHER Castle Mountain Drug...(406) E Main St 59645, LT MINERAL MINERAL Mineral Pharmacy Inc...(406) River St MISSOULA MISSOULA Granite Pharmacy Frenchtown...(406) Beckwith St 59834, LT Lolo Drug LLC...(406) Glacier Dr Broadway Pharmacy...(406) W Broadway St Community RX...(406) Fort Missoula Rd Costco Pharmacy...(406) Northern Pacific St CVS Pharmacy...(406) Brooks St Granite Pharmacy Health Solutio...(406) th Ave Ste Granite Pharmacy Missoula...(406) th Ave Ste , PR Health Service Pharmacy University of Montana...(406) Eddy Ave Missoula Pharmacy...(406) S Reserve St Ste Osco Pharmacy...(406) Oxford St Osco Pharmacy...(406) N Reserve St Osco Pharmacy...(406) S Russell St Osco Pharmacy...(406) E Broadway St Palmers Drug...(406) SW Higgins Ave Partners Solutions...(406) Palmer St Ste B Pharmacy Type: H Partnership Health Center Pharmacy..(406) Railroad St W Rosauers Pharmacy...(406) S Reserve St Safeway...(406) W Broadway St Safeway...(406) S Reserve St Savmor...(406) S 3rd St W Ste Shopko Pharmacy...(406) S Reserve St 59801, LT Target Pharmacy...(406) N Reserve St Village Health Care Center...(406) South Ave W Walgreens...(406) N Reserve St Walgreens...(406) Brooks St Walmart Pharmacy...(406) Brooks St

10 MISSOULA MISSOULA MONTANA PHARMACY LISTING RAVALLI MISSOULA (cont.) Walmart Pharmacy...(406) Mullan Rd SEELEY LAKE SEELEY LAKE Seeley Swan Pharmacy...(406) Hwy 83 N Lazy Pine Mall MUSSELSHELL MUSSELSHELL ROUNDUP ROUNDUP Shopko Pharmacy...(406) Main St 59072, LT PARK PARK CLYDE PARK CLYDE PARK Western Drug Too...(406) Miles 59018, PR GARDINER GARDINER Gardiner Pharmacy...(406) Park St LIVINGSTON LIVINGSTON Kc Western Drug Long Term Care...(406) W Park St Ste B Osco Pharmacy...(406) Park St S Shopko Pharmacy...(406) Washington St 59047, LT Western Drug of Livingston...(406) W Park St PONDERA PONDERA CONRAD CONRAD Olsons Drug...(406) th Ave SE 59425, LT Village Drug...(406) S Main St Ste POWELL DEER LODGE DEER LODGE RAVALLI CORVALLIS CORVALLIS FLORENCE FLORENCE HAMILTON HAMILTON STEVENSVILLE STEVENSVILLE POWELL Keystone Drug LLP...(406) Main St Safeway...(406) N Main St RAVALLI Corvallis Drug...(406) Main St 59828, LT Florence Pharmacy...(406) Old US Hwy Bitterroot Drug Inc...(406) W Main St 59840, LT, H Hamilton Pharmacy...(406) W Main St Healthcare Providers...(406) N 1st St Kmart Pharmacy...(406) N 1st St Osco Pharmacy...(406) N 1st St Timber Ridge Pharmacy...(406) N 1st St 59840, LT, H Walgreens...(406) N 1st St Family Pharmacy Inc...(406) Eastside Hwy Ridgeway Pharmacy...(406) Stevensville Cutoff Rd 59870, LT 7

11 RAVALLI RAVALLI MONTANA PHARMACY LISTING YELLOWSTONE RAVALLI (cont.) Valley Drug...(406) Main St VICTOR VICTOR North Ridge Healthcare...(406) US Hwy 93 N Ste B Ridgeway Pharmacy Ltd...(406) US Hwy 93 N SANDERS SANDERS PLAINS PLAINS Plains Drug...(406) Railroad St 59859, PR THOMPSON FA THOMPSON FA Dougs Drug...(406) Main St SILVER BOW SILVER BOW BUTTE BUTTE Community Health Center Pharmacy...(406) S Montana St CVS Pharmacy...(406) Harrison Ave Driscoll Drug...(406) S Excelsior Ave Kmart Pharmacy...(406) Harrison Ave Medical Arts Pharmacy...(406) S Crystal St Ste Safeway...(406) Massachusetts Ave Three Bears Pharmacy...(406) Three Bears Dr 59701, LT Walgreens...(406) Harrison Ave Walgreens Infusion Services...(406) W Platinum St Ste D Pharmacy Type: H Walmart Pharmacy...(406) Harrison Ave STILLWATER STILLWATER COLUMBUS COLUMBUS Columbus Health Mart...(406) N 5th 59019, PR SWEET GRASS SWEET GRASS BIG TIMBER BIG TIMBER Cole Drug...(406) McLeod St 59011, PR TETON TETON CHOTEAU CHOTEAU Choteau Drug...(406) Main Ave N 59422, PR, LT FAIRFIELD FAIRFIELD Fairfield Drug Inc...(406) Central Ave 59436, PR TOOLE TOOLE SHELBY SHELBY Northtown Drugs...(406) Main St 59474, LT Shopko Pharmacy...(406) W Roosevelt Hwy 59474, LT TREASURE FORSYTH FORSYTH HARLOWTON HARLOWTON BILLINGS BILLINGS TREASURE Yellowstone Pharmacy...(406) Main St 59327, PR, LT WHEATLAND WHEATLAND Remedies Pharmacy & Hardware...(406) N Central Ave 59036, PR, LT YELLOWSTONE YELLOWSTONE Billings Clinic Atrium Pharmacy...(406) th Ave N

12 YELLOWSTONE YELLOWSTONE MONTANA PHARMACY LISTING YELLOWSTONE YELLOWSTONE (cont.) Osco Pharmacy...(406) Central Ave Billings Health & Rehab Commu...(406) Central Ave Osco Pharmacy...(406) Grand Ave Costco Pharmacy...(406) King Ave W Pharmacy 1...(406) th Ave N Ctr For Healthy Aging Pharmacy...(406) Rimrock Rd Pharmacy 1 LTC...(406) th Ave N Ste 110B CVS Pharmacy...(406) Grand Ave Riverstone Health Pharmacy...(406) S 27th St Ste E CVS Pharmacy...(406) Grand Ave Sam s Club Pharmacy...(406) King Ave E CVS Pharmacy...(406) Main St Shopko Pharmacy...(406) S 24th St W CVS Pharmacy...(406) , LT 823 N 27th St St Johns Pharmacy...(406) Rimrock Rd CVS Pharmacy...(406) Central Ave St Vincents Hosp Pharmacy...(406) N 30th St Deaconess Billings Clinic...(406) Ave C Target Pharmacy...(406) , LT 2601 Central Ave First Pharmacy...(406) th St W Valley Health Care Center...(406) th St W Juros United Drugs...(406) Grand Ave Walgreens...(406) Main St Kmart Pharmacy...(406) Central Ave Walgreens...(406) Grand Ave Omnicare of Billings...(406) Enterprise Ave Ste Walgreens...(406) , H 1330 Grand Ave Osco Pharmacy...(406) Grand Ave Walgreens Infusion Services...(406) N 31st St Ste Osco Pharmacy...(406) Pharmacy Type: H 611 N 27th St Walmart Pharmacy...(406) King Ave W Osco Pharmacy...(406) Central Ave Osco Pharmacy...(406) Main St

13 YELLOWSTONE YELLOWSTONE MONTANA PHARMACY LISTING YELLOWSTONE YELLOWSTONE (cont.) Walmart Pharmacy...(406) Main St LAUREL LAUREL CVS Pharmacy...(406) SE 4th St Genes Pharmacy...(406) E Main St Walmart Pharmacy...(406) Bernhardt Rd

14 For more information, please contact Blue Cross Medicare Advantage Customer Service, at or, for TTY/TDD users, 711, 8 a.m.-8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voic ) will be used on weekends and holidays, or visit mybluemapd.com. This Pharmacy Directory was updated on 01/01/2014. Prim is offered by Prime Therapeutics. Prime Therapeutics is a separate company from Blue Cross and Blue Shield of Montana and provides pharmacy benefit management services for Blue Cross Medicare Advantage. PPO plans are provided by Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC s plans depends on contract renewal.