2017 Pharmacy Directory

Transcription

1 2017 Pharmacy Directory Blue Cross Medicare Advantage Basic (HMO) SM Blue Cross Medicare Advantage Choice Plus (PPO) SM Blue Cross Medicare Advantage Choice Premier (PPO) SM This Pharmacy Directory was updated on 11/2017. For more recent information or other questions, please contact Blue Cross Medicare Advantage SM Customer Service, at or, for TTY/TDD users, 711. We are open 8:00 a.m.- 8:00 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 getbluemt.com/mapd/pharmacies. Y0096_BEN_MT_MAPHAR17_NM

2 Blue Cross Medicare Advantage SM 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 11/2017. For the most current list, please contact us. Our contact information appears on the front and back cover pages. Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at getbluemt.com/mapd/pharmacies. You may also call Customer Service for updated provider information. You can go to all the pharmacies on this list, but your costs for some drugs may be less at pharmacies in this list that offer preferred cost-sharing. We have marked these pharmacies with SAVE to distinguish them from other pharmacies in our network that offer standard cost-sharing. Cost-sharing information can be found in the Summary of Benefits. You can get prescription drugs shipped to your home through our network mail order delivery program which is called Prim by Walgreens Mail Service. For more information, please contact us or see the mail order section of this pharmacy directory. This directory is for the State of Montana which includes the area in which you live. However, we cover a larger service area, and there are more pharmacies where your prescriptions may be covered by our Plan. For information on more pharmacies in our plan network not listed in this directory, please see the section in this pharmacy directory Network Pharmacies outside the geographic area or contact Blue Cross Medicare Advantage Customer Service, at or, for TTY/TDD users, 711. We are open 8:00 a.m. - 8:00 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 getbluemt.com/mapd/pharmacies. 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 8:00 a.m. - 8:00 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 8:00 a.m. a 8:00 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). i

3 We also list pharmacies that are in our network but are outside the State of Montana area in which you live. You may also fill your prescriptions at these pharmacies. For more information, please see the section in this pharmacy directory on Network Pharmacies outside the State of Montana or contact Blue Cross Medicare Advantage Customer Service, at or, for TTY/TDD users, 711. We are open 8:00 a.m. - 8:00 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 getbluemt.com/mapd/pharmacies. 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. For more information, please see the section in this pharmacy directory Network Pharmacies outside the geographic area or contact Blue Cross Medicare Advantage Customer Service, at or, for TTY/TDD users, 711. We are open 8:00 a.m. - 8:00 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 getbluemt.com/mapd/pharmacies. Pharmacy Type Retail Long Term Care Home Infusion Extended Supply Preferred Network Preferred Extended Supply Network Total Number of Pharmacies 65,204 Pharmacies 5,433 Pharmacies 1,064 Pharmacies 50,980 Pharmacies 25,673 Pharmacies 21,187 Pharmacies The types of pharmacies in this directory appear in this order: Pharmacies are listed alphabetically by county and city and by type of pharmacy. The types of pharmacies in this directory appear in this order: Mail Order Pharmacies Retail Pharmacies Long-Term Care Pharmacies Home Infusion Pharmacies Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies Under each listing we also show additional pharmacy features. These features are identified on each page with the following key: SAVE = Preferred cost-sharing. Drugs from these pharmacies may cost less than other pharmacies in our network. = -day supply. These are retail pharmacies that offer an extended (-day) supply of medications. 24HR = Pharmacy is open 24-hours. = Pharmacy accepts electronic prescriptions from prescribers. ii

4 Mail Order Pharmacy Prim by Walgreens Mail Service (877) (TTY users: 711) 24 hours a day, seven days a week You can get prescription drugs shipped to your home through our network mail order delivery program. For refills of your mail order prescriptions, please contact us 10 to 20 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription drugs within 5-8 business days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at: (877) , (TTY users: 711), 24 hours a day, seven days a week, or visit Chain Pharmacies Below are chain pharmacies in our network. For locations and phone numbers of stores near you, call the numbers below (TTY users: 711) or visit the pharmacy website. Albertsons-Osco... (877) Sam's Club... (888) Costco... (800) Shopko... (800) CVS... (800) Walgreens... (800) Kmart... (800) Walmart... (800) Safeway... (800) = -day supply 1

5 ANACONDA Blue Cross Medicare Advantage s Network Pharmacies ANACONDA COMMUNITY HOSP ANACONDA PHCY...(406) PENNSYLVANIA CVS PHARMACY... (406) E PARK AVE STOKES PHARMACY ANACONDA... (406) WEST PARK AVENUE SAVE, THRIFTY DRUG...(406) E PARK ST ASHLAND BIGHORN VALLEY PHARMACY - ASHLAND... (406) MAIN STREET 503 BAKER BAKER DRUG CO... (406) S MAIN SAVE, BELGRADE LEE AND DADS PHARMACY DBA TOWN AND COUNTRY FOODS PHARMACY... (406) W MADISON AVE SAVE, OSCO PHARMACY # (406) JACKRABBIT LN SAVE, BIG SANDY BIG SANDY PHARMACY...(406) JOHANNES AVE BIG SKY BOZEMAN HEALTH BIG SKY MEDICAL CENTER PHARMACY...(406) TOWN CENTER AVE SAVE, BIG TIMBER COLE DRUG...(406) MCLEOD 511 BIGFORK BIGFORK DRUG... (406) MT HIGHWAY 35 STE SAVE, BILLINGS BILLINGS CLINIC ATRIUM PHARMACY...(406) TH AVE N 59101, 24HR, BILLINGS HEALTH & REHABILITATION COMMUNITY... (406) CENTRAL AVE COSTCO PHARMACY... (406) KING AVE W CVS PHARMACY... (406) GRAND AVE CVS PHARMACY... (406) GRAND AVENUE CVS PHARMACY... (406) MAIN STREET CVS PHARMACY... (406) NORTH 27TH STREET = -day supply = Electronic prescribing 2

6 Blue Cross Medicare Advantage s Network Pharmacies BOULDER CVS PHARMACY #... (406) CENTRAL AVE CVS PHARMACY # (406) CENTRAL AVE FIRST PHARMACY... (406) TH ST W JUROS UNITED DRUGS...(406) GRAND AVE OMNICARE OF BILLINGS... (406) ENTERPRISE AVE STE HR OSCO PHARMACY # (406) MAIN ST SAVE, OSCO PHARMACY #38... (406) GRAND AVE SAVE, OSCO PHARMACY # (406) N 27TH ST SAVE, OSCO PHARMACY # (406) GRAND AVE SAVE, OSCO PHARMACY #47... (406) CENTRAL SAVE, OSCO PHARMACY # (406) CENTRAL AVE SAVE, PHARMACY 1...(406) TH AVE N SUITE 110A SAVE, PHARMACY 1 LTC... (406) TH AVE N STE 110B RIVERSTONEHEALTH PHARMACY..(406) S 27TH ST SAMS PHARMACY (406) KING AVE E SHOPKO PHARMACY # (406) S 24TH ST W ST JOHNS PHARMACY...(406) RIMROCK RD ST VINCENTS HEALTHCARE...(406) N 30TH ST SAVE, 24HR, WALGREENS # (406) MAIN ST WALGREENS # (406) GRAND AVE WALGREENS # (406) GRAND AVE WALMART PHARMACY (406) KING AVE WEST WALMART PHARMACY (406) MAIN STREET BOULDER ELKHORN PHARMACY INC...(406) N MAIN = -day supply = Electronic prescribing 3

7 BOX ELDER Blue Cross Medicare Advantage s Network Pharmacies BOX ELDER ROCKY BOY HEALTH BOARD...(406) RR BOZEMAN COSTCO PHARMACY... (406) CATRON STREET CVS PHARMACY... (406) NORTH 19TH AVENUE 59718, 24HR, GENOA, A QOL HEALTHCARE COMPANY, LLC...(406) FARMHOUSE LANE, STE P HIGHLAND PARK PHARMACY...(406) HIGHLAND BLVD SAVE, MSU STUDENT HEALTH SERVICE PHARMACY...(406) MSU STUDENT HEALTH SERVICE RX 7TH AND GRANT OSCO PHARMACY #6...(406) S 23RD SAVE, PRICE RITE DRUG... (406) N 7TH AVE SAVE, ROSAUERS PHARMACY #40... (406) TECHNOLOGY BLVD SAVE, SAFEWAY PHARMACY # (406) W MAIN ST SAVE, SMITHS PHARMACY # (406) N 19TH AVE WALMART PHARMACY (406) NORTH 7TH AVENUE WESTERN DRUG OF BOZEMAN...(406) E MAIN ST BROADUS BROADUS IGA PHARMACY... (406) S PARK BROWNING BLACKFEET COMMUNITY HEALTH HOSPITAL... (406) HOSPITAL CIRCLE BUTTE COMMUNITY HEALTH CENTER PHARMACY...(406) S MONTANA ST CVS PHARMACY... (406) HARRISON ST DRISCOLL DRUG... (406) S EXCELSIOR KMART PHARMACY (406) HARRISON AVENUE MEDICAL ARTS PHARMACY... (406) S CRYSTAL ST STE SAVE, SAFEWAY PHARMACY # (406) MASSACHUSETTS AVE SAVE, THREE BEARS PHARMACY...(406) THREE BEARS DR = -day supply = Electronic prescribing 4

8 Blue Cross Medicare Advantage s Network Pharmacies WALGREENS # (406) HARRISON AVE WALMART PHARMACY (406) HARRISON AVENUE CHESTER CHESTER PHARMACY INC... (406) MAIN STREET REMEDIES PHARMACY & GIFT... (406) EAST WASHINGTON AVE CHINOOK CHINOOK PHARMACY...(406) INDIANA ST CHOTEAU CHOTEAU DRUG... (406) MAIN AVE SAVE CLYDE PARK WESTERN DRUG, TOO... (406) MILES 518 COLSTRIP COLSTRIP FAMILY PHARMACY... (406) MAIN ST STE B COLUMBIA FALLS GOOD MEDICINE PHARMACY - NVH... (406) TH ST W MONTANA VETERANS HOME...(406) VETERANS DRIVE DEER LODGE SMITHS PHARMACY # (406) NUCLEUS AVE COLUMBUS STILLWATER FAMILY PHARMACY.. (406) N 5TH 519 CONRAD OLSON'S DRUG...(406) TH AVE SE VILLAGE DRUG... (406) S MAIN ST SUITE CORVALLIS CORVALLIS DRUG... (406) MAIN ST SAVE, CROW AGENCY CROW INDIAN HOSPITAL PHARMACY...(406) HWY AND I 522 CULBERTSON CULBERTSON PHARMACY INC...(406) BROADWAY CUT BANK OSCO PHARMACY #33... (406) W MAIN SAVE, DEER LODGE KEYSTONE DRUG LLP... (406) MAIN ST SAVE, = -day supply = Electronic prescribing 5

9 DILLON Blue Cross Medicare Advantage s Network Pharmacies SAFEWAY PHARMACY # (406) N MAIN ST SAVE, DILLON SAFEWAY PHARMACY # (406) N MONTANA ST SAVE, SHOPKO PHARMACY # (406) E GLENDALE ST VANS PHARMACY...(406) SOUTHSIDE BLVD ENNIS ENNIS HEALTHMART PHARMACY...(406) MAIN ST EUREKA EUREKA DRUG...(406) US HIGHWAY 93 N SAVE, FAIRFIELD FAIRFIELD DRUG INC...(406) CENTRAL AVE SAVE FLORENCE FLORENCE PHARMACY...(406) OLD US HIGHWAY FORSYTH YELLOWSTONE PHARMACY... (406) MAIN ST SAVE, FORT BENTON BENTON PHARMACY... (406) FRONT ST FRENCHTOWN GRANITE PHARMACY FRENCHTOWN...(406) BECKWITH ST GARDINER GARDINER PHARMACY... (406) PARK ST 530 GLASGOW SHOPKO PHARMACY # (406) US HIGHWAY 2 W WESTERN DRUG...(406) ND AVE S SAVE, 5TH AVENUE PHARMACY AND GIFT... (406) RD STREET S GLENDIVE F & G PHARMACY...(406) N MERRILL AVE GABERT CLINIC PHARMACY...(406) DILWORTH OSCO PHARMACY # (406) N HARMON SAVE, GREAT FALLS ANDERSON FAMILY PHARMACY...(406) TH AVE S BENEFIS AMBULATORY PHARMACY...(406) TH AVE S STE = -day supply = Electronic prescribing 6

10 Blue Cross Medicare Advantage s Network Pharmacies HARDIN BIG SKY MANAGED CARE HELENA (406) JACKSON ST STE A BIG SKY MANAGED CARE...(406) ST AVE S STE CLINIC PHARMACY...(406) TH ST S CVS PHARMACY... (406) TH AVE S OSCO PHARMACY #35... (406) RD ST NW SAVE, OSCO PHARMACY #37... (406) TH AVE S SAVE, PLAZA UNITED PHARMACY... (406) TH AVE S PUBLIC DRUG CO...(406) CENTRAL AVE SAVE, SAMS PHARMACY (406) NORTHWEST BYP SHOPKO PHARMACY... (406) NORTHWEST BYP SMITHS PHARMACY # (406) MARKET PLACE DRIVE SNYDER DRUGS... (406) TH AVE NO WALGREENS # (406) TH AVE WALGREENS # (406) RD ST NW WALMART PHARMACY (406) SMELTER AVE N.E WALMART PHARMACY (406) TH AVE S SAVE, HAMILTON BITTERROOT DRUG INC... (406) W MAIN ST HEALTHCARE PROVIDERS...(406) N FIRST ST HEALTHCARE PROVIDERS-LTC... (406) N 1ST ST STE B OSCO PHARMACY # (406) N FIRST ST TIMBER RIDGE PHARMACY... (406) N 1ST ST SAVE, WALGREENS # (406) N 1ST STREET HARDIN BIGHORN VALLEY PHARMACY...(406) WEST 4TH STREET SUITE B 534 SHOPKO PHARMACY # (406) N CENTER AVE 534 = -day supply = Electronic prescribing 7

11 HARLEM Blue Cross Medicare Advantage s Network Pharmacies HARLEM FORT BELKNAP HEALTH CENTER PHARMACY...(406) GROS VENTRE AVE MILK RIVER PHARMACY...(406) US HWY HARLOWTON REMEDIES PHARMACY...(406) S CENTRAL AVE 536 HAVRE BULLHOOK COMMUNITY HEALTH CENTER PHARMACY...(406) TH ST SAVE, HEALTH MART... (406) ST ST SAVE, KMART PHARMACY (406) HIGHWAY #2 WEST NORTHERN MONTANA PHARMACY (406) W 13 ST SAVE, WALMART PHARMACY (406) US HIGHWAY 2 W WESTERN DRUG PHARMACY... (406) TH AVE STE B HAYS HAYS HEALTH CENTER PHARMACY...(406) WHITE CROW RD HEART BUTTE HEART BUTTE PHARMACY... (406) DISNEY HELENA COSTCO PHARMACY... (406) E CUSTER AVE CVS PHARMACY... (406) EUCLID CVS PHARMACY... (406) N MONTANA CVS PHARMACY # (406) N MONTANA AVE GENEVA WOODS PHARMACY...(406) WINNE AVE SUITE F GENEVA WOODS PHARMACY...(406) WINNE AVE SUITE A KMART PHARMACY (406) CEDAR STREET OSCO PHARMACY # (406) N MONTANA SAFEWAY PHARMACY # (406) N MONTANA AVE SAVE, SHOPKO PHARMACY # (406) N MONTANA AVE = -day supply = Electronic prescribing 8

12 Blue Cross Medicare Advantage s Network Pharmacies LEWISTOWN ST PETER COMMUNITY PHARMACY...(406) BROADWAY HR, ST PETERS PHARMACY- BROADWAY... (406) BROADWAY WALGREENS # (406) TH AVE WALMART PHARMACY (406) PROSPECT AVENUE KALISPELL COSTCO PHARMACY... (406) US HIGHWAY 93 N 591 KMART PHARMACY (406) US HWY 2 E 591 MEDICAL ARTS PHARMACY... (406) CONWAY DR 591 SAVE, OSCO PHARMACY #18... (406) W IDAHO 591 SAVE, ROSAUERS PHARMACY #37... (406) US HWY 93 S 591 SAVE, SHOPKO PHARMACY # (406) US HIGHWAY 2 E 591 SMITHS PHARMACY # (406) RD AVE NORTH EAST 591 SYKES PHARMACY... (406) ND AVE WEST 591 THE CLINICAL PHARMACY...(406) CONWAY DRIVE 591 SAVE, WALGREENS # (406) W IDAHO ST 591, 24HR, WALMART PHARMACY (406) HUTTON RANCH RD 591 LAKESIDE REMEDIES LAKESIDE... (406) STONER LOOP LAME DEER LAME DEER HEALTH CENTER PHARMACY...(406) N CHEYENNE AVENUE 543 LAUREL CVS PHARMACY... (406) SE 4TH 544 WALMART PHARMACY (406) BERNHARDT RD 544 LEWISTOWN MT MENTAL HEALTH CNTR PHARMACY...(406) CASINO CREEK DR OSCO PHARMACY #19... (406) W JANEAUX ST SAVE, SEIDEN DRUG COMPANY INC...(406) WENDELL AVE STE = -day supply = Electronic prescribing 9

13 LIBBY Blue Cross Medicare Advantage s Network Pharmacies SHOPKO PHARMACY # (406) NE MAIN ST LIBBY GRANITE PHARMACY LIBBY...(406) MINNESOTA AVE NORTHWEST COMMUNITY HEALTH CENTER...(406) E 2ND ST ROSAUERS PHARMACY #14... (406) W 9TH ST SAVE, LIVINGSTON KC WESTERN DRUG LONG TERM CARE... (406) W PARK STREET STE B 547 OSCO PHARMACY #42... (406) PARK ST S 547 SAVE, SHOPKO PHARMACY # (406) WASHINGTON ST 547 WESTERN DRUG OF LIVINGSTON... (406) W PARK STREET 547 LODGE GRASS LODGE GRASS HEALTH CENTER PHARMACY...(406) HARDING AVE 550 LOLO LOLO DRUG LLC...(406) GLACIER DRIVE MALTA VALLEY DRUG OF MALTA, INC...(406) S 1ST AVE E MILES CITY BIG SKY PHARMACY...(406) MAIN ST SAVE, OSCO PHARMACY #39... (406) S HAYNES SAVE, WALMART PHARMACY (406) STOWER STREET MISSOULA BROADWAY PHARMACY... (406) W BROADWAY COSTCO PHARMACY... (406) NORTHERN PACIFIC AVENUE CVS PHARMACY... (406) BROOKS ST CVS PHARMACY #... (406) N RESERVE ST GRANITE PHARMACY HEALTH SOLUTIONS...(406) TH AVE STE GRANITE PHARMACY MISSOULA...(406) TH AVE STE HEALTH SERVICE PHARMACY UNI OF MT... (406) EDDY AVE = -day supply = Electronic prescribing 10

14 Blue Cross Medicare Advantage s Network Pharmacies PLENTYWOOD MISSOULA FRESH MARKET PHARMACY # (406) S RESERVE STREET SAVE, MISSOULA FRESH MARKET PHARMACY # (406) WEST BROADWAY ST SAVE, MISSOULA PHARMACY...(406) S RESERVE ST STE OSCO PHARMACY # (406) RUSSELL ST OSCO PHARMACY #20... (406) OXFORD ST SAVE, OSCO PHARMACY #24... (406) E BROADWAY ST SAVE, OSCO PHARMACY #43... (406) N RESERVE ST SAVE, PALMERS DRUG... (406) SW HIGGINS AVE SAVE, PARTNERSHIP HEALTH CENTER PHARMACY...(406) RAILROAD ST W PINNACLE COMPOUNDING... (406) KENSINGTON AVE STE E ROSAUERS PHARMACY #27... (406) RESERVE ST SAVE, SAVMOR DRUG... (406) S 3RD ST W SUITE SHOPKO PHARMACY # (406) S RESERVE ST VILLAGE HEALTH CARE CENTER... (406) SOUTH AVE W WALGREENS # (406) BROOKS ST WALGREENS # (406) N RESERVE ST SAVE, WALMART PHARMACY (406) HWY 93 SOUTH WALMART PHARMACY (406) MULLAN ROAD CLINIC PHARMACY...(406) WYOMING ST STE A CLINIC PHARMACY SUITE B...(406) WYOMING ST STE B SAVE, PHILIPSBURG GRANITE PHARMACY... (406) N. MONTGOMERY ST PLAINS PLAINS DRUG...(406) RAILROAD ST SAVE, PLENTYWOOD PLENTYWOOD DRUG INC...(406) N MAIN ST = -day supply = Electronic prescribing 11

15 POLSON Blue Cross Medicare Advantage s Network Pharmacies POLSON HEALTHCARE PLUS... (406) ONE 7TH AVE E SUITE C PROVIDENCE LAKESHORE PHARMACY...(406) A US SAFEWAY PHARMACY # (406) MT HIGHWAY SAVE, ST JOSEPH PHARMACY... (406) TH AVE E WALGREENS # (406) MT HIGHWAY WALMART PHARMACY (406) MEMORY LN POPLAR POPLAR HEALTH CENTER PHARMACY...(406) H ST E POPLAR PHARMACY...(406) H ST EAST SAVE, PRYOR PRYOR HEALTH STATION PHARMACY...(406) PRYOR GAP RD 566 RED LODGE RED LODGE DRUG... (406) NORTH BROADWAY 568 RONAN FAMILY HEALTH PHARMACY...(406) US HWY SAVE, R AND R HEALTH CARE SOLUTIONS...(406) US HIGHWAY 93 STE B SAVE, ROUNDUP SHOPKO PHARMACY # (406) MAIN ST 572 SAINT IGNATIUS CSKT SAINT IGNATIUS HEALTH CENTER PHARMACY...(406) MISSION DRIVE MISSION DRUG...(406) N MAIN SAVE, SCOBEY SERVICE DRUG INC...(406) MAIN ST SEELEY LAKE SEELEY SWAN PHARMACY... (406) MT HIGHWAY 83 N LAZY PINE MALL STE J SAVE, SHELBY NORTHTOWN DRUGS...(406) MAIN ST SHOPKO PHARMACY # (406) ROOSEVELT HWY = -day supply = Electronic prescribing 12

16 Blue Cross Medicare Advantage s Network Pharmacies WHITEFISH SHERIDAN MAC'S CHC PHARMACY... (406) MADISON ST SIDNEY CLINIC PHARMACY...(406) TH AVE SW SHOPKO PHARMACY # (406) S CENTRAL AVE WHITE DRUG #25... (406) EAST MAIN STEVENSVILLE FAMILY PHARMACY INC... (406) EASTSIDE HWY RIDGEWAY PHARMACY...(406) STEVENSVILLE CUTOFF RD W SAVE, VALLEY DRUG & VARIETY... (406) MAIN ST SUPERIOR MINERAL PHARMACY INC... (406) RIVER ST THOMPSON FALLS DOUGS DRUG...(406) MAIN ST SAVE, THREE FORKS RAILWAY DRUG... (406) MAIN ST. S A TOWNSEND TOWNSEND DRUG...(406) BROADWAY SAVE, TROY KOOTENAI DRUG...(406) E MISSOULA AVE VICTOR NORTH RIDGE PHARMACY... (406) HWY 93 N. SUITE B RIDGEWAY PHARMACY LTD...(406) HWY 93 N WARM SPRINGS MONTANA STATE HOSPITAL PHARMACY...(406) GARNET WAY WEST YELLOWSTONE SILVERTIP PHARMACY... (406) N CANYON ST STE F WHITE SULPHUR SPRINGS CASTLE MOUNTAIN DRUG... (406) US HIGHWAY 12 E SAVE, WHITEFISH ALPINE APOTHECARY... (406) HWY 93 S SAVE, NORTH VALLEY HOSPITAL, INC... (406) HOSPITAL WAY = -day supply = Electronic prescribing 13

17 WHITEHALL Blue Cross Medicare Advantage s Network Pharmacies SAFEWAY PHARMACY # (406) HIGHWAY 93 SOUTH SAVE, WALGREENS # (406) E 13TH ST WHITEFISH DISCOUNT PHARMACY (406) BAKER AVE WHITEHALL WHITEHALL DRUG...(406) W. LEGION AVE WOLF POINT WOLF POINT PHARMACY... (406) TH AVE NORTH SAVE, WOLF POINT HEALTH CENTER PHARMACY...(406) TH AVE N = -day supply = Electronic prescribing 14

18 Long Term Care Pharmacies Blue Cross Medicare Advantage s Network Pharmacies Residents of a long-term care facility may access their prescription drugs covered under our plan through the facility's long-term care pharmacy or another network long-term care pharmacy. For more information, please see your Evidence of Coverage. BENEFIS AMBULATORY PHARMACY...(406) TH AVE S STE 2 GREAT FALLS BENTON PHARMACY... (406) FRONT ST FORT BENTON BIG SANDY PHARMACY...(406) JOHANNES AVE BIG SANDY BIG SKY MANAGED CARE HELENA (406) JACKSON ST STE A GREAT FALLS BIG SKY MANAGED CARE...(406) ST AVE S STE 110 GREAT FALLS BIGFORK DRUG... (406) MT HIGHWAY 35 STE 7 BIGFORK BILLINGS HEALTH & REHABILITATION COMMUNITY... (406) CENTRAL AVE BILLINGS BITTERROOT DRUG INC... (406) W MAIN ST HAMILTON BROADUS IGA PHARMACY... (406) S PARK BROADUS CASTLE MOUNTAIN DRUG... (406) US HIGHWAY 12 E WHITE SULPHUR SPRINGS CENTRAL MONTANA MEDICAL CENTER...(406) WENDELL AVE LEWISTOWN CHESTER PHARMACY INC... (406) MAIN STREET CHESTER CHINOOK PHARMACY...(406) INDIANA ST CHINOOK CHOTEAU DRUG... (406) MAIN AVE CHOTEAU CLINIC PHARMACY...(406) TH ST S GREAT FALLS CLINIC PHARMACY...(406) TH AVE SW SIDNEY COMMUNITY HOSP ANACONDA PHCY...(406) PENNSYLVANIA ANACONDA ENNIS HEALTHMART PHARMACY...(406) MAIN ST ENNIS GABERT CLINIC PHARMACY...(406) DILWORTH GLENDIVE GENEVA WOODS PHARMACY...(406) WINNE AVE SUITE F HELENA GENOA, A QOL HEALTHCARE COMPANY, LLC...(406) FARMHOUSE LANE, STE P BOZEMAN GRANITE PHARMACY... (406) N. MONTGOMERY ST PHILIPSBURG GRANITE PHARMACY FRENCHTOWN...(406) BECKWITH ST FRENCHTOWN GRANITE PHARMACY HEALTH SOLUTIONS...(406) TH AVE STE 1 MISSOULA HEALTHCARE PLUS... (406) ONE 7TH AVE E SUITE C POLSON HEALTHCARE PROVIDERS-LTC... (406) N 1ST ST STE B HAMILTON HOLY ROSARY HEALTH CENTER...(406) WILSON MILES CITY KALISPELL REGIONAL MEDICAL CENTER PHARMACY...(406) SUNNYVIEW LANE KALISPELL 591 KC WESTERN DRUG LONG TERM CARE... (406) W PARK STREET STE B LIVINGSTON 547 KOOTENAI DRUG...(406) E MISSOULA AVE TROY MAC'S CHC PHARMACY... (406) MADISON ST SHERIDAN

19 Long Term Care Pharmacies Blue Cross Medicare Advantage s Network Pharmacies Residents of a long-term care facility may access their prescription drugs covered under our plan through the facility's long-term care pharmacy or another network long-term care pharmacy. For more information, please see your Evidence of Coverage. MCCONE COUNTYHEALTH CENTER...(406) SULLIVAN AVE CIRCLE MONTANA STATE HOSPITAL PHARMACY...(406) GARNET WAY WARM SPRINGS MONTANA VETERANS HOME...(406) VETERANS DRIVE COLUMBIA FALLS MT MENTAL HEALTH CNTR PHARMACY...(406) CASINO CREEK DR LEWISTOWN NORTH RIDGE PHARMACY... (406) HWY 93 N. SUITE B VICTOR NORTHERN MONTANA HOSPITAL PHARMACY...(406) W 13TH ST HAVRE NORTHTOWN DRUGS...(406) MAIN ST SHELBY OLSON'S DRUG...(406) TH AVE SE CONRAD OMNICARE OF BILLINGS... (406) ENTERPRISE AVE STE 1 BILLINGS PHARMACY 1 LTC... (406) TH AVE N STE 110B BILLINGS PHARMERICA... (406) CENTRAL AVE WEST SUITE 105 GREAT FALLS PLAZA UNITED PHARMACY... (406) TH AVE S GREAT FALLS PLENTYWOOD DRUG INC...(406) N MAIN ST PLENTYWOOD POPLAR PHARMACY...(406) H ST EAST POPLAR PRICE RITE DRUG... (406) N 7TH AVE BOZEMAN R AND R HEALTH CARE SOLUTIONS...(406) US HIGHWAY 93 STE B RONAN REMEDIES PHARMACY...(406) S CENTRAL AVE HARLOWTON 536 REMEDIES PHARMACY & GIFT... (406) EAST WASHINGTON AVE. CHESTER SERVICE DRUG INC...(406) MAIN ST SCOBEY SHOPKO PHARMACY... (406) NORTHWEST BYP GREAT FALLS SHOPKO PHARMACY # (406) S 24TH ST W BILLINGS SHOPKO PHARMACY # (406) N MONTANA AVE HELENA SHOPKO PHARMACY # (406) MAIN ST ROUNDUP 572 SHOPKO PHARMACY # (406) ROOSEVELT HWY SHELBY ST JOHNS PHARMACY...(406) RIMROCK RD BILLINGS THE CLINICAL PHARMACY...(406) CONWAY DRIVE KALISPELL 591 THREE BEARS PHARMACY...(406) THREE BEARS DR BUTTE TIMBER RIDGE PHARMACY... (406) N 1ST ST HAMILTON VALLEY DRUG OF MALTA, INC...(406) S 1ST AVE E MALTA VILLAGE DRUG... (406) S MAIN ST SUITE 2 CONRAD VILLAGE HEALTH CARE CENTER... (406) SOUTH AVE W MISSOULA WESTERN DRUG...(406) ND AVE S GLASGOW

20 Long Term Care Pharmacies Blue Cross Medicare Advantage s Network Pharmacies Residents of a long-term care facility may access their prescription drugs covered under our plan through the facility's long-term care pharmacy or another network long-term care pharmacy. For more information, please see your Evidence of Coverage. WHITE DRUG #25... (406) EAST MAIN SIDNEY WHITEFISH DISCOUNT PHARMACY (406) BAKER AVE WHITEFISH WOLF POINT PHARMACY... (406) TH AVE NORTH WOLF POINT YELLOWSTONE PHARMACY... (406) MAIN ST FORSYTH CLINIC PHARMACY...(406) WYOMING ST STE A MISSOULA TH AVENUE PHARMACY AND GIFT... (406) RD STREET S GLASGOW

21 Home Infusion Pharmacies Blue Cross Medicare Advantage s Network Pharmacies For more information, please see your Evidence of Coverage. BIG SKY IV CARE...(406) FOUR MILE DRIVE STE 3 KALISPELL 591 OPTION CARE... (406) N 31ST ST STE 401 BILLINGS OPTION CARE... (406) N 7TH AVE STE H BOZEMAN OPTION CARE... (406) S ALABAMA ST STE 1 BUTTE PARTNERS SOLUTIONS...(406) PALMER ST STE B MISSOULA SPECTRUM HOME SOLUTIONS...(406) TH AVE S GREAT FALLS THE CLINICAL PHARMACY...(406) CONWAY DRIVE KALISPELL

22 Blue Cross Medicare Advantage s Network Pharmacies Indian Health Service / Tribal / Urban Indian 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 our plan'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, please see your Evidence of Coverage. BLACKFEET COMMUNITY HEALTH HOSPITAL... (406) HOSPITAL CIRCLE BROWNING CROW INDIAN HOSPITAL PHARMACY...(406) HWY AND I CROW AGENCY 522 CSKT SAINT IGNATIUS HEALTH CENTER PHARMACY...(406) MISSION DRIVE SAINT IGNATIUS FORT BELKNAP HEALTH CENTER PHARMACY...(406) GROS VENTRE AVE HARLEM HAYS HEALTH CENTER PHARMACY...(406) WHITE CROW RD HAYS HEART BUTTE PHARMACY... (406) DISNEY HEART BUTTE LAME DEER HEALTH CENTER PHARMACY...(406) N CHEYENNE AVENUE LAME DEER 543 LODGE GRASS HEALTH CENTER PHARMACY...(406) HARDING AVE LODGE GRASS 550 POPLAR HEALTH CENTER PHARMACY...(406) H ST E POPLAR PRYOR HEALTH STATION PHARMACY...(406) PRYOR GAP RD PRYOR 566 ROCKY BOY HEALTH BOARD...(406) RR 1 BOX ELDER WOLF POINT HEALTH CENTER PHARMACY...(406) TH AVE N WOLF POINT = -day supply = Electronic prescribing 19

23 Blue Cross and Blue Shield of Montana complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of Montana does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of Montana: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Civil Rights Coordinator If you believe that Blue Cross and Blue Shield of Montana has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, , TTY/TDD: , Fax: , Civilrightscoordinator@hcsc.net. You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C , (TDD) Complaint forms are available at A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Y0096_MRK_MT_NDNOTICE17 Accepted

24 ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: 711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingu ística. Llame al (TTY: 711). ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfu gung. Rufnummer: (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY: 711) 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (TTY:711) まで お電話にてご連絡ください PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: 711). ATTENTION : Si vous parlez français, des services d aide linguistique vous sont proposés gratuitement. Appelez le (ATS : 711). ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711). 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. ملحوظة: إذا كنت تتحدث اذكر اللغة فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم )رقم هاتف الصم والبكم : 711( เร ยน: ถ าค ณพ ดภาษาไทยค ณสามารถใช บร การช วยเหล อทางภาษาได ฟร โทร (TTY: 711). MERK: Hvis du snakker norsk, er gratis språkassistansetjenester tilgjengelige for deg. Ring (TTY: 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: 711). УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером (телетайп: 711). Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call (TTY: 711). ATTENZIONE: In caso la lingua parlata sia l italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: 711).

25 This Pharmacy Directory was updated on 11/2017. The pharmacy network may change at any time. You will receive notice when necessary. For more recent information or other questions, please contact Blue Cross Medicare Advantage SM Customer Service, at or, for TTY/TDD users, 711. We are open 8:00 a.m. - 8:00 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 getbluemt.com/mapd/pharmacies. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits and/or co-payments/co-insurance may change on January 1 of each year. The pharmacy network may change at any time. You will receive notice when necessary. Prime Therapeutics LLC, a separate company, provides pharmacy benefit management services for HCSC. Blue Cross, Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Prime Therapeutics has contracted with Walgreens, a company independent from Prime Therapeutics and Blue Cross and Blue Shield of Montana, to provide mail pharmacy services through the Prim by Walgreens Mail Service. HMO and 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.