DIRECTORY. UnitedHealthcare MedicareRx for Groups (PDP)

Transcription

1 2015 Pharmacy DIRECTORY UnitedHealthcare MedicareRx for Groups (PDP) This directory is a partial list of network pharmacies near you. This directory is for Idaho. For more information, please call Customer Service at: Toll-Free , TTY a.m. to 8 p.m. local time, Monday through Friday Y0066_140805_ Last updated October 2014

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 front and back cover pages of this directory. For the most current list of our network pharmacies, please see the front and back cover pages of this directory for information on how to contact 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 order 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 front and back cover pages. You do not have to use the same network pharmacy every time you fill a prescription drug. 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 Evidence of Coverage for more information. For a complete description of your prescription drug coverage, including how to fill your prescriptions, please see your Evidence of Coverage and Drug List (Formulary). If you have questions about any of the above, please see the front and back cover pages of this directory for information on how to contact us. Pharmacy Saver Pharmacy Saver is a cost savings prescription drug program available to our plan members. The plan has worked with many of our network pharmacies to offer even lower prices on many common prescription drugs. 1 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 listings on the following pages. symbol in the pharmacy

3 Mail order service pharmacy 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. Members can get a 90-day supply 2 of some of their prescription drugs. 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 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 at , TTY 711, 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. You can find more information about Mail Service Pharmacy 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.

4 90-day supplies 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 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 supplies 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 the following pages. symbol in the pharmacy listings on

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. Duane Reade Food Lion Giant Giant Food Stores Hannaford H-E-B Hy-Vee Kroger & Affiliates Baker s Pharmacy City Market Dillons Fred Meyer Fry s Pharmacy Gerbes JayCs King Soopers Kroger Pay Less Pharmacy QFC Pharmacy Ralphs Scotts Smith s Food & Drug Martins Publix Safeway & Affiliates Carrs Quality Center Pavilion's Randalls Safeway Tom Thumb Vons Sam s Club Stop & Shop Target Pharmacy Thrifty White TTY Walmart Wegmans TTY users should call 711, unless a different phone number is listed. This list may change. For a current list of national pharmacy chains or to check for a pharmacy not listed in this directory, call us at the number located on the front and back cover pages of this directory.

6 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. Ada Costco Pharmacy 2051 S Cole Rd Boise, ID , TTY: 711 Custom Rx 173 W 4th St Kuna, ID , TTY: 711 Customedica Pharmacy 149 W State St Ste 101 Eagle, ID , TTY: 711 Family Medicine Health Center Ph 6094 W Emerald St Boise, ID , TTY: 711 Fred Meyer Pharmacy 5425 Chinden Blvd Garden City, ID , TTY: 711 Fred Meyer Pharmacy 1850 East Fairview Avenue , TTY: 711 Fred Meyer Pharmacy 5230 W Franklin Boise, ID , TTY: 711 Fred Meyer Pharmacy 3527 Federal Way Boise, ID , TTY: 711 Fred Meyer Pharmacy W Overland Rd Boise, ID , TTY: 711 Fred Meyer Pharmacy 1400 W Chinden Blvd Meridian, ID , TTY: 711 Heartland LTC Pharmacy 3320 N Milwaukee St Boise, ID , TTY: 711 Kmart Pharmacy Fairview Ave Boise, ID , TTY: 711 Ladd Family Pharmacy 1109 S Broadway Boise, ID , TTY: 711

7 Lifes Doors HCs Pharmacy 420 S Orchard Boise, ID , TTY: 711 Medicap Pharmacy 2790 W Cherry Ln Ste , TTY: 711 Omnicare of Boise 320 E Corporate Dr Suite , TTY: 711 Pauls Pharmacy 700 E Avalon Kuna, ID , TTY: 711 Medicap Pharmacy 2790 W Cherry Lane , TTY: 711 Pauls Pharmacy Lake Hazel Rd Boise, ID , TTY: 711 Mednow Eagle Pharmacy 323 E Riverside Dr Ste 120 Eagle, ID , TTY: 711 Mednow Pharmacy at St Alphonsus 999 N Curtis Rd Ste 102 Boise, ID , TTY: 711 Mountain Care Pharmacy 286 N Maple Grove Rd Boise, ID , TTY: 711 Pharmerica 2950 E Magic View Dr Ste , TTY: 711 Portico Pharmacy 3355 E Louise Dr , TTY: 711 Premium Rx Services 9196 W Emerald St Ste 110 Ste 110 Boise, ID , TTY: 711 Ridley's Pharmacy 1403 N Meridian Rd Kuna, ID , TTY: 711

8 Rite Aid Pharmacy 1100 Vista Avenue Boise, ID , TTY: 711 Rite Aid Pharmacy 5005 West Overland Road Boise, ID , TTY: 711 Rite Aid Pharmacy 660 East Boise Avenue Boise, ID , TTY: 711 Rite Aid Pharmacy Fairview Avenue Boise, ID , TTY: 711 Rite Aid Pharmacy 7020 West State Street Boise, ID , TTY: 711 Rite Aid Pharmacy 1515 West State Street Boise, ID , TTY: 711 Rite Aid Pharmacy 1600 North Main Street Meridian Plaza , TTY: 711 Rosauers Pharmacy 2986 N Eagle Rd Meridian, ID , TTY: Overland Rd Boise, ID , TTY: S Vista Ave Boise, ID , TTY: W State St Boise, ID , TTY: UStick Rd Boise, ID , TTY: 711

9 6560 S Federal Way Boise, ID , TTY: S Eagle Rd Eagle, ID , TTY: W Cherry Ln , TTY: E Fairview , TTY: E Parkcenter Blvd Boise, ID , TTY: Overland Rd Boise, ID , TTY: W State St Boise, ID , TTY: Broadway Ave Boise, ID , TTY: N Cole Rd Boise, ID , TTY: 711 Shopko Pharmacy 3499 E Fairview Ave , TTY: N Eagle Rd Boise, ID , TTY: 711 Shopko Pharmacy 2655 Broadway Ave Boise, ID , TTY: W State St Boise, ID , TTY: 711 Shopko Pharmacy 8105 Fairview Ave Boise, ID , TTY: 711

10 St Lukes Meridian Medical Ctr Ph 520 S Eagle Rd Ste , TTY: 711 Star Pharmacy 9732 W State St Star, ID , TTY: Overland Rd , TTY: East Fairview Ave , TTY: West State Street Garden City, ID , TTY: N Cole Rd Boise, ID , TTY: W Overland Rd Boise, ID , TTY: N Eagle Rd Meridian, ID , TTY: S Five Mile Boise, ID , TTY: N Linder Rd Meridian, ID , TTY: S Eagle Rd Eagle, ID , TTY: S Broadway Ave Boise, ID , TTY: W Cherry Ln Meridan, ID , TTY: 711

11 869 E Avalon St Kuna, ID , TTY: Fairview Ave E , TTY: N Meridian Rd , TTY: W UStick Rd Boise, ID , TTY: S Federal Way Boise, ID , TTY: Overland Drive Boise, ID , TTY: N Glenwood St Garden City, ID , TTY: W Fairview Ave Boise, ID , TTY: E Chinden Blvd Eagle, ID , TTY: W Overland Rd Boise, ID , TTY: 711 Bannock Bengal Pharmacy 990 South 8th Pocatello, ID , TTY: 711 Costco Pharmacy 305 West Quinn Rd Pocatello, ID , TTY: S Apple St Boise, ID , TTY: 711

12 Cross Pharmacy 4990 Valenty Rd Chubbuck, ID , TTY: 711 Shaver Phcy and Compounding Ctr 235 S 4th Ave Pocatello, ID , TTY: 711 Ed Snells Pharmacy Shop 1015 E Young St Pocatello, ID , TTY: 711 Shopko Pharmacy 4215 Yellowstone Ave Chubbuck, ID , TTY: 711 Fred Meyer Pharmacy 800 Yellowstone Hwy Pocatello, ID , TTY: 711 Smiths Pharmacy 4845 Yellowstone Ave Chubbuck, ID , TTY: 711 Kmart Pharmacy 3945 Pole Line Rd Pocatello, ID , TTY: Yellowstone Ave Chubbuck, ID , TTY: 711 Not Tsoo Gah Nee Indian Hlth Ctr Rt 6 Mission Rd Fort Hall, ID , TTY: Yellowstone Ave Chubbuck, ID , TTY: 711 Ridley's Pharmacy 1000 Pocatello Creek Rd Pocatello, ID , TTY: Yellowstone Pocatello, ID , TTY: E Benton Pocatello, ID , TTY: 711

13 Bear Lake Broulims Pharmacy 130 S 4th Street Montpelier, ID , TTY: 711 Benewah Benewah Medical Center Phcy 1115 B St Plummer, ID , TTY: 711 Jacks Pharmacy Inc 103 E College Ave St Maries, ID , TTY: 711 Bingham Broulims Pharmacy 570 S State St Shelley, ID , TTY: 711 Medical Plaza Pharmacy 98 Poplar St Mob Building Blackfoot, ID , TTY: 711 Pharmacy Shop 69 N Pine St Blackfoot, ID , TTY: 711 Pharmacy Shop Express 1441 Parkway Dr Blackfoot, ID , TTY: 711 Ridleys Pharmacy 1295 Parkway Blvd. Blackfoot, ID , TTY: Jensen Grove Dr. Blackfoot, ID , TTY: W Bridge St Blackfoot, ID , TTY: 711 Wallace Drug 44 S Main Aberdeen, ID , TTY: 711 Blaine Chateau Drug 451 4th St Ketchum, ID , TTY: 711

14 Luke's Family Pharmacy 101 S Main St Hailey, ID , TTY: 711 Sandpoint Super Drug 604 N 5th Ave Sandpoint, ID , TTY: Main St N Hailey, ID , TTY: Highway 95 North Ponderay, ID , TTY: 711 The Drug Store 91 E Croy Hailey, ID , TTY: 711 White Cross Pharmacy 5453 Highway 2 Priest River, ID , TTY: 711 Valley Apothecary 201 N. Washington Ave Ketchum, ID , TTY: 711 White Cross Pharmacy 1319 Highway 2 Ste A Sandpoint, ID , TTY: 711 Bonner Medicine Man Sandpoint 624 Larch St Sandpoint, ID , TTY: 711 Safeway 702 N 5th Ave Sandpoint, ID , TTY: 711 Yokes Pharmacy 212 Bonner Mall Way Ponderay, ID , TTY: 711 Bonneville Fred Meyer Pharmacy 1555 Northgate Mile Idaho Falls, ID , TTY: 711

15 Heartland Pharmacy 3250 E 17th St Ammon, ID , TTY: E 17th St Idaho Falls, ID , TTY: 711 Hyway Drug 120 Northgate Mile Idaho Falls, ID , TTY: 711 Shopko Pharmacy 800 E 17th St Idaho Falls, ID , TTY: 711 Kmart Pharmacy 3101 East 17th St Ammon, ID , TTY: 711 Smiths Pharmacy 400 South Woodruff Idaho Falls, ID , TTY: 711 Mikes Pharmacy 180 S Holmes Ave Idaho Falls, ID , TTY: 711 Teton Pharmacy 2470 Jafer Ct Idaho Falls, ID , TTY: 711 Prescription Center Inc 2252 Coronado St Idaho Falls, ID , TTY: So. 25th East Ammon, ID , TTY: 711 Sams Pharmacy 700 East 17th Street Idaho Falls, ID , TTY: South Utah Avenue Idaho Falls, ID , TTY: S 2500 E Ammon, ID , TTY: E 17th St Ammon, ID , TTY: 711

16 1725 1st St Idaho Falls, ID , TTY: 711 Well Life Boundary Pharmacy 6603 Main St Bonners Ferry, ID , TTY: W Broadway Idaho Falls, ID , TTY: East 17th St Idaho Falls, ID , TTY: 711 Westgate Drug Store 1850 W Broadway Idaho Falls, ID , TTY: 711 Boundary Medicine Man Bonners Ferry Pharm 6452 Main St Bonners Ferry, ID , TTY: 711 Safeway 6519 Main St Bonners Ferry, ID , TTY: 711 Butte Lost River Drug 551 Highland Dr. Arco, ID , TTY: 711 Canyon Costco Pharmacy N Marketplace Blvd Nampa, ID , TTY: 711 Fred Meyer Pharmacy 50 Second Street South Nampa, ID , TTY: 711 Kmart Pharmacy 1813 Caldwell Blvd Nampa, ID , TTY: 711 Med Now Er Pharmacy th Ave Rd Nampa, ID , TTY: 711

17 Medical Clinic Pharmacy 315 E Elm St Suite150 Caldwell, ID , TTY: 711 Reddish Pharmacy 215 E Hawaii Ave Ste 100 Nampa, ID , TTY: 711 Medicap Pharmacy 410 East Grove Avenue Parma, ID , TTY: 711 Ridleys Pharmacy 430 E Main St Middleton, ID , TTY: 711 Mednow Mercy North Pharmacy 4400 E Flamingo Ave Nampa, ID , TTY: 711 Rite Aid Pharmacy 2809 East Cleveland Boulevard Caldwell, ID , TTY: 711 Pauls Pharmacy 425 N 10th Ave Caldwell, ID , TTY: th Ave Rd Nampa, ID , TTY: 711 Pauls Pharmacy th Ave Rd Nampa, ID , TTY: Cleveland Blvd Caldwell, ID , TTY: 711 Penny Wise Drug 802 Cleveland Boulevard Caldwell, ID , TTY: th Ave S Nampa, ID , TTY: 711

18 2500 Blaine St Caldwell, ID , TTY: th Avenue Road Nampa, ID , TTY: 711 Shopko Pharmacy 2100 Caldwell Blvd Nampa, ID , TTY: N Middleton Rd Nampa, ID , TTY: 711 Target Pharmacy N Marketplace Blvd Nampa, ID , TTY: th Ave S Caldwell, ID , TTY: 711 Vic's Family Pharmacy 1603-A 12th Ave Rd Nampa, ID , TTY: th Ave Rd Nampa, ID , TTY: 711 Vic's Family Pharmacy Inc. 118 S Midland Blvd Nampa, ID , TTY: Caldwell Blvd Nampa, ID , TTY: East Franklin Road Nampa, ID , TTY: E Cleveland Blvd Caldwell, ID , TTY: East Cleveland Blvd Caldwell, ID , TTY: th Ave S Nampa, ID , TTY: 711

19 Caribou Broulims Pharmacy 89 West 2nd St South Soda Springs, ID , TTY: 711 Caribou Memorial Hospital Pharma 300 South 3rd West Soda Springs, ID , TTY: E Main St Burley, ID , TTY: 711 Clearwater Glenwood Pharmacy 1105 Michigan Ave Orofino, ID , TTY: 711 Eastman Drug Store 116 S Main St Soda Springs, ID , TTY: 711 Cassia Kwik-Meds 256 Overland Ave Burley, ID , TTY: 711 Smiths Pharmacy 937 E Main St Burley, ID , TTY: North Overland Avenue Burley, ID , TTY: 711 Elmore Sav Mor Drug 490 N 2nd East Mountain Home, ID , TTY: N Main St Mountain Home, ID , TTY: 711 St Lukes Elmore Pharmacy 895 N 6th E Mountain Home, ID , TTY: American Legion Blvd. Mountain Home, ID , TTY: 711

20 Franklin Larrys Family Hm Pharmacy 217 South State Preston, ID , TTY: 711 Preston Drug Inc 39 N 1st E Preston, ID , TTY: W Highway 52 Emmett, ID , TTY: 711 Gooding Kendrick Pharmacy 414 Main St Gooding, ID , TTY: 711 Fremont Ashton Community Pharmacy 23 South 8th Street Suite 2 Ashton, ID , TTY: 711 Falls Drug and Hardware 23 N Bridge St Saint Anthony, ID , TTY: 711 Gem Bi-Mart Pharmacy 179 West Highway 52 Emmett, ID , TTY: Hwy 16 Emmett, ID , TTY: 711 Ridleys Pharmacy 1427 Main St Gooding, ID , TTY: 711 Wendell Pharmacy 280 S Idaho St Wendell, ID , TTY: 711 Idaho Arnzen Drug 429 Main St Cottonwood, ID , TTY: 711 Arnzens Kamiah Drug 318 Main St Kamiah, ID , TTY: 711

21 Irwin Drug Inc 146 W Main St Grangeville, ID , TTY: South Lincoln Jerome, ID , TTY: 711 Jefferson Broulims Pharmacy 150 N State St Rigby, ID , TTY: 711 Kootenai Costco Pharmacy 355 East NEider Ave Coeur D Alene, ID , TTY: 711 Idaho Drug 139 E Main St Rigby, ID , TTY: 711 Fred Meyer Pharmacy 560 West Kathleen Couer D Alene, ID , TTY: 711 Jerome Jerome Drug 111 Pioneer Ct Ste 2 Jerome, ID , TTY: 711 R and R Pharmacy 133 West A Jerome, ID , TTY: 711 Ridleys Pharmacy 1016 S Lincoln Jerome, ID , TTY: 711 Interlake Pharmacy 700 Ironwood Dr Ste 100 Coeur D Alene, ID , TTY: 711 Kmart Pharmacy W 201 NEider Road Coeur D Alene, ID , TTY: 711 Medicine Man Hayden Pharmacy 240 W Hayden Hayden, ID , TTY: 711

22 Medicine Man North Pharmacy 305 W Kathleen Ave Coeur D Alene, ID , TTY: 711 Rite Aid Pharmacy 43 West Prairie Shopping Center Hayden, ID , TTY: 711 Medicine Man Pharmacy 8093 Cornerstone Dr Hayden, ID , TTY: 711 Medicine Man Pharmacy Inc 1114 W Ironwood Dr Coeur D Alene, ID , TTY: 711 Medicine Man Rathdrum Pharmacy N Westwood Dr Rathdrum, ID , TTY: 711 Medicine Man Sw Phcy 805 E Polston Ave Post Falls, ID , TTY: 711 Medicine Man West Pharmacy 802 E Medical Ct Post Falls, ID , TTY: 711 Rite Aid Pharmacy 208 West Ironwood Drive Ironwood Square Coeur D Alene, ID , TTY: 711 Safeway 121 NEider Avenue Coeur Dalene, ID , TTY: 711 Safeway North th St Coeur Dalene, ID , TTY: W Prairie Ave Hayden, ID , TTY: 711 Shopko Pharmacy 217 W Ironwood Dr Coeur D Alene, ID , TTY: 711 Rathdrum Drug N Highway 41 Rathdrum, ID , TTY: 711

23 6405 W Pointe Pkwy Post Falls, ID , TTY: 711 White Cross Pharmacy Spirit La N 5th Ave Spirit Lake, ID , TTY: East Mullan Avenue Post Falls, ID , TTY: W Honeysuckle Ave Hayden, ID , TTY: E SEltice Way Post Falls, ID , TTY: W Appleway Ave Coeur D Alene, ID , TTY: 711 Walmart Pharmacy 550W Honeysuckle Ave Hayden, ID , TTY: 711 Well Life Post Falls Pharmacy 1501 E SEltice Way Post Falls, ID , TTY: 711 Latah Hodgins Drug Store Inc 307 S Main St Moscow, ID , TTY: 711 Marketime Drug 209 E 3rd St Moscow, ID , TTY: 711 Northwest Pharmacy Services 525 Pine St Potlatch, ID , TTY: 711 Red Cross Pharmacy Inc 509 E Main St Kendrick, ID , TTY: 711 Rite Aid Pharmacy 1810 West Pullman Road Palouse Empire Mall Moscow, ID , TTY: 711

24 Rosauers Pharmacy 411 N Main St Moscow, ID , TTY: 711 Medicine Shoppe 167 W Main St Ste 1 Rexburg, ID , TTY: 711 Safeway 1320 Blaine St Moscow, ID , TTY: 711 Sav On Pharmacy 490 N 2nd E Rexburg, ID , TTY: W Pullman Rd Moscow, ID , TTY: North 2nd East Rexburg, ID , TTY: N Main St Moscow, ID , TTY: E Main St Rexburg, ID , TTY: 711 Lemhi Rigbys Pharmacy 1200 Shoup St Salmon, ID , TTY: 711 Madison Broulims Pharmacy 124 W Main St Rexburg, ID , TTY: 711 Minidoka Minidoka Memorial Hospital Pharm th Street Rupert, ID , TTY: 711 Ridleys Pharmacy 310 Oneida St Rupert, ID , TTY: 711

25 Nez Perce Kmart Pharmacy st St Lewiston, ID , TTY: 711 Northern Idaho Indian Health 111 Beaver Grade Rd Lapwai, ID , TTY: 711 Orchards Pharmacy 523 Thain Rd Lewiston, ID , TTY: 711 Safeway 2330 NEz Perce Dr Lewiston, ID , TTY: st St Lewiston, ID , TTY: 711 Shopko Pharmacy 2120 Thain Grade Lewiston, ID , TTY: 711 Owl Contracted Prescription Serv th Ave Ste 2 Lewiston, ID , TTY: 711 Rite Aid Pharmacy th Avenue Lewiston, ID , TTY: 711 Rosauers Pharmacy 332 Thain Rd Lewiston, ID , TTY: 711 The Owl Pharmacy th Ave Lewiston, ID , TTY: NEz Perce Dr Lewiston, ID , TTY: 711 Oneida Allen Drug 4 N Main St Malad, ID , TTY: 711

26 Owyhee Homedale Drug 5 N Main Homedale, ID , TTY: 711 Pauls Pharmacy 20 E Wyoming Homedale, ID , TTY: 711 Payette 405 S Main St Payette, ID , TTY: 711 Rockland Pharmacy 524 Tyhee Ave American Falls, ID , TTY: 711 Shoshone Kohal Pharmacy 740 Mckinley Ave Ste B Kellogg, ID , TTY: 711 Kohal Pharmacy and Medical Suppl 504 N Division Pinehurst, ID , TTY: 711 Power Keymed Inc 231 S Arthur Ave Pocatello, ID , TTY: 711 Maag Prescription and Medical Su 333 W Center St Pocatello, ID , TTY: 711 Ridleys Pharmacy 911 N Main St Pocatello, ID , TTY: 711 Osburn Drug 805 Mullan Ave Osburn, ID , TTY: 711 Sunnyside Drug 131 W Cameron Ave Kellogg, ID , TTY: Commerce Drive Smelterville, ID , TTY: 711

27 Yokes Pharmacy 117 N Hill Street Kellogg, ID , TTY: 711 Fred Meyer Pharmacy 705 Blue Lakes Blvd Twin Falls, ID , TTY: 711 Teton Broulims Pharmacy 240 S Main St Driggs, ID , TTY: 711 Corner Drug 10 South Main Driggs, ID , TTY: 711 Twin Falls Buhl Drug 419 Broadway Ave S Buhl, ID , TTY: 711 Costco Pharmacy 731 Pole Line Drive Twin Falls, ID , TTY: 711 Dicks Pharmacy 526K Shoup Ave W Twin Falls, ID , TTY: 711 Kj's Pharmacy 615 Filer Ave Twin Falls, ID , TTY: 711 Kmart Pharmacy 2258 Addison Ave East Twin Falls, ID , TTY: 711 Kurts Pharmacy 1203 Filer Ave E Twin Falls, ID , TTY: 711 Medical office Pharmacy 476 Cheney Dr W Suite 140 Twin Falls, ID , TTY: 711 Orchard Drug 995 Washington St South Twin Falls, ID , TTY: 711

28 Ridleys Pharmacy 705 E US Hwy 30 Buhl, ID , TTY: Cheney Dr W Twin Falls, ID , TTY: 711 Ridleys Pharmacy 210 Main St S Pmb 443 Kimberly, ID , TTY: 711 Sav Mor Drug 139 Main Ave W Twin Falls, ID , TTY: 711 Shopko Pharmacy 1649 Poleline Rd E Twin Falls, ID , TTY: Washington St N Twin Falls, ID , TTY: Blue Lakes Blvd N Twin Falls, ID , TTY: 711 Valley Mccall Drug 1001 N 2nd St Mccall, ID , TTY: 711 Smiths Pharmacy 1913 Addison Ave East Twin Falls, ID , TTY: 711 Target Pharmacy 1611 Blue Lakes Blvd N Twin Falls, ID , TTY: 711 Rite Aid Pharmacy 451 Deinhard Ln The Marketplace At Mccall Mccall, ID , TTY: 711 Wheelers Pharmacy 104 N Main Cascade, ID , TTY: 711

29 Washington Bi-Mart Pharmacy 1545 East 6th Street Weiser, ID , TTY: 711 Ridleys Pharmacy 652 E First St Weiser, ID , 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 P.O. Box , Orlando, FL Mission, KS P.O. Box 29061, Phoenix, AZ , TTY , TTY 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. Ada Coram CVS/Specialty Infusion Ser W Executive Dr Boise, ID , TTY: 711 Twin Falls Home Iv Services and Medical Sup 526 L Shoup Ave W Twin Falls, ID , TTY: 711

30 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. Ada Heartland LTC Pharmacy 3320 N Milwaukee St Boise, ID , TTY: 711 Medicap Pharmacy 2790 W Cherry Ln Ste , TTY: 711 Medicap Pharmacy 2790 W Cherry Lane , TTY: 711 Mednow Eagle Pharmacy 323 E Riverside Dr Ste 120 Eagle, ID , TTY: 711 Mednow Pharmacy at St Alphonsus 999 N Curtis Rd Ste 102 Boise, ID , TTY: 711 Mountain Care Pharmacy 286 N Maple Grove Rd Boise, ID , TTY: 711 Omnicare of Boise 320 E Corporate Dr Suite , TTY: 711 Pharmerica 2950 E Magic View Dr Ste , TTY: 711 Premium Rx Services 9196 W Emerald St Ste 110 Ste 110 Boise, ID , TTY: 711 Bannock Cross Pharmacy 4990 Valenty Rd Chubbuck, ID , TTY: 711 Bonneville Heartland Pharmacy 3250 E 17th St Ammon, ID , TTY: 711 Teton Pharmacy 2470 Jafer Ct Idaho Falls, ID , TTY: 711

31 Long-term care pharmacies near you Canyon Medical Clinic Pharmacy 315 E Elm St Suite150 Caldwell, ID , TTY: 711 Medicap Pharmacy 410 East Grove Avenue Parma, ID , TTY: 711 Mednow Mercy North Pharmacy 4400 E Flamingo Ave Nampa, ID , TTY: 711 Elmore St Lukes Elmore Pharmacy 895 N 6th E Mountain Home, ID , TTY: 711 Gooding Wendell Pharmacy 280 S Idaho St Wendell, ID , TTY: 711 Jerome R and R Pharmacy 133 West A Jerome, ID , TTY: 711 Vic's Family Pharmacy Inc. 118 S Midland Blvd Nampa, ID , TTY: 711 Caribou Caribou Memorial Hospital Pharma 300 South 3rd West Soda Springs, ID , TTY: 711 Clearwater Glenwood Pharmacy 1105 Michigan Ave Orofino, ID , TTY: 711 Madison Medicine Shoppe 167 W Main St Ste 1 Rexburg, ID , TTY: 711 Minidoka Minidoka Memorial Hospital Pharm th Street Rupert, ID , TTY: 711 Nez Perce Idaho State Veterans Home st Ave Lewiston, ID , TTY: 711

32 Long-term care pharmacies near you Owl Contracted Prescription Serv th Ave Ste 2 Lewiston, ID , TTY: 711 Oneida Allen Drug 4 N Main St Malad, ID , TTY: 711 Maag Prescription and Medical Su 333 W Center St Pocatello, ID , TTY: 711 Shoshone Kohal Pharmacy 740 Mckinley Ave Ste B Kellogg, ID , TTY: 711 Power Keymed Inc 231 S Arthur Ave Pocatello, ID , TTY: 711 Twin Falls Kj's Pharmacy 615 Filer Ave Twin Falls, ID , TTY: 711 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. Bannock Not Tsoo Gah Nee Indian Hlth Ctr Rt 6 Mission Rd Fort Hall, ID , TTY: 711 Benewah Benewah Medical Center Phcy 1115 B St Plummer, ID , TTY: 711

33 Indian health service/tribal/urban Indian health program (I/T/U) pharmacies near you Nez Perce Northern Idaho Indian Health 111 Beaver Grade Rd Lapwai, ID , TTY: 711

34 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 our Customer Service number listed above. Esta información está disponible sin costo en otros idiomas. Comuníquese con el Servicio al Cliente al número indicado arriba. 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. NOTE: If you are receiving Extra Help from Medicare, your co-pays may be lower or you may have no co-pays. 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. UHEX15MP _000 Last updated October 2014