DIRECTORY Pharmacy. Toll-Free , TTY 711

Transcription

1 2016 Pharmacy DIRECTORY This directory is a list of network pharmacies near you. This directory is for South Dakota. 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. Beadle Coborns Pharmacy 2150 Dakota Ave S Huron, SD , TTY: 711 Bon Homme Bon Homme Pharmacy 410 W 16th Ave Tyndall, SD , TTY: 711 Kmart Pharmacy th Street SW Huron, SD , TTY: 711 Scotland Pharmacy 620 Billars St Scotland, SD , TTY: 711 Lewis Drug Huron 1950 Dakota Avenue South Huron, SD , TTY: 711 Northside Pharmacy 100 Dakota Ave N Suite A Huron, SD , TTY: 711 Brookings Brothers Pharmacy th St Brookings, SD , TTY: 711 Hy Vee Pharmacy nd Avenue South Brookings, SD , TTY: 711 Wal-Mart Pharmacy 2791 Dakota Avenue South Huron, SD , TTY: 711 Lewis Drug Brookings nd Avenue South Brookings, SD , TTY: 711 Bennett Martin Drug and Mercantile 304 Main St Martin, SD , TTY: 711 Wal-Mart Pharmacy th St Brookings, SD , TTY: 711

7 Brown Dt Pharmacy 815 1st Ave SE Ste 202 Aberdeen, SD , TTY: 711 Jones Drug 816 6th Avenue Suite 1 Aberdeen, SD , TTY: 711 Kesslers Pharmacy 621 6th Ave SE Aberdeen, SD , TTY: 711 Shopko Pharmacy 500 N Highway 281 Aberdeen, SD , TTY: 711 State Street Pharmacy 105 South State St Suite 111 Aberdeen, SD , TTY: 711 United Clinic Pharmacy rd Ave SE Ste 110 Aberdeen, SD , TTY: 711 Kmart Pharmacy 18156th Ave SE Aberdeen, SD , TTY: 711 Loris Pharmacy 1205 N 1S St Groton, SD , TTY: 711 Plaza Pharmacy th Ave SE Suite 23 Aberdeen, SD , TTY: 711 Wal-Mart Pharmacy th Avenue SE Aberdeen, SD , TTY: 711 Brule 201 N Main St Chamberlain, SD , TTY: 711 Buffalo Fort Thompson Ihc Clinic Pharmac Hwy 47 And Hwy 34 Fort Thompson, SD , TTY: 711

8 Butte Lynns Dakotamart Pharmacy Bell 600 National St Belle Fourche, SD , TTY: 711 Clark Clark Community Pharmacy 211 N Commercial Street Clark, SD , TTY: 711 Shopko Pharmacy 1 N 5th Ave Belle Fourche, SD , TTY: 711 Charles Mix Hoffman Drug 408 Main St Platte, SD , TTY: 711 Clay Davis Pharmacy Ltd 5 W Cherry St Vermillion, SD , TTY: 711 Hy Vee Pharmacy 525 West Cherry Street Vermillion, SD , TTY: 711 James Drug 201 S Main Wagner, SD , TTY: 711 Wal-Mart Pharmacy 1207 Princeton Street Vermillion, SD , TTY: 711 Wagner Indian Health Care Pharma 111 Washington Ave NW Wagner, SD , TTY: 711 Wollman andes Pharmacy 332 Main St Lake Andes, SD , TTY: 711 Codington Brown Clinic Pharmacy 506 1st Ave SE Watertown, SD , TTY: 711 Genoa Healthcare th St NE Watertown, SD , TTY: 711 Hy Vee Pharmacy th Avenue SE Watertown, SD , TTY: 711

9 Prairie Lakes Campus Pharmacy 401 9th Ave NW Watertown, SD , TTY: 711 Shopko Pharmacy 700 9th Ave SE Watertown, SD , TTY: 711 Davison Avera Queen of Peace Hospital Ca 525 N Foster St Mitchell, SD , TTY: 711 Kmart Pharmacy 1313 South Burr Mitchell, SD , TTY: 711 Wal-Mart Pharmacy th St SE Watertown, SD , TTY: N Main St Mitchell, SD , TTY: 711 Walgreens 421 9th Ave SE Watertown, SD , TTY: 711 Corson Mclaughlin IHS Clinic Pharmacy 701 East 6th St Mclaughlin, SD , TTY: 711 Smiths Drug 301 Main St Lemmon, SD , TTY: 711 Custer Carson Drug LLC 521 Mt Rushmore Rd Custer, SD , TTY: W Havens Ave Mitchell, SD , TTY: 711 Shopko Pharmacy 1900 N Main St Mitchell, SD , TTY: 711 Wal-Mart Pharmacy 1101 East Spruce St Mitchell, SD , TTY: 711 Walgreens 901 S Burr St Mitchell, SD , TTY: 711

10 Day Cornwell Drug 701 Main St Webster, SD , TTY: 711 Deuel Deuel County Pharmacy 411 3rd Ave S Clear Lake, SD , TTY: 711 Dewey Eagle Butte IHS Hospital Pharmac 317 Main St Eagle Butte, SD , TTY: 711 Vilas Pharmacy 123 S Main St Eagle Butte, SD , TTY: 711 Douglas Prairie Pharmacy 1311 Braddock St Armour, SD , TTY: 711 Prairie Pharmacy Corsica 230 Main St Corsica, SD , TTY: 711 Edmunds Turner Drug Inc 3033 Main St Bowdle, SD , TTY: 711 Vilas Pharmacy 401 5th Avenue Ipswich, SD , TTY: 711 Fall River Fall River Hospital Pharmacy 1201 Hwy 71 South Hot Springs, SD , TTY: 711 Lynns Dakotamart Pharmacy Hot 501 S 6th St Hot Springs, SD , TTY: 711 Shopko Pharmacy 2701 Highway 18 W Hot Springs, SD , TTY: 711 South Dakota State Veterans Home 2500 Minnekahta Ave Hot Springs, SD , TTY: 711 Faulk Faulkton Drug 118 8th Ave S Faulkton, SD , TTY: 711

11 Grant Bien Pharmacy 222 S Main St Milbank, SD , TTY: 711 Hughes Kmart Pharmacy 1615 N Harrison Avenue Pierre, SD , TTY: S Main St Milbank, SD , TTY: 711 Lynn's Dakotamart Pharmacy Pie 120 W Sioux Ave Pierre, SD , TTY: 711 Gregory Burke Community Pharmacy 9th And Jackson St Burke, SD , TTY: 711 Vilas LTC Pharmacy 200 E Dakota Ste 2 Pierre, SD , TTY: 711 Gregory Drug 604 Main St Gregory, SD , TTY: 711 Haakon Dakota Country Pharmacy, Inc. 130 S Center Philip, SD , TTY: 711 Vilas Pharmacy 100 Mac Lane 2 Ste 2 Pierre, SD , TTY: 711 Wal-Mart Pharmacy 1730 No Garfield Road Pierre, SD , TTY: 711 Hand Miller Rexall Drug 209 N Broadway Miller, SD , TTY: 711 Walgreens 100 E Sioux Ave Pierre, SD , TTY: 711

12 Hutchinson Heritage Pharmacy 609 S Hwy 81 Freeman, SD , TTY: 711 Kingsbury 213 Calumet South West Desmet, SD , TTY: 711 Medicine Shoppe 102 West Main Parkston, SD , TTY: 711 Nelson Drug Inc 125 S Main St Arlington, SD , TTY: 711 Norm's Thrifty White Pharmacy 389 S Main St Freeman, SD , TTY: 711 Parkston Drug Inc 112 West Main St Parkston, SD , TTY: 711 Jackson Wanblee Indian Hlth Ctr Pharmacy Highway 44 Wanblee, SD , TTY: 711 Jerauld 202 East Main St Wessington Springs, SD , TTY: 711 Lake Lewis Drug Madison 741 South Washington Avenue Madison, SD , TTY: 711 Shopko Pharmacy 800 S Washington Ave Madison, SD , TTY: 711 Lawrence Kmart Pharmacy 2323 Colorado Boulevard Spearfish, SD , TTY: 711 Regional Pharmacy 1420 N 10th St Spearfish, SD , TTY: 711

13 Safeway Pharmacy 1606 North Ave Suite 2 Spearfish, SD , TTY: 711 Dan's Drugstore 5028 S Cliff Ave Sioux Falls, SD , TTY: 711 Wal-Mart Pharmacy st Avenue Spearfish, SD , TTY: 711 Haisch Pharmacy 303 E 5th St Canton, SD , TTY: 711 Walgreens 1430 North Ave Spearfish, SD , TTY: 711 Hy-Vee Pharmacy 1231 E 57th St Sioux Falls, SD , TTY: 711 White Drug 71 Charles St Deadwood, SD , TTY: 711 Lewis Drug 6109 S Louise Ave Sioux Falls, SD , TTY: 711 Lincoln Avera Dermatology Pharmacy 6701 S Minnesota Ave Sioux Falls, SD , TTY: 711 Avera Th Street Pharmacy 4400 W 69th Street Suite 300 Sioux Falls, SD , TTY: 711 Caretrends Pharmacy 6709 S Minnesota Avenue Suite 105 Sioux Falls, SD , TTY: 711 Lewis Drug 720 E 1st Street Tea, SD , TTY: South Main Street Lennox, SD , TTY: South Minnesota Avenue Sioux Falls, SD , TTY: 711

14 715 East 5th Street Canton, SD , TTY: 711 Pharmacy Specialties & Clinic, I 2333 W 57th St Ste 109 Sioux Falls, SD , TTY: 711 Mccook Heritage Pharmacy 206 N Main Bridgewater, SD , TTY: 711 Salem Community Drug 300 N Main Salem, SD , TTY: 711 Walgreens 4900 S Cliff Ave Sioux Falls, SD , TTY: 711 Lyman Lower Brule IHS Clinic Pharmacy 1 Clinic Blvd Lower Brule, SD , TTY: 711 Presho Community Pharmacy 116 North Main St, Suite #2 Presho, SD , TTY: 711 Marshall Quarve Drug 710 Main St Britton, SD , TTY: 711 Mcpherson Vilas Pharmacy 712 7th St Eureka, SD , TTY: 711 Meade County Drug 1111 Lazelle Street Sturgis, SD , TTY: 711 Shopko Pharmacy 2105 Lazelle St Sturgis, SD , TTY: 711 Vilas Pharmacy 100 Main Street Faith, SD , TTY: 711

15 Mellette Ranchland Drug 101 N. Main White River, SD , TTY: 711 Miner Rafferty Robbins Drug 108 S Main St Howard, SD , TTY: 711 Minnehaha Avera Long Term Care Pharmacy 3820 N Potsdam Ave Ste 2 Sioux Falls, SD , TTY: 711 Avera Mckennan Campus Pharmacy 1325 S Cliff Ave Suite Cp Sioux Falls, SD , TTY: 711 Avera Specialty Pharmacy 1301 S Cliff Ave Suite 200 Sioux Falls, SD , TTY: 711 Complete Home Care Inc 1104 W Russell St Sioux Falls, SD , TTY: 711 Costco Pharmacy 3700 S Grange Ave Sioux Falls, SD , TTY: 711 Hy Vee Pharmacy 3000 S Minnesota Avenue Sioux Falls, SD , TTY: 711 Hy Vee Pharmacy 1601 S Sycamore Road Sioux Falls, SD , TTY: 711 Hy Vee Pharmacy 4101 South Louise Avenue Sioux Falls, SD , TTY: 711 Hy Vee Pharmacy 1900 South Marion Road Sioux Falls, SD , TTY: 711 Brandon Health Mart Pharmacy 1517 W Holly Blvd Brandon, SD , TTY: 711 Hy Vee Pharmacy 3020 East 10th Street Sioux Falls, SD , TTY: 711

16 Hy-Vee Pharmacy 2700 W 10th St Sioux Falls, SD , TTY: 711 Lewis Drug Southeast 4409 East 26th Street Sioux Falls, SD , TTY: 711 Kmart Pharmacy 3709 East 10th Street Sioux Falls, SD , TTY: 711 Lewis Drug Southwest 5500 West 41st Street Sioux Falls, SD , TTY: 711 Kmart Pharmacy 3020 W 12th St Sioux Falls, SD , TTY: 711 Lewis Drug Westgate 2700 West 12th Street Sioux Falls, SD , TTY: 711 Lewis Drug 500 W 41st St Sioux Falls, SD , TTY: N Highway 77 Dell Rapids, SD , TTY: 711 Lewis Drug Brandon 115 N Splitrock Blvd Brandon, SD , TTY: S Grange Ave Sioux Falls, SD , TTY: 711 Lewis Drug Eastgate 1301 East 10th Street Sioux Falls, SD , TTY: 711 Lewis Drug Long Term Care Pharma 2701 South Minnesota Avenue Suite 1 Sioux Falls, SD , TTY: 711 Medicap Pharmacy 304 W Hwy 38 Ste 102 Hartford, SD , TTY: 711 Omnicare of South Dakota 709 North Kiwanis Ave Sioux Falls, SD , TTY: 711

17 Pharmerica 1507 W 51st Street Suite 103 Sioux Falls, SD , TTY: 711 Sams Pharmacy 3201 South Louise Ave Sioux Falls, SD , TTY: 711 Sanford Cancer Center Oncology C 1309 W 17th St Suite 101 Sioux Falls, SD , TTY: 711 Vanhove Prescription Shop 1200 S 7th St Ave Ste 100 Sioux Falls, SD , TTY: 711 Wal-Mart Pharmacy 3209 South Louise Sioux Falls, SD , TTY: 711 Wal-Mart Pharmacy 5521 E Arrowhead Parkway Sioux Falls, SD , TTY: 711 Shopko Pharmacy 1601 W 41st St Sioux Falls, SD , TTY: 711 Wal-Mart Pharmacy 5200 W 60th Street N Sioux Falls, SD , TTY: 711 Shopko Pharmacy 4501 E Arrowhead Pkwy Sioux Falls, SD , TTY: 711 Walgreens 2605 W 12th St Sioux Falls, SD , TTY: 711 Target Pharmacy 3600 S Louise Ave Sioux Falls, SD , TTY: 711 Walgreens 3620 W 41st St Sioux Falls, SD , TTY: 711 Target Pharmacy 1021 S Highline Pl Sioux Falls, SD , TTY: 711 Walgreens 1806 S Minnesota Ave Sioux Falls, SD , TTY: 711

18 Walgreens 1720 S Sycamore Ave Sioux Falls, SD , TTY: 711 Family Thrift Center 1516 E St Patrick St Rapid City, SD , TTY: 711 Walgreens 7120 W 41st St Sioux Falls, SD , TTY: 711 Family Thrift Center 855 Omaha St , TTY: 711 Moody Fsst Clinic Pharmacy 701 W Broad Ave Flandreau, SD , TTY: E 2nd Ave Flandreau, SD , TTY: 711 Ftc Express Pharmacy 3464 Sturgis Road Rapid City, SD , TTY: 711 Kmart Pharmacy 1111 E North St , TTY: 711 Pennington Boyds Drug Mart East 909 E St Patrick St , TTY: 711 Boyds Drug Mart West 655 Mountain View Rd Rapid City, SD , TTY: 711 Boyds Drug Rx Express 2650 Mt Rushmore Rd , TTY: 711 Medicine Shoppe Advanced Care Ph 1308 Mt Rushmore Rd , TTY: 711 Medicine Shoppe Pharmacy 1304 Mt Rushmore Rd , TTY: 711 Pharmerica th Street Suite , TTY: 711

19 Rapid City IHS Hospital Pharmacy 3200 Canyon Lake Dr , TTY: 711 Target Pharmacy 1415 Eglin St Rapid City, SD , TTY: 711 Regional Long Term Care Pharmacy 1906 Lombardy Dr Ste 101 Rapid City, SD , TTY: 711 Wal-Mart Pharmacy 1200 Lacrosse , TTY: 711 Regional Specialty Pharmacy 1906 Lombardy Dr Ste 102 Rapid City, SD , TTY: 711 Wal-Mart Pharmacy 100 E Stumer Rd , TTY: 711 Safeway Pharmacy 730 Mountain View Rd Rapid City, SD , TTY: 711 Walgreens 540 Mountain View Rd Rapid City, SD , TTY: 711 Safeway Pharmacy 2120 Mt Rushmore Rapidcity, SD , TTY: 711 Walgreens 1125 N Lacrosse St , TTY: 711 Sams Pharmacy 925 Eglin St , TTY: 711 Walgreens 1902 Mount Rushmore Rd , TTY: 711 Shopko Pharmacy 1845 Haines Ave , TTY: 711 Wall Drug Store Inc 510 Main Wall, SD , TTY: 711

20 Potter Vilas Pharmacy 103 E Commercial Gettysburg, SD , TTY: 711 Roberts Shopko Pharmacy 1710 Sd Hwy 10 Sisseton, SD , TTY: 711 Woodrow Wilson Keeble Memorial H 100 Lake Traverse Dr Sisseton, SD , TTY: 711 Shannon Kyle IHS Clinic Pharmacy 1000 Health Center Circle Kyle, SD , TTY: 711 Pine Ridge IHS Hospital Pharmacy Highway 18 East Pine Ridge, SD , TTY: 711 Spink Randall Pharmacy /2 W 1st St Redfield, SD , TTY: 711 S Dakota Developmental Center Ph W 3rd St Redfield, SD , TTY: 711 Stanley Shanes Pharmacy 202 Island Dr Ste 2 Ft Pierre, SD , TTY: 711 Todd Mission Community Pharmacy 161 Main Street Mission, SD , TTY: 711 Rosebud IHS Hospital Pharmacy Hwy Soldier Creek Rd Rosebud, SD , TTY: 711 Tripp Shopko Pharmacy 1140 E 5th St Winner, SD , TTY: 711 Winner Health Mart Pharmacy 702 W 2nd St Winner, SD , TTY: 711

21 Turner Centerville Community Pharmacy 513 Broadway Centerville, SD , TTY: 711 Getskow Pharmacy 105 N Broadway Ave Marion, SD , TTY: W Park Ave Viborg, SD , TTY: 711 Pioneer Drug 107 E Main St Elk Point, SD , TTY: 711 Redlers Long Term Care LLC 317 Dakota Dunes Blvd Ste A Dakota Dunes, SD , TTY: 711 Walworth Family Pharmacy of Mobridge Inc 323 Main St Mobridge, SD , TTY: 711 Parker Pharmacy, LLC Sd Highway 19 Ste 2 Parker, SD , TTY: 711 Family Pharmacy-Clinic th Ave W Mobridge, SD , TTY: 711 Union Dunes Family Pharmacy 101 Tower Road Suite 130 Dakota Dunes, SD , TTY: North Third Beresford, SD , TTY: 711 Yankton Hy Vee Pharmacy 2100 Broadway Ave Yankton, SD , TTY: 711 Kmart Pharmacy 2210 Broadway Avenue Yankton, SD , TTY: 711 Rogers Family Pharmacy 218 West 4th Street Yankton, SD , TTY: 711

22 Sacred Heart Hospital Pharmacy 501 Summit St Yankton, SD , TTY: 711 Walgreens 2020 Broadway Ave Yankton, SD , TTY: 711 South Dakota Human Services Cent 3515 S Broadway Yankton, SD , TTY: 711 Yankton Medical Clinic Pharmacy 1104 W 8th St Yankton, SD , TTY: 711 Wal-Mart Pharmacy 3001 Broadway Avenue Yankton, SD , TTY: 711 Yankton Rexall Drug 109 W 3rd St Yankton, SD , 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 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

23 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. None available in your local area 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. Beadle Coborns Pharmacy 2150 Dakota Ave S Huron, SD Brookings Brothers Pharmacy th St Brookings, SD Lewis Drug Huron 1950 Dakota Avenue South Huron, SD Hy Vee Pharmacy nd Avenue South Brookings, SD Bennett Martin Drug and Mercantile 304 Main St Martin, SD Bon Homme Bon Homme Pharmacy 410 W 16th Ave Tyndall, SD Lewis Drug Brookings nd Avenue South Brookings, SD Brown Dt Pharmacy 815 1st Ave SE Ste 202 Aberdeen, SD

24 Long-term care pharmacies near you (continued) Brule 201 N Main St Chamberlain, SD Butte Lynns Dakotamart Pharmacy Bell 600 National St Belle Fourche, SD Codington Genoa Healthcare th St NE Watertown, SD Davison 1507 N Main St Mitchell, SD Day Cornwell Drug 701 Main St Webster, SD Deuel Deuel County Pharmacy 411 3rd Ave S Clear Lake, SD Edmunds Turner Drug Inc 3033 Main St Bowdle, SD Vilas Pharmacy 401 5th Avenue Ipswich, SD Fall River Fall River Hospital Pharmacy 1201 Hwy 71 South Hot Springs, SD South Dakota State Veterans Home 2500 Minnekahta Ave Hot Springs, SD Faulk Faulkton Drug 118 8th Ave S Faulkton, SD Grant Bien Pharmacy 222 S Main St Milbank, SD

25 Long-term care pharmacies near you (continued) 109 S Main St Milbank, SD Gregory Gregory Drug 604 Main St Gregory, SD Hutchinson Heritage Pharmacy 609 S Hwy 81 Freeman, SD Medicine Shoppe 102 West Main Parkston, SD Haakon Dakota Country Pharmacy, Inc. 130 S Center Philip, SD Hand Miller Rexall Drug 209 N Broadway Miller, SD Hughes Vilas LTC Pharmacy 200 E Dakota Ste 2 Pierre, SD Vilas Pharmacy 100 Mac Lane 2 Ste 2 Pierre, SD Parkston Drug Inc 112 West Main St Parkston, SD Jerauld 202 East Main St Wessington Springs, SD Kingsbury 213 Calumet South West Desmet, SD Lake Lewis Drug Madison 741 South Washington Avenue Madison, SD

26 Long-term care pharmacies near you (continued) Lawrence White Drug 71 Charles St Deadwood, SD Lincoln Lewis Drug 6109 S Louise Ave Sioux Falls, SD Lewis Drug 720 E 1st Street Tea, SD Salem Community Drug 300 N Main Salem, SD Mcpherson Vilas Pharmacy 712 7th St Eureka, SD Minnehaha Avera Long Term Care Pharmacy 3820 N Potsdam Ave Ste 2 Sioux Falls, SD South Main Street Lennox, SD Avera Mckennan Campus Pharmacy 1325 S Cliff Ave Suite Cp Sioux Falls, SD East 5th Street Canton, SD Mccook Heritage Pharmacy 206 N Main Bridgewater, SD Complete Home Care Inc 1104 W Russell St Sioux Falls, SD Hy Vee Pharmacy 1900 South Marion Road Sioux Falls, SD Lewis Drug Long Term Care Pharma 2701 South Minnesota Avenue Suite 1 Sioux Falls, SD

27 Long-term care pharmacies near you (continued) 1002 N Highway 77 Dell Rapids, SD Regional Long Term Care Pharmacy 1906 Lombardy Dr Ste 101 Rapid City, SD Omnicare of South Dakota 709 North Kiwanis Ave Sioux Falls, SD Pharmerica 1507 W 51st Street Suite 103 Sioux Falls, SD Moody 127 E 2nd Ave Flandreau, SD Pennington Medicine Shoppe Advanced Care Ph 1308 Mt Rushmore Rd Medicine Shoppe Pharmacy 1304 Mt Rushmore Rd Pharmerica th Street Suite Potter Vilas Pharmacy 103 E Commercial Gettysburg, SD Spink Randall Pharmacy /2 W 1st St Redfield, SD S Dakota Developmental Center Ph W 3rd St Redfield, SD Turner Centerville Community Pharmacy 513 Broadway Centerville, SD W Park Ave Viborg, SD

28 Long-term care pharmacies near you (continued) Union 100 North Third Beresford, SD Walworth Family Pharmacy-Clinic th Ave W Mobridge, SD Pioneer Drug 107 E Main St Elk Point, SD Redlers Long Term Care LLC 317 Dakota Dunes Blvd Ste A Dakota Dunes, SD Yankton Sacred Heart Hospital Pharmacy 501 Summit St Yankton, SD South Dakota Human Services Cent 3515 S Broadway Yankton, SD Yankton Rexall Drug 109 W 3rd St Yankton, SD 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. Buffalo Fort Thompson Ihc Clinic Pharmac Hwy 47 And Hwy 34 Fort Thompson, SD Charles Mix Wagner Indian Health Care Pharma 111 Washington Ave NW Wagner, SD

29 Indian health service/tribal/urban Indian health program (I/T/U) pharmacies near you (continued) Corson Mclaughlin IHS Clinic Pharmacy 701 East 6th St Mclaughlin, SD Pennington Rapid City IHS Hospital Pharmacy 3200 Canyon Lake Dr Dewey Eagle Butte IHS Hospital Pharmac 317 Main St Eagle Butte, SD Roberts Woodrow Wilson Keeble Memorial H 100 Lake Traverse Dr Sisseton, SD Jackson Wanblee Indian Hlth Ctr Pharmacy Highway 44 Wanblee, SD Shannon Kyle IHS Clinic Pharmacy 1000 Health Center Circle Kyle, SD Lyman Lower Brule IHS Clinic Pharmacy 1 Clinic Blvd Lower Brule, SD Pine Ridge IHS Hospital Pharmacy Highway 18 East Pine Ridge, SD Todd Rosebud IHS Hospital Pharmacy Hwy Soldier Creek Rd Rosebud, SD

30 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 SD Last updated September 18, 2015