Community Health Partnership Pharmacy Directory

Transcription

1 Community Health Partnership Pharmacy Directory This booklet provides a list of Community Health Partnership's network pharmacies. All network pharmacies may not be listed in this directory. Please contact Community Health Partnership at , 24 hours a day, seven days a week (TTY/TDD Users should call ) for additional information. Pharmacies may have been added or removed from the list after this directory was printed. To get current information about Community Health Partnership network pharmacies in your area, please visit our Website at or call our Customer Services Department at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) H5206_CHP_113_08 CMS Approval 11/2007 1

2 Introduction This booklet provides a list of Community Health Partnership's network pharmacies and includes some basic information about how to fill your prescriptions with Community Health Partnership. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage. We call the pharmacies on this list our network pharmacies because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Community Health Partnership. In most cases, your prescriptions are covered under Community Health Partnership only if they are filled at a network pharmacy. Once you go to one, you are not required to continue going to the same pharmacy to fill your prescription, you can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described later. Can the list of network pharmacies change? Yes, Community Health Partnership may add or remove pharmacies from our pharmacy directory. To get current information about Community Health Partnership network pharmacies in your area, please visit our Website at or call our Customer Services Department at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) How do I find Community Health Partnership network pharmacy in my area? To locate a pharmacy in your area you may consult the pharmacy directory below. The pharmacy directory lists area pharmacies first by state of location, then by county, city, and zip code. Or, you may visit our Website at or call our Customer Services at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) How do I fill a prescription at a network pharmacy? To fill your prescription at a network pharmacy, you must show your Community Health Partnership Member ID card. If you do not have your ID card with you when you fill your prescription, you may have to pay the full cost of the prescription (rather than paying just your co-payment). If this happens, you can ask us to reimburse you for our share of the cost by submitting a claim to us. To find out how to submit a claim, look in your Evidence of Coverage or call our Customer Services. 2

3 Filling prescriptions outside the network Generally, we only cover drugs filled at an out-of-network pharmacy in limited, non-routine circumstances when a network pharmacy is not available. Below are some circumstances when we would cover prescriptions fill at an out-of-network pharmacy. Before you fill your prescription in these situations, call our Customer Services Department, 24 hours a day, seven days a week at and TTY/TDD to see if there is a network pharmacy in your area where you can fill your prescription. If you do go to an out-of-network pharmacy for the reasons listed below, you may have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our of the cost by submitting a claim form. However, even after we reimburse you for our share of the cost, you may pay more for a drug purchased at an out-of-network pharmacy because the out-of-network pharmacy's price is higher than what a network pharmacy would have charged. You should submit a claim to us if you fill a prescription at an out-of-network pharmacy as any amount you pay, consistent with the circumstance listed above, will help you qualify for catastrophic coverage. To learn how to submit a paper claim, please refer to the paper claims process described next. The following are a few exceptions when we will pay for a prescription filled at a pharmacy outside of our network. Getting coverage when you travel or are away from the plan s service area If you take a prescription drug on a regular basis and you are going on a trip, be sure to check your supply of the drug before you leave. When possible, take along all the medication you will need. If you are traveling within the United States and territories and become ill, lose or run out of your prescription drugs we will cover prescriptions that are filled at an out-of-network pharmacy. In this situation, you will have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a claim form. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription. To learn how to submit a paper claim, please refer to the paper claims process described later. You can also call Customer Service to find out if there is a network pharmacy in the area where you are traveling. If there are no network pharmacies in that area, Customer Service may be able to make arrangements for you to get your prescriptions from an out-of-network pharmacy. We cannot pay for any prescriptions that are filled by pharmacies outside of the United States and territories, even for a medical emergency. 3

4 What if I need a prescription because of a medical emergency or because I needed urgent care? We will cover prescriptions that are filled at an out-of-network pharmacy if the prescriptions are related to care for a medical emergency or urgent care. In this situation, you will have to pay the full cost (rather than paying just your co-payment) when you fill your prescription. You can ask us to reimburse you for our share of the cost by submitting a paper claim form. If you go to an out-of-network pharmacy, you may be responsible for paying the difference between what we would pay for a prescription filled at an in-network pharmacy and what the out-of-network pharmacy charged for your prescription. To learn how to submit a paper claim, please refer to the paper claims process described later. Other times you can get your prescription covered if you go to an out-of network pharmacy We will cover your prescription at an out-of-network pharmacy if at least one of the following applies: If you are unable to obtain a covered drug in a timely manner within our service area because there is no network pharmacy within a reasonable driving distance that provides 24 hour service. If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail (including high cost and unique drugs). If you are getting a vaccine that is medically necessary but not covered by Medicare Part B and some covered drugs that are administered in your doctor's office. How do I submit a paper claim? When you go to a network pharmacy, your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy for one of the reasons listed above, the pharmacy may not be able to submit the claim directly to us. When that happens, you will have to pay the full cost of your prescription. When you return home, simply submit your claim and your receipt to the following address: Medicare Part D Paper Claims P.O. Box 407 Boys Town, NE Upon receipt, we will make an initial coverage determination on the claim. Please refer to your Evidence of Coverage or call Customer Service for more information on initial coverage determinations. 4

5 How do I use the pharmacy directory? The pharmacy directory lists area pharmacies first by the state of location, then by county, city, and zip code. If your pharmacy coverage includes coverage at a Mail Order, Home Infusion, Long Term Care, or Specialty pharmacy, that pharmacy information may be located at the end of the document. For more information For more detailed information about your Community Health Partnership prescription drug coverage, please review the Evidence of Coverage and Community Health Partnership's formulary. If you have questions about Community Health Partnership, please call our Customer Services Department at , 24 hours a day, seven days a week. TTY/TDD Users should call Or, visit 5

6 Retail Pharmacies STATE: WI COUNTY: BARRON CITY: Chetek ZIP: Ohde Pharmacy PO Box 127 Chetek, WI COUNTY: BUFFALO CITY: Mondovi ZIP: Mahlum Pharmacy 122 S Eau Claire St Mondovi, WI COUNTY: CHIPPEWA CITY: Bloomer ZIP: Bloomer Medical Center 1501 Thompson St Bloomer, WI Eds Pharmacy 1511 Main St Bloomer, WI CITY: Cadott ZIP: Miller Healthmart Pharmacy 318 N Main St Cadott, WI CITY: Chippewa Falls ZIP: Chippewa Pharmacy 2449 County Trunk I Clinic Pharmacy Of Chippewa Falls 2655 County Hwy I Kmart Pharmacy # Prairie View Rd Konsella Drug Store 224 N Bridge St Medicine Shoppe # N Bridge St Shopko Pharmacy # State Highway Walgreens # Woodward Ave Walmart Pharmacy # Commercial Blvd CITY: Cornell ZIP: Cornell Pharmacy 300 Main St Cornell, WI CITY: Stanley ZIP: Our Lady Of Victory Hospital 1120 Pine St Stanley, WI Our Lady Of Victory Pharmacy 1120 Pine St Stanley, WI COUNTY: CLARK 6

7 CITY: Abbotsford ZIP: Pamida Pharmacy # E Spruce St Abbotsford, WI CITY: Neillsville ZIP: Pamida Pharmacy # E Division Neillsville, WI Sniteman Pharmacy 528 Hewett St Neillsville, WI CITY: Withee ZIP: Owen-Withee Pharmacy PO Box 144 Withee, WI COUNTY: DUNN CITY: Colfax ZIP: Colfax Pharmacy 525 Main Street Colfax, WI CITY: Menomonie ZIP: Ericksons Pharmacy # th St E Kmart Pharmacy # Oak Ave Medicine Shoppe # Main St E Medicine Shoppe # Broadway St N Red Cedar Pharmacy 2321 Stout Rd Wal-Mart Pharmacy # Cedar Falls Rd Walgreens Pharmacy # Pine Ave W COUNTY: EAU CLAIRE CITY: Augusta ZIP: Wally Shong Drug Store 120 W Lincoln St Augusta, WI CITY: Eau Claire 7

8 ZIP: Clinic Pharmacy Of Oakwood 3501 Golf Road Clinic Pharmacy-Eau Claire 2116 Craig Rd Kmart Pharmacy # E Clairemont Ave Midelfort Long Term Care Pharmacy 1707 Westgate Rd Midelfort Pharmacy- Clairemont Campus 733 W Clairemont Ave Putnam Pharmacy 407 E Clairemont Ave Shopko Pharmacy # W Clairemont Ave Target Pharmacy 3649 S Hastings Way Value Center Pharmacy 2157 Eastridge Center Wal-Mart Pharmacy # Gateway Dr Walgreens # W Clairmont Ave Walgreens Pharmacy # S Hastings Way ZIP: Clinic Pharmacy Of Riverview 1000 Starr Ave Eau Claire, WI Eau Claire Pharmacy 2741 N Clairemont Ave Eau Claire, WI Midelfort Pharmacy - Luther Campus 1400 Bellinger St Eau Claire, WI Midelfort Pharmacy And Home Medical 202 N Barstow St Eau Claire, WI CITY: Fall Creek ZIP: Fall Creek Pharmacy 119 E Lincoln Fall Creek, WI COUNTY: PIERCE CITY: Ellsworth ZIP: Village Pharmacy 183 E Main St Ellsworth, WI CITY: Prescott ZIP: Most Pharmacy 201 Broad St N Prescott, WI CITY: River Falls 8

9 ZIP: Econofoods Pharmacy # S Main St River Falls, WI Freeman Drugs 104 S Main St River Falls, WI Shopko Pharmacy # Paulson Rd River Falls, WI Walgreens Pharmacy # N Main St River Falls, WI CITY: Spring Valley ZIP: Spring Valley Drug 104 S Mckay Ave Spring Valley, WI COUNTY: SAINT CROIX CITY: Baldwin ZIP: Village Pharmacy 840 Main St Baldwin, WI CITY: Hudson ZIP: Community Pharmacy At Hudson Hospital 405 Stageline Rd County Market Pharmacy 2310 Crest View Dr Econofoods Pharmacy # Coulee Rd Hudson Hospital 405 Stageline Rd Hudson Pharmacy 400 Wisconsin St Micklesen Drug Inc 530 2nd St Wal-Mart Pharmacy # Crest View Dr CITY: New Richmond ZIP: Econofoods Pharmacy # W 4th St New Richmond, WI Pamida Pharmacy # S Knowles Ave New Richmond, WI Wal-Mart Pharmacy # W Richmond Way New Richmond, WI Westfields Hospital 535 Hospital Rd New Richmond, WI CITY: Somerset ZIP: Somerset Clinic 700 Rivard St Somerset, WI COUNTY: TREMPEALEAU CITY: Arcadia ZIP: Pamida Pharmacy # Blaschko Ave Arcadia, WI CITY: Blair 9

10 ZIP: Blair Pharmacy 125 W Broadway Blair, WI Tri-County Memorial Hosp Phcy 1801 Lincoln St Whitehall, WI CITY: Galesville ZIP: Galesville Pharmacy PO Box 8 Galesville, WI CITY: Osseo ZIP: Midelfort Lehman Pharmacy- Osseo th St Osseo, WI Osseo Area Health th St Osseo, WI CITY: Strum ZIP: Strum Pharmacy Inc 111 5th Ave N Strum, WI CITY: Whitehall ZIP: Colby Pharmacy Main Whitehall, WI

11 Long-Term Care Pharmacies Are long-term care pharmacies part of Community Health Partnership's pharmacy network? In some cases, residents of a long-term care facility may access their prescription drugs through the facility s long-term care pharmacy or another network long-term care pharmacy. STATE: WI COUNTY: CHIPPEWA CITY: Chippewa Falls ZIP: Chippewa Valley LTC Pharmacy th St COUNTY: DUNN CITY: Menomonie ZIP: Medicine Shoppe # Main St E Medicine Shoppe # Broadway St N COUNTY: EAU CLAIRE CITY: Eau Claire ZIP: Midelfort Long Term Care Pharmacy 1707 Westgate Rd Midelfort Pharmacy- Clairemont Campus 733 W Clairemont Ave ZIP: Midelfort Pharmacy - Luther Campus 1400 Bellinger St Eau Claire, WI Midelfort Pharmacy And Home Medical 202 N Barstow St Eau Claire, WI CITY: Fall Creek ZIP: Fall Creek Pharmacy 119 E Lincoln Fall Creek, WI COUNTY: PIERCE CITY: Spring Valley ZIP: Spring Valley Drug 104 S Mckay Ave Spring Valley, WI COUNTY: SAINT CROIX CITY: Hudson ZIP: Community Pharmacy At Hudson Hospital 405 Stageline Rd COUNTY: TREMPEALEAU CITY: Blair ZIP: Blair Pharmacy 125 W Broadway Blair, WI CITY: Galesville 12

12 ZIP: Galesville Pharmacy PO Box 8 Galesville, WI CITY: Osseo ZIP: Midelfort Lehman Pharmacy- Osseo th St Osseo, WI Network Pharmacies outside the geographic area We have network pharmacies outside of the service area where you can get your drugs covered as a member of our plan. Please call our call our Customer Services at , 24 hours a day, seven days a week. (TTY/TDD Users should call ) for more information. 13