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Transcription:

2016 Pharmacy DIRECTORY This directory is a list of network pharmacies near you. This directory is for Rhode Island. For more information, please call Customer Service at: Toll-Free 1-888-556-6648, TTY 711 8 a.m. to 8 p.m. local time, Monday through Friday Y0066_150908_140732 Last updated September 18, 2015

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 www.unitedpharmacysaver.com. Pharmacies included in the Pharmacy Saver program are indicated by a pharmacy listings on the following pages. symbol in the

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 1-888-279-1828, TTY 1-866-394-7218, 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 1-888-279-1828, TTY 1-866-394-7218, 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.

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

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 1-800-723-3929 Duane Reade 1-866-375-6925 Food Lion 1-800-210-9569 Giant 1-888-469-4426 Giant Food Stores 1-888-814-4268 Hannaford 1-800-213-9040 H-E-B 1-800-432-3113 Hy-Vee 1-515-267-2800 Kroger & Affiliates Baker s City Market Dillons Fred Meyer Fry s Harris Teeter King Soopers Kroger QFC Ralphs Smith s 1-800-576-4377 Martins 1-888-562-7846 Publix 1-800-782-5497 Sam s Club 1-888-746-7726 Stop & Shop 1-800-767-7772 Target 1-800-440-0680 Thrifty White 1-888-558-9941 1-877-250-5823 TTY 1-877-924-7889 Walmart 1-800-925-6278 Wegmans 1-800-934-6267 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.

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. Bristol 615 Metacom Ave Rte 136 Warren, RI 02885 401-245-0400, TTY: 711 180 County Rd Barrington, RI 02806 401-245-0464, TTY: 711 400 Metacom Ave Bristol, RI 02809 401-253-2050, TTY: 711 173 State St Bristol, RI 02809 401-253-8808, TTY: 711 Delekta Pharmacy Inc 496 Main St Warren, RI 02885 401-245-6767, TTY: 711 580 Metacom Avenue Bristol, RI 02809 401-253-2723, TTY: 711 1086 Willet Avenue East Providence, RI 02915 401-433-5710, TTY: 711 236 County Road Barrington, RI 02806 401-245-8855, TTY: 711 591 Metacom Ave Bristol, RI 02809 401-254-3903, TTY: 711 Kent Apothecare Compounding Solutions 3303 South County Trail E. Greenwich, RI 02818 401-821-5000, TTY: 711 Genoa Healthcare 2 Old County Rd Barrington, RI 02806 401-237-4125, TTY: 711 507 Main St East Greenwich, RI 02818 401-884-7045, TTY: 711

1125 Main St West Warwick, RI 02893 401-822-2762, TTY: 711 2250 New London Tpk East Greenwich, RI 02818 401-821-3145, TTY: 711 763 Tiogue Ave Coventry, RI 02816 401-821-2060, TTY: 711 1285 S County Trl East Greenwich, RI 02818 401-886-0902, TTY: 711 767 Warwick Ave Warwick Ave Sc Warwick, RI 02888 401-467-7788, TTY: 711 198 Buttonwoods Ave 401-739-4330, TTY: 711 2790 Post Rd 401-739-3173, TTY: 711 Genoa Healthcare 75 Lambert Lind Hwy Ste 125 401-287-4990, TTY: 711 2400 Warwick Ave Meadowbrook Plz Warwick, RI 02889 401-737-2305, TTY: 711 Horizon Pharmacy 2756 Post Rd Ste 105 401-681-4220, TTY: 711 834 Providence St West Warwick, RI 02893 401-821-3563, TTY: 711 1734 Main St West Warwick, RI 02893 401-821-7428, TTY: 711 Omnicare of Rhode Island 30 Centre of New England Blvd Coventry, RI 02816 401-827-1615, TTY: 711 Pharmerica 83 Vermont Avenue Ste 2 Warwick, RI 02888 401-737-4165, TTY: 711

Phusion Pharmacy 17 Coventry Shoppers Park Coventry, RI 02816 401-823-0000, TTY: 711 Sam's Pharmacy 25 Pace Blvd 401-262-3145, TTY: 711 1080 Bald Hill Road 401-822-0002, TTY: 711 2470 Warwick Ave Warwick, RI 02889 401-732-4060, TTY: 711 2055 Warwick Avenue Warwick, RI 02888 401-738-6300, TTY: 711 300 Quaker Lane 401-828-0533, TTY: 711 719 Tiogue Avenue Coventry, RI 02816 401-822-4800, TTY: 711 900 Tiogue Avenue Coventry, RI 02816 401-823-4343, TTY: 711 1201 Warwick Avenue Warwick, RI 02889 401-463-6010, TTY: 711 Suburban Pharmacy 242 Pawtuxet Ave Warwick, RI 02888 401-781-2110, TTY: 711 2595 West Shore Road Warwick, RI 02889 401-737-4771, TTY: 711 Target Pharmacy 1245 Bald Hill Rd Warwick, RI 02888 401-821-8283, TTY: 711 1155 Main Street West Warwick, RI 02893 401-828-9793, TTY: 711 Target Pharmacy 400 Bald Hill Rd, Ste 200 Ste 200 401-244-1973, TTY: 711

Wal-Mart Pharmacy 650 Centre of New England Blvd Coventry, RI 02816 401-823-7060, TTY: 711 1 Cowesett Ave West Warwick, RI 02893 401-826-0879, TTY: 711 Wal-Mart Pharmacy 840 Post Road Warwick, RI 02888 401-781-8340, TTY: 711 875 Tiogue Ave. Coventry, RI 02816 401-822-7602, TTY: 711 Wal-Mart Pharmacy 650 Bald Hill Road 401-821-7844, TTY: 711 1000 Division St East Greenwich, RI 02818 401-884-7370, TTY: 711 2399 Warwick Ave Warwick, RI 02889 401-737-5810, TTY: 711 3336 Post Rd 401-737-1952, TTY: 711 1560 Warwick Ave Warwick, RI 02889 401-737-2913, TTY: 711 Newport Bakers Pharmacy 53 Narragansett Ave Jamestown, RI 02835 401-423-2800, TTY: 711 181 Bellevue Ave Newport, RI 02840 401-846-7800, TTY: 711 99 East Main Rd Middletown, RI 02842 401-847-0254, TTY: 711 500 Main Rd Tiverton, RI 02878 401-624-8421, TTY: 711 10 Tpk At E Main Rd Rte 138 Portsmouth, RI 02871 401-682-2098, TTY: 711

287 Broadway Newport, RI 02840 401-847-6762, TTY: 711 12 E Main Rd Middletown, RI 02842 401-847-8520, TTY: 711 7 East Main Road Middletown, RI 02840 401-849-4600, TTY: 711 3034 East Main Road Portsmouth, RI 02871 401-683-1270, TTY: 711 2456 East Main Road Portsmouth, RI 02871 401-683-3062, TTY: 711 677 Main Road Tiverton, RI 02878 401-624-8411, TTY: 711 1360 West Main Road Middletown, RI 02842 401-849-9640, TTY: 711 Wal-Mart Pharmacy 199 Connell Highway Newport, RI 02840 401-848-5861, TTY: 711 Providence Atwood Prescription Center Inc 1524 Atwood Ave Johnston, RI 02919 401-831-0100, TTY: 711 Blackstone Health Mart Pharmacy 465 Lonsdale Ave Ste B Pawtucket, RI 02860 401-475-5655, TTY: 711 1054 Cass Ave Woonsocket, RI 02895 401-767-3600, TTY: 711 1998 Mendon Rd Cumberland, RI 02864 401-333-1225, TTY: 711 444 Willett Ave East Providence, RI 02915 401-433-1120, TTY: 711 681 Reservoir Ave Cranston, RI 02910 401-943-7188, TTY: 711

583 Taunton Ave East Providence, RI 02914 401-434-2993, TTY: 711 601 Smithfield Ave Pawtucket, RI 02860 401-727-1866, TTY: 711 835 Newport Ave Pawtucket, RI 02861 401-726-0724, TTY: 711 315 Broad St Cumberland, RI 02864 401-726-8110, TTY: 711 120 Eddie Dowling Hwy N Smithfield, RI 02896 401-762-3172, TTY: 711 799 Hope St Providence, RI 02906 401-331-5240, TTY: 711 1919 Mineral Spring Ave N. Providence, RI 02904 401-353-2501, TTY: 711 400 Admiral St Providence, RI 02908 401-351-5030, TTY: 711 445 Putnam Pike Apple Valley Mal Apple Valley Mall Greenville, RI 02828 401-231-5320, TTY: 711 1188 Pontiac Ave 401-736-5701, TTY: 711 1400 Hartford Ave Johnston, RI 02919 401-861-0310, TTY: 711 131 Webster Ave Providence, RI 02909 401-944-6060, TTY: 711 20 High St Pascoag, RI 02859 401-568-4224, TTY: 711 481 Angell St Providence, RI 02906 401-521-4340, TTY: 711

1068 Putnam Pike Chepachet, RI 02814 401-568-6043, TTY: 711 1195 Oakland Ave 401-463-1971, TTY: 711 205 Atwood Ave 401-942-4100, TTY: 711 450 Clinton St Woonsocket, RI 02895 401-767-2120, TTY: 711 425 East Ave Pawtucket, RI 02860 401-722-8704, TTY: 711 309 Broad St Central Falls, RI 02863 401-721-9880, TTY: 711 2125 Diamond Hill Rd Cumberland, RI 02864 401-335-4563, TTY: 711 640 Warren Ave East Providence, RI 02914 401-438-2272, TTY: 711 935 Manton Ave Providence, RI 02909 401-453-5612, TTY: 711 960 Broad St S. Providence, RI 02905 401-461-3699, TTY: 711 39 Providence Pl Providence Place Mall #1010 Providence, RI 02903 401-270-4440, TTY: 711 63 Newport Ave Rumford, RI 02916 401-431-0461, TTY: 711 1993 Plainfield Pike Johnston, RI 02919 401-942-3286, TTY: 711 1776 Broad St Cranston, RI 02905 401-780-8902, TTY: 711

26 Putnam Pike Johnston, RI 02919 401-231-0814, TTY: 711 Genoa Healthcare 55 John A Cummings Way Woonsocket, RI 02895 401-762-7526, TTY: 711 Care Plus CVS/Pharmacy 2 Dudley St Ste 170 Providence, RI 02905 401-421-1555, TTY: 711 Howell Smith Druggist 749 Central Ave Pawtucket, RI 02861 401-725-7711, TTY: 711 Chapel Pharmacy Inc 2081 Diamond Hill Rd Cumberland, RI 02864 401-333-5858, TTY: 711 Infusion Resource LLC 2 Heming Way Drive East Providence, RI 02915 401-431-0200, TTY: 711 East Side Presc Center Inc 632 Hope St Providence, RI 02906 401-751-1430, TTY: 711 Jb Pharmacy 1017 Smith St Providence, RI 02908 401-861-1194, TTY: 711 Eleanor Slater Hospital Phcy 2090 Wallum Lake Rd Pascoag, RI 02859 401-462-3077, TTY: 711 Eleanor Slater Pharmacy 111 Howard Ave 401-462-3077, TTY: 711 Genoa Healthcare 530 N Main St Ste 6 Providence, RI 02904 401-276-6370, TTY: 711 Lifespan Pharmacy 593 Eddy St Davol Building Providence, RI 02903 401-444-4909, TTY: 711 Lifespan Pharmacy 164 Summit Ave Providence, RI 02906 401-493-5500, TTY: 711 Osco Pharmacy 15 Smithfield Rd Admiral Plz North Providence, RI 02904 401-353-4075, TTY: 711

Phreds Drug Inc 1300 Oaklawn Ave 401-463-6300, TTY: 711 452 Putnam Pike Smithfield, RI 02828 401-232-5500, TTY: 711 QOL Meds 101 Bacon St Pawtucket, RI 02860 401-722-0299, TTY: 711 1665 Mineral Spring Avenue North Providence, RI 02904 401-353-3113, TTY: 711 250 Atwood Avenue 401-944-7172, TTY: 711 220 Newport Avenue East Providence, RI 02916 401-434-1333, TTY: 711 727 East Avenue Pawtucket, RI 02860 401-724-6800, TTY: 711 655 Warren Avenue East Providence, RI 02914 401-434-5700, TTY: 711 2136 Mendon Road Cumberland, RI 02864 401-333-1220, TTY: 711 570 Pontiac Avenue Cranston, RI 02910 401-781-6360, TTY: 711 548 Dyer Avenue 401-942-3386, TTY: 711 1459 Atwood Avenue Johnston, RI 02919 401-831-9804, TTY: 711 342 Power Road Pawtucket, RI 02860 401-724-3274, TTY: 711 150 Mineral Spring Avenue Pawtucket, RI 02860 401-726-0547, TTY: 711

200 Academy Avenue Providence, RI 02908 401-521-4941, TTY: 711 456 Branch Avenue Providence, RI 02904 401-331-3554, TTY: 711 900 Victory Highway Slatersville, RI 02876 401-766-4603, TTY: 711 1510 Smith Street North Providence, RI 02911 401-353-3500, TTY: 711 711 Broad Street Providence, RI 02907 401-331-9550, TTY: 711 1011 Cranston Street 401-275-0849, TTY: 711 200 Social Street Woonsocket, RI 02895 401-762-9200, TTY: 711 Simpsons Pharmacy Inc 10 Newport Ave Pawtucket, RI 02861 401-722-7600, TTY: 711 47 Village Plaza Way North Scituate, RI 02857 401-934-2480, TTY: 711 11 Commerce Way Johnston, RI 02919 401-861-3150, TTY: 711 135 Pitman Street Providence, RI 02906 401-861-4879, TTY: 711 595 Smithfield Road N Smithfield, RI 02896 401-765-6722, TTY: 711 1114 Broad Street Central Falls, RI 02863 401-722-5801, TTY: 711 446 Putnam Pike Greenville, RI 02828 401-949-1848, TTY: 711

70 Mendon Road Cumberland, RI 02864 401-722-3401, TTY: 711 1925 Pawtucket Ave E Providence, RI 02914 401-726-5332, TTY: 711 200 Atwood Avenue 401-944-2669, TTY: 711 Target Pharmacy 371 Putnam Pike Ste A250 Smithfield, RI 02917 401-232-2854, TTY: 711 1128 Mineral Spring Avenue N Providence, RI 02904 401-727-3900, TTY: 711 Target Pharmacy 620 George Washington Hwy Lincoln, RI 02865 401-642-0081, TTY: 711 850 Manton Avenue Providence, RI 02909 401-453-0288, TTY: 711 Wal-Mart Pharmacy 1776 Plainfield Pike Cranston, RI 02921 401-946-2040, TTY: 711 622 George Washington Hwy Lincoln, RI 02865 401-334-0754, TTY: 711 Wal-Mart Pharmacy 7 Dowling Village Blvd N Smithfield, RI 02896 401-769-1695, TTY: 711 204 Garfield Avenue 401-943-8285, TTY: 711 Wal-Mart Pharmacy 51 Silver Spring Street Providence, RI 02904 401-272-5340, TTY: 711 368398 Cottage Street Pawtucket, RI 02861 401-722-6538, TTY: 711 385 Cottage St Pawtucket, RI 02861 401-727-4407, TTY: 711

295 Academy Ave Providence, RI 02908 401-273-7675, TTY: 711 1074 Mineral Spring Ave North Providence, RI 02904 401-725-6824, TTY: 711 1010 Park Ave Cranston, RI 02910 401-946-0337, TTY: 711 1387 Plainfield St Johnston, RI 02919 401-942-6182, TTY: 711 1763 Broad Street Cranston, RI 02905 401-461-6770, TTY: 711 100 Broad St Pawtucket, RI 02860 401-724-6724, TTY: 711 45 Cumberland St Woonsocket, RI 02895 401-765-5040, TTY: 711 1279 Oaklawn Ave 401-463-8039, TTY: 711 25 Putnam Pike Johnston, RI 02919 401-231-6561, TTY: 711 1140 N Main St Providence, RI 02904 401-278-4901, TTY: 711 354 Admiral Street Providence, RI 02908 401-331-2636, TTY: 711 333 Atwells Ave Providence, RI 02903 401-276-8301, TTY: 711 533 Elmwood Ave Providence, RI 02907 401-781-7930, TTY: 711 600 Warren Ave East Providence, RI 02914 401-438-9501, TTY: 711

1 Pocasset Ave Providence, RI 02909 401-464-6501, TTY: 711 1583 Atwood Ave Johnston, RI 02919 401-231-1280, TTY: 711 335 Prairie Ave Providence, RI 02905 401-781-5120, TTY: 711 1 Eddie Dowling Hwy North Smithfield, RI 02896 401-229-9290, TTY: 711 We Care Rx 678 Park Ave Unit 2 Cranston, RI 02910 401-270-7225, TTY: 711 White Cross Pharmacy 1057 Mineral Spring Ave North Providence, RI 02904 401-726-6200, TTY: 711 White Cross Pharmacy 1057 Mineral Spring Ave North Providence, RI 02904 401-726-6200, TTY: 711 Washington Bayview Pharmacy Inc 3045 Towerhill Rd Unit 3 Saunderstown, RI 02874 401-284-4505, TTY: 711 6495 Post Rd North Kingstown, RI 02852 401-885-4920, TTY: 711 150 Granite St Westerly, RI 02891 401-348-2070, TTY: 711 11 Main St Wakefield, RI 02879 401-783-3384, TTY: 711 1187 Main St Wyoming, RI 02898 401-539-4000, TTY: 711 1123 Boston NEck Road Narragansett, RI 02882 401-783-1753, TTY: 711 151 Franklin St Westerly, RI 02891 401-596-8182, TTY: 711

3986 Old Post Rd Charlestown, RI 02813 401-364-0900, TTY: 711 170 Granite Street Westerly, RI 02891 401-596-2734, TTY: 711 Electric Boat Pharmacy 100 Romano Vineyard Way North Kingstown, RI 02852 401-294-2925, TTY: 711 1193 Boston NEck Road Narragansett, RI 02882 401-789-5124, TTY: 711 Mcquade Market Place Pharmacy 106 Main St Westerly, RI 02891 401-596-0277, TTY: 711 63 Brown Street North Kingstown, RI 02852 401-294-3662, TTY: 711 QOL Meds 55 Cherry Lane Wakefield, RI 02879 401-782-3511, TTY: 711 5945 Post Road North Kingstown, RI 02852 401-885-5100, TTY: 711 7691 Post Road North Kingstown, RI 02852 401-294-7830, TTY: 711 604 Kingstown Road Wakefield, RI 02879 401-783-8630, TTY: 711 21 Kingstown Road Richmond, RI 02898 401-539-6001, TTY: 711 20 Woodruff Avenue Narragansett, RI 02882 401-792-7179, TTY: 711 Seaside Pharmacy of Westerly 224 Post Rd Westerly, RI 02891 401-637-4577, TTY: 711 91 Point Judith Road Narragansett, RI 02882 401-783-7768, TTY: 711

Wakefield Prescription Center 580 Kingstown Rd Wakefield, RI 02879 401-789-9791, TTY: 711 Wal-Mart Pharmacy 1031 Ten Rod Road North Kingstown, RI 02852 401-294-3455, TTY: 711 Wal-Mart Pharmacy 258 Post Road Westerly, RI 02891 401-322-0793, 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 29061 Mission, KS 66201 Phoenix, AZ 85038 Toll-free 1-888-279-1828 Toll-free 1-800-489-2197 TTY 1-866-394-7218 TTY 1-888-492-2968 www.optumrx.com www..com/mailservice Manifest Pharmacy, LLC 1018 South Batesville Road, Bldg 4-A Greer, SC 29650 Toll-free 1-888-614-0119 orders@manifestrx.com 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.

Home infusion pharmacies near you (continued) Kent New England Home Infusion Inc 3303 South County Trail E. Greenwich, RI 02818 401-821-0600 Providence Carepoint Partners 15 Hazel St Pawtucket, RI 02860 401-727-6100 Infusion Resource LLC 2 Heming Way Drive East Providence, RI 02915 401-431-0200 Option Care 66 Amaral St East Providence, RI 02915 401-431-1300 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. Bristol Delekta Pharmacy Inc 496 Main St Warren, RI 02885 401-245-6767 Genoa Healthcare 2 Old County Rd Barrington, RI 02806 401-237-4125 Kent Genoa Healthcare 75 Lambert Lind Hwy Ste 125 401-287-4990 Horizon Pharmacy 2756 Post Rd Ste 105 401-681-4220 Omnicare of Rhode Island 30 Centre of New England Blvd Coventry, RI 02816 401-827-1615 Pharmerica 83 Vermont Avenue Ste 2 Warwick, RI 02888 401-737-4165

Long-term care pharmacies near you (continued) Phusion Pharmacy 17 Coventry Shoppers Park Coventry, RI 02816 401-823-0000 Genoa Healthcare 55 John A Cummings Way Woonsocket, RI 02895 401-762-7526 Providence Atwood Prescription Center Inc 1524 Atwood Ave Johnston, RI 02919 401-831-0100 Eleanor Slater Hospital Phcy 2090 Wallum Lake Rd Pascoag, RI 02859 401-462-3077 Eleanor Slater Pharmacy 111 Howard Ave 401-462-3077 Genoa Healthcare 530 N Main St Ste 6 Providence, RI 02904 401-276-6370 QOL Meds 101 Bacon St Pawtucket, RI 02860 401-722-0299 White Cross Pharmacy 1057 Mineral Spring Ave North Providence, RI 02904 401-726-6200 White Cross Pharmacy 1057 Mineral Spring Ave North Providence, RI 02904 401-726-6200 Washington QOL Meds 55 Cherry Lane Wakefield, RI 02879 401-782-3511 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. None available in your local area

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 1-888-556-6648, TTY 711 8 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. UHEX16PD3724700_000 RI Last updated September 18, 2015