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 1-800-546-5677, 24 hours a day, seven days a week (TTY/TDD Users should call 1-866-706-4759.) 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 www.communityhealthpartnership.com or call our Customer Services Department at 1-800-546-5677, 24 hours a day, seven days a week. (TTY/TDD Users should call 1-866-706-4759.) H5206_CHP_113_08 CMS Approval 11/2007 1
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 www.communityhealthpartnership.com or call our Customer Services Department at 1-800-546-5677, 24 hours a day, seven days a week. (TTY/TDD Users should call 1-866-706-4759.) 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 www.communityhealthpartnership.com or call our Customer Services at 1-800-546-5677, 24 hours a day, seven days a week. (TTY/TDD Users should call 1-866-706-4759.) 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
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 1-800-546-5677 and TTY/TDD 1-866-706-4759 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
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 68010. 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
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 1-800-546-5677, 24 hours a day, seven days a week. TTY/TDD Users should call 1-866-706-4759. Or, visit www.communityhealthpartnership.com. 5
Retail Pharmacies STATE: WI COUNTY: BARRON CITY: Chetek ZIP: 54728 Ohde Pharmacy PO Box 127 Chetek, WI 54728 715-924-3592 COUNTY: BUFFALO CITY: Mondovi ZIP: 54755 Mahlum Pharmacy 122 S Eau Claire St Mondovi, WI 54755 715-926-4938 COUNTY: CHIPPEWA CITY: Bloomer ZIP: 54724 Bloomer Medical Center 1501 Thompson St Bloomer, WI 54724 715-568-2000 Eds Pharmacy 1511 Main St Bloomer, WI 54724 715-568-2190 CITY: Cadott ZIP: 54727 Miller Healthmart Pharmacy 318 N Main St Cadott, WI 54727 715-289-3243 CITY: Chippewa Falls ZIP: Chippewa Pharmacy 2449 County Trunk I 715-723-2824 Clinic Pharmacy Of Chippewa Falls 2655 County Hwy I 715-726-4177 Kmart Pharmacy #3735 409 Prairie View Rd 715-726-1831 Konsella Drug Store 224 N Bridge St 715-723-9177 Medicine Shoppe #270 603 N Bridge St 715-723-9192 Shopko Pharmacy #237 2677 State Highway 53 715-726-1631 Walgreens #7966 849 Woodward Ave 715-726-8540 Walmart Pharmacy #5373 2786 Commercial Blvd 715-738-2418 CITY: Cornell ZIP: 54732 Cornell Pharmacy 300 Main St Cornell, WI 54732 715-239-6453 CITY: Stanley ZIP: 54768 Our Lady Of Victory Hospital 1120 Pine St Stanley, WI 54768 715-649-5571 Our Lady Of Victory Pharmacy 1120 Pine St Stanley, WI 54768 715-644-6168 COUNTY: CLARK 6
CITY: Abbotsford ZIP: 54405 Pamida Pharmacy #108 1011 E Spruce St Abbotsford, WI 54405 715-223-2480 CITY: Neillsville ZIP: 54456 Pamida Pharmacy #324 1008 E Division Neillsville, WI 54456 715-743-6632 Sniteman Pharmacy 528 Hewett St Neillsville, WI 54456 715-743-3500 CITY: Withee ZIP: 54498 Owen-Withee Pharmacy PO Box 144 Withee, WI 54498 715-229-2020 COUNTY: DUNN CITY: Colfax ZIP: 54730 Colfax Pharmacy 525 Main Street Colfax, WI 54730 715-962-3784 CITY: Menomonie ZIP: 54751 Ericksons Pharmacy #341 1508 9th St E 715-235-9611 Kmart Pharmacy #3541 103 Oak Ave 715-235-6770 Medicine Shoppe #1685 149 Main St E 715-235-2121 Medicine Shoppe #527 1232 Broadway St N 715-235-4235 Red Cedar Pharmacy 2321 Stout Rd 715-233-7500 Wal-Mart Pharmacy #1819 180 Cedar Falls Rd 715-235-7885 Walgreens Pharmacy #9514 121 Pine Ave W 715-235-9275 COUNTY: EAU CLAIRE CITY: Augusta ZIP: 54722 Wally Shong Drug Store 120 W Lincoln St Augusta, WI 54722 715-286-2515 CITY: Eau Claire 7
ZIP: 54701 Clinic Pharmacy Of Oakwood 3501 Golf Road 715-858-4224 Clinic Pharmacy-Eau Claire 2116 Craig Rd 715-858-4811 Kmart Pharmacy #4051 2424 E Clairemont Ave 715-834-7380 Midelfort Long Term Care Pharmacy 1707 Westgate Rd 715-838-5856 Midelfort Pharmacy- Clairemont Campus 733 W Clairemont Ave 715-838-5000 Putnam Pharmacy 407 E Clairemont Ave 715-552-7210 Shopko Pharmacy #24 955 W Clairemont Ave 715-832-8336 Target Pharmacy 3649 S Hastings Way 715-838-0447 Value Center Pharmacy 2157 Eastridge Center 715-833-6760 Wal-Mart Pharmacy #1669 3915 Gateway Dr 715-834-5966 Walgreens #1937 1106 W Clairmont Ave 715-852-0063 Walgreens Pharmacy #3497 1819 S Hastings Way 715-834-3121 ZIP: 54703 Clinic Pharmacy Of Riverview 1000 Starr Ave Eau Claire, WI 54703 715-858-4366 Eau Claire Pharmacy 2741 N Clairemont Ave Eau Claire, WI 54703 715-833-6767 Midelfort Pharmacy - Luther Campus 1400 Bellinger St Eau Claire, WI 54703 715-838-6000 Midelfort Pharmacy And Home Medical 202 N Barstow St Eau Claire, WI 54703 715-838-1800 CITY: Fall Creek ZIP: 54742 Fall Creek Pharmacy 119 E Lincoln Fall Creek, WI 54742 715-877-2994 COUNTY: PIERCE CITY: Ellsworth ZIP: 54011 Village Pharmacy 183 E Main St Ellsworth, WI 54011 715-273-5151 CITY: Prescott ZIP: 54021 Most Pharmacy 201 Broad St N Prescott, WI 54021 715-262-3294 CITY: River Falls 8
ZIP: 54022 Econofoods Pharmacy #322 303 S Main St River Falls, WI 54022 715-425-8494 Freeman Drugs 104 S Main St River Falls, WI 54022 715-425-2255 Shopko Pharmacy #2130 1777 Paulson Rd River Falls, WI 54022 715-425-6272 Walgreens Pharmacy #10585 1047 N Main St River Falls, WI 54022 715-426-4089 CITY: Spring Valley ZIP: 54767 Spring Valley Drug 104 S Mckay Ave Spring Valley, WI 54767 715-778-5684 COUNTY: SAINT CROIX CITY: Baldwin ZIP: 54002 Village Pharmacy 840 Main St Baldwin, WI 54002 715-684-2674 CITY: Hudson ZIP: 54016 Community Pharmacy At Hudson Hospital 405 Stageline Rd 715-531-6450 County Market Pharmacy 2310 Crest View Dr 715-381-5923 Econofoods Pharmacy #344 2351 Coulee Rd 715-386-5856 Hudson Hospital 405 Stageline Rd 715-531-6000 Hudson Pharmacy 400 Wisconsin St 715-386-0151 Micklesen Drug Inc 530 2nd St 715-386-3344 Wal-Mart Pharmacy #1365 2222 Crest View Dr 715-386-1345 CITY: New Richmond ZIP: 54017 Econofoods Pharmacy #321 110 W 4th St New Richmond, WI 54017 715-246-2186 Pamida Pharmacy #315 1470 S Knowles Ave New Richmond, WI 54017 715-246-5823 Wal-Mart Pharmacy #5432 250 W Richmond Way New Richmond, WI 54017 715-246-9097 Westfields Hospital 535 Hospital Rd New Richmond, WI 54017 952-653-2528 CITY: Somerset ZIP: 54025 Somerset Clinic 700 Rivard St Somerset, WI 54025 800-877-1588 COUNTY: TREMPEALEAU CITY: Arcadia ZIP: 54612 Pamida Pharmacy #834 1625 Blaschko Ave Arcadia, WI 54612 608-323-8134 CITY: Blair 9
ZIP: 54616 Blair Pharmacy 125 W Broadway Blair, WI 54616 608-989-2919 Tri-County Memorial Hosp Phcy 1801 Lincoln St Whitehall, WI 54773 715-538-4361 CITY: Galesville ZIP: 54630 Galesville Pharmacy PO Box 8 Galesville, WI 54630 608-582-2446 CITY: Osseo ZIP: 54758 Midelfort Lehman Pharmacy- Osseo 13025 8th St Osseo, WI 54758 715-597-3166 Osseo Area Health 13025 8th St Osseo, WI 54758 715-597-3121 CITY: Strum ZIP: 54770 Strum Pharmacy Inc 111 5th Ave N Strum, WI 54770 715-695-3417 CITY: Whitehall ZIP: 54773 Colby Pharmacy 36363 Main Whitehall, WI 54773 715-538-4947 10
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 7490 156th St 715-726-0834 COUNTY: DUNN CITY: Menomonie ZIP: 54751 Medicine Shoppe #1685 149 Main St E 715-235-2121 Medicine Shoppe #527 1232 Broadway St N 715-235-4235 COUNTY: EAU CLAIRE CITY: Eau Claire ZIP: 54701 Midelfort Long Term Care Pharmacy 1707 Westgate Rd 715-838-5856 Midelfort Pharmacy- Clairemont Campus 733 W Clairemont Ave 715-838-5000 ZIP: 54703 Midelfort Pharmacy - Luther Campus 1400 Bellinger St Eau Claire, WI 54703 715-838-6000 Midelfort Pharmacy And Home Medical 202 N Barstow St Eau Claire, WI 54703 715-838-1800 CITY: Fall Creek ZIP: 54742 Fall Creek Pharmacy 119 E Lincoln Fall Creek, WI 54742 715-877-2994 COUNTY: PIERCE CITY: Spring Valley ZIP: 54767 Spring Valley Drug 104 S Mckay Ave Spring Valley, WI 54767 715-778-5684 COUNTY: SAINT CROIX CITY: Hudson ZIP: 54016 Community Pharmacy At Hudson Hospital 405 Stageline Rd 715-531-6450 COUNTY: TREMPEALEAU CITY: Blair ZIP: 54616 Blair Pharmacy 125 W Broadway Blair, WI 54616 608-989-2919 CITY: Galesville 12
ZIP: 54630 Galesville Pharmacy PO Box 8 Galesville, WI 54630 608-582-2446 CITY: Osseo ZIP: 54758 Midelfort Lehman Pharmacy- Osseo 13025 8th St Osseo, WI 54758 715-597-3166 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 1-800-546-5677, 24 hours a day, seven days a week. (TTY/TDD Users should call 1-866-706-4759.) for more information. 13