PHarmacy DIrEcTOry. NETwOrk HEaLTH medicare advantage PLaNs

Transcription

1 1570 midway Place menasha,wi TTy monday Friday, 8 a.m. to 8 p.m. NetworkHealthmedicare.com NetworkCares (PPO snp) Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) Network PlatinumSelect (PPO) H5215_RXPD/13_V1 CMS ACCEPTED NETwOrk HEaLTH medicare advantage PLaNs Network Health Insurance corporation 2013 PHarmacy DIrEcTOry

2 Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) NetworkCares (PPO SNP) Network PlatinumSelect (PPO) Pharmacy Directory This booklet provides a list of Network PlatinumPlus Pharmacy, Network PlantinumPremier Pharmacy, NetworkCares and Network PlatinumSelect s network pharmacies. We also list pharmacies that are in our network but are outside of our service area. Please contact Network Health Medicare Advantage Plans at , 24 hours a day/7 days a week, for additional information. 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. To get current information about Network Health Medicare Advantage Plans network pharmacies in your area, please visit our website at networkhealthmedicare.com or call our customer service at , 24 hours a day/7 days a week. (TTY/TDD users should call ) Beneficiaries must use network pharmacies to access their prescription drug benefit. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, Network Health Insurance Corporation is a Medicare Advantage Organization with a Medicare Contract. To receive this document in an alternate format, please call Customer Service at , TTY/TDD users call We are open Monday through Friday, 8 a.m. to 8 p.m. From October 1, 2012 through February 14, 2013 we are available 7 days a week from 8 a.m. to 8 p.m. H5215_RXPD/13_V1 CMS Accepted

3 TABLE OF CONTENTS Introduction Mail Order Pharmacy Home Infusion Pharmacies Long-Term Care Pharmacies Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) Pharmacies NETWORK HEALTH INSURANCE CORPORATION 1570 Midway Place PO Box 120 Menasha, WI Customer Service hours a day/7 days a week TTY/TDD

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5 Introduction This booklet provides a list of Network Health Medicare Advantage Plan s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Network Health Medicare Advantage Plan s formulary. If you have additional questions, please call customer service at , 24 hours a day/7 days a week. TTY/TDD users should call Or, visit networkhealthmedicare.com. We call the pharmacies on this list our network pharmacies because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under Network Health Medicare Advantage Plans only if they are filled at a network pharmacy or through our mail order pharmacy service. 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 nonnetwork pharmacies under certain circumstances as described in your Evidence of Coverage. Preferred pharmacies are network pharmacies with which our Plan has negotiated even lower cost-sharing for its plan members for covered prescription drugs than at non-preferred pharmacies. However, you will still have access to lower drug prices at non-preferred pharmacies than at out-of-network pharmacies. You may go to either of these types of network pharmacies to receive your covered prescription drugs. Network Health Medicare Advantage Plan s Network Pharmacies This directory contains the different types of pharmacies in our network. These pharmacies are listed alphabetically by community. To locate a participating pharmacy, find the community nearest you and check the listing of participating pharmacies. Or, you can visit our website at networkhealthmedicare.com or call our Customer Service at , 24 hours a day/7 days a week. TTY/TDD users should call Legend * Preferred Pharmacy # Extended Supply Pharmacy. This pharmacy can provide a long-term supply of maintenance drugs. 1

6 Algoma 801 Jefferson St Algoma WI (920) Appleton Consumer Prescription 2310 W College Ave Appleton WI (920) Copps Food Center 2700 N Ballard Rd Appleton WI (920) Copps Food Center 511 W Calumet St Appleton WI (920) CVS 1485 Oneida St Appleton WI (920) CVS 700 W Wisconsin Ave Appleton WI (920) Sam's Club 4895 Integrity Way Appleton WI (920) Shopko Express Pharmacy 2101 E Evergreen Dr Appleton WI (920) Shopko Express Pharmacy W3208 Van Roy Rd Appleton WI (920) W Northland Ave Appleton WI (920) Target Pharmacy 1800 South Kensington Dr Appleton WI (920) E Calumet St Appleton WI (920) N Mutual Way Appleton WI (920) S Oneida St Appleton WI (920) N Meade St Appleton WI (920) E Calumet St Appleton WI (920) W College Ave Appleton WI (920) W Northland Ave Appleton WI (920) Ashwaubenon 2301 S Oneida St Ashwaubenon WI (920)

7 Beaver Dam Marshland 705 S University Ave Beaver Dam WI (920) Park Ave Beaver Dam WI (920) Thrifty White Drug 609 N Spring St Beaver Dam WI (920) Francis Ln Beaver Dam WI (920) Park Ave Beaver Dam WI (920) Bellevue 1979 Lime Kiln Rd Bellevue WI (920) Berlin Field 135 W Huron St Berlin WI (920) Broadway St Berlin WI (920) Brillion 1010 W Ryan St Brillion WI (920) Brownsville Agnesian 900 Main St Brownsville WI (920) Campbellsport The Village Apothecary 110 W Main St Campbellsport WI (920) Cedar Grove 313 S Main St Cedar Grove WI (920) Chilton 810 S Irish Rd Chilton WI (920) W Calumet St Chilton WI (920) Clintonville Erickson 8 S Main St STE B Clintonville WI (715) S Main St Clintonville WI (715) S Main St Clintonville WI (715) De Pere 1881 Chicago St De Pere WI (920) Shopko Express 3705 Monroe Rd De Pere WI (920) N Wisconsin St De Pere WI (920) Stowe Drug Store 375 Main Ave De Pere WI (920)

8 De Pere (continued) 1415 Lawrence Dr De Pere WI (920) Main Ave De Pere WI (920) Denmark Bellin Health Pharmacy 595 County Road R Denmark WI (920) Fond du Lac Agnesian 145 N Main St (920) Agnesian 912 S Hickory Rd (920) Agnesian Pharmacy Plus 420 E Division St (920) Wisconsin American Dr (920) Kremer 9 N Main St (920) Pick N Save 55 W Pioneer Rd (920) Pick N Save 760 W Johnson St (920) W Johnson St (920) Target Pharmacy 485 N Rolling Meadows Dr Fond du Lac WI (920) N Rolling Meadows Dr (920) N Main St (920) W Pioneer Rd (920) Grand Chute Copps Food Center 2400 W Wisconsin Ave Grand Chute WI (920) N Casaloma Dr Grand Chute WI (920) Green Bay Aurora Green Bay Clinic Disp 2253 W Mason St Green Bay WI (920) Green Brier Rd Green Bay WI (920) Aurora Visiting Nurse Assoc 931 Discovery Ave Green Bay WI (920) Bellin Health Pharmacy 1630 Commanche Ave STE 102 Green Bay WI (920) Bellin Health Pharmacy 3263 Eaton Rd Green Bay WI (920)

9 Green Bay (continued) Bellin Health Pharmacy 744 S Webster Ave Green Bay WI (920) Copps Food Center 1291 Lombardi Access Rd Green Bay WI (920) Copps Food Center 1819 Main St Green Bay WI (920) CVS 1561 W Mason St Green Bay WI (920) CVS 2222 S Webster Ave Green Bay WI (920) CVS 2400 Velp Ave Green Bay WI (920) CVS 930 Main St Green Bay WI (920) Kmart 1109 Lombardi Ave Green Bay WI (920) Krider Pharmacy and Gifts 1119 W Mason St Green Bay WI (920) Sam's Club 2470 W Mason St Green Bay WI (920) Shopko Express 2585 Lineville Rd Green Bay WI (920) S Military Ave Green Bay WI (920) Lineville Rd Green Bay WI (920) E Mason St Green Bay WI (920) Bay Park Sq Green Bay WI (920) Streus 635 Main St Green Bay WI (920) Target Pharmacy 1001 Cormier Rd Green Bay WI (920) Target Pharmacy 2050 Lime Kiln Rd Green Bay WI (920) Main St Green Bay WI (920) W Mason St Green Bay WI (920) N Military Ave Green Bay WI (920) W Mason St Green Bay WI (920) E Mason St Green Bay WI (920) Main St Green Bay WI (920) University Ave Green Bay WI (920) Cardinal Ln Green Bay WI (920)

10 Horicon Kiel Lomira Marshland 700 Washington St Horicon WI (920) Howards Grove 620 S Wisconsin Dr Howards Grove WI (920) Iola Sweet Med Prescriptions Plus 155 N Main St Iola WI (715) Kaukauna 2700 Crooks Ave Kaukauna WI (920) Crooks Ave Kaukauna WI (920) Kewaunee 802 N Main St Kewaunee WI (920) Service Rd Kiel WI (920) State Road 67 Kiel WI (920) Kimberly 800 E Maes St Kimberly WI (920) Kohler 795C Woodlake Rd Kohler WI (920) Lakewood Nicolet Pharmacy Commercial Rd Lakewood WI (715) Little Chute 219 W Main St Little Chute WI (920) Aurora Pres Dispensing Cntr 375 East Ave STE 1 Lomira WI (920) Luxemburg Luxemburg Pharmacy 125 School Creek Trl Luxemburg WI (920) Manitowoc 601 Reed Ave Manitowoc WI (920) Copps Food Center 3300 Calumet Ave Manitowoc WI (920) Custom Health Pharmacy 1011 S 10th St Manitowoc WI (920) CVS 701 E Reed Ave Manitowoc WI (920) Health Mart Manitowoc Phcys 919 S 8th St Manitowoc WI (920)

11 Manitowoc (continued) HFM Meds To Go 1650 S 41st St Manitowoc WI (920) HFM 3310 Calumet Ave Manitowoc WI (920) Calumet Ave Manitowoc WI (920) Calumet Ave Manitowoc WI (920) Calumet Ave Manitowoc WI (920) Markesan Agnesian 49 S Bridge St Markesan WI (920) Mayville Agnesian 360 S Mountain Dr Mayville WI (920) Marshland 1028 Horicon St Mayville WI (920) Menasha 1578 Appleton Rd Menasha WI (920) Racine St Menasha WI (920) Montello Bentley Drug Store 25 W Montello St Montello WI (608) Neenah CVS 901 S Green Bay Rd Neenah WI (920) Pick N Save 828 Fox Point Plz Neenah WI (920) Green Bay Rd Neenah WI (920) Winneconne Ave Neenah WI (920) W Towne Dr Neenah WI (920) S Commercial St Neenah WI (920) New London Jernegan's Health Mart 1301 Mill St New London WI (920) N Shawano St New London WI (920) N Shawano St New London WI (920) North Fond du Lac Agnesian 723 Park Ridge Ln North Fond du Lac WI (920)

12 Oconto Oconto 1008 Main St Oconto WI (920) Charles St Oconto WI (920) Oconto Falls CMH 855 S Main St Oconto Falls WI (920) Oconto Falls Pharmacy HM 323 E Highland Dr Oconto Falls WI (920) Omro Omro 109 E Main St Omro WI (920) Oshkosh 2101 Bowen St Oshkosh WI (920) N Westhaven Dr Oshkosh WI (920) Pick N Save 1940 S Koeller St Oshkosh WI (920) Schultz 220 N Main St Oshkosh WI (920) Koeller Rd Oshkosh WI (920) Target Pharmacy 1900 S Koeller St Oshkosh WI (920) S Washburn St Oshkosh WI (920) Emmers Ln Oshkosh WI (920) W Murdock Ave Oshkosh WI (920) S Koeller St Oshkosh WI (920) Plover Copps Food Center 1850 Plover Rd Plover WI (715) Plover Rd Plover WI (715) Crossroads Dr Plover WI (715) Plymouth 2635 Eastern Ave Plymouth WI (920) Kmart 2615 Eastern Ave Plymouth WI (920) Walton Dr Plymouth WI (920) Eastern Ave Plymouth WI (920)

13 Princeton Bentley Drug 528 W Water St Princeton WI (920) Pulaski Pulaski Health Mart 121 N Saint Augustine St Pulaski WI (920) Reeseville Village Healthmart 202 S Main St Reeseville WI (920) Ripon Kmart 1200 W Fond du Lac St Ripon WI (920) Ripon Drug 328 Watson St Ripon WI (920) W Fond du Lac St Ripon WI (920) Seymour 1010 S Mainline Dr Seymour WI (920) Shawano Dreier Health Mart 117 S Main St Shawano WI (715) Kmart 1211 E Green Bay St Shawano WI (715) Thedacare 100 County Road B Shawano WI (715) E Green Bay St Shawano WI (715) E Green Bay St Shawano WI (715) Sheboygan 2414 Kohler Memorial Dr (920) Superior Ave (920) Glander Prescription Plus 3529 Superior Ave (920) Pick N Save 1317 N 25th St (920) Pick N Save 2625 S Business Dr (920) Sheboygan Health Mart 577 S Taylor Dr (920) S Taylor Dr (920) S Taylor Dr (920) Vanguard Dr (920)

14 Sheboygan (continued) 1029 N 14th St (920) Calumet Dr Sheboygan WI (920) S Business Dr (920) Sheboygan Falls Target Pharmacy 4085 State Highway 28 Sheboygan Falls WI (920) Stevens Point Copps Food Center 5657 Us Highway 10 E Stevens Point WI (715) Kmart 111 Division St N Stevens Point WI (715) Main St Stevens Point WI (715) Trigs County Market 1600 Academy Ave Stevens Point WI (715) Park Ridge Dr Stevens Point WI (715) Church St Stevens Point WI (715) Illinois Ave Stevens Point WI (715) Two Rivers 2219 Garfield St STE 100 Two Rivers WI (920) Memorial Dr Two Rivers WI (920) Medicine Shoppe 1500 Washington St Two Rivers WI (920) Washington St Two Rivers WI (920) Waupaca Kmart 830 W Fulton St Waupaca WI (715) Riverside Clinic Pharmacy 800 Riverside Dr Waupaca WI (715) Stratton Drug Store 107 N Main St Waupaca WI (715) W Fulton St Waupaca WI (715) Waupaca Woods Pharmacy HM 101 N Western Ave Waupaca WI (715) Waupun Agnesian 904 W Main St Waupun WI (920) E Main St Waupun WI (920)

15 Wautoma 900 E Division St Wautoma WI (920) CHN N2934 State Road 22 Wautoma WI (920) N2585 Plaza Rd Wautoma WI (920) Wrightstown Bellin Health Remote Disp 555 Quality Ct Wrightstown WI (920) Westfield Bentley 206 S Main St Westfield WI (608) Winneconne 916 E Main St Winneconne WI (920) Wittenberg Gwidt HM 203 E Westgor Ave Wittenberg WI (715)

16 Mail Order Pharmacy Express Scripts, Inc. (800) TTY (800) Mail Order Pharmacy 12

17 Home Infusion Pharmacies Network Health Medicare Advantage Plans will cover Part D drugs used for home infusion therapy if: Your prescription drug is on Network Health Medicare Advantage Plan's formulary or you have a formulary exception; Network Health Medicare Advantage Plans has approved your prescription drug for home infusion therapy; and Your prescription is written by an authorized prescriber. Affinity Home Care Plus (HI) 2074 American Dr STE A Neenah WI (715) Home Care Pharmacy (HI) 5665 S Westridge Dr New Berlin WI (262) US Bioservices (HI) 5100 E Hunter Ave STE 101 Anaheim CA (800) Apria Healthcare (HI) 5345 S Moorland Rd New Berlin WI (262) Aurora Pharmacy (HI) 801 Jefferson St Algoma WI (920) Bio Rx (HI) Kenwood Rd Blue Ash OH (513) Chartwell Midwest Wisconsin (HI) 2241 Pinehurst Dr Middleton WI (608) Igg of America (HI) 514 Progress Dr STE X Linthicum MD (877) Ministry Home Care Plus (HI) 1927 N Central Ave STE B Marshfield WI (715) Option Care (HI) 985 Avenue Of The Cities Silvis IL (309) Pentech Health (HI) 4 Creek Pkwy STE A Boothwyn PA (800) US Bioservices (HI) 109 Chelsea Pkwy Boothwyn PA (800) US Bioservices (HI) 501 W 44th Ave Unit A Denver CO (800) US Bioservices (HI) 3200 Internet Blvd Frisco TX (888) US Bioservices (HI) 8028 Reeder Rd Lenexa KS (800) Home Infusion Pharmacies Coram Specialty Infusion Svcs (HI) 5345 S Moorland Rd STE 101 New Berlin WI (262) Thedacare Infusion Pharmacy (HI) 1818 N Meade St Appleton WI (920)

18 Long-Term Care Pharmacies Residents of a long-term care facility may access their prescription drugs covered under Network Health Medicare Advantage Plans through the facility's long-term care pharmacy or another network long-term care pharmacy. Appleton King Menasha Long-Term Care Pharmacies Shopko Rxcare (LTC) 3701 E Evergreen Dr Appleton WI (920) Beaver Dam Thrifty White Drug (LTC) 609 N Spring St Beaver Dam WI (920) Green Bay Streus Pharmacy (LTC) 528 N Monroe Ave Green Bay WI (920) Greenville NCS Healthcare (LTC) N926 Tower View Dr Greenville WI (800) Wisconsin Veterans Home Phcy (LTC) N2665 County Rd Qq King WI (715) La Crosse Pinnacle Phcy of La Crosse (LTC) 3235 Airport Rd La Crosse WI (608) Madison Genoa Healthcare (LTC) 625 W Washington Ave Madison WI (608) Pinnacle Pharmacy (LTC) 2818 Progress Rd Madison WI (608) Willow Pharmacy (LTC) 2702 International Ln Madison WI (608) Morton Pharmacy (LTC) 712 Midway Rd Menasha WI (920) Milwaukee Roeschen's Omnicare Pharmacy (LTC) 5185 S 9th St Milwaukee WI (414) Monona Shopko Rxcare (LTC) 2217 Industrial Dr Monona WI (608) New London Jernegan's Health Mart (LTC) 1301 Mill St New London WI (920)

19 Part D Pharmacy Directory: CY2012 Long-Term Care Pharmacies Oshkosh LHO Pharmacy 225 N Eagle St Oshkosh WI (920) Pewaukee Pharmerica (LTC) N29 W23721 Woodgate Ct W Pewaukee WI (262) Ripon Ripon Drug (LTC) 328 Watson St Ripon WI (920) Two Rivers Medicine Shoppe Pharmacy (LTC) 1500 Washington St Two Rivers WI (920) Wittenberg Gwidt Pharmacy (LTC) 203 E Westgor Ave STE 1 Wittenberg WI (715) Long-Term Care Pharmacies 15

20 I/T/U Pharmacies Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) Pharmacies Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through Network Health Medicare Advantage Plan's pharmacy network. Those other than Native Americans and Alaskan Natives may be able to access these pharmacies under limited circumstances (e.g., emergencies). Bowler Stockbridge-Muncy Hlth Ctr Phy (I/T/U) W12802 County Road A Bowler WI (715) Oneida Oneida Comm Health Center Phcy (I/T/U) 525 Airport Dr Oneida WI (920)

21 Network Health Insurance corporation 1570 midway Place menasha,wi TTy monday Friday, 8 a.m. to 8 p.m. NetworkHealthmedicare.com NetworkCares (PPO snp) Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) Network PlatinumSelect (PPO) H5215_RXPD/13_V1 CMS ACCEPTED