Network Health Medicare Advantage Plans

Network Health Medicare Advantage Plans Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) Network PlatinumSelect (PPO) NetworkCares(SNP PPO) 2016 Pharmacy Directory This pharmacy directory was updated on 12/18/2015. For more recent information or other questions, please contact Network Health Medicare Advantage plans customer service at 800-316-3107 or, for TTY users, 800-899-2114, 24 hours a day/seven days a week, or visit NetworkHealthMedicare.com. Network Health Medicare Advantage plans are PPO plans with a Medicare contract. NetworkCaresis a PPO SNP plan with Medicare contract and a contract with the Forward Health Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage plans depends on contract renewal. The benefit information is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change January 1 of each year. NetworkCaresis available to anyone who has both Medical Assistance from the State and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help you receive. The formulary and pharmacy network may change at any time. You will receive notice when necessary. As an enrollee of our plan, you can get a long-term supply (up to 90 days) of drugs shipped to your home using our plan s network mail order delivery program. Usually you will receive your mail order prescriptions within 14 calendar days. If your order does not arrive within the estimated timeframe, call Express Scripts Customer Service at 800-316-3107 (TTY 800-899-2114), 24 hours a day/7 days a week. H5215_619p1r2_081815 Accepted 12272015

TABLE OF CONTENTS Introduction... 1... 3 Mail Order Pharmacy... 13 Home Infusion Pharmacies... 14 Long-Term Care Pharmacies... 15 Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) Pharmacies... 17 NETWORK HEALTH 1570 Midway Place PO Box 120 Menasha, WI 54952 Customer Service 800-316-3107 TTY 800-899-2114 24 hours a day/seven days a week NetworkHealthMedicare.com

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. When this pharmacy directory refers to we, us, or our, it means Network Health Insurance Corporation. When it refers to plan or our plan, it means Network Health Medicare Advantage Plans. 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 pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. 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 here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of December 18, 2015. For the most current list, please contact us. Our contact information appears on the front and back cover pages. Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at NetworkHealthMedicare.com. You may also call customer service for updated provider information. You can go to all the pharmacies on this list, but your costs for some drugs may be lower at pharmacies in this list that offer preferred cost sharing. We have marked these pharmacies with (*) to distinguish them from other pharmacies in our network that offer standard cost sharing. Cost sharing information can be found in the Summary of Benefits. You can get prescription drugs shipped to your home through our network mail order delivery service which is called Express Scripts Home Delivery. For more information, please contact us or see the mail order section of this pharmacy directory. If you have questions about any of the above, including for instructions on how to submit claims for prescriptions that you had to fill at a non-network pharmacy, please see the first and last cover pages of this directory for information on how to contact us. 1

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. Call customer service (phone numbers are located on the front and back covers of this booklet) or visit our website at NetworkHealthMedicare.com for additional information. * Preferred Pharmacy Legend # Extended Supply Pharmacy. This pharmacy can provide an extended day supply of medications (up to a 90-day supply). 2

Algoma 801 Jefferson St Algoma, WI 54201 (920) 487-2887 Appleton Consumer Prescription # * 2310 W College Ave Appleton, WI 54914 (920) 739-9232 Copps Food Center 2700 N Ballard Rd Appleton, WI 54911 (920) 996-0121 Copps Food Center 511 W Calumet St Appleton, WI 54915 (920) 734-3882 CVS # 1485 Oneida St Appleton, WI 54915 (920) 733-1194 CVS # 700 W Wisconsin Ave Appleton, WI 54914 (920) 991-1190 Fox Valley Hemo and Oncology # * 1531 S Madison St STE 250 Appleton, WI 54915 (920) 730-4429 Sam's Club # * 1000 N Westhill Blvd Appleton, WI 54914 (920) 733-7410 Shopko Express Pharmacy # * 2101 E Evergreen Dr Appleton, WI 54913 (920) 733-2305 Shopko Express Pharmacy # * W3208 Van Roy Rd Appleton, WI 54915 (920) 733-3846 1000 W Northland Ave Appleton, WI 54914 (920) 739-6871 Target 1800 South Kensington Dr Appleton, WI 54915 (920) 749-9775 Target 4301 W Wisconsin Ave STE 42 Appleton, WI 54913 (920) 243-7877 3701 E Calumet St Appleton, WI 54915 (920) 996-0746 955 N Mutual Way Appleton, WI 54913 (920) 954-6400 1901 S Oneida St Appleton, WI 54915 (920) 739-7321 2803 N Meade St Appleton, WI 54911 (920) 830-6985 3330 E Calumet St Appleton, WI 54915 (920) 733-3016 700 W College Ave Appleton, WI 54914 (920) 733-6599 729 W Northland Ave Appleton, WI 54914 (920) 954-8100 3

Ashwaubenon 2301 S Oneida St Ashwaubenon, WI 54304 (920) 490-0424 1979 Lime Kiln Rd Bellevue, WI 54311 (920) 288-0638 Berlin Cedar Grove 313 S Main St Cedar Grove, WI 53013 (920) 668-6286 Beaver Dam Marshland Pharmacy # 705 S University Ave Beaver Dam, WI 53916 (920) 356-0040 822 Park Ave Beaver Dam, WI 53916 (920) 887-7461 Field Pharmacy # 135 W Huron St Berlin, WI 54923 (920) 361-1565 W861 County Road F Berlin, WI 54923 (920) 361-3433 Brillion Chilton 810 S Irish Rd Chilton, WI 53014 (920) 849-7330 245 W Calumet St Chilton, WI 53014 (920) 849-2818 Thrifty White Drug # * 609 N Spring St Beaver Dam, WI 53916 (920) 885-3277 120 Francis Ln Beaver Dam, WI 53916 (920) 885-5808 607 Park Ave Beaver Dam, WI 53916 (920) 356-0148 Bellevue Costco # * 2355 Costco Way Bellevue, WI 54311 (920) 469-5710 1010 W Ryan St Brillion, WI 54110 (920) 756-2640 Brownsville Agnesian 900 Main St Brownsville, WI 53006 (920) 583-1310 Campbellsport The Village Apothecary # * 110 W Main St Campbellsport, WI 53010 (920) 533-4012 Clintonville Erickson 8 S Main St STE B Clintonville, WI 54929 (715) 823-2222 291 S Main St Clintonville, WI 54929 (715) 823-2350 201 S Main St Clintonville, WI 54929 (715) 823-4238 De Pere 1881 Chicago St De Pere, WI 54115 (920) 403-8050 4

De Pere (continued) CVS # 800 Main Ave De Pere, WI 54115 (920) 336-6373 Shopko Express Pharmacy # * 3705 Monroe Rd De Pere, WI 54115 (920) 336-6096 230 N Wisconsin St De Pere, WI 54115 (920) 336-2323 1415 Lawrence Dr De Pere, WI 54115 (920) 336-7168 150 S Wisconsin Ave De Pere, WI 54115 (920) 278-3241 901 Main Ave De Pere, WI 54115 (920) 983-6153 Denmark Bellin Health Pharmacy # * 595 County Road R Denmark, WI 54208 (920) 863-5800 Fond du Lac Agnesian 145 N Main St Fond du Lac, WI 54935 (920) 926-4660 Agnesian 912 S Hickory Rd Fond du Lac, WI 54935 (920) 929-7480 Agnesian Pharmacy Plus # * 420 E Division St Fond du Lac, WI 54935 (920) 926-8585 210 Wisc American Dr Fond du Lac, WI 54937 (920) 907-7260 Kremer 9 N Main St Fond du Lac, WI 54935 (920) 921-2550 Pick N Save 55 W Pioneer Rd Fond du Lac, WI 54935 (920) 923-7780 Pick N Save 760 W Johnson St Fond du Lac, WI 54935 (920) 929-7422 616 W Johnson St Fond du Lac, WI 54935 (920) 921-5490 Target 485 N Rolling Meadows Dr Fond du Lac, WI 54937 (920) 921-6759 377 N Rolling Meadows Dr Fond du Lac, WI 54935 (920) 921-9591 1060 E Johnson St Fond du Lac, WI 54935 (920) 266-4323 192 N Main St Fond du Lac, WI 54935 (920) 921-5264 20 W Pioneer Rd Fond du Lac, WI 54935 (920) 907-0556 Gillett St Clare Memorial Hosp Phcy # 117 N McKenzie St Gillett, WI 54124 (920) 848-6323 Grand Chute Copps Food Center 2400 W Wisconsin Ave Grand Chute, WI 54914 (920) 831-0400 5

Grand Chute (continued) 1305 N Casaloma Dr Grand Chute, WI 54913 (920) 730-8218 Green Bay 2253 W Mason St Green Bay, WI 54303 (920) 327-7220 2845 Green Brier Rd Green Bay, WI 54311 (920) 288-3140 Bellin Health Pharmacy # 1630 Commanche Ave STE 102 Green Bay, WI 54313 (920) 430-4555 Bellin Health Pharmacy # 744 S Webster Ave Green Bay, WI 54301 (920) 431-5696 Bellin Health Remote Disp # 3263 Eaton Rd Green Bay, WI 54311 (920) 433-6790 Copps Food Center 1291 Lombardi Access Rd Green Bay, WI 54304 (920) 498-9783 Copps Food Center 1819 Main St Green Bay, WI 54302 (920) 469-3436 CVS # 1561 W Mason St Green Bay, WI 54303 (920) 497-5959 CVS # 2222 S Webster Ave Green Bay, WI 54301 (920) 430-8089 CVS # 2400 Velp Ave Green Bay, WI 54303 (920) 434-3954 CVS # 930 Main St Green Bay, WI 54301 (920) 436-9382 Krider Pharmacy and Gifts # 1119 W Mason St Green Bay, WI 54303 (920) 499-6225 Sam's Club # * 2470 W Mason St Green Bay, WI 54303 (920) 494-0536 Shopko Express Pharmacy # * 2585 Lineville Rd Green Bay, WI 54313 (920) 662-9450 216 S Military Ave Green Bay, WI 54303 (920) 499-0895 2320 Lineville Rd Green Bay, WI 54313 (920) 434-5846 2430 E Mason St Green Bay, WI 54302 (920) 468-6044 301 Bay Park Sq Green Bay, WI 54304 (920) 499-5889 Target 1001 Cormier Rd Green Bay, WI 54304 (920) 499-2608 Target 2050 Lime Kiln Rd Green Bay, WI 54311 (920) 406-9049 2292 Main St Green Bay, WI 54311 (920) 465-7737 2440 W Mason St Green Bay, WI 54303 (920) 499-2330 116 N Military Ave Green Bay, WI 54303 (920) 498-3247 6

Green Bay (continued) 1165 W Mason St Green Bay, WI 54303 (920) 498-3794 1401 E Mason St Green Bay, WI 54301 (920) 435-7679 1995 Main St Green Bay, WI 54302 (920) 465-6210 2204 University Ave Green Bay, WI 54302 (920) 469-5516 464 Cardinal Ln Green Bay, WI 54313 (920) 661-9355 Green Lake CHN Pharmacy Green Lake # * 762 Commercial Ave Green Lake, WI 54941 (920) 294-4244 Horicon Marshland Pharmacy # 700 Washington St Horicon, WI 53032 (920) 485-3400 Howards Grove 620 S Wisconsin Dr Howards Grove, WI 53083 (920) 565-5425 Iola Sweet Med Prescriptions Plus # * 155 N Main St Iola, WI 54945 (715) 445-3117 Kaukauna 2700 Crooks Ave Kaukauna, WI 54130 (920) 759-3050 2412 Crooks Ave Kaukauna, WI 54130 (920) 759-9165 Kewaunee 802 N Main St Kewaunee, WI 54216 (920) 388-2915 Kiel 1001 Service Rd Kiel, WI 53042 (920) 894-4370 1120 State Road 67 Kiel, WI 53042 (920) 894-3604 Kimberly 800 E Maes Ave Kimberly, WI 54136 (920) 788-9154 Kohler 795 Woodlake Rd Kohler, WI 53044 (920) 459-8768 Lakewood Nicolet 15481 Commercial Rd Lakewood, WI 54138 (715) 276-3646 Little Chute Smith 1800 Freedom Rd STE D Little Chute, WI 54140 (920) 788-8888 219 W Main St Little Chute, WI 54140 (920) 687-6193 7

Lomira Aurora Pres Dispensing Center # 375 East Ave STE 1 Lomira, WI 53048 (920) 269-2080 Luxemburg Luxemburg 125 School Creek Trl Luxemburg, WI 54217 (920) 845-5832 Manitowoc 601 Reed Ave Manitowoc, WI 54220 (920) 686-5237 Copps Food Center 3300 Calumet Ave Manitowoc, WI 54220 (920) 682-3051 CVS # 701 E Reed Ave Manitowoc, WI 54220 (920) 682-3726 HFM 3310 Calumet Ave Manitowoc, WI 54220 (920) 320-4400 Manitowoc Pharmacies # * 919 S 8th St Manitowoc, WI 54220 (920) 684-6789 3415 Calumet Ave Manitowoc, WI 54220 (920) 684-0251 4115 Calumet Ave Manitowoc, WI 54220 (920) 684-5016 2702 Calumet Ave Manitowoc, WI 54220 (920) 683-8887 Markesan Agnesian 49 S Bridge St Markesan, WI 53946 (920) 398-3261 Mayville Agnesian 360 S Mountain Dr Mayville, WI 53050 (920) 387-7570 2050 Horicon St Mayville, WI 53050 (920) 387-0257 Menasha 1578 Appleton Rd Menasha, WI 54952 (920) 722-1895 305 Racine St Menasha, WI 54952 (920) 722-4759 Montello Bentley 25 W Montello St Montello, WI 53949 (608) 297-2474 Neenah CVS # 901 S Green Bay Rd Neenah, WI 54956 (920) 729-1448 Neenah Hometown Pharmacy # 1415 S Commercial St Neenah, WI 54956 (920) 729-4910 Pick N Save 828 Fox Point Plz Neenah, WI 54956 (920) 722-1348 699 Green Bay Rd Neenah, WI 54956 (920) 751-0270 1155 Winneconne Ave Neenah, WI 54956 (920) 722-1185 8

Neenah (continued) 1191 W Towne Dr Neenah, WI 54956 (920) 725-3152 500 S Commercial St Neenah, WI 54956 (920) 729-1311 New London Jernegan's Health Mart # * 1301 Mill St New London, WI 54961 (920) 982-7670 1717 N Shawano St New London, WI 54961 (920) 982-7906 981 N Shawano St New London, WI 54961 (920) 982-5189 North Fond du Lac Agnesian 723 Park Ridge Ln North Fond du Lac, WI 54937 (920) 926-8660 Oconto Oconto Pharmacy # 1008 Main St Oconto, WI 54153 (920) 834-4455 126 Charles St Oconto, WI 54153 (920) 834-9800 Oconto Falls Oconto Falls Pharmacy HM # * 323 E Highland Dr Oconto Falls, WI 54154 (920) 848-3721 St Clare Memorial Hosp Phcy # 855 S Main St Oconto Falls, WI 54154 (920) 846-8059 Omro Omro 328 E Main St Omro, WI 54963 (920) 685-5041 Oshkosh 2101 Bowen St Oshkosh, WI 54901 (920) 303-5006 855 N Westhaven Dr Oshkosh, WI 54904 (920) 303-8830 CVS # 1736 W 9th Ave Oshkosh, WI 54902 (920) 235-6664 Murdock Hometown Phcy # 1828 Jackson St Oshkosh, WI 54901 (920) 231-3300 Pick N Save 1940 S Koeller St Oshkosh, WI 54902 (920) 236-9494 Sawyer Street Hometown Phcy # 321 N Sawyer St Oshkosh, WI 54902 (920) 426-0763 Schultz 220 N Main St Oshkosh, WI 54901 (920) 233-2151 1300 Koeller Rd Oshkosh, WI 54901 (920) 426-5770 Smartscript 4041 State Road 91 STE B Oshkosh, WI 54904 (920) 268-1994 9

Oshkosh (continued) Target 1900 S Koeller St Oshkosh, WI 54902 (920) 233-4287 351 S Washburn St Oshkosh, WI 54904 (920) 231-2219 1100 Emmers Ln Oshkosh, WI 54904 (920) 237-4753 315 W Murdock Ave Oshkosh, WI 54901 (920) 231-8664 950 S Koeller St Oshkosh, WI 54902 (920) 303-1712 Plover Copps Food Center 1850 Plover Rd Plover, WI 54467 (715) 344-0066 1800 Plover Rd Plover, WI 54467 (715) 342-9368 250 Crossroads Dr Plover, WI 54467 (715) 345-7870 Plymouth 2635 Eastern Ave Plymouth, WI 53073 (920) 893-1442 428 Walton Dr Plymouth, WI 53073 (920) 892-2656 2455 Eastern Ave Plymouth, WI 53073 (920) 893-5895 Princeton Bentley Drug # * 528 W Water St Princeton, WI 54968 (920) 295-6271 Pulaski Healthmart Pulaski 121 N Saint Augustine St Pulaski, WI 54162 (920) 822-3011 Ripon Kmart 1200 W Fond du Lac St Ripon, WI 54971 (920) 748-1203 Ripon Drug # * 328 Watson St Ripon, WI 54971 (920) 748-5174 1203 W Fond du Lac St Ripon, WI 54971 (920) 748-6005 Seymour 1010 S Mainline Dr Seymour, WI 54165 (920) 833-0430 Shawano Dreier Health Mart 117 S Main St Shawano, WI 54166 (715) 526-2011 Kmart 1211 E Green Bay St Shawano, WI 54166 (715) 526-6551 ThedaCare 100 County Road B Shawano, WI 54166 (715) 526-3456 1244 E Green Bay St Shawano, WI 54166 (715) 524-5983 10

Shawano (continued) 401 E Green Bay St Shawano, WI 54166 (715) 524-5600 Sheboygan 2414 Kohler Memorial Dr Sheboygan, WI 53081 (920) 459-2630 509 Superior Ave Sheboygan, WI 53081 (920) 459-2637 Glander Prescription Plus # * 3529 Superior Ave Sheboygan, WI 53081 (920) 459-2755 Pick N Save 1317 N 25th St Sheboygan, WI 53081 (920) 457-5839 Pick N Save 2625 S Business Dr Sheboygan, WI 53081 (920) 452-2739 Sheboygan Health Mart 577 S Taylor Dr Sheboygan, WI 53081 (920) 459-7467 518 S Taylor Dr Sheboygan, WI 53081 (920) 458-0040 3711 S Taylor Dr Sheboygan, WI 53081 (920) 459-8601 4433 Vanguard Dr Sheboygan, WI 53081 (920) 459-9470 1029 N 14th St Sheboygan, WI 53081 (920) 458-7707 2702 Calumet Dr Sheboygan, WI 53083 (920) 457-5656 3320 S Business Dr Sheboygan, WI 53081 (920) 452-5858 Sheboygan Falls Target 4085 State Highway 28 Sheboygan Falls, WI 53085 (920) 451-8448 Stevens Point Copps Food Center 1500 Pinecrest Ave Stevens Point, WI 54481 (715) 345-1745 Kmart 111 Division St N Stevens Point, WI 54481 (715) 341-5613 1200 Main St Stevens Point, WI 54481 (715) 344-1230 Trigs County Market 1600 Academy Ave Stevens Point, WI 54481 (715) 341-6102 10 Park Ridge Dr Stevens Point, WI 54481 (715) 344-7368 3301 Church St Stevens Point, WI 54481 (715) 345-2843 900 Illinois Ave Stevens Point, WI 54481 (715) 344-6834 11

Two Rivers 2219 Garfield St STE 100 Two Rivers, WI 54241 (920) 794-8029 5300 Memorial Dr Two Rivers, WI 54241 (920) 793-7380 Medicine Shoppe Pharmacy # 1500 Washington St Two Rivers, WI 54241 (920) 794-1225 2206 Washington St Two Rivers, WI 54241 (920) 793-8352 Waupaca Kmart 830 W Fulton St Waupaca, WI 54981 (715) 258-4285 Shopko Express Pharmacy # * 800 Riverside Dr Waupaca, WI 54981 (715) 256-1115 825 W Fulton St Waupaca, WI 54981 (715) 258-9000 Stratton Drug Store # * 107 N Main St Waupaca, WI 54981 (715) 258-7057 925 W Fulton St Waupaca, WI 54981 (715) 258-9228 Waupaca Hometown Pharmacy # 115 N Western Ave Unit 8 Waupaca, WI 54981 (715) 256-0400 Waupun Agnesian 904 W Main St Waupun, WI 53963 (920) 324-3010 999 E Main St Waupun, WI 53963 (920) 324-4696 Wautoma 900 E Division St Wautoma, WI 54982 (920) 787-6940 CHN N2934 State Road 22 Wautoma, WI 54982 (920) 787-5757 N2585 Plaza Rd Wautoma, WI 54982 (920) 787-2090 Westfield Bentley 206 S Main St Westfield, WI 53964 (608) 296-2877 Winneconne 946 E Main St Winneconne, WI 54986 (920) 582-4414 Wittenberg Gwidt 203 E Westgor Ave Wittenberg, WI 54499 (715) 253-2164 Wrightstown Bellin Health Remote Disp # * 555 Quality Ct Wrightstown, WI 54180 (920) 532-0700 12

Mail Order Pharmacy You can get prescription drugs shipped to your home through our network mail order delivery service which is called Express Scripts Home Delivery. If you have used mail order services with your current plan before, or if you opt in now, our network pharmacy will automatically fill and ship new prescriptions received directly from your doctors or other prescribers. You may opt out of automatic deliveries of new prescriptions at any time by contacting us. If you never had mail order delivery and/or decide to stop automatic fills of new prescriptions, we will contact you each time we get a new prescription from a provider, to see if you want the medication filled and shipped at that time. This will give you an opportunity to make sure that the correct drug (including strength, amount, and form) will be delivered, and, if necessary, allow you to cancel or delay the order before you are billed and it is shipped. Mail Order Pharmacy To refill your mail order prescriptions, please contact us 21 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription drugs within 14 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at 800-316-3107 (TTY (hearing impaired) should call 800 899-2114). Express Scripts Mail Order # (800) 316-3107 TTY (800) 899-2114 13

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 plans' 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. Home Infusion Pharmacies Affinity Home Care Plus (HI) 2074 American Dr STE A Neenah, WI 54956 (715) 387-0755 Chartwell Midwest Wisconsin (HI) 2241 Pinehurst Dr Middleton, WI 53562 (608) 831-8555 Coram Specialty Infusion Services (HI) 5345 S Moorland Rd STE 101 New Berlin, WI 53151 (262) 207-1590 Home Care Pharmacy (HI) 5665 S Westridge Dr New Berlin, WI 53151 (262) 786-9870 IGG of America (HI) 514 Progress Dr STE X Linthicum, MD 21090 (877) 674-9700 Ministry Home Care Plus (HI) 1927 N Central Ave STE B Marshfield, WI 54449 (715) 387-0755 Nufactor (HI) 41093 County Center Dr Temecula, CA 92591 (800) 323-6832 Option Care (HI) 985 Avenue of the Cities Silvis, IL 61282 (309) 762-7979 Pentech Health (HI) 4 Creek Pkwy STE A Boothwyn, PA 19061 (800) 223-4376 ThedaCare Infusion Pharmacy (HI) 1818 N Meade St Appleton, WI 54911 (920) 969-0919 US Bioservices (HI) 5100 E Hunter Ave STE 101 Anaheim, CA 92807 (800) 801-1140 US Bioservices (HI) 109 Chelsea Pkwy Boothwyn, PA 19061 (800) 400-9549 US Bioservices (HI) 501 W 44th Ave Unit A Denver, CO 80216 (800) 809-0647 US Bioservices (HI) 8028 Reeder Rd Lenexa, KS 66214 (800) 860-6581 Wheaton Franciscan INF Phcy (HI) 5000 W Chambers St Milwaukee, WI 53210 (414) 874-6240 14

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 Green Bay King HealthDirect IPS (LTC) 3701 E Evergreen Dr Appleton, WI 54913 (920) 739-5900 Beaver Dam Thrifty White Drug (LTC) 609 N Spring St Beaver Dam, WI 53916 (920) 885-3277 Brownsville Agnesian Pharmacy (LTC) 900 Main St Brownsville, WI 53006 (920) 583-1310 De Forest Hometown Long Term Care Phcy (LTC) 643 S Main St De Forest, WI 53532 (608) 846-2750 Krider Pharmacy and Gifts (LTC) 1119 W Mason St Green Bay, WI 54303 (920) 499-6225 Streus Pharmacy (LTC) 528 N Monroe Ave Green Bay, WI 54301 (920) 437-0206 Streus Pharmacy (LTC) 635 Main St Green Bay, WI 54301 (920) 437-0206 Greenfield Surety Pro Pharmacy (LTC) 9200 W Layton Ave Greenfield, WI 53228 (414) 433-0188 Greenville NCS Healthcare (LTC) N926 Tower View Dr Greenville, WI 54942 (800) 236-5665 Wisconsin Veterans Home Phcy (LTC) N2665 County Rd QQ King, WI 54946 (715) 258-1674 La Crosse Pinnacle Phcy of La Crosse (LTC) 3235 Airport Rd La Crosse, WI 54603 (608) 781-7900 Madison Genoa Healthcare (LTC) 625 W Washington Ave Madison, WI 53703 (608) 251-1838 Oakwood Pharmacy (LTC) 6201 Mineral Point Rd Madison, WI 53705 (608) 230-4217 Pinnacle Pharmacy (LTC) 2818 Progress Rd Madison, WI 53716 (608) 216-0140 Long-Term Care Pharmacies 15

Long-Term Care Pharmacies Long-Term Care Pharmacies Madison (continued) Willow Pharmacy (LTC) 2702 International Ln Madison, WI 53704 (608) 240-2280 Mayville Agnesian Pharmacy (LTC) 360 S Mountain Dr Mayville, WI 53050 (920) 387-7570 Menasha Morton Pharmacy (LTC) 712 Midway Rd Menasha, WI 54952 (920) 886-2908 Milwaukee Genoa Healthcare (LTC) 10424 W Bluemound Rd STE B Milwaukee, WI 53226 (414) 244-9844 Pharmerica (LTC) 9041 W Heather Ave Milwaukee, WI 53224 (800) 477-7221 Phoenix Pharmacy (LTC) 1845 N Farwell Ave STE 200 Milwaukee, WI 53202 (414) 225-4478 Roeschen's Omnicare Pharmacy (LTC) 5185 S 9th St Milwaukee, WI 53221 (414) 486-3100 New London Jernegan's Health Mart (LTC) 1301 Mill St New London, WI 54961 (920) 982-7670 Oshkosh LHO Pharmacy (LTC) 225 N Eagle St Oshkosh, WI 54902 (920) 966-1345 Ripon Ripon Drug (LTC) 328 Watson St Ripon, WI 54971 (920) 748-5174 Two Rivers Medicine Shoppe Pharmacy (LTC) 1500 Washington St Two Rivers, WI 54241 (920) 794-1225 West Allis Prescriptions Plus (LTC) 10233 W Greenfield Ave West Allis, WI 53214 (414) 727-5750 Wittenberg Gwidt Pharmacy (LTC) 203 E Westgor Ave STE 1 Wittenberg, WI 54499 (715) 253-2164 16

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 plans' 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 54416 (715) 793-5027 Indian Health Service/Tribal/Urban Indian Health Program Oneida Oneida Comm Health Center Phcy (I/T/U) 525 Airport Dr Oneida, WI 54155 (920) 869-4826 17

This pharmacy directory was updated on 12/18/2015. For more recent information or other questions, please contact Network Health Medicare Advantage plans customer service at 800-316-3107 or, for TTY users, 800-899-2114, 24 hours a day/seven days a week, or visit NetworkHealthMedicare.com. 18