street organization phone street address state …...programs stern jody l 1-386-963-2543...

STATE LEGAL ENTITY NAME ORGANIZATION

NAMEORGANIZATION DESCRIPTION TITLE LAST NAME FIRST NAME MI PHONE

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Alabama

AETNA LIFE INSURANCE COMPANY Aetna Medicare PFFS

Director, Medicare Clinical Pharmacy Programs Stern Jody L

1-386-963-2543

1-860-754-1481

sternJL@aetna.com 5350 148th Place Wellborn FL 32094

Alabama

AETNA LIFE INSURANCE COMPANY Aetna Medicare PDP

1-386-963-2543

1-860-754-1481

Alabama

BCBS OF ALABAMA AND BCBS OF TENNESSEE BlueRx PDP

Clinical Pharmacy Admin Layne Paul

1-205-220-6522

playne@bcbsal.org

450 Riverchase Parkway East Birmingham AL 35244

Alabama

BLUE CROSS AND BLUE SHIELD OF ALABAMA

Blue Cross Blue Shield of Alabama Local CCP

1-205-220-6522

playne@bcbsal.org

Alabama

CHESAPEAKE LIFE INSURANCE COMPANY

HealthMarkets Care Assured PFFS

Director of Pharmacy Schaffer Mike

1-215-988-6835

1-215-557-7437

mike.schaffer@healthmarkets.com

One Commerce Square, Suite 3110

2005 Market Street Philadelphia PA 19103

Alabama

CONNECTICUT GENERAL LIFE INSURANCE COMPANY CIGNA Medicare Rx PDP Zheng Yi

1-860-226-6731

yi.zheng@cigna.com

900 Cottage Grove Road B5PHR Bloomfield CT 6002

Alabama

COVENTRY HEALTH AND LIFE INSURANCE COMPANY Advantra® Freedom PFFS

Director, Phamacy Operations Williams Roger

1-801-954-3043

rlwilliams@cvty.com

Coventry Health Care, Inc.

2650 S Decker Lane Salt Lake City UT 84119

Alabama

COVENTRY HEALTH AND LIFE INSURANCE COMPANY Coventry AdvantraRx PDP

Dir, Pharmacy Ops Williams Roger L

1-801-954-3043

rlwilliams@cvty.com

2650 S Decker Ln Salt Lake City UT 84119

AlabamaDAVITA VILLAGEHEALTH, INC.

DaVita VillageHealth Insurance of Alabama, Inc. Local CCP

Director of Clinical Pharmacy Manley Harold

1-518-932-4416

Harold.Manley@villagehealth.com 16 Vagele Lane Glenmont NY 12077

Alabama

ENVISION INSURANCE COMPANY EnvisionRx Plus PDP

Vice President Pharmacy Peterson Amanda

1-330-405-8080 6320

1-330-405-8081

apeterson@rxoptions.net

2181 E Aurora Road Twinsburg OH 44087

Alabama

FIRST HEALTH LIFE AND HEALTH INSURANCE COMPANY First Health Part D PDP

1-801-954-3043

rlwilliams@cvty.com

Alabama

HEALTH NET LIFE INS CO/HEALTH NET INS OF NY Health Net PDP

Director, Clinical Pharmacy Services

Misquitta, Pharm. D. Cathrine V

1-916-463-9603

1-916-463-9750

cathrine.v.misquitta@healthnet.com

10540 White Rock Rd.., Ste. 280

Mail Stop: CA-175-02-02 Rancho Cordova CA 95670

Alabama

HEALTHSPRING INC. HEALTHSPRING OF ALABAMA, INC.

HealthSpring Prescription Drug Plan PDP

Director, Government Programs Christopher Kelly

1-615-565-8110

1-615-234-2154

Kelly.Christopher@healthspring.com

601 Mainstream Drive Nashville TN 37228

AlabamaHEALTHSPRING OF ALABAMA, INC.

Healthspring of Alabama, Inc. Local CCP

1-615-565-8110

AlabamaHUMANA INSURANCE COMPANY

Humana Insurance Company PFFS Ewing Joy

1-502-580-3538

jewing@humana.com

500 West Main Street Louisville KY 40202

Humana Insurance Company Regional CCP Ewing Joy

1-502-580-3538

jewing@humana.com

Humana Insurance Company PDP Ewing Joy

1-502-580-3538

jewing@humana.com

2008 MTMP Contacts, Updated 0613/08 1

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Alabama

MARQUETTE NATIONAL LIFE INSURANCE COMPANY

Today's Options Powered by CCRx PFFS

Clinical Pharmacist Roper Lisa

1-405-230-8766 lroper@hhsi.com

4888 Loop Central Suite 800 Houston TX 77042

Alabama

MEDCO CONTAINMENT LIFE INSURANCE COMPANY

Medco Medicare Prescription Plan PDP

Chief Medical Officer Eisenberg, MD Edward

1-201-269-6717

1-201-269-1008

woody_eisenberg@medco.com

100 Parsons Pond Drive E2-7 Franklin Lakes NJ 7417

Alabama

PENN LIFE INS CO AND AMER PROG LIFE AND HTH INS CO MEMBERHEALTH PDP

VP Clinical Operations Rajan Samuel

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

29100 Aurora Rd., Ste. 301 Solon OH 44139

Alabama

PENNSYLVANIA LIFE INSURANCE COMPANY

Pennsylvania Life Insurance Company PDP

Medicare Clinical Pharmacist Brown Nancy J

1-401-333-3987 7941

1-800-373-0238

njbrown@pharmacare.com

695 George Washington Highway Lincoln RI 2865

Alabama

PYRAMID LIFE INSURANCE COMPANY Today's Options PFFS

Alabama RXAMERICA, LLC RxAmerica PDP

Director of Medicare Operations Low Jeff

1-801-961-6251

1-801-961-6313

jeff.low@rxamerica.com

221 N. Charles Lindbergh Dr. SLC UT 84116

Alabama

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. SierraRx PDP

Director, Pharmacy Services Evans, M.D. Steven

1-702-877-8377

Steven.Evans@uhc.com

2716 N. Tenaya Way Las Vegas NV 89128

Alabama

SILVERSCRIPT INSURANCE COMPANY

SilverScript Insurance Company PDP Help Desk MTM

1-866-443-0934

MedicareSupportServices@caremark.com

9501 E. Shea Blvd Scottsdale AZ 85260

Alabama

STERLING LIFE INSURANCE COMPANY

Sterling Life Insurance Company PDP Hirsch Jeff

1-314-810-6102

jhirsch@express-scripts.com

One Express Way St. Louis MO 63121

Alabama

UNICARE LIFE AND HEALTH INS. COMPANY

Unicare Life & Health Ins. Company PFFS

Clinical Pharmacist Hettich Lisa

1-765-526-2515

lisa.hettich@wellpoint.com

8407 Fallbrook Avenue West Hills CA 91304

Alabama

UNICARE LIFE AND HEALTH INSURANCE COMPANY UniCare PDP

Pharmacist Clinical Hettich Lisa

1-765-526-2515

lisa.hettich@wellpoint.com 8990 Duke Drive

Mail Stop OH2104-A844 Mason OH 45040

Alabama

UNITED AMERICAN INSURANCE COMPANY

United American Insurance Company PDP

Vice President and Health Actuary Hendee Peter G

1-972-569-3646

1-972-569-3679

phendee@torchmarkcorp.com

3700 S. Stonebridge Drive McKinney TX 75070

Alabama

UNITED HEALTH CARE INS. CO. AND UNITED NEW YORK UnitedHealthcare PDP Solutions Rx

1-949-252-4339

1-949-474-4237

Joseph.Addiego@rxsol.com 2300 Main Street Irvine CA 92614

Alabama

UNITED HEALTHCARE INSURANCE COMPANY

SecureHorizons MedicareDirect PFFS Solutions RX

1-949-221-9994

1-949-747-4237

joseph.addiego@rxsol.com 2300 Main Street Irvine CA 92614

Alabama

UNITED HEALTHCARE INSURANCE COMPANY UnitedHealthcare PDP Solutions Rx

1-949-252-4339

1-949-474-4237

Alabama

UNITED HEALTHCARE OF ALABAMA, INC.

SecureHorizons by UnitedHealthcare Local CCP Solutions RX

1-949-221-9994

1-949-747-4237

Alabama VIVA HEALTH, INC. VIVA Medicare Plus Local CCPManager of Quality Improvement Scott Jan P

1-205-930-5520

1-205-930-5597

jpscott@uabmc.edu

1222 14th Avenue South Birmingham AL 35205

Alabama

WELLCARE HEALTH INSURANCE OF ARIZONA, INC. WellCare PFFS

Manager, Medication Therapy Management Rackley Qiana

1-813-290-6200 6620

qiana.rackley@wellcare.com

8735 Henderson Rd Tampa FL 33634

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Alabama

WELLCARE PRESCRIPTION INSURANCE, INC. WellCare PDP

Senior Director, Specialty Pharmacy Lannigan Jeff

1-813-290-6200 5119

jeff.lannigan@wellcare.com

8735 Henderson Road Tampa FL 33634

AlabamaWINDSOR HEALTH PLAN, INC Windsor Rx PDP Pharmacy Director King Sonya

1-615-782-7860

1-615-782-7822

sking@windsorhealthgroup.com

7100 Commerce Way, Ste 285 Brentwood TN 37027

AlabamaWINDSOR HEALTH PLANS, INC.

Windsor Medicare Extra Local CCP Pharmacy Director King Sonya

1-615-782-7860

1-615-782-7822

Alaska

1-386-963-2543

1-860-754-1481

Alaska

1-386-963-2543

1-860-754-1481

Alaska

1-860-226-6731

yi.zheng@cigna.com

Alaska

1-330-405-8080 6320

1-330-405-8081

Alaska

FIRST HEALTH LIFE AND HEALTH INSURANCE COMPANY Coventry AdvantraRx PDP

1-801-954-3043

rlwilliams@cvty.com

Alaska

1-801-954-3043

rlwilliams@cvty.com

Alaska

1-916-463-9603

1-916-463-9750

Alaska

1-615-565-8110

1-615-234-2154

AlaskaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

AlaskaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Alaska

1-201-269-6717

1-201-269-1008

Alaska

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Alaska

1-401-333-3987 7941

1-800-373-0238

Alaska RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Alaska

1-866-443-0934

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Alaska

Sterling Life Insurance Company PFFS

V.P. Compliance & Regulatory Affairs Bodway Craig

1-360-647-9080 29098

1-360-647-8632

Craig.Bodway@sterlingplans.com

2219 Rimland Drive

PO Box 5348 Bellingham WA 98227

Alaska

1-314-810-6102

Alaska

1-765-526-2515

Alaska

1-765-526-2515

Alaska

1-972-569-3646

1-972-569-3679

Alaska

1-949-252-4339

1-949-474-4237

Alaska

1-949-221-9994

1-949-747-4237

Alaska

1-949-252-4339

1-949-474-4237

Alaska

1-813-290-6200 5119

American Samoa

1-949-252-4339

1-949-474-4237

American Samoa

1-949-252-4339

1-949-474-4237

ArizonaABRAZO ADVANTAGE HEALTH PLAN

Abrazo Advantage Health Plan Local CCP Pharmacy Director Cruz Patti

1-602-824-3773

1-602-824-3762

pcruz@abrazohealth.com 7878 N. 16th St. Suite 105 Phoenix AZ 85020

Arizona AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Arizona

AETNA LIFE INSURANCE COMPANY Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Arizona

1-386-963-2543

1-860-754-1481

Arizona

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

ArizonaARCADIAN HEALTH PLAN, INC.

Desert Canyon Community Care Local CCP

Vice President of Pharmacy Services Owens Glenda

1-909-971-6816

1-909-971-6866

gowens@arcadianhealth.com

955 Overland Court., Second Floor San Dimas CA 91773

ArizonaARIZONA PHYSICIANS IPA, INC.

APIPA Personal Care Plus Local CCP Pharmacy Director Cabrera Lourdes

1-954-858-4302

1-954-858-3765

lcabrera@uhc.com

13621 NW 12TH ST Sunrise FL 33323

ArizonaBRIDGEWAY HEALTH SOLUTIONS

Advantage by Bridgeway Health Solutions Local CCP

VP Pharmacy Operations Health Plans Pica Mike

1-732-476-1047

1-732-549-5824

mpica@centene.com

499 Thornall Street, 4th floor Edison NJ 8837

ArizonaCARE1ST HEALTH PLAN OF ARIZONA

ONECare by Care1st Health Plan Of Arizona Local CCP

Compliance Officer Hollin Cheyenne

1-602-778-1850 8318

chollin@care1st.com

2355 E. Camelback Rd., Ste. 300 Phoenix AZ 85016

Arizona

1-215-988-6835

1-215-557-7437

ArizonaCIGNA HEALTHCARE OF ARIZONA, INC.

CIGNA HealthCare of Arizona Local CCP Chief Pharmacist Zheng Yi

1-860-226-6731

yi.zheng@cigna.com

900 Cottage Grove Rd. Wilde Hartford CT 6152

ArizonaCIGNA HEALTHCARE OF ARIZONA, INC.

CIGNA HealthCare of Arizona PFFS Zheng Yi

1-860-226-6731

yi.zheng@cigna.com

900 Cottage Grove Rd. Wilde Hartford CT 6152

Arizona

1-860-226-6731

yi.zheng@cigna.com

Arizona

1-801-954-3043

rlwilliams@cvty.com

Arizona

1-801-954-3043

rlwilliams@cvty.com

Arizona

1-330-405-8080 6320

1-330-405-8081

Arizona

1-801-954-3043

rlwilliams@cvty.com

ArizonaFOX INSURANCE COMPANY

Fox Insurance Company PDP

Clinical Pharmacist Verma Saurabh

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

40 West 25th Street 6th Floor New York NY 10010

ArizonaHEALTH CHOICE ARIZONA, INC.

Health Choice Generations Local CCP

Director, Pharmacy Sartor Lynn

1-480-303-4431

1-480-350-2231

lsartor@iasishealthcare.com

1600 W. Broadway, Suite 110 Tempe AZ 85282

Arizona

1-916-463-9603

1-916-463-9750

Arizona

HEALTH NET LIFE INSURANCE COMPANY Health Net Regional CCP

Senior Vice President, Chief Clinical Officer White Virginia E

1-916-463-9603

Virginia.E.White@healthnet.com

10540 White Rock Rd., Ste 280

Mail Stop: CA-175-02-02 Rancho Cordove CA 95670

ArizonaHEALTH NET OF ARIZONA, INC.

Health Net of Arizona, Inc. Local CCP

Senior Vice President

White, Pharm. D. Virginia E

1-916-463-9603

1-916-463-9750

10540 White Rock Rd., Ste. 280 Rancho Cordova CA 95670

Arizona

1-615-565-8110

1-615-234-2154

ArizonaHUMANA HEALTH PLAN, INC.

Humana Health Plan, Inc. Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

ArizonaHUMANA INSURANCE COMPANY

Humana Insurance Company Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Arizona

1-201-269-6717

1-201-269-1008

ArizonaMENNONITE MUTUAL AID ASSOCIATION

Mennonite Mutual Aid Association PFFS Moyna Audrey

1-847-559-3999

1-847-559-4733

audrey.moyna@caremark.com

ArizonaPACIFICARE OF ARIZONA, INC

1-949-221-9994

1-949-747-4237

Arizona

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Arizona

1-401-333-3987 7941

1-800-373-0238

Arizona

Arizona RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

ArizonaSCAN HEALTH PLAN OF ARIZONA

SCAN Health Plan Arizona Local CCP

Director of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

sbakshi@scanhealthplan.com

3800 Kilroy Airport Way Suite 100 Long Beach CA 90806

Arizona

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. Sierra Spectrum Local CCP

1-702-877-8377

Arizona

1-702-877-8377

Arizona

1-866-443-0934

Arizona

SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION Mercy Care Advantage Local CCP

Corporate Director of Pharmacy Clark Mark

1-602-659-1100

mark.clark@schalleranderson.com

4645 E Cotton Center Blvd

Building 1, Suite 200 Phoenix AZ 85040

Arizona

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Arizona

1-314-810-6102

ArizonaSUN HEALTH MEDISUN, INC.

Sun Health MediSunONE Local CCP

Director of Pharmacy Nesemann Lydia

1-623-974-7474

1-623-974-7495

Lydia.Nesemann@sunhealth.org P.O. Box 1489

13632 N. 99th Ave, Suite B Sun City AZ 85372

Arizona

1-765-526-2515

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Arizona

1-765-526-2515

Arizona

1-972-569-3646

1-972-569-3679

Arizona

1-949-252-4339

1-949-474-4237

Arizona

Evercare® Health Plans Local CCP Solutions RX

1-949-221-9994

1-949-747-4237

Arizona

Evercare® Health Plans Demo Solutions RX

1-949-221-9994

1-949-747-4237

Arizona

1-949-221-9994

1-949-747-4237

Arizona

1-949-252-4339

1-949-474-4237

ArizonaUNITEDHEALTHCARE OF ARIZONA INC

1-949-221-9994

1-949-747-4237

Arizona

UNIVERSAL HEALTH CARE INSURANCE COMPANY

Universal Health Care Insurance Company, Inc. PFFS

VICE PRESIDENT CLINICAL PROGRAM SCHOENING SHELLIE K

1-800-546-5677 1110

SSCHOENING@PTI-NPS.COM

14301 FIRST NATIONAL BANK PARKWAY SUITE 200 OMAHA NE 68154

ArizonaUPH/MIHS VENTURES L.L.C.

University Physicians/Maricopa Care Advantage Local CCP Rabbitt Rebecca

1-800-332-5455

Rebecca.rabbitt@express-scripts.com

13900 Riverport Drive

Maryland Heights MO 63043

Arizona

1-813-290-6200 6620

Arizona

1-813-290-6200 5119

Arkansas

1-386-963-2543

1-860-754-1481

Arkansas

1-386-963-2543

1-860-754-1481

ArkansasARKANSAS BCBS, A MUTUAL INS CO

Arkansas Blue Cross and Blue Shield PDP

Dir. Clinical Operations Moyna Audrey

1-847-559-3999

1-847-559-4733

211 Sanders Road Northbrook IL 60062

Arkansas

ARKANSAS BLUE CROSS AND BLUE SHIELD, A MUTUAL INS.

Arkansas Blue Cross - Medi-Pak Advantage PFFS

Dir. Clinical Operations Monya Audrey

1-847-559-3999

1-847-559-4733

ArkansasARKANSAS COMMUNITY CARE

Arkansas Community Care, Inc. Local CCP

1-909-971-6816

1-909-971-6866

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Arkansas

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

Care Improvement Plus Regional CCP Help Desk MTM

1-866-443-0934

medicaresupportservices@caremark.com

9501 East Shea Boulevard Scottsdale AZ 85260

Arkansas

1-215-988-6835

1-215-557-7437

Arkansas

1-860-226-6731

yi.zheng@cigna.com

Arkansas

1-801-954-3043

rlwilliams@cvty.com

Arkansas

1-801-954-3043

rlwilliams@cvty.com

Arkansas

1-330-405-8080 6320

1-330-405-8081

Arkansas

1-801-954-3043

rlwilliams@cvty.com

ArkansasFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

Arkansas

1-916-463-9603

1-916-463-9750

Arkansas

1-615-565-8110

1-615-234-2154

ArkansasHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Arkansas

1-201-269-6717

1-201-269-1008

ArkansasMERCY HEALTH PLANS Mercy Health Plans Local CCP

Director of Clinical Pharmacy Linsin Cathy

1-314-214-2489

1-314-214-8101

clinsin@mhp.mercy.net

14528 S. Outer 40, Ste. 300 Chesterfield MO 63017

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Arkansas

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Arkansas

1-401-333-3987 7941

1-800-373-0238

Arkansas

Arkansas RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Arkansas

1-702-877-8377

Arkansas

1-866-443-0934

Arkansas

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Arkansas

1-314-810-6102

Arkansas

1-765-526-2515

Arkansas

1-765-526-2515

Arkansas

UNISON HEALTH PLAN OF TENNESSEE, INC. Unison Advantage Local CCP Brekosky Robert

1-412-349-6167

1-412-457-1616

robert.brekosky@unisonhealthplan.com Unison Plaza

1001 Brinton Road Pittsburgh PA 15221

Arkansas

1-972-569-3646

1-972-569-3679

Arkansas

1-949-252-4339

1-949-474-4237

Arkansas

1-949-221-9994

1-949-747-4237

Arkansas

1-949-252-4339

1-949-474-4237

ArkansasUNITEDHEALTHCARE OF ARKANSAS, INC.

1-949-221-9994

1-949-747-4237

Arkansas

WELLCARE HEALTH INSURANCE OF ILLINOIS, INC. WellCare PFFS

1-813-290-6200 6620

Arkansas

1-813-290-6200 5119

ArkansasWINDSOR HEALTH PLAN, INC Windsor Rx PDP Pharmacy Director King Sonya

1-615-782-7860

1-615-782-7822

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

ArkansasWINDSOR HEALTH PLANS, INC.

1-615-782-7860

1-615-782-7822

CaliforniaAETNA HEALTH OF CALIFORNIA,INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

California

1-386-963-2543

1-860-754-1481

California

1-386-963-2543

1-860-754-1481

CaliforniaAIDS HEALTHCARE FOUNDATION

POSITIVE HEALTHCARE PARTNERS Local CCP

MEDICAL DIRECTOR HOWELL SCOTT

1-954-522-3132

1-954-522-3260

SCOTT.HOWELL@AIDSHEALTH.ORG 110 SE 6th St. Fort Lauderdale FL 33301

California

ALAMEDA ALLIANCE JOINT POWERS AUTHORITY (JPA) Alliance for Health Local CCP

Manager, Pharmacy Services Yang Anna

1-510-747-6155

1-510-747-4507

AYang@alamedaalliance.org

1240 South Loop Road Alameda CA 94502

California

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE CO.

BC LIFE & HEALTH INSURANCE COMPANY Regional CCP

1-765-526-2515

CaliforniaANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Mailstop OH2104-A844 Mason OH 45040

CaliforniaARTA MEDICARE HEALTH PLAN, INC.

Arta Medicare Health Plan Local CCP Pharmacy Director Sefain Hani

1-818-368-7538

1-818-368-7169

hsefain@pharmacyconsult.net

19641 Tulsa Street Chatsworth CA 91311

CaliforniaBLUE CROSS OF CALIFORNIA

Blue Cross of California Local CCP

1-765-526-2515

CaliforniaBLUE CROSS OF CALIFORNIA

Blue Cross Of California PFFS

1-765-526-2515

California

BRAVO HEALTH INSURANCE COMPANY, INC. Bravo Health PDP

Clinical Pharmacist Owens Heather

1-800-625-9432

1-866-464-0709

heather.owens@bravohealth.com

3601 O'Donnell Street Baltimore MD 21224

California

CA PHYSICIANS' SERVICE DBA BLUE SHIELD OF CA

Blue Shield of California PDP

Medication Management Coordinator Becker-Ellison Dawn

1-916-350-6624

1-916-350-6216

dawn.becker-ellison@blueshieldca.com

4205 Town Center Blvd El Dorado Hills CA 95762

California

CALIFORNIA PHYSICIANS' SERVICE

Blue Shield of California Local CCP

Medication Management Coordinator Becker-Ellison Dawn

1-916-350-6624

1-916-350-6216

dawn.becker-ellison@blueshieldca.com

4205 Town Center Blvd El Dorado Hills CA 95762

CaliforniaCARE1ST HEALTH PLAN

Care1st Medicare Advantage Plan Local CCP Pharmacy Director Lasconia Michael

1-323-889-6638 6532

mlasconia@care1st.com

601 Potrero Grande Drive Monterey Park CA 91755

CaliforniaCAREMORE HEALTH PLAN CareMore Health Plan Local CCP

Director of Pharmacy Rose James

1-562-622-2900 2982

1-562-622-2814

james.rose@caremore.org

12900 Park Plaza Drive Suite 150 Cerritos CA 90703

California

CENTRAL HEALTH PLAN OF CALIFORNIA, INC.

Central Health Medicare Plan Local CCP

Pharmacy Operations Manager Britton, MD Timothy

1-866-314-2427 2229

1-626-388-2363

tbritton@centralhealthplan.com

18575 East Gale Avenue Suite 258 City of Industry CA 91748

California

1-215-988-6835

1-215-557-7437

California

CHINESE COMMUNITY HEALTH PLAN

Chinese Community Health Plan Local CCP

Director of Pharmacy Services Wong Adrian

1-415-955-8800 3275

1-415-955-8814

awong@cchphmo.com

445 Grant Avenue, Suite 700 San Francisco CA 94108

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

CaliforniaCITIZENS CHOICE HEALTHPLAN

Citizens Choice Healthplan Local CCP

Director, Health Care Services Maxon, RN Marcie

1-562-207-4508

1-323-728-8494

mmaxon@mycchp.com

17315 Studebaker Road Suite 200 Cerritos CA 90703

CaliforniaCOMMUNITY HEALTH GROUP

Community Health Group Local CCP

Director-Health Care Operations Koizumi Noreen

1-619-498-6476

1-619-407-4648

nkoizu@chgsd.com 740 Bay Blvd. Chula Vista CA 91910

California

1-860-226-6731

yi.zheng@cigna.com

California

CONTRA COSTA CO MED SVCS DBA CONTRA COSTA HEALTH

Contra Costa Health Plan Local CCP Lawson Mark

1-215-937-5352

1-215-937-8450

Mark.Lawson@PerformRx.com

200 Stevens Drive Philadelpha PA 19113

CaliforniaEASY CHOICE HEALTH PLAN INC.

Easy Choice Health Plan Local CCP Account Executive Umeda Greg

1-916-428-5321

1-858-621-5147

greg.umeda@medimpact.com

MedImpact Healthcare Systems, Inc.

10680 Treena Street San Diego CA 92131

California

1-330-405-8080 6320

1-330-405-8081

California

1-801-954-3043

rlwilliams@cvty.com

California

1-801-954-3043

rlwilliams@cvty.com

CaliforniaGEMCARE HEALTH PLAN INC.

GEMCARE Health Plan Local CCP

Vice President Clinical Programs Schoening Shellie K

1-800-546-5677 1110

1-866-632-7946

schoening@pti-nps.com P.O. Box 407 Boys Town NE 68010

California

1-916-463-9603

1-916-463-9750

California

HEALTH NET LIFE INSURANCE COMPANY

Health Net Life Insurance Company Local CCP

Senior Vice President, Chief Clinical Officer

1-916-463-9603

10540 White Rock Rd., Ste. 280

Mail Stop: CA-175-02-02 Rancho cordova CA 95670

California

HEALTH NET LIFE INSURANCE COMPANY, INC. Health Net PFFS V.P., Operations

1-916-463-9603

1-916-463-8056

virginia.e.white@healthnet.com

California HEALTH NET_OF CA Health Net Of CA Local CCP V.P. OperationsWhite, Pharm. D. Virginia E

1-916-463-9603

1-916-463-9750

California

1-615-565-8110

1-615-234-2154

California HMO CALIFORNIA Brand New Day Local CCP

Vice President Medicare Operations & Compliance Snyder Connie

1-562-981-5054

1-562-981-5818

connie_snyder@universalcare.com

1600 East Hill Street Signal Hill CA 90755

CaliforniaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

CaliforniaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

CaliforniaIEHP HEALTH ACCESS

IEHP Medicare DualChoice Local CCP

Director of Pharmaceutical Services Chan Chris

1-909-890-2943

1-909-890-2995 chan-c@iehp.org

303 E. Vanderbilt Way, Suite 100 San Bernardino CA 92408

CaliforniaINTER VALLEY HEALTH PLAN, INC. Inter Valley Health Plan Local CCP

VP of Health Services Tenorio Susan

1-800-251-8191 631

1-909-620-8092

cmscasework@ivhp.com PO Box 6002

300 South Park Ave, Suite 300 Pomona CA 91769

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

CaliforniaKAISER FOUNDATION HP, INC. Kaiser Permanente Local CCP

Director, Medicare Compliance Fletcher Michael

1-626-405-6629

michael.p.fletcher@kp.org

393 E. Walnut Street, 7th Floor Pasadena CA 91188

CaliforniaL. A. CARE HEALTH PLAN L.A. Care Health Plan Local CCP

Director, Pharmacy & Formulary Leong Susan

1-213-438-5655

1-213-438-5721

sleong@lacare.org

555 West 5th Street 19th Floor Los Angeles CA 90013

California

California MD CARE, INC. MD Care Inc Local CCP Help Desk MTM1-866-443-0934

1-480-661-2774

9501 E Shea Blvd. Scottsdale AZ 85260

California

1-201-269-6717

1-201-269-1008

California MEDCORE HP Medcore HP Local CCP Hirsch Jeff1-314-810-6102

CaliforniaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

California

MOLINA HEALTHCARE OF CALIFORNIA

Molina Healthcare of California Local CCP

Director, Pharmacy Johnson Beth

1-801-858-0466

1-801-748-0536

beth.johnson@molinahealthcare.com

7050 South UnionPark Center Midvale UT 84047

CaliforniaORANGE COUNTY HEALTH AUTHORITY OneCare Local CCP

Director of Clinical Pharmacy Gericke Kristin

1-714-246-8471

1-714-246-8649

kgericke@caloptima.org

1120 West La Veta Avenue Orange CA 92868

California

PACIFICARE OF CALIFORNIA/SECURE HORIZONS

1-949-221-9994

1-949-747-4237

California

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

California

1-401-333-3987 7941

1-800-373-0238

California

California RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

CaliforniaSAN MATEO HEALTH COMMISSION

Health Plan of San Mateo Local CCP

Pharmacy Manager Cheung Barrie

1-650-616-2073

CMSPartD@hpsm.org

701 Gateway Blvd, Ste 400

South San Francisco CA 94080

CaliforniaSAN MIGUEL HEALTH PLAN, INC. San Miguel Health Plan Local CCP

Chief Medical Officer Bass Stephan

1-562-787-1403

1-562-435-9200

sbassmd@aol.com

100 West Broadway Suite 4000 Long Beach CA 90802

California

SANTA CLARA COUNTY HEALTH AUTHORITY

Santa Clara Family Health Plan Local CCP Garg Angeli

1-408-874-1818

1-408-874-1961

agarg@scfhp.com

210 East Hacienda Ave Campbell CA 95008

California SCAN HEALTH PLAN SCAN Health Plan Local CCPDirector of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

California SCAN HEALTH PLAN SCAN Health Plan Local CCPDirector of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

California SCAN HEALTH PLAN VillageHealth DemoDirector of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

California

1-702-877-8377

California

1-866-443-0934

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

California

SOLANO-NAPA-YOLO COMMISSION ON MEDICAL CARE

Partnership HealthPlan of California Local CCP

Chief Medical Officer Cammisa Chris

1-707-863-4228

1-707-863-4118

ccammisa@partnershiphp.org

360 Campus Lane, Suite 100 Fairfield CA 94534

California

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

California

1-314-810-6102

California

1-765-526-2515

California

1-972-569-3646

1-972-569-3679

California

1-949-252-4339

1-949-474-4237

California

1-949-221-9994

1-949-747-4237

California

1-949-252-4339

1-949-474-4237

California

1-813-290-6200 6620

California

1-813-290-6200 5119

CaliforniaWESTERN HEALTH ADVANTAGE

Western Health Advantage Local CCP

Clinical Pharmacist Fischer Joe

1-916-563-2273

1-916-563-3182

j.fischer@westernhealth.com

2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833

Colorado

1-386-963-2543

1-860-754-1481

Colorado

1-386-963-2543

1-860-754-1481

ColoradoANTHEM INSURANCE COMPANIES, INC.

Anthem Insurance Companies, Inc. PFFS

1-765-526-2515

ColoradoANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Colorado

1-215-988-6835

1-215-557-7437

Colorado COLORADO ACCESS Colorado Access Local CCPDirector of Pharmacy Girgis Irene

1-720-744-5526

Irene.Girgis@coaccess.com

10065 E. Harvard Ave. Suite 600 Denver CO 80231

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Colorado

1-860-226-6731

yi.zheng@cigna.com

Colorado

1-801-954-3043

rlwilliams@cvty.com

Colorado

1-801-954-3043

rlwilliams@cvty.com

ColoradoDENVER HEALTH MEDICAL PLAN, INC.

Denver Health Medical Plan Local CCP Medical Director Brody, MD David

1-720-956-2361

1-720-956-2303

david.brody@dhha.org

777 Bannock Street

Mail Code 6000 Denver CO 80204

Colorado

1-330-405-8080 6320

1-330-405-8081

Colorado

1-801-954-3043

rlwilliams@cvty.com

ColoradoFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

Colorado

1-916-463-9603

1-916-463-9750

Colorado

1-615-565-8110

1-615-234-2154

ColoradoHMO COLORADO, INC.

Anthem Blue Cross and Blue Shield Local CCP

1-765-526-2515

ColoradoHUMANA HEALTH PLAN, INC.

1-502-580-3538

jewing@humana.com

ColoradoHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

ColoradoKAISER FOUNDATION HP OF CO Kaiser Permanente Local CCP

Quality & Clinical Pharmacy Manager Chester Beth

1-303-326-7612

1-303-739-3574

beth.chester@kp.org

16601 E. Centretech Parkway Aurora CO 80011

Colorado

1-201-269-6717

1-201-269-1008

ColoradoMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

ColoradoPACIFICARE OF COLORADO, INC

AARP MedicareComplete provided by SecureHorizons Local CCP Solutions RX

1-949-221-9994

1-949-747-4237

Colorado

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Colorado

1-401-333-3987 7941

1-800-373-0238

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Colorado

ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION

Rocky Mountain Health Plans PDP Pharmacy Director Nolan Steve

1-970-244-7760 5182

steve.nolan@rmhp.org PO Box 10600 Grand Junction CO 81502

ColoradoROCKY MOUNTAIN HEALTH PLANS

Rocky Mountain Health Plans 1876 Cost Pharmacy Director Nolan Steve

1-970-244-7760 5182

Colorado RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Colorado

1-702-877-8377

Colorado

1-866-443-0934

Colorado

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Colorado

1-314-810-6102

Colorado

1-765-526-2515

Colorado

1-765-526-2515

Colorado

1-972-569-3646

1-972-569-3679

Colorado

1-949-252-4339

1-949-474-4237

Colorado

UNITED HEALTHCARE INSURANCE COMPANY Erickson Advantage Demo Solutions RX

1-949-221-9994

1-949-747-4237

Colorado

1-949-221-9994

1-949-747-4237

Colorado

1-949-221-9994

1-949-747-4237

Colorado

1-949-221-9994

1-949-747-4237

Colorado

1-949-252-4339

1-949-474-4237

Colorado

1-813-290-6200 6620

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Colorado

1-813-290-6200 5119

Connecticut AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Connecticut

1-386-963-2543

1-860-754-1481

Connecticut

1-386-963-2543

1-860-754-1481

Connecticut

1-386-963-2543

1-860-754-1481

Connecticut

AMERICAN PROGRESSIVE LIFE/HLTH INS. Today's Options PFFS

ConnecticutANTHEM HEALTH PLANS, INC

Director of Clinical Operations Moyna Audrey

1-847-559-3999

1-847-559-4733

ConnecticutANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

Connecticut BLUE MEDICARERX Blue MedicareRx PDPClinical Pharmacist Hettich Lisa

1-765-526-2515

Connecticut

CONNECTICARE INSURANCE COMPANY, INC.

ConnectiCare Insurance Company, Inc. PFFS Aral Jasmine

1-646-447-7186

jaral2@hipusa.com 55 Water Street New York NY 10041

Connecticut CONNECTICARE, INC. ConnectiCare, Inc. Local CCP Aral Jasmine1-646-447-7186

jaral2@hipusa.com 55 Water Street New York NY 10041

Connecticut

1-860-226-6731

yi.zheng@cigna.com

Connecticut

1-330-405-8080 6320

1-330-405-8081

Connecticut

1-801-954-3043

rlwilliams@cvty.com

Connecticut

1-801-954-3043

rlwilliams@cvty.com

Connecticut

1-916-463-9603

1-916-463-9750

Connecticut

1-916-463-9603

1-916-463-8056

ConnecticutHEALTH NET OF CONNECTICUT

Health Net of Connecticut Local CCP

Senior Vice President, Chief Clinical Officer

White, Pharm D. Virginia E

1-916-463-9603

1-916-463-9750

Virginia.E.White@healthent.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Connecticut

1-615-565-8110

1-615-234-2154

ConnecticutHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

ConnecticutHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Connecticut

1-201-269-6717

1-201-269-1008

ConnecticutOXFORD HEALTH PLANS (CT), INC.

SecureHorizons by UnitedHealthCare Local CCP Solutions RX

1-949-221-9994

1-949-747-4237

Connecticut

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Connecticut

1-401-333-3987 7941

1-800-373-0238

Connecticut RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

ConnecticutSENIOR WHOLE HEALTH, LLC

Senior Whole Health of Connecticut Local CCP

Director of Pharmacy Services Dichter Gayle

1-617-494-5353 6324

1-617-494-5599

gdichter@seniorwholehealth.com 58 Charles Street Cambridge MA 2141

Connecticut

1-866-443-0934

Connecticut

1-314-810-6102

Connecticut

1-765-526-2515

Connecticut

1-765-526-2515

Connecticut

1-972-569-3646

1-972-569-3679

Connecticut

1-949-252-4339

1-949-474-4237

Connecticut

1-949-221-9994

1-949-747-4237

Connecticut

1-949-221-9994

1-949-747-4237

Connecticut

1-949-221-9994

1-949-747-4237

Connecticut

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

ConnecticutWELLCARE OF CONNECTICUT, INC. WellCare Local CCP

Manager, Clinical Pharmacy Rackley Qiana

1-813-290-6200 6620

Qiana.Rackley@wellcare.com

Connecticut

1-813-290-6200 5119

Delaware AETNA HEALTH, INC Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Delaware

1-386-963-2543

1-860-754-1481

Delaware

AETNA LIFE INSURANCE COMPANY Aetna Medicare Regional CCP

1-386-963-2543

1-860-754-1481

Delaware

1-386-963-2543

1-860-754-1481

Delaware

DelawareBRAVO HEALTH MID- ATLANTIC INC. Bravo Health PFFS

Vice President, Pharmacy Services Owens Heather

1-410-864-4583

1-866-464-0709

Delaware

1-860-226-6731

yi.zheng@cigna.com

Delaware

1-801-954-3043

rlwilliams@cvty.com

Delaware

1-801-954-3043

rlwilliams@cvty.com

Delaware

1-330-405-8080 6320

1-330-405-8081

Delaware FIRST CARE, INC.Medi-CareFirst BlueCross BlueShield PDP

Director, Pharmacy Management Wong Winston

1-410-528-7897

winston.wong.pharmd@carefirst.com

1501 S. Clinton St 8th Floor Baltimore MD 21224

Delaware

1-801-954-3043

rlwilliams@cvty.com

Delaware

1-916-463-9603

1-916-463-9750

Delaware

1-615-565-8110

1-615-234-2154

DelawareHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

DelawareHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Delaware

1-201-269-6717

1-201-269-1008

DelawareMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Delaware

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Delaware

1-401-333-3987 7941

1-800-373-0238

Delaware RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Delaware

1-702-877-8377

Delaware

1-866-443-0934

Delaware

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Delaware

1-314-810-6102

Delaware

1-765-526-2515

Delaware

1-765-526-2515

Delaware

1-972-569-3646

1-972-569-3679

Delaware

1-949-252-4339

1-949-474-4237

Delaware

1-949-221-9994

1-949-747-4237

Delaware

1-949-221-9994

1-949-747-4237

Delaware

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Delaware

1-813-290-6200 6620

Delaware

1-813-290-6200 5119

Florida AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Florida

1-386-963-2543

1-860-754-1481

Florida

1-386-963-2543

1-860-754-1481

Florida

1-386-963-2543

1-860-754-1481

Florida

AIDS HEALTHCARE FOUNDATION MCO OF FLORIDA, INC.

Positive Healthcare Partners Local CCP

Plan Medical Director Howell Scott

1-954-496-9321

1-954-318-4161

scott.howell@aidshealth.org

110 SE 6th Street, Ste 1960 Fort Lauderdale FL 33301

FloridaAMERIGROUP FLORIDA, INC.

AMERIGROUP Community Care Local CCP

Director Clinical Pharmacy Miller Leslie

1-757-518-3420

lmille4@amerigroupcorp.com

4425 Corporation Lane #300 Virginia Beach VA 23462

Florida AVMED, INCAvMed Medicare Preferred Local CCP

Manager of Clinical Pharmacy Kuznik Melissa

1-352-337-8785

1-352-337-8737

Melissa.Kuznik@avmed.org

AvMed Health Plans

4300 NW 89 Blvd. Gainesville FL 32606

Florida AVMED, INC.AvMed Medicare Preferred PPO Local CCP

Manager of Clinical Pharmacy Kuznik Melissa

1-352-337-8785

1-352-337-8737

Melissa.Kuznik@avmed.org

AvMed Health Plans

4300 NW 89 Blvd. Gainesville FL 32606

Florida

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.

Blue Cross and Blue Shield of Florida, Inc. Local CCP

Director, Government Pharmacy Programs Griffin Cynthia

1-904-905-6307

1-904-905-5907

Cynthia.Griffin@bcbsfl.com

4800 Deerwood Campus Pkwy

DCC Building 300, 3rd Floor Jacksonville FL 32246

Florida

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.

Blue Cross and Blue Shield of Florida, Inc. PDP

1-904-905-6307

1-904-905-5907

Florida

1-800-625-9432

1-866-464-0709

FloridaCAPITAL HEALTH PLAN Capital Health Plan Local CCP

Clinical Pharmacist Johnston April

1-850-523-7416

1-850-383-3495

awjohnston@chp.org P.O. Box 15349 Tallahassee FL 32317

FloridaCARE PLUS HEALTH PLAN

CarePlus Health Plans, Inc. Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

Florida

1-215-988-6835

1-215-557-7437

FloridaCITRUS HEALTH CARE

CITRUS HEALTH CARE PDP

VICE PRESIDENT CLINICAL PROGRAMS SCHOENING SHELLIE

1-800-546-5677 1110

1-866-632-7946

SCHOENING@PTI-NPS.COM PO BOX 407 BOYS TOWN NE 68010

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

FloridaCITRUS HEALTH CARE, INC. Citrus Health Care, Inc. Local CCP

Vice President Clinical Programs Schoening Shellie

1-402-965-8800 1110

1-402-965-9774

Schoening@pti-nps.com PO BOX 407 Boys town NE 68010

Florida

1-860-226-6731

yi.zheng@cigna.com

Florida

1-330-405-8080 6320

1-330-405-8081

Florida

1-801-954-3043

rlwilliams@cvty.com

Florida

1-801-954-3043

rlwilliams@cvty.com

Florida

FIRST MEDICAL HEALTH PLAN (OF FLORIDA)

First Medical Health Plan of Florida, Inc. Local CCP Miller Scott A

1-847-964-6944

Scott.a.miller@walgreens.com

1415 Lake Cook Road Deerfield IL 60015

FloridaFLORIDA HEALTH CARE PLAN, INC.

Florida Health Care Plan, Inc. Local CCP Pharmacist fox Dave

1-800-352-9824 4016

1-386-676-7165 dfox@fhcp.com

1340 Ridgewood Avenue Holly Hill FL 32117

FloridaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

FloridaFREEDOM HEALTH PLAN, INC. Freedom Health, Inc. Local CCP Pharmacy Director Keilty Mike

1-813-506-6000 1031

1-813-506-6152

partd@freedomh.com

5403, Church Ave N, Tamap FL 33614

FloridaHEALTH FIRST HEALTH PLANS, INC.

Health First Medicare Plans Local CCP

Compliance Analyst Breisch Laura

1-321-434-5660

1-321-434-4361

Laura.Breisch@health-first.org

6450 US Highway 1 Rockledge FL 32955

Florida

1-916-463-9603

1-916-463-9750

FloridaHEALTH OPTIONS, INC

Health Options, Inc / Blue Cross Blue Shield of FL Local CCP

1-904-905-6307

1-904-905-5907

Florida

1-615-565-8110

1-615-234-2154

FloridaHEALTHSUN HEALTH PLANS, INC.

HealthSun Health Plans, Inc. Local CCP

Compliance Officer de la Llama Marianela

1-305-234-9292

1-305-444-9148

cms_medical@healthsun.com

1205 SW 37th Avenue Miami FL 33135

Florida

HUMANA HEALTH INSURANCE COMPANY OF FL, INC.

Humana Health Insurance Company Of Fl, Inc. Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

FloridaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

FloridaHUMANA MEDICAL PLAN, INC

Humana Medical Plan, Inc. Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

Florida

LEON MEDICAL CENTERS HEALTH PLANS, INC

Leon Medical Centers Health Plans, Inc. Local CCP VP of UM Hernandez Henry

1-305-559-5366

1-305-644-2530

henry.hernandez@lmchealthplans.com

11501 SW 40th Street Miami FL 33165

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Florida

FloridaMD MEDICARE CHOICE MD MedicareChoice Local CCP Pharmacy Director Limberg Cari

1-813-477-3886

1-813-880-8425

cgonzalez@mdmedicarechoice.com

5501 West Waters Ave. Suite 401 Tampa FL 33634

Florida

1-201-269-6717

1-201-269-1008

Florida

MEDICA HEALTHCARE PLANS, INC.

Medica HealthCare Plans, Inc. Local CCP

Clinical Pharmacist Borges Alejandro M

1-305-460-0690

1-305-460-0613

aborges@medicaplans.com

4000 Ponce de Leon Blvd. Suite 650 Coral Gables FL 33146

FloridaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

FloridaMETCARE HEALTH PLANS, INC. AdvantageCare Local CCP

Pharmacy DUR/MTM PerfromRx Lawson Mark

1-215-937-5352

1-215-937-8450

mark.lawson@performrx.com

200 Stevens Drive Philadelphia PA 19113

FloridaOPTIMUM HEALTHCARE, INC.

Optimum HealthCare, Inc. Local CCP

Supervisor, MTM DUR Programs Lawson Mark

1-215-937-5352

1-215-937-8450

Mark.Lawson@PerformRx.com

Florida

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Florida

1-401-333-3987 7941

1-800-373-0238

FloridaPHYSICIANS UNITED PLAN, INC. Physicians United Plan Local CCP

Chief Pharmacy Officer Bullard, R.Ph. Richard

1-480-624-9265

1-480-624-9401

dick.bullard@partnersrx.com

15950 N. 76th Street Suite 200 Scottsdale AZ 85260

FloridaPREFERRED CARE PARTNERS INC.

Preferred Care Partners, Inc. Local CCP Pharmacy Director Prieto Jennifer

1-305-670-8440 1274

1-786-888-1964

jprieto@mypreferredcare.com

9100 S. DadelandBlvd. Suite 1250 Miami FL 33156

Florida

FloridaQUALITY HEALTH PLANS, INC

QUALITY HEALTH PLANS PDP

Director of Pharmacy Rackley Qiana

1-727-945-8400 158

1-727-756-1080

qhprxgroup@qualityhealthplans.com

2435 US Highway 19 Suite 470 Holiday FL 34691

FloridaQUALITY HEALTH PLANS, INC. Quality Health Plans Local CCP

Director of Pharmacy Rackley Qiana

1-727-945-8400 158

1-727-756-1080

qhprxgroup@qualityhealthplans.com

2435 US Highway 19 Suite 470 Holiday FL 34691

Florida RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Florida

1-866-443-0934

Florida

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Florida

1-314-810-6102

FloridaSUMMIT HEALTH PLAN, INC.

Summit Health Plan, Inc. Local CCP

Vice President Compliance Gartner Darcey

1-954-858-3667

1-954-858-3695

darcey.gartner@vistahealthplan.com

1340 Concord Terrace Sunrise FL 33323

Florida

1-765-526-2515

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Florida

1-765-526-2515

Florida

1-972-569-3646

1-972-569-3679

Florida

1-949-252-4339

1-949-474-4237

Florida

1-949-221-9994

1-949-747-4237

Florida

1-949-221-9994

1-949-747-4237

Florida

1-949-221-9994

1-949-747-4237

Florida

SecureHorizons by UnitedHealthcare Regional CCP Solutions RX

1-949-221-9994

1-949-747-4237

Florida

1-949-221-9994

1-949-747-4237

Florida

1-949-252-4339

1-949-474-4237

Florida

UNITED HEALTHCARE OF FL, INC.

1-949-221-9994

1-949-747-4237

Florida

UNITED HEALTHCARE OF FLORIDA INC.

1-949-221-9994

1-949-747-4237

Florida

1-800-546-5677 1110

FloridaUNIVERSAL HEALTH CARE, INC.

Universal Health Care, Inc. Local CCP

1-800-546-5677 1110

FloridaUNIVERSAL HEALTH CARE, INC.

Universal Health Care, Inc. Local CCP

1-800-546-5677 1110

Florida

VISTA HEALTHPLAN OF SOUTH FLORIDA, INC.

Vista Healthplan of South Florida, Inc. Local CCP

Vice President, Compliance Gartner Darcey

1-954-858-3667

1-954-858-3695

FloridaVISTA HEALTHPLAN, INC. Vista Healthplan, Inc. Local CCP

Vice President, Compliance Gartner Darcey

1-954-858-3667

1-954-858-3695

FloridaWELL CARE OF FLORIDA, INC. WellCare Local CCP

1-813-290-6200 6620

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Florida

1-813-290-6200 6620

Florida

1-813-290-6200 5119

GeorgiaAETNA HEALTH INC.(GEORGIA) Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Georgia

1-386-963-2543

1-860-754-1481

Georgia

1-386-963-2543

1-860-754-1481

Georgia

1-386-963-2543

1-860-754-1481

GeorgiaANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

GeorgiaANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Georgia

ARCADIAN HEALTH PLAN OF GEORGIA, INC.

Southeast Community Care Local CCP

1-909-971-6816

1-909-971-6866

GeorgiaBLUE CROSS BLUE SHIELD OF GEORGIA

Blue Cross Blue Shield Healthcare Plan of Georgia Local CCP

1-765-526-2515

Georgia

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO

1-866-443-0934

Georgia

1-215-988-6835

1-215-557-7437

Georgia

CONNECTICUT GENERAL LIFE INSURANCE COMPANY

CIGNA Medicare Access PFFS Zheng Yi

1-860-226-6731

yi.zheng@cigna.com

900 Cottage Grove Rd Hartford CT 6152

Georgia

1-860-226-6731

yi.zheng@cigna.com

Georgia

1-801-954-3043

rlwilliams@cvty.com

Georgia

1-801-954-3043

rlwilliams@cvty.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Georgia

COVENTRY HEALTH CARE OF GEORGIA, INC. Advantra Local CCP

Director, Pharmacy Ops Williams Roger L

1-801-954-3043

rlwilliams@cvty.com

GeorgiaDAVITA VILLAGEHEALTH, INC.

DaVita VillageHealth of Georgia, Inc. Local CCP

1-518-932-4416

Georgia

1-330-405-8080 6320

1-330-405-8081

Georgia

1-801-954-3043

rlwilliams@cvty.com

Georgia

1-916-463-9603

1-916-463-9750

Georgia

1-916-463-9603

1-916-463-8056

Georgia

1-615-565-8110

1-615-234-2154

GeorgiaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Georgia

INSTIL HEALTH INSURANCE COMPANY

InStil Health Insurance Company PDP

Director Medical Services Lachuk Lester

1-803-763-6559

1-803-935-1605

Lester.Lachuk@myinstil.com

17 Technology Circle, AG-790 Columbia SC 29203

GeorgiaKAISER FOUNDATION HP OF GA, INC.

Kaiser Permanente Senior Advantage Local CCP

Interim Clinic Manager Charnelda Gray

1-404-364-7085

1-404-364-7347

Charnelda.L.Gray@kp.org

3495 Piedmont Road NE Atlanta GA 30305

Georgia

1-201-269-6717

1-201-269-1008

Georgia

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Georgia

1-401-333-3987 7941

1-800-373-0238

Georgia

Georgia RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Georgia

1-702-877-8377

Georgia

1-866-443-0934

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Georgia

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Georgia

1-314-810-6102

Georgia

1-765-526-2515

Georgia

1-765-526-2515

Georgia

1-972-569-3646

1-972-569-3679

Georgia

1-949-252-4339

1-949-474-4237

Georgia

1-949-221-9994

1-949-747-4237

Georgia

Evercare® Health Plans Demo Solutions RX

1-949-221-9994

1-949-747-4237

Georgia

1-949-221-9994

1-949-747-4237

Georgia

1-949-252-4339

1-949-474-4237

Georgia

UNITED HEALTHCARE OF GEORGIA, INC.

1-949-221-9994

1-949-747-4237

Georgia

1-800-546-5677 1110

Georgia

1-813-290-6200 6620

GeorgiaWELLCARE OF GEORGIA, INC. WellCare Local CCP

1-813-290-6200 6620

Georgia

1-813-290-6200 5119

1-949-252-4339

1-949-474-4237

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Hawaii

1-386-963-2543

1-860-754-1481

Hawaii

1-386-963-2543

1-860-754-1481

Hawaii ALOHACARE AlohaCare Local CCPDirector of Clinical Operations Catalan Stella

1-808-973-6359

1-808-973-0726

scatalan@alohacarehawaii.org

1357 Kapiolani Blvd., Suite 1250 Honolulu HI 96814

Hawaii

1-860-226-6731

yi.zheng@cigna.com

Hawaii

1-330-405-8080 6320

1-330-405-8081

Hawaii

1-801-954-3043

rlwilliams@cvty.com

Hawaii

1-801-954-3043

rlwilliams@cvty.com

HawaiiFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

HawaiiHAWAII MED. SRVC. ASSN. HMSA's 65C Plus 1876 Cost

Clinical Pharmacist Nishimura Rachel

1-808-948-6808

1-808-948-5510

rachel_nishimura@hmsa.com 5 - PBM

818 Keeaumoku St Honolulu HI 96814

Hawaii

1-916-463-9603

1-916-463-9750

Hawaii

1-916-463-9603

1-916-463-8056

Hawaii

1-615-565-8110

1-615-234-2154

HawaiiHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

HawaiiHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

HawaiiKAISER FOUNDATION HP, INC.

Kaiser Foundation Health Plan, Inc. (Hawaii) Local CCP

Quality Management Coordinator Wilson Susan T

1-808-432-7533

susan.t.wilson@kp.org

Kaiser Permanente

501 Alakawa Street Honolulu HI 96819

Hawaii

1-201-269-6717

1-201-269-1008

Hawaii

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Hawaii

1-401-333-3987 7941

1-800-373-0238

Hawaii RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Hawaii

1-866-443-0934

Hawaii

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Hawaii

1-314-810-6102

Hawaii

1-765-526-2515

Hawaii

1-765-526-2515

Hawaii

1-972-569-3646

1-972-569-3679

Hawaii

1-949-252-4339

1-949-474-4237

Hawaii

1-949-221-9994

1-949-747-4237

Hawaii

1-949-221-9994

1-949-747-4237

Hawaii

1-949-221-9994

1-949-747-4237

Hawaii

1-949-252-4339

1-949-474-4237

Hawaii

1-813-290-6200 6620

Hawaii

1-813-290-6200 5119

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

BLUE CROSS OF IDAHO HEALTH SERVICES, INC

Blue Cross Of Idaho Hlth Services Inc Local CCP

Pharmacy Clinical Services Hettich Lisa

1-765-526-2515

8407 Fallbrook Ave # CAAF01 West Hills CA 91304

BLUE CROSS OF IDAHO HEALTH SERVICES, INC.

Blue Cross Of Idaho Hlth Services Inc PFFS

1-765-526-2515

8407 Fallbrook Ave # CAAF01

attn: Network Management West Hills CA 91304

BLUE CROSS OF IDAHO HLTH SERVICES INC

Blue Cross Of Idaho Hlth Services Inc Local CCP

1-765-526-2515

8407 Fallbrook Ave #CAAF01

Attn: Network Management West Hills CA 91304

1-215-988-6835

1-215-557-7437

1-860-226-6731

yi.zheng@cigna.com

EDUCATORS MUTUAL INSURANCE ASSOCIATION

Educators Mutual Insurance Association PDP Gallegos Jennifer

1-801-262-7476

jgallegos@educatorsmutual.com

852 East Arrowhead Lane Murray UT 84107

1-330-405-8080 6320

1-330-405-8081

1-801-954-3043

rlwilliams@cvty.com

1-801-954-3043

rlwilliams@cvty.com

1-916-463-9603

1-916-463-9750

1-615-565-8110

1-615-234-2154

IdahoHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

IdahoHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-201-269-6717

1-201-269-1008

IdahoMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

1-401-333-3987 7941

1-800-373-0238

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

IdahoREGENCE BLUE SHIELD OF IDAHO

Regence BlueShield Of Idaho Local CCP

Manager Clinical Pharmacy Leonard Ruth J

1-208-395-7732

1-208-395-7744

rleona@regence.com

1211 West Myrtle Suite 110

PO Box 2560 Boise ID 87301

REGENCE LIFE AND HEALTH INSURANCE COMPANY

Regence Life and Health PDP

1-208-395-7732

1-208-395-7744

rjleona@regence.com

Idaho RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

1-702-877-8377

1-866-443-0934

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

1-314-810-6102

1-765-526-2515

1-972-569-3646

1-972-569-3679

1-949-252-4339

1-949-474-4237

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

1-949-252-4339

1-949-474-4237

1-813-290-6200 6620

1-813-290-6200 5119

IllinoisAETNA HEALTH OF ILLINOIS, INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Illinois

1-386-963-2543

1-860-754-1481

Illinois

1-386-963-2543

1-860-754-1481

Illinois

1-386-963-2543

1-860-754-1481

Illinois

1-215-988-6835

1-215-557-7437

Illinois

1-860-226-6731

yi.zheng@cigna.com

Illinois

1-801-954-3043

rlwilliams@cvty.com

Illinois

1-801-954-3043

rlwilliams@cvty.com

Illinois

1-330-405-8080 6320

1-330-405-8081

Illinois ESSENCE L.L.P. Essence Healthcare Local CCPDirector of Quality Improvement Keys Mary Kay

1-314-851-3664

1-314-851-3610

mkeys@essencehealthcare.com 12655 Olive Blvd St. Louis MO 63141

Illinois

1-801-954-3043

rlwilliams@cvty.com

IllinoisGROUP HEALTH PLAN, INC. Group Health Plan, Inc. Local CCP

1-801-954-3043

rlwilliams@cvty.com

Illinois

HARMONY HEALTH PLAN OF ILLINOIS, INC. WellCare Local CCP

1-813-290-6200 6620

IllinoisHCSC INSURANCE SERVICES COMPANY

HISC - Blue Cross Blue Shield of IL, TX, and NM PDP Pharmacy Director Nguyen Marie

1-651-286-4206

1-651-286-4403

MNguyen@primetherapeutics.com

Prime Therapeutics, LLC

1020 Discovery Road Eagen MN 55121

IllinoisHEALTH ALLIANCE MEDICAL PLANS

Health Alliance Medical Plans Local CCP

Director of Pharmacy Barrington Christina

1-800-851-3379 8078

1-217-255-4598

christina.barrington@healthalliance.org 301 S. Vine St. Urbana IL 61801

IllinoisHEALTH ALLIANCE MEDICAL PLANS

Health Alliance Medical Plans Local CCP

1-800-851-3379 8078

1-217-255-4598

Illinois

1-916-463-9603

1-916-463-9750

Illinois

1-615-565-8110

1-615-234-2154

Illinois HEALTHSPRING, INC. HealthSpring, Inc. Local CCP

1-615-565-8110

1-615-291-7011

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

IllinoisHUMANA HEALTH PLAN, INC.

1-502-580-3538

jewing@humana.com

IllinoisHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Illinois

1-201-269-6717

1-201-269-1008

IllinoisMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Illinois

MERCY HEALTH PLANS OF MISSOURI INC.

Mercy Health Plans of Missouri, Inc. Local CCP

1-314-214-2489

1-314-214-8101

IllinoisOSF HEALTHPLANS, INC. OSF Care Advantage Local CCP

Associate Director of Pharmacy Porch William

1-309-677-8553

1-309-677-8354

william.porch@osfhealthcare.org

7915 N Hale Ave, Ste D Peoria IL 61615

IllinoisOSF HEALTHPLANS, INC. OSF Care Preferred Local CCP

Associate Director of Pharmacy Porch Willaim

1-309-677-8553

1-309-677-8354

william.porch@osfhealthcare.org

7915 N Hale Ave, Ste D Peoria IL 61615

Illinois

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Illinois

1-401-333-3987 7941

1-800-373-0238

Illinois

PERSONAL CARE INSURANCE OF ILLINOIS

PersonalCare Advantra Gold and Silver Local CCP

1-801-954-3043

rlwilliams@cvty.com

Illinois

Illinois RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Illinois

1-702-877-8377

Illinois

1-866-443-0934

Illinois

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Illinois

1-314-810-6102

Illinois

1-765-526-2515

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Illinois

1-765-526-2515

Illinois

1-972-569-3646

1-972-569-3679

Illinois

1-949-252-4339

1-949-474-4237

Illinois

UNITED HEALTHCARE INS. COMPANY, INC.

1-949-221-9994

1-949-747-4237

Illinois

1-949-221-9994

1-949-747-4237

Illinois

1-949-221-9994

1-949-747-4237

Illinois

1-949-221-9994

1-949-747-4237

Illinois

1-949-252-4339

1-949-474-4237

Illinois

UNITED HEALTHCARE OF THE MIDWEST, INC.

1-949-221-9994

1-949-747-4237

Illinois

UNITED HEALTHCARE PLAN OF THE RIVER VALLEY, INC.

1-949-221-9994

1-949-747-4237

Illinois

1-813-290-6200 6620

Illinois

1-813-290-6200 5119

IndianaADVANTAGE HEALTH SOLUTIONS, INC.

Advantage Health Solutions, Inc. Local CCP

Director, Pharmacy and Data Analysis Musial Brian

1-317-573-6691

bmusial@advantageplan.com

9490 Priority Way West Drive Indianapolis IN 46240

Indiana

1-386-963-2543

1-860-754-1481

Indiana

1-386-963-2543

1-860-754-1481

IndianaANTHEM INSURANCE COMPANIES, INC.

Anthem Blue Cross and Blue Shield Local CCP Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

michelle.drummond@wellpoint.com

8407 Fallbrook Avenue

Mailstop CAAF West Hills CA 91304

1-765-526-2515

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Anthem Blue Cross and Blue Shield Regional CCP

1-765-526-2515

IndianaANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Indiana

1-215-988-6835

1-215-557-7437

Indiana

1-860-226-6731

yi.zheng@cigna.com

Indiana

1-860-226-6731

yi.zheng@cigna.com

Indiana

1-801-954-3043

rlwilliams@cvty.com

Indiana

1-330-405-8080 6320

1-330-405-8081

Indiana ESSENCE L.L.P. Essence Healthcare Local CCP Director of QA Keys Mary Kay1-314-851-3664

1-314-851-3610

mkeys@essencehealthcare.com 12655 Olive Blvd. St. Louis MO 63141

Indiana

1-801-954-3043

rlwilliams@cvty.com

Indiana

1-801-954-3043

rlwilliams@cvty.com

Indiana

HARMONY HEALTH PLANS OF ILLINOIS, INC. WellCare Local CCP

1-813-290-6200 6620

Indiana

1-916-463-9603

1-916-463-9750

Indiana

1-615-565-8110

1-615-234-2154

IndianaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Indiana

1-201-269-6717

1-201-269-1008

IndianaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Indiana NHP OF INDIANA, LLCWelborn HMO Senior Advantage Local CCP Elpers Cathy

1-877-447-8744 1314

1-812-773-0514

elpersc@welbornhealthplans.com

101 S.E. Third Street Evansville IN 47708

Indiana

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Indiana

1-401-333-3987 7941

1-800-373-0238

Indiana

Indiana RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Indiana

1-702-877-8377

Indiana

1-866-443-0934

Indiana

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Indiana

1-314-810-6102

Indiana

1-765-526-2515

Indiana

1-765-526-2515

Indiana

1-972-569-3646

1-972-569-3679

Indiana

1-949-252-4339

1-949-474-4237

Indiana

1-949-221-9994

1-949-747-4237

Indiana

1-949-221-9994

1-949-747-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Indiana

1-949-252-4339

1-949-474-4237

Indiana

1-813-290-6200 6620

Indiana

1-813-290-6200 5119

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

BLUE CROSS BLUE SHIELD NORTHERN PLAINS ALLIANCE MedicareBlue PPO Regional CCP

Director of Pharmacy Heaton Alan

1-651-662-8758

1-651-662-6009

al_heaton@bluecrossmn.com

Blue Cross and Blue Shield of Minnesota

3400 Yankee Drive Eagan MN 55122

BLUE CROSS BLUE SHIELD NORTHERN PLAINS ALLIANCE MedicareBlue Rx PDP

1-651-662-8758

1-651-662-6009

Blue Cross Blue Shield of Minnesota

1-860-226-6731

yi.zheng@cigna.com

COVENTRY HEALTH AND LIFE INS COMPANY

Coventry Health and Life Insurance Company Local CCP

Director Pharmacy Ops. Williams Roger

1-801-954-3043

rlwilliams@cvty.com

1-801-954-3043

rlwilliams@cvty.com

IowaCOVENTRY HEALTH CARE OF IOWA, INC.

Coventry Health Care of Iowa, Inc. Local CCP

1-801-954-3043

rlwilliams@cvty.com

1-330-405-8080 6320

1-330-405-8081

1-801-954-3043

rlwilliams@cvty.com

1-801-954-3043

rlwilliams@cvty.com

IowaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

1-916-463-9603

1-916-463-9750

1-615-565-8110

1-615-234-2154

IowaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-201-269-6717

1-201-269-1008

IowaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

1-401-333-3987 7941

1-800-373-0238

Iowa RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

1-866-443-0934

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

1-314-810-6102

1-765-526-2515

1-972-569-3646

1-972-569-3679

1-949-252-4339

1-949-474-4237

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-949-252-4339

1-949-474-4237

UNITED HEALTHCARE OF THE MIDLANDS, INC.

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

1-813-290-6200 6620

1-813-290-6200 5119

Kansas

1-386-963-2543

1-860-754-1481

Kansas

1-386-963-2543

1-860-754-1481

KansasBLUE CROSS BLUE SHIELD OF KANSAS Blue MedicareRx PDP

1-765-526-2515

Kansas

1-215-988-6835

1-215-557-7437

Kansas

1-860-226-6731

yi.zheng@cigna.com

Kansas

COVENTRY HEALTH AND LIFE INS. COMPANY

Coventry Health And Life Ins. Company Local CCP

Director Pharmacy Operations Williams Roger L

1-801-954-3043

rlwilliams@cvty.com

Kansas

1-801-954-3043

rlwilliams@cvty.com

Kansas

1-801-954-3043

rlwilliams@cvty.com

Kansas

COVENTRY HEALTH CARE OF KANSAS, INC.

Coventry Health Care of Kansas, Inc. Local CCP

1-801-954-3043

rlwilliams@cvty.com

Kansas

1-330-405-8080 6320

1-330-405-8081

Kansas

1-801-954-3043

rlwilliams@cvty.com

Kansas

1-916-463-9603

1-916-463-9750

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Kansas

1-615-565-8110

1-615-234-2154

KansasHUMANA HEALTH PLAN, INC.

1-502-580-3538

jewing@humana.com

KansasHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Kansas

1-201-269-6717

1-201-269-1008

KansasMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Kansas

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Kansas

1-401-333-3987 7941

1-800-373-0238

Kansas

Kansas RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Kansas

1-702-877-8377

Kansas

1-866-443-0934

Kansas

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Kansas

1-314-810-6102

Kansas

1-765-526-2515

Kansas

1-765-526-2515

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Kansas

1-972-569-3646

1-972-569-3679

Kansas

1-949-252-4339

1-949-474-4237

Kansas

1-949-221-9994

1-949-747-4237

Kansas

1-949-221-9994

1-949-747-4237

Kansas

1-949-221-9994

1-949-747-4237

Kansas

1-949-221-9994

1-949-747-4237

Kansas

1-949-252-4339

1-949-474-4237

Kansas

1-813-290-6200 6620

Kansas

1-813-290-6200 5119

Kentucky

1-386-963-2543

1-860-754-1481

Kentucky

1-386-963-2543

1-860-754-1481

Kentucky

ANTHEM HEALTH PLANS OF KENTUCKY, INC.

1-765-526-2515

Kentucky

ANTHEM HEALTH PLANS OF KENTUCKY, INC.

1-765-526-2515

KentuckyANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

KentuckyANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

KentuckyANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Kentucky

1-860-226-6731

yi.zheng@cigna.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Kentucky

1-801-954-3043

rlwilliams@cvty.com

Kentucky

1-330-405-8080 6320

1-330-405-8081

Kentucky ESSENCE L.L.P. Essence Healthcare Local CCP Director of QA Keys Mary Kay1-314-851-3664

1-314-851-3610

Kentucky

1-801-954-3043

rlwilliams@cvty.com

Kentucky

1-801-954-3043

rlwilliams@cvty.com

Kentucky

1-916-463-9603

1-916-463-9750

Kentucky

1-615-565-8110

1-615-234-2154

KentuckyHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Kentucky

1-201-269-6717

1-201-269-1008

Kentucky

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Kentucky

1-401-333-3987 7941

1-800-373-0238

Kentucky

Kentucky RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Kentucky

1-702-877-8377

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Kentucky

1-866-443-0934

Kentucky

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Kentucky

1-314-810-6102

Kentucky

1-765-526-2515

Kentucky

1-765-526-2515

Kentucky

1-972-569-3646

1-972-569-3679

Kentucky

1-949-252-4339

1-949-474-4237

Kentucky

1-949-221-9994

1-949-747-4237

Kentucky

1-949-252-4339

1-949-474-4237

KentuckyUNIVERSITY HEALTH CARE, INC. Passport Advantage Local CCP

Supervisor, Pharmacy DUR/MTM Lawson Mark

1-215-937-5352

1-215-937-8450

200 Stevens Drive 4th Floor Philadelphia PA 19113

Kentucky

1-813-290-6200 6620

Kentucky

1-813-290-6200 5119

Louisiana

1-386-963-2543

1-860-754-1481

Louisiana

1-386-963-2543

1-860-754-1481

Louisiana

ARCADIAN HEALTH PLAN OF LOUISIANA, INC.

Arcadian Community Care Local CCP

1-909-971-6816

1-909-971-6866

Louisiana

1-215-988-6835

1-215-557-7437

Louisiana

1-860-226-6731

yi.zheng@cigna.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Louisiana

1-801-954-3043

rlwilliams@cvty.com

Louisiana

1-801-954-3043

rlwilliams@cvty.com

Louisiana

1-330-405-8080 6320

1-330-405-8081

Louisiana

1-801-954-3043

rlwilliams@cvty.com

Louisiana

1-916-463-9603

1-916-463-9750

Louisiana

1-615-565-8110

1-615-234-2154

Louisiana

HUMANA HEALTH BENEFIT PLAN OF LA, INC.

Humana Health Benefit Plan of LA, Inc. PFFS Ewing Joy

1-502-580-3538

jewing@humana.com

Louisiana

HUMANA HEALTH BENEFIT PLAN OF LOUISIANA INC

Humana Health Benefit Plan Of Louisiana Inc Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

LouisianaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

LouisianaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Louisiana

LOUISIANA HEALTH SERVICE AND INDEMNITY COMPANY

Blue Cross and Blue Shield of Louisiana PDP

Medicare Part D Pharmacy Manager McLean Gionne

1-225-298-7134

1-225-298-7545

gionne.mclean@bcbsla.com

5525 Reitz Avenue Baton Rouge LA 70809

Louisiana

1-201-269-6717

1-201-269-1008

Louisiana

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Louisiana

1-401-333-3987 7941

1-800-373-0238

Louisiana

Louisiana RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Louisiana

1-702-877-8377

Louisiana

1-866-443-0934

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Louisiana

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Louisiana

1-314-810-6102

Louisiana

TENET CHOICES, INC. / PEOPLES HEALTH NETWORK Peoples Health Local CCP

Clinical Pharmacist Smith Shannon

1-504-849-4500 8887

1-504-849-6901

phn-pbmteam@peopleshealth.com

Three Lakeway Center

3838 N Causeway Blvd, Suite 2200 Metairie LA 70002

Louisiana

TENET CHOICES, INC. / PEOPLES HEALTH NETWORK Peoples Health Local CCP PharmD Smith Shannon

1-504-849-4500 8887

1-504-849-6901

phn-pbmteam@peopleshealth.com

Three Lakeway Center

3838 N Causeway Blvd, Suite 2200 Metairie LA 70002

Louisiana

1-765-526-2515

Louisiana

1-765-526-2515

Louisiana

1-972-569-3646

1-972-569-3679

Louisiana

1-949-252-4339

1-949-474-4237

Louisiana

1-949-221-9994

1-949-747-4237

Louisiana

1-949-252-4339

1-949-474-4237

Louisiana

1-800-546-5677 1110

LouisianaVANTAGE HEALTH PLAN, INC.

Vantage Health Plan, Inc. Local CCP Director of UR/QM Halley Melissa

1-318-361-0900 110

mhalley@vhpla.com 130 DeSiard St Suite 300 Monroe LA 71201

Louisiana

1-813-290-6200 6620

LouisianaWELLCARE OF LOUISIANA, INC. WellCare Local CCP

1-813-290-6200 6620

Louisiana

1-813-290-6200 5119

Maine AETNA HEALTH Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

MaineANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

MaineANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

MaineARCADIAN HEALTH PLAN, INC.

Northeast Community Care Local CCP

1-909-971-6816

1-909-971-6866

1-215-988-6835

1-215-557-7437

1-860-226-6731

yi.zheng@cigna.com

1-860-226-6731

yi.zheng@cigna.com

1-330-405-8080 6320

1-330-405-8081

1-801-954-3043

rlwilliams@cvty.com

1-801-954-3043

rlwilliams@cvty.com

MaineFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

1-916-463-9603

1-916-463-9750

1-615-565-8110

1-615-234-2154

MaineHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

MaineHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

MaineMARTINS POINT GENERATIONS, LLC

Martin's Point Generations Advantage Local CCP

Vice President, Pharmacy Services Takach Michael

1-207-791-3745

1-207-828-2494

miket@martinspoint.org

331 Veranda Street

PO Box 9746 Portland ME 4104

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-201-269-6717

1-201-269-1008

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

1-401-333-3987 7941

1-800-373-0238

Maine RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

1-866-443-0934

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

1-314-810-6102

1-765-526-2515

1-972-569-3646

1-972-569-3679

1-949-252-4339

1-949-474-4237

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

1-949-252-4339

1-949-474-4237

1-813-290-6200 5119

MarylandAETNA HEALTH INC. (MARYLAND) Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Maryland

1-386-963-2543

1-860-754-1481

Maryland

1-386-963-2543

1-860-754-1481

Maryland

1-386-963-2543

1-860-754-1481

Maryland

1-386-963-2543

1-860-754-1481

Maryland

MarylandAMERIGROUP MARYLAND, INC.

1-757-518-3420

MarylandBRAVO HEALTH MID- ATLANTIC INC. Bravo Health PFFS

1-410-864-4583

1-866-464-0709

MarylandBRAVO HEALTH MID- ATLANTIC INC. Bravo Health Local CCP

1-800-625-9432

1-866-464-0709

3601 O'Donnell St Baltimore MD 21224

Maryland

CARE IMPROVEMENT PLUS OF MARYLAND, INC.

Care Improvement Plus Local CCP Help Desk MTM

1-866-443-0934

Maryland

1-860-226-6731

yi.zheng@cigna.com

Maryland

1-801-954-3043

rlwilliams@cvty.com

Maryland

1-801-954-3043

rlwilliams@cvty.com

Maryland

1-330-405-8080 6320

1-330-405-8081

Maryland FIRST CARE, INC.Medi-CareFirst BlueCross BlueShield PDP

1-410-528-7897

Maryland

1-801-954-3043

rlwilliams@cvty.com

Maryland

1-916-463-9603

1-916-463-9750

Maryland

1-615-565-8110

1-615-234-2154

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

MarylandHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

MarylandHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Maryland

KAISER FNDN HP OF THE MID-ATLANTIC STS

Kaiser Permanente Medicare Plus 1876 Cost Pharmacy Director Downard Susan

1-301-816-6835

susan.l.downard@kp.org

2101 East Jefferson St Rockville MD 20852

Maryland

MarylandMARYLAND CARE - MEDICARE, INC. Golden Advantage Plus Local CCP

Director Corporate Pharmacy Clark Mark

1-602-659-2062

mark.clark@schalleranderson.com

4645 E Cotton Center Blvd Phoenix AZ 85040

Maryland

1-201-269-6717

1-201-269-1008

MarylandMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Maryland

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Maryland

1-401-333-3987 7941

1-800-373-0238

Maryland RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Maryland

1-702-877-8377

Maryland

1-866-443-0934

Maryland

1-314-810-6102

Maryland

1-765-526-2515

Maryland

1-765-526-2515

Maryland

1-972-569-3646

1-972-569-3679

Maryland

1-949-252-4339

1-949-474-4237

Maryland

1-949-221-9994

1-949-747-4237

Maryland

1-949-221-9994

1-949-747-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Maryland

1-949-221-9994

1-949-747-4237

Maryland

1-949-252-4339

1-949-474-4237

Maryland

1-813-290-6200 6620

Maryland

1-813-290-6200 5119

Massachusetts

1-386-963-2543

1-860-754-1481

Massachusetts

1-386-963-2543

1-860-754-1481

Massachusetts

BLUE CROSS AND BLUE SHIELD OF MA HMO BLUE, INC.

Blue Cross and Blue Shield of Massachusetts Local CCP

Clinical Pharmacist Flori, RPh Jeremy J

1-617-246-6654

jeremy.flori@bcbsma.com Landmark Center

401 Park Drive Boston MA 2215

Massachusetts

BLUE CROSS AND BLUE SHIELD OF MA HMO BLUE, INC.

Blue Cross and Blue Shield of Massachusetts Local CCP

Clinical Pharmacist Flori, RPh Jeremy J

1-617-246-6654

jeremy.flori@bcbsma.com Landmark Center

401 Park Drive Boston MA 2215

Massachusetts

BLUE CROSS AND BLUE SHIELD OF MASS. HMO BLUE, INC.

Blue Cross and Blue Shield of Massachusetts PFFS

Clinical Pharmacist FLORI, RPh JEREMY

1-617-246-6654

JEREMY.FLORI@BCBSMA.COM

401 PARK DRIVE BOSTON MA 2215

Massachusetts BLUE MEDICARERX Blue MedicareRx PDPClinical Pharmacist Hettich Lisa

1-765-526-2515

Massachusetts

1-215-988-6835

1-215-557-7437

MassachusettsCOMMONWEALTH CARE ALLIANCE

Commonwealth Care Alliance Local CCP

Director of Pharmacy Shebli Basem

1-617-426-0600 238

1-617-426-3109

bshebli@commonwealthcare.org 30 Winter Street Boston MA 2108

MassachusettsCOMMONWEALTH CARE ALLIANCE, INC.

Commonwealth Care Alliance, Inc. Local CCP

Director of Pharmacy Shebli Basem

1-617-426-0600 238

1-617-426-3109

bshebli@commonwealthcare.org 30 Winter Street Boston MA 2108

Massachusetts

1-860-226-6731

yi.zheng@cigna.com

Massachusetts

1-801-954-3043

rlwilliams@cvty.com

Massachusetts

1-330-405-8080 6320

1-330-405-8081

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

MassachusettsFALLON COMMUNITY HEALTH PLAN

Fallon Community Health Plan Local CCP Pharmacist Haji Mojgan

1-800-333-2535 69916

mojgan.haji@fchp.org

One Chestnut Place

10 Chestnut Street Worcester MA 1608

MassachusettsFALLON COMMUNITY HEALTH PLAN

Fallon Community Health Plan Local CCP Pharmacist Haji Mojgan

1-800-333-2535 69916

mojgan.haji@fchp.org

One Chestnut Place

10 Chestnut Street Worcester MA 1608

Massachusetts

1-801-954-3043

rlwilliams@cvty.com

Massachusetts

1-801-954-3043

rlwilliams@cvty.com

Massachusetts

1-916-463-9603

1-916-463-9750

Massachusetts

1-916-463-9603

1-916-463-8056

Massachusetts

1-615-565-8110

1-615-234-2154

MassachusettsHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

MassachusettsHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Massachusetts

1-201-269-6717

1-201-269-1008

Massachusetts

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Massachusetts

1-401-333-3987 7941

1-800-373-0238

Massachusetts RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

MassachusettsSENIOR WHOLE HEALTH, LLC Senior Whole Health Local CCP

1-617-494-5353 6324

1-617-494-5599

gdichter@seniorwholehealth.com

58 Charles Street, 2nd Floor Cambridge MA 2141

Massachusetts

1-866-443-0934

Massachusetts

1-314-810-6102

Massachusetts

TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION, Tufts Health Plan PFFS

Senior Clinical Pharmacist Calcagni Christophe

1-617-972-9400 3217

1-617-673-0133

christopher_calcagni@tufts-health.com 705 Mt Auburn St Watertown MA 2472

MassachusettsTUFTS ASSOCIATED HMO, INC. Tufts Health Plan Local CCP

1-617-972-9400 3217

1-617-673-0133

christopher_calcagni@tufts-health.com

705 Mt Auburn Street Watertown MA 2472

MassachusettsTUFTS ASSOCIATED HMO, INC. Tufts Health Plan Local CCP

1-617-972-9400 3217

1-617-673-0133

christopher_calcagni@tufts-health.com

705 Mt Auburn Street Watertown MA 2472

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Massachusetts

1-765-526-2515

Massachusetts

1-765-526-2515

Massachusetts

1-972-569-3646

1-972-569-3679

Massachusetts

1-949-252-4339

1-949-474-4237

Massachusetts

1-949-221-9994

1-949-747-4237

Massachusetts

1-949-221-9994

1-949-747-4237

Massachusetts

1-949-221-9994

1-949-747-4237

Massachusetts

Evercare® Senior Care Options Local CCP Solutions RX

1-949-221-9994

1-949-747-4237

Massachusetts

1-949-221-9994

1-949-747-4237

Massachusetts

1-949-252-4339

1-949-474-4237

Massachusetts

1-813-290-6200 5119

Michigan

1-386-963-2543

1-860-754-1481

Michigan

1-386-963-2543

1-860-754-1481

Michigan

ALLIANCE HEALTH AND LIFE INSURANCE COMPANY Alliance Medicare Rx PDP

Director, Pharmacy Care Management Pindolia Vanita

1-248-443-8849 vpindoli@hap.org

2850 West Grand Blvd Detroit MI 48202

Michigan

ALLIANCE HEALTH AND LIFE INSURANCE, CO Alliance Medicare PPO Local CCP

Michigan

BLUE CARE NETWORK OF MICHIGAN Blue Care Network Local CCP

Pharmacy Manager Cavanaugh Jeanne

1-248-455-3592

1-248-455-3692

jcavanaugh@bcbsm.com

20500 Civic Center Drive Southfield MI 48076

MichiganBLUE CROSS BLUE SHIELD OF MICHIGAN

Blue Cross Blue Shield of Michigan PFFS

Clinical Pharmacist Davis Betsy

1-248-448-7868

bdavis1@bcbsm.com

27300 West Eleven Mile Road MC B776 Southfield MI 48034

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

MichiganBLUE CROSS BLUE SHIELD OF MICHIGAN

Blue Cross Blue Shield of Michigan PDP

Clinical Pharmacist Davis Betsy

1-248-448-7868

bdavis1@bcbsm.com

27300 West Eleven Mile Road MC B776 Southfield MI 48034

Michigan

1-800-625-9432

1-866-464-0709

Michigan

1-215-988-6835

1-215-557-7437

MichiganCOMMUNITY CHOICE MICHIGAN

Community Choice Michigan Local CCP

Vice President Pharmacy Services Keeley Jon

1-937-224-3300 2011

1-937-531-2434

part_D@csmg-online.com 1 S. Main Street

One Dayton Centre Dayton OH 45402

Michigan

1-860-226-6731

yi.zheng@cigna.com

Michigan

1-801-954-3043

rlwilliams@cvty.com

Michigan

1-801-954-3043

rlwilliams@cvty.com

MichiganDAVITA VILLAGEHEALTH, INC.

DaVita VillageHealth of Michigan, Inc. Local CCP

1-518-932-4416

Michigan

1-330-405-8080 6320

1-330-405-8081

Michigan

FIDELIS SECURECARE OF MICHIGAN

Fidelis SecureCare Of Michigan Local CCP Wilborn Jerome

1-734-779-1680

1-734-779-1681

jerry.wilborn@fidelissc.com

38777 West Six Mile Road Suite 207 Livonia MI 48152

Michigan

1-801-954-3043

rlwilliams@cvty.com

MichiganGREAT LAKES HEALTH PLAN, INC.

Great Lakes Personal Care Plus Local CCP

Pharmacy Manager Cormier Leah

1-713-599-5773

leah_f_cormier@uhc.com

2000 West Loop South, Suite 800 Houston TX 77027

MichiganHEALTH ALLIANCE PLAN OF MICHIGAN HAP Senior Plus Local CCP

Michigan

1-916-463-9603

1-916-463-9750

MichiganHEALTHPLUS OF MICHIGAN HealthPlus of Michigan Local CCP

Pharmacy Project and Development Manager Sopo Deborah A

1-810-230-2276

1-810-720-2757

dsopo@healthplus.org

2050 S. Linden Road Flint MI 48532

Michigan

1-615-565-8110

1-615-234-2154

MichiganHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-502-580-3538

jewing@humana.com

Michigan

1-201-269-6717

1-201-269-1008

MichiganMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

MichiganMIDWEST HEALTH PLAN, INC. Midwest Advantage Local CCP

SR. DIRECTOR OF HEALTH SERVICES ANDERSON ELLEN

1-313-586-6033

1-313-586-6045

EANDERSON@MIDWESTHEALTHPLAN.COM

5050 SCHAEFER ROAD DEARBORN MI 48126

Michigan

MOLINA HEALTHCARE OF MICHIGAN

Molina Healthcare of Michigan Local CCP

1-801-858-0466

1-801-748-0536

MichiganPARAMOUNT CARE, INC Paramount Elite Local CCP

Coordinator, Prescription Drug PRogram Bogner Craig M

1-419-887-2249

1-419-887-2015

craig.bogner@promedica.org

1901 Indian Wood Circle Maumee OH 43537

Michigan

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Michigan

1-401-333-3987 7941

1-800-373-0238

Michigan PRIORITY HEALTH PriorityMedicare Local CCPDirector, Pharmacy Marciniak Steve

1-248-324-2820

Steven.Marciniak@priorityhealth.com

34505 West 12 Mile Rd Farmington Hills MI 48331

Michigan

PRIORITY HEALTH INSURANCE COMPANY PriorityMedicareRx PDP

Director, Pharmacy Marciniak Steve

1-248-324-2820

Steven.Marciniak@priorityhealth.com

34505 West 12 Mile Rd Farmington Hills MI 48331

Michigan

Michigan RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Michigan

1-866-443-0934

Michigan

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Michigan

1-314-810-6102

Michigan

1-765-526-2515

Michigan

1-765-526-2515

Michigan

1-972-569-3646

1-972-569-3679

Michigan

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Michigan

1-949-221-9994

1-949-747-4237

Michigan

1-949-221-9994

1-949-747-4237

Michigan

1-949-221-9994

1-949-747-4237

Michigan

1-949-252-4339

1-949-474-4237

Michigan

1-813-290-6200 6620

Michigan

1-813-290-6200 5119

Minnesota

1-386-963-2543

1-860-754-1481

Minnesota

1-386-963-2543

1-860-754-1481

Minnesota

1-651-662-8758

1-651-662-6009

Minnesota

1-651-662-8758

1-651-662-6009

Minnesota BLUE PLUS Blue Plus Local CCP

Senior Manager, Product and Program Management Conway Elizabeth

1-651-662-3258

elizabeth_conway@bluecrossmn.com

Minnesota

1-860-226-6731

yi.zheng@cigna.com

Minnesota

1-330-405-8080 6320

1-330-405-8081

Minnesota

1-801-954-3043

rlwilliams@cvty.com

Minnesota

1-801-954-3043

rlwilliams@cvty.com

MinnesotaFIRST PLAN OF MINNESOTA First Plan Blue Local CCP

Director of Pharmacy First Plan of Minnesota McDannold Roger

1-218-740-2330 7263

1-218-834-9531

roger_mcdannold@suphealthctr.com

SuperiorHealth Pharmacy

1010 Fourth Street Two Harbors MN 55616

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Minnesota

FIRSTSOLUTIONS DBA FIRST PLAN OF MINNESOTA First Plan Blue Local CCP

Director of Pharmacy First Plan of Minnesota McDannold Roger

1-218-740-2330 7263

1-218-834-9531

roger_mcdannold@suphealthctr.com

SuperiorHealth Pharmacy

1010 Fourth Street Two Harbors MN 55616

MinnesotaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

Minnesota GROUP HEALTH

HealthPartners Classic MN Senior Health Options Local CCP

Director Pharmacy Services Cooper Sue

1-952-967-5818

susan.x.cooper@healthpartners.com

8170 33rd Avenue South, PO Box 1309

MS: 21111B Minneapolis MN 55440

MinnesotaGROUP HEALTH PLAN, INC.

HealthPartners Classic Plan Local CCP

Director Pharmacy Services Cooper Susan

1-952-967-5818

8170 33rd Avenue South

PO Box 1309 Minneapolis MN 55440

Minnesota

1-916-463-9603

1-916-463-9750

Minnesota HEALTHPARTNERSHealthPartners Freedom Plan 1876 Cost

1-952-967-5818

Minnesota

HEALTHPARTNERS INSURANCE COMPANY

HealthPartners Liberty Medicare PFFS

1-952-967-5818

Minnesota

1-615-565-8110

1-615-234-2154

MinnesotaHMO MINNESOTA D/B/A BLUE PLUS Blue Plus Local CCP

Senior Manager, Product and Program Management Conway Elizabeth

1-651-662-3258

elizabeth_conway@bluecrossmn.com

MinnesotaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

MinnesotaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

MinnesotaITASCA MEDICAL CARE Itasca Medical Care Local CCP MTM, Manager Moyna Audry

1-847-559-3999

1-847-559-4733

audry.moyna@caremark.com

9501 E. Shea Blvd. Scottsdale AZ 85260

Minnesota

1-201-269-6717

1-201-269-1008

MinnesotaMEDICA HEALTH PLAN Medica Health Plans Local CCP Weiss Justin

1-952-992-2469

justin.weiss@medica.com

401 Carlson Parkway Minnetonka MN 55305

MinnesotaMEDICA HEALTH PLANS Medica Health Plans PFFS Weiss Justin

1-952-992-2469

MinnesotaMEDICA HEALTH PLANS Medica Health Plans Local CCP Weiss Justin

1-952-992-2469

MinnesotaMEDICA INSURANCE COMPANY

Medica Insurance Company 1876 Cost Weiss Justin

1-952-992-2469

MinnesotaMETROPOLITAN HEALTH PLAN

Metropolitan Health Plan MSHO Local CCP

Director of Medical Administration Moore Ned

1-612-596-0725

1-612-904-4265

ned.moore@co.hennepin.mn.us

400 South 4th Street Suite 201 Minneapolis MN 55415

MinnesotaMETROPOLITAN HEALTH PLAN

North Star Advantage / North Star Advantage Plus Local CCP

Director of Medical Administration Moore Ned

1-612-596-0725

1-612-904-4265

ned.moore@co.hennepin.mn.us

400 South 4th Street Suite 201 Minneapolis MN 55415

Minnesota

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Minnesota

1-401-333-3987 7941

1-800-373-0238

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

MinnesotaPRIMEWEST HEALTH SYSTEM

Primewest Health System Local CCP

Utilization Management & Pharmacy Manager Hagen Christophe A

1-320-335-5228

1-320-335-5238

chris.hagen@primewest.org

2209 Jefferson Street Suite 101 Alexandria MN 56308

MinnesotaPRIMEWEST HEALTH SYSTEM

PrimeWest Health System Local CCP

Manager, Utilization Management & Pharmacy Hagen Christophe A

1-320-335-5228

1-320-335-5238

chris.hagen@primewest.org

PrimeWest Health System

2209 Jefferson Street, Suite 101 Alexandria MN 56308

Minnesota

Minnesota RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Minnesota

1-866-443-0934

MinnesotaSOUTH COUNTRY HEALTH ALLIANCE

South Country Health Alliance Local CCP Nguyen Marie

1-651-286-4206

1-651-286-4424

mnguyen@primetherapeutics.com

Prime Therapeutics Inc.

1020 Discovery Road No. 100 Eagan MN 55121

MinnesotaSOUTH COUNTRY HEALTH ALLIANCE

South Country Health Alliance Local CCP Nguyen Marie

1-651-286-4206

1-651-286-4424

Prime Therapeutics Inc.

1020 Discovery Road No. 100 Eagan MN 55121

Minnesota

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Minnesota

1-314-810-6102

Minnesota UCARE MINNESOTA UCare Local CCP Medical Director Christianson Craig1-612-676-3375

1-612-676-6501

cchristianson@ucare.org PO Box 52 Minneapolis MN 55440

1-612-676-6501

Minnesota

1-765-526-2515

Minnesota

1-765-526-2515

Minnesota

1-972-569-3646

1-972-569-3679

Minnesota

1-949-252-4339

1-949-474-4237

Minnesota

1-949-221-9994

1-949-747-4237

Minnesota

1-949-252-4339

1-949-474-4237

Minnesota

1-813-290-6200 6620

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Minnesota

1-813-290-6200 5119

Mississippi

1-386-963-2543

1-860-754-1481

Mississippi

1-386-963-2543

1-860-754-1481

Mississippi

1-860-226-6731

yi.zheng@cigna.com

Mississippi

1-801-954-3043

rlwilliams@cvty.com

Mississippi

1-801-954-3043

rlwilliams@cvty.com

Mississippi

1-330-405-8080 6320

1-330-405-8081

Mississippi

1-801-954-3043

rlwilliams@cvty.com

Mississippi

1-916-463-9603

1-916-463-9750

Mississippi

1-615-565-8110

1-615-234-2154

MississippiHEALTHSPRING OF TENNESSEE, INC. Healthspring, Inc. Local CCP

1-615-565-8110

1-615-234-2154

MississippiHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Mississippi

1-201-269-6717

1-201-269-1008

Mississippi

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Mississippi

1-401-333-3987 7941

1-800-373-0238

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Mississippi

Mississippi RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Mississippi

1-702-877-8377

Mississippi

1-866-443-0934

Mississippi

1-314-810-6102

Mississippi

1-765-526-2515

Mississippi

1-765-526-2515

Mississippi

1-412-349-6167

1-412-457-1616

Mississippi

1-972-569-3646

1-972-569-3679

Mississippi

1-949-252-4339

1-949-474-4237

Mississippi

1-949-221-9994

1-949-747-4237

Mississippi

1-949-252-4339

1-949-474-4237

Mississippi

1-813-290-6200 6620

Mississippi

1-813-290-6200 5119

MississippiWINDSOR HEALTH PLAN, INC Windsor Rx PDP Pharmacy Director King Sonya

1-615-782-7860

1-615-782-7822

MississippiWINDSOR HEALTH PLANS, INC.

1-615-782-7860

1-615-782-7822

Missouri

1-386-963-2543

1-860-754-1481

Missouri

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

MissouriANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

MissouriANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Missouri

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

1-866-443-0934

Missouri

1-215-988-6835

1-215-557-7437

Missouri

1-860-226-6731

yi.zheng@cigna.com

Missouri

COVENTRY HEALTH AND LIFE INS. COMPANY

Coventry Health And Life Ins. Company Local CCP

1-801-954-3043

rlwilliams@cvty.com

Missouri

1-801-954-3043

rlwilliams@cvty.com

Missouri

1-801-954-3043

rlwilliams@cvty.com

Missouri

COVENTRY HEALTH CARE OF KANSAS, INC.

Coventry Health Care of Kansas, Inc. Local CCP

1-801-954-3043

rlwilliams@cvty.com

Missouri

1-330-405-8080 6320

1-330-405-8081

Missouri ESSENCE L.L.P. Essence Healthcare Local CCPDirector of Quality Improvement Keys Mary Kay

1-314-851-3664

1-314-851-3610

mkeys@essencehealthcare.com 12655 Olive Blvd St. Louis MO 63141

Missouri

1-801-954-3043

rlwilliams@cvty.com

MissouriGROUP HEALTH PLAN, INC. Group Health Plan, Inc. Local CCP

1-801-954-3043

rlwilliams@cvty.com

Missouri

HARMONY HEALTH PLAN OF ILLINOIS, INC. WellCare Local CCP

1-813-290-6200 6220

Missouri

1-916-463-9603

1-916-463-9750

Missouri

1-615-565-8110

1-615-234-2154

Missouri

HEALTHY ALLIANCE LIFE INSURANCE COMPANY

Blue Cross Blue Shield of Missouri PFFS

1-765-526-2515

Missouri HMO MISSOURI, INC.Anthem Blue Cross and Blue Shield Local CCP

1-765-526-2515

MissouriHUMANA HEALTH PLAN, INC.

1-502-580-3538

jewing@humana.com

MissouriHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Missouri

1-201-269-6717

1-201-269-1008

MissouriMERCY HEALTH PLANS Mercy Health Plans Local CCP

1-314-214-2489

1-314-214-8101

Missouri

MERCY HEALTH PLANS OF MISSOURI INC.

Mercy Health Plans of Missouri, Inc. Local CCP

1-314-214-2489

1-314-214-8101

Missouri

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Missouri

1-401-333-3987 7941

1-800-373-0238

Missouri

Missouri RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Missouri

1-702-877-8377

Missouri

1-866-443-0934

Missouri

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Missouri

1-314-810-6102

Missouri

1-765-526-2515

Missouri

1-972-569-3646

1-972-569-3679

Missouri

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Missouri

1-949-221-9994

1-949-747-4237

Missouri

1-949-221-9994

1-949-747-4237

Missouri

1-949-221-9994

1-949-747-4237

Missouri

1-949-252-4339

1-949-474-4237

Missouri

UNITED HEALTHCARE OF THE MIDWEST, INC.

1-949-221-9994

1-949-747-4237

Missouri

1-813-290-6200 6620

Missouri

1-813-290-6200 5119

Montana

1-386-963-2543

1-860-754-1481

Montana

1-386-963-2543

1-860-754-1481

Montana

1-651-662-8758

1-651-662-6009

Montana

1-651-662-8758

1-651-662-6009

MontanaCLEAR CHOICE HEALTH PLANS, INC.

Clear Choice Health Plans Local CCP Hirsch Jeff

1-314-810-6102

Montana

1-860-226-6731

yi.zheng@cigna.com

Montana

1-330-405-8080 6320

1-330-405-8081

Montana

1-801-954-3043

rlwilliams@cvty.com

Montana

1-801-954-3043

rlwilliams@cvty.com

MontanaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Montana

1-916-463-9603

1-916-463-9750

Montana

1-615-565-8110

1-615-234-2154

MontanaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

MontanaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Montana

1-201-269-6717

1-201-269-1008

MontanaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

MontanaNEW WEST HEALTH SERVICES

New West Health Services Local CCP Quality Director Wassell Monica

1-406-457-2210

1-406-457-2255

mwassell@nwhp.com 130 Neill Avenue Helena MT 59601

Montana

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Montana

1-401-333-3987 7941

1-800-373-0238

Montana

Montana RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Montana

1-866-443-0934

Montana

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Montana

1-314-810-6102

Montana

STERLING LIFE INSURANCE COMPANY (MT)

Sterling Life Insurance Company PFFS Hirsch Jeff

1-314-810-6102

Montana

1-765-526-2515

Montana

1-765-526-2515

Montana

1-972-569-3646

1-972-569-3679

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Montana

1-949-252-4339

1-949-474-4237

Montana

1-949-221-9994

1-949-747-4237

Montana

1-949-252-4339

1-949-474-4237

Montana

1-813-290-6200 6620

Montana

1-813-290-6200 5119

Nebraska

1-386-963-2543

1-860-754-1481

Nebraska

1-386-963-2543

1-860-754-1481

Nebraska

1-651-662-8758

1-651-662-6009

Nebraska

1-651-662-8758

1-651-662-6009

Nebraska

1-860-226-6731

yi.zheng@cigna.com

Nebraska

COVENTRY HEALTH AND LIFE INSURANCE CO. (NEBRASKA)

1-801-954-3043

rlwilliams@cvty.com

Nebraska

1-801-954-3043

rlwilliams@cvty.com

Nebraska

COVENTRY HEALTH CARE OF NEBRASKA, INC.

Coventry Health Care of Nebraska Advantra Local CCP

1-801-954-3043

rlwilliams@cvty.com

Nebraska

1-330-405-8080 6320

1-330-405-8081

Nebraska

1-801-954-3043

rlwilliams@cvty.com

Nebraska

1-801-954-3043

rlwilliams@cvty.com

NebraskaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Nebraska

1-916-463-9603

1-916-463-9750

Nebraska

1-615-565-8110

1-615-234-2154

NebraskaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

NebraskaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Nebraska

1-201-269-6717

1-201-269-1008

NebraskaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Nebraska

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Nebraska

1-401-333-3987 7941

1-800-373-0238

Nebraska

Nebraska RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Nebraska

1-866-443-0934

Nebraska

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Nebraska

1-314-810-6102

Nebraska

1-765-526-2515

Nebraska

1-765-526-2515

Nebraska

1-972-569-3646

1-972-569-3679

Nebraska

1-949-252-4339

1-949-474-4237

Nebraska

1-949-221-9994

1-949-747-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Nebraska

1-949-221-9994

1-949-747-4237

Nebraska

1-949-252-4339

1-949-474-4237

Nebraska

UNITED HEALTHCARE OF THE MIDLANDS, INC.

1-949-221-9994

1-949-747-4237

Nebraska

1-813-290-6200 6620

Nebraska

1-813-290-6200 5119

Nevada AETNA HEALTH Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Nevada

1-386-963-2543

1-860-754-1481

Nevada

1-386-963-2543

1-860-754-1481

Nevada

1-386-963-2543

1-860-754-1481

NevadaANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Nevada

1-215-988-6835

1-215-557-7437

Nevada

1-860-226-6731

yi.zheng@cigna.com

Nevada

1-801-954-3043

rlwilliams@cvty.com

Nevada

1-801-954-3043

rlwilliams@cvty.com

Nevada

1-330-405-8080 6320

1-330-405-8081

Nevada

1-801-954-3043

rlwilliams@cvty.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Nevada

1-916-463-9603

1-916-463-9750

NevadaHEALTH PLAN OF NEVADA, INC. Senior Dimensions Local CCP

1-702-877-8377

NevadaHEALTH PLAN OF NEVADA, INC. Senior Dimensions Local CCP

1-702-877-8377

Nevada

1-615-565-8110

1-615-234-2154

NevadaHOMETOWN HEALTH PLAN Senior Care Plus Local CCP Pharmacist Britt Judy

1-775-982-3089

1-775-982-3748

jbritt@hometownhealth.com 830 Harvard Way Reno NV 89502

NevadaHOMETOWN HEALTH PLAN Senior Care Plus Local CCP Pharmacist Britt Judy

1-775-982-3089

1-775-982-3748

jbritt@hometownhealth.com 830 Harvard Way Reno NV 89502

NevadaHUMANA HEALTH PLAN, INC.

AARP MedicareComplete provided by SecureHorizons Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

NevadaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

NevadaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Nevada

1-201-269-6717

1-201-269-1008

Nevada

MOLINA HEALTHCARE OF NEVADA, INC.

Molina Healthcare of Nevada Local CCP

1-801-858-0466

1-801-748-0536

Nevada

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Nevada

1-401-333-3987 7941

1-800-373-0238

Nevada

ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC.

1-765-526-2515

Nevada

ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICES, INC.

Anthem Blue Cross and Blue Shield PFFS

1-765-526-2515

Nevada RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Nevada

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.

Sierra Nevada Spectrum Regional CCP

1-702-877-8377

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Nevada

1-702-877-8377

Nevada

1-702-877-8377

Nevada

1-866-443-0934

Nevada

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Nevada

1-314-810-6102

Nevada

1-765-526-2515

Nevada

1-765-526-2515

Nevada

1-972-569-3646

1-972-569-3679

Nevada

1-949-252-4339

1-949-474-4237

Nevada

1-949-221-9994

1-949-747-4237

Nevada

1-949-252-4339

1-949-474-4237

Nevada

1-800-546-5677 1110

Nevada

1-813-290-6200 6620

Nevada

1-813-290-6200 5119

New Hampshire

1-386-963-2543

1-860-754-1481

New Hampshire

1-386-963-2543

1-860-754-1481

New Hampshire

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New HampshireANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

New HampshireANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

New Hampshire

1-860-226-6731

yi.zheng@cigna.com

New Hampshire

1-860-226-6731

yi.zheng@cigna.com

New Hampshire

1-330-405-8080 6320

1-330-405-8081

New Hampshire

1-801-954-3043

rlwilliams@cvty.com

New Hampshire

1-801-954-3043

rlwilliams@cvty.com

New HampshireFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

New Hampshire

1-916-463-9603

1-916-463-9750

New Hampshire

1-615-565-8110

1-615-234-2154

New HampshireHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

New HampshireHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

New Hampshire

1-201-269-6717

1-201-269-1008

New Hampshire

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

New Hampshire

1-401-333-3987 7941

1-800-373-0238

New Hampshire RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

New Hampshire

1-866-443-0934

New Hampshire

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

New Hampshire

1-314-810-6102

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New Hampshire

1-765-526-2515

New Hampshire

1-765-526-2515

New Hampshire

1-972-569-3646

1-972-569-3679

New Hampshire

1-949-252-4339

1-949-474-4237

New Hampshire

1-949-221-9994

1-949-747-4237

New Hampshire

1-949-252-4339

1-949-474-4237

New Hampshire

1-813-290-6200 5119

New Jersey AETNA HEALTH, INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

New Jersey

1-386-963-2543

1-860-754-1481

New Jersey

1-386-963-2543

1-860-754-1481

New Jersey

1-386-963-2543

1-860-754-1481

New Jersey

1-386-963-2543

1-860-754-1481

New Jersey

New JerseyAMERICHOICE OF NEW JERSEY, INC

AmeriChoice Personal Care Plus Local CCP

1-713-599-5773

leah_f_cormier@UHC.com

New JerseyAMERIGROUP NEW JERSEY, INC.

1-757-518-3420

New JerseyAMERIHEALTH HMO, INC. AmeriHealth Rx PDP

Senior Clinical Pharmacist DaCosta Maribel

1-215-241-7928

Maribel.DaCosta@futurescriptssecure.com

1901 Market Street 22nd Fl. Philadelphia PA 19103

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New JerseyAMERIHEALTH HMO_INC AmeriHealth 65 Local CCP

Manager, Population Health & Wellness Siejak Kimberly

1-215-241-4016

kimberly.siejak@ibx.com

1901 Market Street 29th Fl. Philadelphia TX 19103

New Jersey

1-800-625-9432

1-866-464-0709

New Jersey

1-860-226-6731

yi.zheng@cigna.com

New Jersey

1-330-405-8080 6320

1-330-405-8081

New Jersey

1-801-954-3043

rlwilliams@cvty.com

New Jersey

1-801-954-3043

rlwilliams@cvty.com

New JerseyFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

New Jersey

1-916-463-9603

1-916-463-9750

New Jersey

HEALTHFIRST HEALTH PLAN OF NEW JERSEY, INC. Healthfirst NJ Local CCP Pharmacy Director Elbeck Maurice

1-212-453-4468

melbeck@healthfirst.org 25 Broadway 9th Floor New York NY 10004

New Jersey

1-615-565-8110

1-615-234-2154

New Jersey

HORIZON HEALTHCARE OF NEW JERSEY, INC.

Horizon Blue Cross Blue Shield of New Jersey, Inc. Local CCP

Director, Clinical Programs Jan Saira

1-973-466-4575

saira_jan@horizonblue.com

3 Penn Plaza East - PP 13Q Newark NJ 7105

New Jersey

HORIZON HEALTHCARE SERVICES DBA HORIZON BCBS NJ

Horizon Blue Cross Blue Shield of New Jersey, Inc. PDP

1-973-466-4575

Three Penn PlazaEast PP-13Q Newark NJ 7105

New JerseyHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

New JerseyHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

New Jersey

1-201-269-6717

1-201-269-1008

New JerseyOXFORD HEALTH PLANS (NJ), INC.

1-949-221-9994

1-949-747-4237

New Jersey

OXFORD HEALTH PLANS OF NEW JERSEY, INC

1-949-221-9994

1-949-747-4237

New Jersey

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

New Jersey

1-401-333-3987 7941

1-800-373-0238

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New Jersey RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

New Jersey

1-702-877-8377

New Jersey

1-866-443-0934

New Jersey

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

New Jersey

1-314-810-6102

New Jersey

1-765-526-2515

New Jersey

1-765-526-2515

New Jersey

1-972-569-3646

1-972-569-3679

New Jersey

1-949-252-4339

1-949-474-4237

New Jersey

1-949-221-9994

1-949-747-4237

New Jersey

1-949-221-9994

1-949-747-4237

New Jersey

1-949-252-4339

1-949-474-4237

New Jersey

1-813-290-6200 6620

New Jersey

WELLCARE HEALTH PLANS OF NEW JERSEY, INC. WellCare Local CCP

Manager Clinical Pharmacy Rackley Qiana

1-813-290-6200 6620

New Jersey

1-813-290-6200 5119

New Mexico

1-386-963-2543

1-860-754-1481

New MexicoAMERIGROUP NEW MEXICO, INC.

1-757-518-3420

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New Mexico

1-860-226-6731

yi.zheng@cigna.com

New Mexico

1-330-405-8080 6320

1-330-405-8081

New Mexico

1-801-954-3043

rlwilliams@cvty.com

New Mexico

1-801-954-3043

rlwilliams@cvty.com

New MexicoHCSC INSURANCE SERVICES COMPANY

1-651-286-4206

1-651-286-4403

New MexicoHCSC INSURANCE SERVICES COMPANY

HISC - Blue Cross Blue Shield of New Mexico Local CCP

Pharmacy Director, Government Programs Nguyen Marie

1-651-286-4206

1-651-283-4403

Prime Therapeutics

1020 Discovery Road, No.100 Egan MN 55121

New Mexico

1-916-463-9603

1-916-463-9750

New Mexico

1-916-463-9603

1-916-463-8056

New Mexico

1-615-565-8110

1-615-234-2154

New MexicoHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

New MexicoLOVELACE HEALTH SYSTEM, INC. Lovelace Senior Plan Local CCP

Director Pharmacy Services Murvin Thomas

1-505-232-1804

thomas.murvin@ardenthealth.com

4101 Indian School Rd, NE Albuquerque NM 87110

New Mexico

LOVELACE INSURANCE COMPANY

Lovelace Insurance Company Local CCP

Director: Pharmacy Services Murvin Thomas E

1-505-232-1804

1-505-262-7390

thomas.murvin@ardenthealth.com

4101 Indian School R. NE Suite 110S Albuquerque NM 87111

New Mexico

1-201-269-6717

1-201-269-1008

New Mexico

MOLINA HEALTHCARE OF NEW MEXICO, INC.

Molina Healthcare of New Mexico, Inc. Local CCP

1-801-858-0466

1-801-748-0536

New Mexico

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

New Mexico

1-401-333-3987 7941

1-800-373-0238

New Mexico

PHYSICIANS HEALTH CHOICE OF NEW MEXICO

PHYSICIANS HEALTH CHOICE OF NEW MEXICO Local CCP

Vice President of Pharmacy - Envision Peterson Amanda

1-330-486-6302

2181 E. Aurora Rd. STE 201 Twinsburg OH 44087

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New MexicoPRESBYTERIAN HEALTH PLAN

Presbyterian Senior Care Local CCP Pharmacy Director Georgopoulos Larry

1-505-923-5530

1-505-923-5540

lgeorgop@phs.org P.O. Box 27489 Albuquerque NM 87125

New Mexico

PRESBYTERIAN INSURANCE COMPANY, INC.

Presbyterian MediCare PPO Local CCP Pharmacy Director Georgopoulos Larry

1-505-923-5530

1-505-923-5201

lgeorgop@phs.org P.O. Box 26267 Albuquerque NM 87125

New Mexico RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

New Mexico

1-702-877-8377

New Mexico

1-866-443-0934

New Mexico

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

New Mexico

1-314-810-6102

New Mexico

1-765-526-2515

New Mexico

1-765-526-2515

New Mexico

1-972-569-3646

1-972-569-3679

New Mexico

1-949-252-4339

1-949-474-4237

New Mexico

1-949-221-9994

1-949-747-4237

New Mexico

1-949-221-9994

1-949-747-4237

New Mexico

1-949-221-9994

1-949-747-4237

New Mexico

1-949-252-4339

1-949-474-4237

New Mexico

1-813-290-6200 6620

New Mexico

1-813-290-6200 5119

New York AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New York

1-386-963-2543

1-860-754-1481

New York

1-386-963-2543

1-860-754-1481

New York

1-386-963-2543

1-860-754-1481

New YorkAFFINITY HEALTH PLAN, INC. Affinity Health Plan Local CCP

Medication Therapy Management Hirsch Jeff

1-800-344-3405

New York

AMERICAN PROGRESSIVE LIFE AND HEALTH INS CO NY

American Progressive Life & Health Ins Co of NY PDP

1-401-333-3987 7941

1-800-373-0238

New York

New YorkAMERICHOICE OF NEW YORK, INC

AmeriChoice Personal Care Plus Local CCP

1-713-599-5773

leah_f_cormier@UHC.com

New YorkAMERIGROUP NEW YORK, LLC

1-757-518-3420

New York

1-800-625-9432

1-866-464-0709

New York

CAMBRIDGE LIFE INSURANCE COMPANY Advantra® Freedom PFFS

1-801-954-3043

rlwilliams@cvty.com

New York

CAMBRIDGE LIFE INSURANCE COMPANY Coventry AdvantraRx PDP

1-801-954-3043

rlwilliams@cvty.com

New York

CAMBRIDGE LIFE INSURANCE COMPANY First Health Part D PDP

1-801-954-3043

rlwilliams@cvty.com

New York

CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.

CDPHP Medicare Choice Local CCP

Academic Intervention Pharmacist Winn Sue

1-518-641-3225

1-518-641-3208

swinn@cdphp.com

500 Patroon Creek Blvd Albany NY 12206

New YorkCATHOLIC SPECIAL NEEDS PLAN, LLC ArchCare Advantage Local CCP Moyna Audrey

1-847-559-3999

1-847-559-4733

audrey.moyna@caremark.com Caremark

New YorkCDPHP UNIVERSAL BENEFITS, INC. CDPHP Medicare PPO Local CCP

1-518-641-3225

1-518-641-3208

swinn@cdphp.com

New York

COMPREHENSIVE CARE MANAGEMENT CORP.

Comprehensive Care Management Corp. Local CCP Genao-Tejada Sonia

1-718-944-2101

sgenaotejada@bethabe.org

2275 Olinville Avenue Bronx NY 10647

New York

1-860-226-6731

yi.zheng@cigna.com

New York

1-860-226-6731

yi.zheng@cigna.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New York ELDERPLAN, INC. Elderplan, Inc. Local CCPAVP Medical Management Montella Lynda

1-718-921-8409

1-718-921-8813

lmontell@mjhs.org

6323 Seventh Avenue Brooklyn NY 11220

New YorkELDERPLAN, INC. - SHMO Elderplan, Inc. Local CCP

AVP Medical Management Montella Lynda

1-718-921-8409

1-718-921-8813

lmontell@mjhs.org

6323 Seventh Avenue Brooklyn NY 11220

New York

EMPIRE HEALTHCHOICE ASSURANCE, INC.

Empire BlueCross BlueShield Local CCP

1-847-559-3999

1-847-559-4733

New York

EMPIRE HEALTHCHOICE ASSURANCE, INC.

Empire BlueCross BlueShield PFFS

1-765-526-2515

New York

EMPIRE HEALTHCHOICE HMO, INC.

Empire BlueCross BlueShield HMO Local CCP

1-847-559-3999

1-847-559-4733

New York

1-330-405-8080 6320

1-330-405-8081

New YorkEXCELLUS HEALTH PLAN, INC Simply Prescriptions PDP

Director, FLRx Clinical Operations Rocco Darlene

1-585-327-7544

darlene.rocco@flrx.com 165 Court Street Rochester NY 14647

New YorkEXCELLUS HEALTH PLAN, INC.

Excellus Health Plan, Inc. Local CCP

1-585-327-7544

Excellus Health Plan, Inc. Local CCP

1-585-327-7544

Excellus Health Plan, Inc. 1876 Cost

1-585-327-7544

New York

FIRST UNITED AMERICAN LIFE INSURANCE COMPANY

First United American Life Insurance Company PDP

1-972-569-3646

1-972-569-3679

New YorkGHI (GROUP HEALTH INCORPORATED)

GHI Medicare Prescription Drug Plan PDP Director Sebastian Tobin

1-212-615-4567

1-212-563-8500

Tsebastian@ghi.com 441 Ninth Avenue New York NY 10001

New YorkGROUP HEALTH INCORPORATED

GHI Medicare Choice PPO Local CCP Director Laurora Nicholas

1-646-447-7838

Nlaurora@HIPUSA.com 55 Water Street New York NY 10041

New York GROUP HEALTH, INC.GHI Medicare Private Fee for Service PFFS Laurora Nicholas

1-646-447-7838

Nlaurora@hipusa.com 55 Water Street New York NY 10041

New York GUILDNET, INC. GuildNet Local CCP Director Laurora Nicholaus1-646-447-7838

Nlaurora@hipusa.com 55 Water Street New York NY 10041

New York

HEALTH NET INSURANCE OF NEW YORK, INC. Health Net Pearl PFFS V.P., Operations

White, Pharm D Virginia E

1-916-463-9603

1-916-463-8056

New York

1-916-463-9603

1-916-463-9750

New YorkHEALTHNOW NEW YORK INC Senior Blue Local CCP

Director Clinical Pharmacy Services Baker Philip

1-716-887-8765

baker.philip@healthnow.org

257 West Genesee Street Buffalo NY 14202

New YorkHEALTHNOW NEW YORK INC.

HealthNow New York Inc. PDP

1-716-887-8765

New YorkHEALTHNOW NEW YORK INC.

Traditional Blue Medicare PPO Local CCP

1-716-887-8765

New YorkHEALTHNOW NEW YORK, INC.

Traditional Blue Medicare PFFS PFFS

1-716-887-8765

New York

1-615-565-8110

1-615-234-2154

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New YorkHIP HEALTH PLAN OF NEW YORK

HIP Insurance Company of New York PDP Director Aral Jasmine

1-646-447-7186 jaral@hipusa.com 55 Water Street New York NY 10041

New YorkHIP OF GREATER NEW YORK

HIP Health Plan of Greater New York Local CCP

Director of Medicare Prescription Programs Laurora Nicholas

1-646-447-7838

nlaurora@hipusa.com 55 Water Street New York NY 10041

New York

HUMANA INSURANCE COMPANY OF NEW YORK

Humana Insurance Company of New York PFFS Ewing Joy

1-502-580-3538

jewing@humana.com

New York

HUMANA INSURANCE COMPANY OF NEW YORK

Humana Insurance Company of New York PDP Ewing Joy

1-502-580-3538

jewing@humana.com

New York

INDEPENDENT HEALTH ASSOCIATION, INC. Independent Health Local CCP

Utilization Management Pharmacist Verrall Kelly

1-716-635-4885

1-716-631-0149

kverrall@independenthealth.com

511 Faber Lakes Drive Buffalo NY 14221

New York

INDEPENDENT HEALTH BENEFITS CORP Independent Health Local CCP

1-716-635-4885

1-716-631-0149

511 Farber Lakes Drive Buffalo NY 14221

New York

INDEPENDENT HEALTH BENEFITS CORPORATION Independent Health PFFS

1-716-635-4885

1-716-631-0149

511 Farber Lakes Drive Buffalo NY 14221

New YorkLIBERTY HEALTH ADVANTAGE, INC.

Liberty Health Advantage Local CCP

Vice President Clinical Programs Schoening Shellie

1-800-546-5677 1110

1-866-632-7946

schoening@pti-nps.com PO Box 407 Boystown NE 68010

New YorkMANAGED HEALTH, INC.

Healthfirst Medicare Plan Local CCP Pharmacy Director Elbeck Maurice

1-212-453-4468

melbeck@healthfirst.org 25 Broadway 9th Floor New York NY 10004

New York

MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK

1-201-269-6717

1-201-269-1008

New YorkMETROPLUS HEALTH PLAN, INC. MetroPlus Health Plan Local CCP

Director, Medicare Clinical Services Marks Iny

1-516-605-6966

1-412-322-2066

imarks@nmhc.com

600 Waterfront Drive Suite 225 Pittsburgh PA 15222

New YorkMVP HEALTH PLAN, INC, MVP Gold Local CCP Pharmacy Director Colin Wendy

1-585-327-2577

1-585-258-8621

wcolin@preferredcare.org 259 Monroe Ave Rochester NY 14607

New York

NEIGHBORHOOD HEALTH PROVIDERS LLC

Neighborhood Health Providers Local CCP

Vice President, Care Management Campbell Deborah S

1-704-329-7065 4402

1-704-329-0211

dcampbell@royalhc.com

4944 Pkwy. Plaza Blvd. Suite 110 Charlotte NC 28217

New York

NEW YORK STATE CATHOLIC HLTH PLAN INC Fidelis Care Local CCP CMO Michelson Marco

1-718-896-6500 1036

mmichels@fideliscare.org

9525 Queens Blvd. Rego Park NY 11374

New YorkOXFORD HEALTH PLANS (NY) INC.

1-949-221-9994

1-949-747-4237

New York

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

New York

ROCHESTER AREA HEALTH MAINTENANCE ORG.

Preferred Care GoldAnywhere Local CCP

Pharmacy Coordinator Colin Wendy

1-585-327-2577

wcolin@preferredcare.org 259 Monroe Ave. Rochester NY 14607

New York

ROCHESTER AREA HMO/ DBA PREFERRED CARE Preferred Care Gold Local CCP

Clinical Pharmacy Coordinator Colin Wendy

1-585-327-2577

wcolin@preferredcare.org 259 Monroe Ave. Rochester NY 14607

New York RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

New YorkSENIOR WHOLE HEALTH, LLC

Senior Whole Health of New York Local CCP

1-617-494-5353 6324

1-617-494-5599

gdichter@seniorwholehealth.com

58 Charles Street, 2nd Floor Cambridge MA 2141

New York

1-866-443-0934

New York

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

New York

1-314-810-6102

New YorkTOUCHSTONE HEALTH HMO, INC. Touchstone Health Local CCP

Pharmacy DUR/MTM PerformRX Lawson Mark

1-215-937-5352

1-215-937-8450

mark.lawson@performrx.com 200 Stevens Dr Philadelphia PA 19113

New YorkTOUCHSTONE HEALTH HMO, INC. Touchstone Health Local CCP

Pharmacy DUR/MTM PerfromRx Lawson Marl

1-215-937-5352

1-215-937-8450

marl.lawson@performrx.com

New York

1-765-526-2515

New York

1-765-526-2515

New York

1-949-252-4339

1-949-474-4237

New York

UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK

1-949-221-9994

1-949-747-4237

New York

UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK

1-949-221-9994

1-949-747-4237

New York

UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK UnitedHealthcare PDP Solutions Rx

1-949-252-4339

1-949-474-4237

New York

UNITED HEALTHCARE OF NEW YORK, INC.

1-949-221-9994

1-949-747-4237

New York VNS CHOICEVNS CHOICE Medicare Local CCP Brown Nancy

1-401-333-3987 7941

1-401-335-7941

PharmaCare Management Services, Inc.

New York

WELLCARE HEALTH INSURANCE OF NEW YORK, INC. WellCare PFFS

1-813-290-6200 6620

New York

1-813-290-6200 5119

New YorkWELLCARE_OF NEW YORK, INC. WellCare Local CCP

1-813-290-6200 6620

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

North Carolina

1-386-963-2543

1-860-754-1481

North Carolina

1-386-963-2543

1-860-754-1481

North Carolina

AMERICA'S 1ST CHOICE INSURANCE COMPANY OF NC, INC.

AMERICA'S 1ST CHOICE INSURANCE COMPANY OF NC, INC. PFFS Pharmacy Schoening Shellie

1-800-546-5677 1110

1-866-632-7946

schoening@pti-nps.com

13660 California Street Omaha NE 68154

North Carolina

ARCADIAN HEALTH PLAN OF NORTH CAROLINA, INC.

1-909-971-6816

1-909-971-6866

North Carolina

BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA

BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA PDP

Director, Health Services Miller Debra

1-336-201-4310

debbie.miller@bcbsnc.com

5660 University Parkway Winston-Salem NC 27105

North Carolina

1-215-988-6835

1-215-557-7437

North Carolina

1-860-226-6731

yi.zheng@cigna.com

North Carolina

1-860-226-6731

yi.zheng@cigna.com

North Carolina

1-801-954-3043

rlwilliams@cvty.com

North Carolina

1-801-954-3043

rlwilliams@cvty.com

North Carolina

1-330-405-8080 6320

1-330-405-8081

North Carolina

FIDELIS SECURECARE OF NORTH CAROLINA

Fidelis SecureCare of North Carolina Local CCP Medical Director Herman Chris

1-877-372-8080

1-877-372-8081

chris.herman@fidelissc.com

11301 Carmel Commons Boulevard Suite 215 Charlotte NC 28226

North Carolina

1-801-954-3043

rlwilliams@cvty.com

North CarolinaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

North Carolina

1-916-463-9603

1-916-463-9750

North Carolina

1-916-463-9603

1-916-463-8056

North Carolina

1-615-565-8110

1-615-234-2154

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

North CarolinaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

North Carolina

1-201-269-6717

1-201-269-1008

North Carolina

PARTNERS NATIONAL HEALTH PLANS OF NC INC

PARTNERS National Health Plans, a BCBSNC company Local CCP

1-336-201-4310

North Carolina

PARTNERS NATIONAL HEALTH PLANS OF NC, INC.

PARTNERS National Health Plans, a BCBSNC company Local CCP

1-336-201-4310

North Carolina

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

North Carolina

1-401-333-3987 7941

1-800-373-0238

North Carolina

North Carolina RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

North Carolina

1-866-443-0934

North Carolina

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

North Carolina

1-314-810-6102

North Carolina

1-765-526-2515

North Carolina

1-765-526-2515

North Carolina

1-972-569-3646

1-972-569-3679

North Carolina

1-949-252-4339

1-949-474-4237

North Carolina

1-949-221-9994

1-949-747-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

North Carolina

1-949-221-9994

1-949-747-4237

North Carolina

1-949-252-4339

1-949-474-4237

North Carolina

UNITED HEALTHCARE OF NORTH CAROLINA

1-949-221-9994

1-949-747-4237

North Carolina

1-813-290-6200 6620

North Carolina

1-813-290-6200 5119

North Dakota

1-386-963-2543

1-860-754-1481

North Dakota

1-386-963-2543

1-860-754-1481

North Dakota

1-651-662-8758

1-651-662-6009

North Dakota

1-651-662-8758

1-651-662-6009

North Dakota

1-860-226-6731

yi.zheng@cigna.com

North Dakota

1-801-954-3043

rlwilliams@cvty.com

North Dakota

1-330-405-8080 6320

1-330-405-8081

North Dakota

1-801-954-3043

rlwilliams@cvty.com

North Dakota

1-801-954-3043

rlwilliams@cvty.com

North DakotaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

North Dakota

1-916-463-9603

1-916-463-9750

North Dakota

1-615-565-8110

1-615-234-2154

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

North DakotaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

North DakotaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

North Dakota

1-201-269-6717

1-201-269-1008

North DakotaMEDICA HEALTH PLANS Medica Health Plans PFFS Weiss Justin

1-952-992-2469

North DakotaMEDICA INSURANCE COMPANY

1-952-992-2469

North Dakota

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

North Dakota

1-401-333-3987 7941

1-800-373-0238

North Dakota RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

North Dakota

1-866-443-0934

North Dakota

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

North Dakota

1-314-810-6102

North Dakota

1-765-526-2515

North Dakota

1-765-526-2515

North Dakota

1-972-569-3646

1-972-569-3679

North Dakota

1-949-252-4339

1-949-474-4237

North Dakota

1-949-221-9994

1-949-747-4237

North Dakota

1-949-252-4339

1-949-474-4237

North Dakota

1-813-290-6200 6620

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

North Dakota

1-813-290-6200 5119

Northern Mariana Islands

1-949-252-4339

1-949-474-4237

Northern Mariana Islands

1-949-252-4339

1-949-474-4237

Ohio AETNA HEALTH, INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

OhioANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

OhioANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

1-800-625-9432

1-866-464-0709

BUCKEYE COMMUNITY HEALTH PLAN, INC.

Advantage by Buckeye Community Health Plan Local CCP

1-732-476-1047

1-732-549-5824

mpica@centene.com

Ohio CARESOURCE CareSource Local CCP

Vice President Pharmacy Services Keeley Jon

1-937-224-3300 2011

1-937-531-2434

part_D@csmg-online.com 1 S. Main Street

One Dayton Centre Dayton OH 45402

1-215-988-6835

1-215-557-7437

COMMUNITY INSURANCE COMPANY

1-765-526-2515

COMMUNITY INSURANCE COMPANY

1-765-526-2515

1-860-226-6731

yi.zheng@cigna.com

COVENTRY HEALTH AND LIFE INS. COMPANY Carelink Advantra PPO Local CCP

1-801-954-3043

rlwilliams@cvty.com

2650 S. Decker Ln. Salt Lake City UT 84119

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-801-954-3043

rlwilliams@cvty.com

1-801-954-3043

rlwilliams@cvty.com

OhioDAVITA VILLAGEHEALTH, INC.

DaVita VillageHealth of Ohio, Inc. Local CCP

1-518-932-4416

1-330-405-8080 6320

1-330-405-8081

1-801-954-3043

rlwilliams@cvty.com

OhioGATEWAY HEALTH PLAN OF OHIO, INC.

Gateway Health Plan Medicare Assured Local CCP

Manager, Clinical Pharmacy Scalise Lorraine

1-412-255-1349

1-888-245-2049

lscalise@gatewayhealthplan.com

600 Grant Street, 41st Floor Pittsburgh PA 15219

1-916-463-9603

1-916-463-9750

HEALTH PLAN OF THE UPPER OHIO VALLEY The Health Plan Local CCP

Director Pharmacy Services Neal Steve

1-740-695-7638

1-740-695-7925

sneal@healthplan.org The Health Plan

52160 National Road East St. Clairsville OH 43950

1-615-565-8110

1-615-234-2154

OhioHOMETOWN HEALTH PLAN The Health Plan Local CCP

1-740-695-7638

1-740-695-7925

OhioHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

OhioKAISER FOUNDATION HP OF OHIO

Kaiser Foundation Health Plan of Ohio 1876 Cost

Manager Abulatory Care Clinical Pharmacy Kramer Amy

1-216-265-4403

1-216-265-4483

amy.Kramer@kp.org 12301 Snow Rd.

Clinical Pharmacy Services Parma OH 44130

MCKINLEY LIFE INSURANCE COMPANY PrimeTime Health Plan Local CCP

Clinical Pharmacist Kmiecik Karen

1-330-363-2250

kkmiecik@aultman.com

2600 Sixth Street SW Canton OH 44710

MCKINLEY LIFE INSURANCE COMPANY PrimeTime Health Plan Local CCP

1-330-363-2250

MCKINLEY LIFE INSURANCE COMPANY PrimeTime Health Plan PFFS

1-330-363-2250

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-201-269-6717

1-201-269-1008

OhioMEDICAL MUTUAL OF OHIO

Advantage Plan from Medical Mutual of Ohio PFFS

Mgr. Pharmaceutical Benefits Hendricks Chad

1-216-687-2882

chad.hendricks@mmoh.com

2060 East Ninth Street Clevleland OH 44115

Advantage Plans from Medical Mutual of Ohio Local CCP

1-216-687-2882

Advantage Plans from Medical Mutual of Ohio PDP

1-216-687-2882

OhioMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

OhioMT. CARMEL HEALTH PLAN, INC. MediGold Local CCP

Director, Clinical Operations Moyna Audrey

1-847-559-3999

1-847-559-4733

OhioPARAMOUNT CARE, INC Paramount Elite Local CCP

Coordinator, Prescription Drug PRogram Bogner Craig M

1-419-887-2249

1-419-887-2015

PARAMOUNT INSURANCE COMPANY

Paramount Prescription Drug Plan PDP Bogner Craig

1-419-887-2249

1-419-887-2015

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

1-401-333-3987 7941

1-800-373-0238

Ohio RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

1-702-877-8377

1-866-443-0934

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

1-314-810-6102

Ohio SUMMACARE INC. SummaCare Local CCP Pharmacy Director Colligan Tim1-800-996-8411

1-330-996-8580

colligant@summacare.com P.O. Box 3620 Akron OH 44309

OhioTHP INSURANCE COMPANY

Health Plan SecureChoice Local CCP

1-740-695-7638

1-740-695-7925

OhioTHP INSURANCE COMPANY

Health Plan SecureFreedom PFFS

1-740-695-7638

1-740-695-7925

1-765-526-2515

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

OhioUNISON HEALTH PLAN OF OHIO, INC. Unison Advantage Local CCP Brekosky Robert

1-412-349-6167

1-412-457-1616

1-972-569-3646

1-972-569-3679

1-949-252-4339

1-949-474-4237

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

1-949-252-4339

1-949-474-4237

UNITED HEALTHCARE OF OHIO, INC.

1-949-221-9994

1-949-747-4237

OhioUPMC HEALTH BENEFITS, INC UPMC Health Plan PDP

Manager, Medicare Operations Cain John

1-412-454-5539

1-412-454-7711 cainjo@upmc.edu

112 Washington Place Suite 800 Pittsburgh PA 15219

WELLCARE HEALTH INSURANCE OF ILLINOIS, INC. WellCare Local CCP

1-813-290-6200 6620

OhioWELLCARE OF OHIO, INC. WellCare Local CCP

Manager Clinical Pharmacy Rackley Qiana

1-813-290-6200 6620

1-813-290-6200 5119

Oklahoma AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Oklahoma

1-386-963-2543

1-860-754-1481

Oklahoma

1-386-963-2543

1-860-754-1481

Oklahoma

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

OklahomaARCADIAN HEALTH PLAN Arcadian Health Plan Local CCP

1-909-971-6816

1-909-971-6866

Oklahoma

1-215-988-6835

1-215-557-7437

OklahomaCOMMUNITY CARE HMO, INC

CommunityCare Senior Health Plan Local CCP QI Analyst Beyersdorf Lee Ann

1-918-594-5295 4053

1-918-877-9729

lbeyersdorf@ccok.com 218 W. 6th Street Tulsa OK 74119

Oklahoma

1-860-226-6731

yi.zheng@cigna.com

Oklahoma

1-801-954-3043

rlwilliams@cvty.com

Oklahoma

1-801-954-3043

rlwilliams@cvty.com

Oklahoma

1-330-405-8080 6320

1-330-405-8081

Oklahoma

1-801-954-3043

rlwilliams@cvty.com

Oklahoma GLOBALHEALTH, INC.Generations Healthcare Local CCP

OklahomaHCSC INSURANCE SERVICES COMPANY

Blue Cross And Blue Shield Of Oklahoma Local CCP

Clinical Pharmacy Manager Hettich Lisa

1-765-526-2515 6346

1-765-391-1023

Lisa.Hettich@wellpoint.com

8407 Fallbrook Ave West Hills CA 91304

OklahomaHCSC INSURANCE SERVICES COMPANY

BLUE CROSS AND BLUE SHIELD OF OKLAHOMA PDP Pharmacy Director Nguyen Marie

1-651-286-4403

Prime Therapeutics

Oklahoma

1-916-463-9603

1-916-463-9750

Oklahoma

1-615-565-8110

1-615-234-2154

OklahomaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Oklahoma

1-201-269-6717

1-201-269-1008

OklahomaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

OklahomaPACIFICARE OF OKLAHOMA, INC.

1-949-221-9994

1-949-747-4237

Oklahoma

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Oklahoma

1-401-333-3987 7941

1-800-373-0238

Oklahoma

Oklahoma RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

OklahomaSELECTCARE OF OKLAHOMA, INC.

SelectCare of Oklahoma Local CCP

Oklahoma

1-702-877-8377

Oklahoma

1-866-443-0934

Oklahoma

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Oklahoma

1-314-810-6102

Oklahoma

1-765-526-2515

Oklahoma

1-765-526-2515

Oklahoma

1-972-569-3646

1-972-569-3679

Oklahoma

1-949-252-4339

1-949-474-4237

Oklahoma

1-949-221-9994

1-949-747-4237

Oklahoma

1-949-252-4339

1-949-474-4237

Oklahoma

1-813-290-6200 6620

Oklahoma

1-813-290-6200 5119

Oregon

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Oregon

1-386-963-2543

1-860-754-1481

OregonASURIS NORTHWEST HEALTH

Asuris Northwest Health PDP

1-208-395-7732

1-208-395-7744

rjleona@regence.com 1211 West Myrtle

OregonATRIO HEALTH PLANS ATRIO MyAdvantage Local CCP

Chief Operations Officer Hoffman Steve O

1-541-672-8620 5206

1-541-672-8670

Steve.Hoffman@atriohp.com

500 SE Cass Ave. Suite 230 Roseburg OR 97470

Oregon

1-215-988-6835

1-215-557-7437

OregonCLEAR CHOICE HEALTH PLANS, INC.

Clear Choice Health Plans Local CCP Hirsch Jeff

1-314-810-6102

Oregon

1-860-226-6731

yi.zheng@cigna.com

Oregon

1-330-405-8080 6320

1-330-405-8081

OregonFAMILYCARE HEALTH PLANS, INC.

FamilyCare Health Plans, Inc. Local CCP

Pharmacy Manager Thanem Michael

1-503-471-2147

1-503-471-2197

michaelt@familycareinc.org

2121 SW Broadway Suite 300 Portland OR 97201

Oregon

1-801-954-3043

rlwilliams@cvty.com

Oregon

1-801-954-3043

rlwilliams@cvty.com

OregonFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

Oregon

1-916-463-9603

1-916-463-9750

Oregon

Health Net Medicare Advantage Local CCP

Vice President, Operations - HNPS

1-916-463-9603

Mail Top: CA-175-02-02 Rancho Cordova CA 95670

OregonHEALTH PLAN OF CAREOREGON, INC.

CareOregon Advantage Local CCP

Clinical Pharmacy Program Coordinator Benkstein Kristen

1-503-416-1734

1-503-416-1428

benksteink@careoregon.org

CareOregon Advantage

315 SW Fifth Avenue, Suite 900 Portland OR 97204

Oregon

1-615-565-8110

1-615-234-2154

OregonHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

OregonHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

OregonKAISER FOUNDATION HP OF THE N W

Kaiser Foundation Health Plan of the NW Local CCP

Pharmacy Benefit Manager Logan Steve

1-503-261-7980

Steve.Logan@kp.org

5725 NE 138th Ave Portland OR 97230

OregonKAISER FOUNDATION HP OF THE N W

1-503-261-7980

Steve.Logan@kp.org

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Oregon

MARION POLK COMMUNITY HEALTH PLAN ADVANTAGE, INC.

Marion Polk Community Health Plan Advantage Local CCP

Medical Management Coordinator Morgan Roberta

1-503-371-7701 145

1-503-371-8046

roberta@mvipa.org

245 Commercial St. SE, Ste. 220 Salem OR 97301

Oregon

1-201-269-6717

1-201-269-1008

OregonMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Oregon

MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION CareSource Local CCP

Medicare Coordinator Ackerman Cynthia

1-541-471-4106

1-541-471-1524

cackerman@mripa.org 740 SE 7th Street Grants Pass OR 97526

Oregon

MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION CareSource Local CCP

Director of Medical Affairs Ackerman Cynthia

1-541-471-4106

1-541-471-1524

cackerman@mripa.org 740 SE 7th Street Grants Pass OR 97526

OregonODS HEALTH PLAN, INC. ODS Health Plan, Inc. Local CCP

Medicare Coordinator

Siegfried-Roads Carey A

1-503-265-4719

1-503-265-4790

siegfrc@odscompanies.com

601 S.W. Second Avenue Portland OR 97204

OregonODS HEALTH PLAN, INC. ODS Health Plan, Inc. PDP

1-503-265-4719

1-503-265-4790

OregonPACIFICARE OF OREGON, INC.

1-949-221-9994

1-949-747-4237

Oregon

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Oregon

1-401-333-3987 7941

1-800-373-0238

OregonPROVIDENCE HEALTH PLAN Providence Health Plan Local CCP

PHARMACY DIRECTOR NOONAN HELEN M

1-503-574-5708

1-503-574-8646

HELEN.NOONAN@PROVIDENCE.ORG PO BOX 3125 PORTLAND OR 97208

Oregon

REGENCE BLUECROSS BLUESHIELD OF OR

Regence BlueCross BlueShield of Oregon Local CCP

1-208-395-7732

1-208-395-7744

rjleona@regence.com

Oregon RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

OregonSAMARITAN HEALTH PLANS, INC.

Samaritan Advantage Health Plan Local CCP

Pharmacy Operations Manager Tracer Tamatha

1-541-768-5207

1-541-768-4294

ttracer@samhealth.org PO Box M Corvallis OR 97339

Oregon

1-702-877-8377

Oregon

1-866-443-0934

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Oregon

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Oregon

1-314-810-6102

Oregon

TRILLIUM COMMUNITY HEALTH PLAN Trillium Advantage Local CCP

Clinical Pharmacist Wick Shauna

1-541-485-2155 1242

1-541-302-8052

swick@trilliumchp.com

1800 Millrace Drive Eugene OR 97403

Oregon

1-765-526-2515

Oregon

1-765-526-2515

Oregon

1-972-569-3646

1-972-569-3679

Oregon

1-949-252-4339

1-949-474-4237

Oregon

1-949-221-9994

1-949-747-4237

Oregon

1-949-221-9994

1-949-747-4237

Oregon

1-949-221-9994

1-949-747-4237

Oregon

1-949-252-4339

1-949-474-4237

Oregon

1-813-290-6200 6620

Oregon

1-813-290-6200 5119

Pennsylvania AETNA HEALTH INC Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Pennsylvania

1-386-963-2543

1-860-754-1481

Pennsylvania

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Pennsylvania

1-386-963-2543

1-860-754-1481

Pennsylvania

PennsylvaniaAVALON INSURANCE COMPANY

Avalon Insurance Company PDP

Pharmacy Manager Frost Lisa

1-717-703-8466

lisa.frost@securerx.com

2500 Elmerton Avenue Harrisburg PA 17177

Pennsylvania

1-800-625-9432

1-866-464-0709

PennsylvaniaBRAVO HEALTH PENNSYLVANIA INC. Bravo Health Local CCP

1-800-625-9432

1-866-464-0709

Pennsylvania

CAPITAL ADVANTAGE INSURANCE COMPANY

Capital Advantage Insurance Company Local CCP

1-717-703-8466

lisa.frost@capbluecross.com

Pennsylvania

1-215-988-6835

1-215-557-7437

Pennsylvania

1-860-226-6731

yi.zheng@cigna.com

Pennsylvania

1-860-226-6731

yi.zheng@cigna.com

Pennsylvania

1-801-954-3043

rlwilliams@cvty.com

Pennsylvania

1-801-954-3043

rlwilliams@cvty.com

Pennsylvania

1-330-405-8080 6320

1-330-405-8081

Pennsylvania

1-801-954-3043

rlwilliams@cvty.com

PennsylvaniaGATEWAY HEALTH PLAN, INC.

Gateway Health Plan Medicare Assured Local CCP

Manager, Clinical Pharmacy Scalise Lorraine

1-412-255-1349

1-888-245-2049

lscalise@gatewayhealthplan.com

600 Grant Street, 41st Floor Pittsburgh PA 15219

PennsylvaniaGEISINGER HEALTH PLAN Geisinger Gold Local CCP

Clinical Pharmacist Collins Vanessa L

1-570-214-9606

1-570-214-6768

vlcollins@thehealthplan.com

100 North Academy Avenue Danville PA 17822

Pennsylvania

GEISINGER INDEMNITY INSURANCE COMPANY Geisinger Gold Local CCP

1-570-214-9606

1-570-214-6768

Pennsylvania

GEISINGER INDEMNITY INSURANCE COMPANY Geisinger Gold PFFS

1-570-214-9606

1-570-214-6768

Pennsylvania

GEISINGER INDEMNITY INSURANCE COMPANY Geisinger Gold PDP

1-570-214-9606

1-570-214-6768

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

PennsylvaniaHEALTH ASSURANCE PENNSYLVANIA, INC. Advantra PPO Local CCP

1-801-954-3043

rlwilliams@cvty.com

Pennsylvania

1-916-463-9603

1-916-463-9750

PennsylvaniaHEALTHAMERICA PENNSYLVANIA, INC.

HealthAmerica Advantra Local CCP

Director, Pharmacy OPS Williams Roger L

1-801-954-3043

rlwilliams@cvty.com

Pennsylvania

1-615-565-8110

1-615-234-2154

PennsylvaniaHIGHMARK SENIOR RESOURCES INC.

Highmark Senior Resources Inc. PDP

Manager, Clinical Pharmacy Services Culley Eric

1-412-544-4005

1-412-544-4092

eric.culley@highmark.com

120 Fifth Avenue Ste. 1812 Pittsburgh PA 15222

Pennsylvania HIGHMARK, INC. Highmark Inc. Local CCPManager- Clincal Services Culley Eric

1-412-544-4005

1-412-544-7546

120 Fifth Avenue Place Suite 1812 Pittsburgh PA 15222

PennsylvaniaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

PennsylvaniaINDEPENDENCE BLUE CROSS Personal Choice 65 Local CCP

1-215-241-4016

1901 Market Street 29th Fl. Philadelphia PA 19103

PennsylvaniaKEYSTONE HEALTH PLAN CENTRAL,INC.

Keystone Health Plan Central, Inc. Local CCP Frost Lisa

1-717-703-8466

lisa.frost@capbluecross.com

PennsylvaniaKEYSTONE HEALTH PLAN EAST, INC. Keystone 65 Local CCP

1-215-241-4016

Kimberly.siejak@ibx.com

1901 Market Street 29th Fl. Philadelphia PA 19103

PennsylvaniaKEYSTONE HEALTH PLAN WEST, INC.

Keystone Health Plan West, Inc. Local CCP

Manager - Clinical Services Culley Eric

1-412-544-4005

1-412-544-7546

Pennsylvania

1-201-269-6717

1-201-269-1008

PennsylvaniaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Pennsylvania

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Pennsylvania

1-401-333-3987 7941

1-800-373-0238

Pennsylvania

QCC INS CO D/B/A AMERIHEALTH INS CO

AmeriHealth Advantage PDP

1-215-937-5352

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Pennsylvania

QCC INS CO D/B/A AMERIHEALTH INS CO AmeriHealth Rx PDP

1-215-241-7928

1901 Market Street 22nd Floor Philadelphia PA 19103

PennsylvaniaQCC INSURANCE COMPANY Select Advantage PFFS

1-215-241-4016

1901 Market Street, 29th flr 29th flr Philadelphia PA 19103

Pennsylvania RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

PennsylvaniaSENIOR PARTNERS BY BRAVO HEALTH Senior Partners Local CCP

1-800-625-9432

1-866-464-0709

Heather.Owens@BravoHealth.com

Pennsylvania

1-702-877-8377

Pennsylvania

1-866-443-0934

Pennsylvania

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Pennsylvania

1-314-810-6102

Pennsylvania

1-765-526-2515

Pennsylvania

1-765-526-2515

Pennsylvania

UNISON HEALTH PLAN OF PENNSYLVANIA, INC. Unison Advantage Local CCP Brekosky Robert

1-412-349-6167

1-412-457-1616

Pennsylvania

1-972-569-3646

1-972-569-3679

Pennsylvania

1-949-252-4339

1-949-474-4237

Pennsylvania

1-949-221-9994

1-949-747-4237

Pennsylvania

1-949-221-9994

1-949-747-4237

Pennsylvania

1-949-221-9994

1-949-747-4237

Pennsylvania

1-949-221-9994

1-949-747-4237

Pennsylvania

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Pennsylvania

UNIVERSITY OF PITTSBURGH MEDICAL CENTER UPMC Health Plan Local CCP

1-412-454-5539

PennsylvaniaUPMC HEALTH BENEFITS, INC UPMC Health Plan PDP

1-412-454-5539

PennsylvaniaUPMC HEALTH NETWORK UPMC Health Plan Local CCP

1-412-454-5539

Pennsylvania

1-813-290-6200 6620

Pennsylvania

1-813-290-6200 5119

Puerto RicoAMERICAN HEALTH, INC.

American Health Medicare Local CCP

Pharmacy and Delegated Entities Manager Hernandez Carmen

1-787-620-1919 4054

1-787-620-0929

chernandez@ahmpr.com

American Health Medicare

P.O. Box 11320 San Juan PR 922

Puerto RicoAUXILIO PLATINO, INC. Auxilio Platino Local CCP

Clinical Pharmacist Muniz Omaris M

1-787-273-1110 2459

1-787-625-8445

omuniz@ssspr.com PO Box 363628 San Juan PR 936

Puerto Rico

COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO CosviMed Care Local CCP Miller Scott A

1-847-964-6944

1-847-374-2645

1411 Lake Cook Road, MS-L-415 Deerfield IL 60015

Puerto Rico

COOPERATIVE DE SEGUROS DE VIDA DE PUERTO RICO CosviMed Care PDP Miller Scott A

1-847-964-6944

1-847-374-2645

1411 Lake Cook Road, MS-L-415 Deerfield IL 60015

Puerto RicoFIRST MEDICAL HEALTH PLAN, INC

First Medical Health Plan, Inc. PDP

pharmacy manager Soto Ivette

1-866-515-5885 337

1-787-625-8544

iv.soto@firstpluspr.com PO box 195080 San Juan PR 60062

Puerto RicoFIRST MEDICAL HEALTH PLAN, INC.

First Medical Health Plan, Inc. Local CCP

Pharmacy manager Soto Ivette

1-866-515-5885 337

1-787-625-8544

iv.soto@firstpluspr.com

First Medical Health Plan

PO box 191580 San Juan PR 919

Puerto RicoFIRST MEDICAL HEALTH PLAN, INC.

First Medical Health Plan, Inc. Local CCP

Pharmacy manager Soto Ivette

1-866-515-5885

1-787-625-1189

iv.soto@firstpluspr.com

First Medical Health Plan

PO box 191580 San Juan PR 919

Puerto Rico

HUMANA HEALTH PLANS OF PUERTO RICO INC

Humana Health Plans Of Puerto Rico Inc Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

Puerto Rico

HUMANA INSURANCE OF PUERTO RICO, INC

Humana Insurance Of Puerto Rico, Inc PFFS Ewing Joy

1-502-580-3538

jewing@humana.com

Puerto Rico

HUMANA INSURANCE OF PUERTO RICO, INC

Humana Insurance of Puerto Rico, Inc PDP Ewing Joy

1-502-580-3538

jewing@humana.com

Puerto Rico

HUMANA INSURANCE OF PUERTO RICO, INC.

Humana Insurance of Puerto Rico, Inc. Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

Puerto Rico

MAPFRE LIFE INSURANCE COMPANY

MAPFRE LIFE INSURANCE COMPANY Local CCP Moyna Audrey

1-847-559-3999

1-847-559-4733

Puerto RicoMCS ADVANTAGE INC. MCS Classicare Local CCP

Pharmacy Clinical Director Rodriguez Carolyn

1-787-758-2500 2700

carodriguez@medicalcardsystem.com PO Box 191720 San Juan PR 919

Puerto RicoMCS ADVANTAGE INC. RedMed Local CCP

1-787-758-2500 2700

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Puerto RicoMCS ADVANTAGE, INC. MCS Classicare PDP

1-787-758-2500 2700

Puerto Rico

MCS LIFE INSURANCE COMPANY MCS Classicare PFFS

1-787-758-2500 2700

Puerto Rico

1-201-269-6717

1-201-269-1008

Puerto Rico

MENNONITE GENERAL HOSPITAL, INC

Menonita Medicare Advantage PDP

Director Clinical Education Miller Scott A

1-847-964-6762

1-847-374-2645

Puerto Rico

MENNONITE GENERAL HOSPITAL, INC.

Menonita Medicare Advantage Local CCP

Director, Clinical Education Miller Scott A

1-847-964-6944

1-847-374-2645

Puerto RicoMMM HEALTHCARE, INC. Medicare y Mucho Más Local CCP

AVP Pharmacy Services Reyes Maria J

1-787-354-7999

1-787-300-5503

maria.reyes@mmmhc.com

Bechara Industrial Park, Marginal Ave. Kennedy

Segarra Street Bldg., No. 411 San Juan PR 936

Puerto Rico

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Puerto Rico

PHARMACY INSURANCE CORPORATION OF AMERICA

Pharmacy Insurance Corporation of America - PICA PDP Clinical Echevarria Irma

1-787-625-4343 4711

1-787-625-4363

ieche@picapr.com PO Box 70232 San Juan PR 936

Puerto RicoPREFERRED HEALTH INC. Preferred Medicare PFFS

Medicare Consultant Perez Awilda

1-787-751-3701

1-787-751-3718

awilda.rodriguez-castro@walgreens.com

273 Ponce de Leon Avenue Suite 801 San Juan PR 917

Puerto Rico

PREFERRED MEDICARE CHOICE, INC.

Preferred Medicare Choice, Inc. Local CCP

VP Pharmacy Services Reyes Maria J

1-787-354-7999

1-787-300-5503

Bechara Industrial Park, Marginal Ave., Kennedy

Segarra Street Bldg. No.411 San Juan PR 936

Puerto Rico

PREFERRED MEDICARE CHOICE, INC.

Preferred Medicare Choice, Inc. PDP

AVP Pharmacy Services Reyes Maria J

1-787-354-7999

1-787-300-5503

Bechara Industrial Park, Marginal Ave., Kennedy

Segarra Street Bldg., No. 411 San Juan PR 936

Puerto RicoPROSALUD HMO, CORP. ProSalud HMO Corp Local CCP

Director Clinical Education Miller Scott

1-847-964-6944

Puerto RicoSDM HEALTHCARE MANAGEMENT, INC.

Salud Dorada con Medicare Local CCP Medical Director Irizarry Maria

1-787-999-4848

1-787-999-7941

mara.irizarry@sdmpr.com P.O Box 3078 Bayamon PR 960

Puerto Rico

1-866-443-0934

Puerto Rico TRIPLE-S, INC. Triple-S PDPClinical Pharmacist Muniz Omaris M

1-787-273-1110 2459

1-787-625-8445

Puerto Rico TRIPLE-S, INC. Triple-S, Inc. Local CCPClinical Pharmacist Muniz Omaris M

1-787-273-1110 2459

1-787-625-8445

Puerto Rico TRIPLE-S, INC. Triple-S, Inc. Local CCPClinical Pharmacist Muniz Omaris M

1-787-273-1110 2459

1-787-625-8445

Puerto Rico

1-949-252-4339

1-949-474-4237

Puerto Rico

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Rhode Island

1-386-963-2543

1-860-754-1481

Rhode Island

1-386-963-2543

1-860-754-1481

Rhode Island

BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND

Blue Cross & Blue Shield Of Rhode Island Local CCP

MTM Clinical Interventions Manager Hettich Lisa

1-765-526-2515

1-765-391-1023

8407 Fallbrook Ave West Hills CA 91304

Rhode Island BLUE MEDICARERX Blue MedicareRx PDPClinical Pharmacist Hettich Lisa

1-765-526-2515

Rhode Island

1-860-226-6731

yi.zheng@cigna.com

Rhode Island

1-330-405-8080 6320

1-330-405-8081

Rhode Island

1-801-954-3043

rlwilliams@cvty.com

Rhode Island

1-801-954-3043

rlwilliams@cvty.com

Rhode Island

1-916-463-9603

1-916-463-9750

Rhode Island

1-615-565-8110

1-615-234-2154

Rhode IslandHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Rhode IslandHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Rhode Island

1-201-269-6717

1-201-269-1008

Rhode Island

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Rhode Island

1-401-333-3987 7941

1-800-373-0238

Rhode Island RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Rhode Island

1-866-443-0934

Rhode Island

1-314-810-6102

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Rhode Island

1-765-526-2515

Rhode Island

1-765-526-2515

Rhode Island

1-972-569-3646

1-972-569-3679

Rhode Island

1-949-252-4339

1-949-474-4237

Rhode Island

UNITED HEALTH PLANS OF NEW ENGLAND, INC.

1-949-221-9994

1-949-747-4237

Rhode Island

1-949-221-9994

1-949-747-4237

Rhode Island

1-949-221-9994

1-949-747-4237

Rhode Island

1-949-221-9994

1-949-747-4237

Rhode Island

1-949-252-4339

1-949-474-4237

Rhode Island

1-813-290-6200 5119

South Carolina

1-386-963-2543

1-860-754-1481

South Carolina

1-386-963-2543

1-860-754-1481

South Carolina

AMERICA'S 1ST CHOICE HEALTH PLANS, INC.

AMERICA'S 1ST CHOICE HEALTH PLANS, INC. PFFS Pharmacy Schoening Shellie

1-800-546-5677 1110

1-866-632-7946

schoening@pti-nps.com

13660 California Street Omaha NE 68154

South CarolinaARCADIAN HEALTH PLAN, INC.

1-909-971-6816

1-909-971-6866

South Carolina

BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA

Blue Cross Blue Shield of South Carolina Local CCP

Director - Provider Contracting Baughman Angie

1-803-264-3234

1-803-419-8020

Angie.Baughman@BCBSSC.com

I-20 at Alpine Road Columbia SC 29219

South Carolina

BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA

Blue Cross Blue Shield of South Carolina PDP

Director - Provider Contracting Baughman Angie

1-803-264-3234

1-803-419-8020

Angie.Baughman@BCBSSC.com

I-20 at Alpine Road Columbia SC 29219

South Carolina

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO

1-866-443-0934

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

South Carolina

1-215-988-6835

1-215-557-7437

South Carolina

1-860-226-6731

yi.zheng@cigna.com

South Carolina

1-860-226-6731

yi.zheng@cigna.com

South Carolina

1-801-954-3043

rlwilliams@cvty.com

South Carolina

1-801-954-3043

rlwilliams@cvty.com

South Carolina

1-330-405-8080 6320

1-330-405-8081

South Carolina

1-801-954-3043

rlwilliams@cvty.com

South Carolina

1-916-463-9603

1-916-463-9750

South Carolina

1-615-565-8110

1-615-234-2154

South CarolinaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

South Carolina

INSTIL HEALTH INSURANCE COMPANY

InStil Health Insurance Company PDP

Director Medical Services Lachuk Lester

1-803-763-6559

1-803-935-1605

Lester.Lachuk@myinstil.com

17 Technology Circle, AG-790 Columbia SC 29203

South Carolina

1-201-269-6717

1-201-269-1008

South Carolina

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

South Carolina

1-401-333-3987 7941

1-800-373-0238

South Carolina

South Carolina RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

South Carolina

SELECT HEALTH OF SOUTH CAROLINA, INC. PerformRx PDP

1-215-937-5352

South Carolina

1-702-877-8377

South Carolina

1-866-443-0934

South Carolina

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

South Carolina

1-314-810-6102

South Carolina

1-765-526-2515

South Carolina

1-765-526-2515

South Carolina

1-972-569-3646

1-972-569-3679

South Carolina

1-949-252-4339

1-949-474-4237

South Carolina

1-949-221-9994

1-949-747-4237

South Carolina

1-949-252-4339

1-949-474-4237

South Carolina

1-800-546-5677 1110

South Carolina

1-813-290-6200 6620

South Carolina

1-813-290-6200 5119

South CarolinaWINDSOR HEALTH PLAN, INC Windsor Rx PDP Pharmacy Director King Sonya

1-615-782-7860

1-615-782-7822

South CarolinaWINDSOR HEALTH PLANS, INC.

1-615-782-7860

1-615-782-7822

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

South Dakota

1-386-963-2543

1-860-754-1481

South Dakota

1-386-963-2543

1-860-754-1481

South Dakota

1-651-662-8758

1-651-662-6009

South Dakota

1-651-662-8758

1-651-662-6009

South Dakota

1-860-226-6731

yi.zheng@cigna.com

South Dakota

COVENTRY HEALTH AND LIFE INSURANCE CO. (SOUTH DAKO

Director Pharmacy Ops. Williams Roger

1-801-954-3043

rlwilliams@cvty.com

South Dakota

1-801-954-3043

rlwilliams@cvty.com

South Dakota

1-330-405-8080 6320

1-330-405-8081

South Dakota

1-801-954-3043

rlwilliams@cvty.com

South Dakota

1-801-954-3043

rlwilliams@cvty.com

South DakotaFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

South Dakota

1-916-463-9603

1-916-463-9750

South Dakota

1-615-565-8110

1-615-234-2154

South DakotaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

South DakotaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

South Dakota

1-201-269-6717

1-201-269-1008

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

South DakotaMEDICA INSURANCE COMPANY

1-952-992-2469

South DakotaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

South Dakota

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

South Dakota

1-401-333-3987 7941

1-800-373-0238

South Dakota

South Dakota RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

South Dakota

1-866-443-0934

South Dakota

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

South Dakota

1-314-810-6102

South Dakota

1-765-526-2515

South Dakota

1-765-526-2515

South Dakota

1-972-569-3646

1-972-569-3679

South Dakota

1-949-252-4339

1-949-474-4237

South Dakota

1-949-221-9994

1-949-747-4237

South Dakota

1-949-252-4339

1-949-474-4237

South Dakota

1-813-290-6200 6620

South Dakota

1-813-290-6200 5119

Tennessee AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Tennessee

1-386-963-2543

1-860-754-1481

Tennessee

1-386-963-2543

1-860-754-1481

Tennessee

1-386-963-2543

1-860-754-1481

TennesseeAMERIGROUP TENNESSEE, INC.

1-757-518-3420

Tennessee

BCBS OF ALABAMA AND BCBS OF TENNESSEE BlueRx PDP

1-205-220-6522

playne@bcbsal.org

Tennessee

BLUE CROSS BLUE SHIELD OF TENNESSEE

BlueCross BlueShield of Tennessee Local CCP Barry Lesley

1-334-213-6653

1-334-213-6617

lbarry@bcbsal.org

TennesseeCARITEN HEALTH PLAN IN Cariten Senior Health Local CCP

Pharmacy supervisor Feliciano Susan

1-865-670-7340

sfelicia@covhlth.com

1420 Centerpoint Blvd Knoxville TN 37932

TennesseeCARITEN INSURANCE COMPANY

Cariten Senior Health (PPO) Local CCP Pharmacy Director Ciufo John

1-865-670-7382

1-865-670-7205

jciufo1@covhlth.com

1420 Centerpoint Blvd Knoxville TN 37932

Tennessee

1-215-988-6835

1-215-557-7437

Tennessee

1-860-226-6731

yi.zheng@cigna.com

Tennessee

1-860-226-6731

yi.zheng@cigna.com

Tennessee

1-801-954-3043

rlwilliams@cvty.com

Tennessee

1-801-954-3043

rlwilliams@cvty.com

Tennessee

1-330-405-8080 6320

1-330-405-8081

Tennessee

1-801-954-3043

rlwilliams@cvty.com

Tennessee

1-916-463-9603

1-916-463-9750

Tennessee

1-615-565-8110

1-615-234-2154

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

TennesseeHEALTHSPRING OF TENNESSEE, INC. Healthspring Local CCP

1-615-565-8110

1-615-234-2154

TennesseeHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Tennessee

1-201-269-6717

1-201-269-1008

Tennessee

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Tennessee

1-401-333-3987 7941

1-800-373-0238

Tennessee

Tennessee RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Tennessee

1-702-877-8377

Tennessee

1-866-443-0934

Tennessee

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Tennessee

1-314-810-6102

TennesseeUAHC HEALTH PLAN OF TENNESSEE, INC. UAHC Gold Local CCP Vice President Northway Cynthia

1-515-237-0001 126

1-515-237-0002

cnorthway@getoutcomes.com

601 E. Locust, Suite 100 Des Moines IA 50309

Tennessee

1-765-526-2515

Tennessee

1-765-526-2515

Tennessee

1-412-349-6167

1-412-457-1616

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Tennessee

1-972-569-3646

1-972-569-3679

Tennessee

1-949-252-4339

1-949-474-4237

Tennessee

1-949-221-9994

1-949-747-4237

Tennessee

1-949-221-9994

1-949-747-4237

Tennessee

1-949-252-4339

1-949-474-4237

Tennessee

UNITED HEALTHCARE OF TENNESSEE, INC.

1-949-221-9994

1-949-747-4237

Tennessee

1-949-221-9994

1-949-747-4237

Tennessee

UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.

AmeriChoice Secure Plus Complete Local CCP Pharmacy Director Cabrera Lourdes

1-954-858-4302

1-954-858-3765

lcabrera@uhc.com

13621 NW 12TH ST SUNRISE FL 33323

Tennessee

1-813-290-6200 6620

Tennessee

1-813-290-6200 5119

TennesseeWINDSOR HEALTH PLAN, INC Windsor Rx PDP Pharmacy Director King Sonya

1-615-782-7860

1-615-782-7822

TennesseeWINDSOR HEALTH PLANS, INC.

1-615-782-7860

1-615-782-7822

Texas AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

TexasAMERIGROUP TEXAS, INC.

1-757-518-3420

TexasARCADIAN HEALTH PLAN, INC.

Texas Community Care Local CCP

1-909-971-6816

1-909-971-6866

TexasARKANSAS COMMUNITY CARE

Arkansas Community Care, Inc. Local CCP

1-909-971-6816

1-909-971-6866

BRAVO HEALTH INSURANCE COMPANY, INC. Bravo Health PFFS

1-800-625-9432

1-866-464-0709

EHCMS.issues@bravohealth.com

TexasBRAVO HEALTH TEXAS, INC. Bravo Health Local CCP

1-800-625-9432

1-866-464-0709

CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY

1-866-443-0934

1-215-988-6835

1-215-557-7437

1-860-226-6731

yi.zheng@cigna.com

1-860-226-6731

yi.zheng@cigna.com

1-801-954-3043

rlwilliams@cvty.com

1-801-954-3043

rlwilliams@cvty.com

1-330-405-8080 6320

1-330-405-8081

TexasEVERCARE OF TEXAS, LLC

1-949-221-9994

1-949-747-4237

FIDELIS SECURECARE OF TEXAS, INC.

Fidelis SecureCare of Texas, Inc. Local CCP

Chief Medical Officer Sarran Scott

1-877-372-6203

1-847-517-1085

scott.sarran@fidelissc.com

1700 East Golf Road Suite 1115 Schaumburg IL 60173

1-801-954-3043

rlwilliams@cvty.com

TexasHCSC INSURANCE SERVICES COMPANY

1-651-286-4206

1-651-286-4403

TexasHCSC INSURANCE SERVICES COMPANY

HISC - Blue Cross Blue Shield of Texas Local CCP

Pharmacy Director, Government Programs Nguyen Marie

1-651-286-4206

1-651-286-4403

Prime Therapeutics

1020 Discovery Road, No. 100 Egan MN 55121

1-916-463-9603

1-916-463-9750

1-916-463-9603

1-916-463-8056

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-615-565-8110

1-615-234-2154

TexasHUMANA HEALTH PLAN OF TEXAS,INC.

Humana Health Plan of Texas, Inc. Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

TexasHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

KS PLAN ADMINISTRATORS, LLC KelseyCare Advantage Local CCP

Director Pharmacy and Infusion Services Salinas Cathryn

1-713-442-5251

1-713-442-5253

Cathy.Salinas@kelsey-seybold.com

8900 Lakes at 610 Drive Houston TX 77054

1-201-269-6717

1-201-269-1008

MOLINA HEALTHCARE OF TEXAS, INC.

Molina Healthcare of Texas, Inc. Local CCP

1-801-858-0466

1-801-748-0536

TexasPACIFICARE OF TEXAS, INC.

1-949-221-9994

1-949-747-4237

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

1-401-333-3987 7941

1-800-373-0238

TexasPSO HEALTH SERVICES, LLC

PHYSICIANS HEALTH CHOICE Local CCP

Vice President of Pharmacy - Envision Peterson Amanda

1-330-486-6302

2181 E. Aurora Rd. STE 201 Twinsburg OH 44087

Texas RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

TexasSCOTT AND WHITE HEALTH PLAN

Scott and White Health Plan SeniorCare 1876 Cost PharmD Gabrillo Evelyn

1-254-298-6152

1-254-298-6189

egabrillo@swmail.sw.org

4236 Lowes Drive Suite 100 Temple TX 76502

TexasSCOTT AND WHITE HEALTH PLAN

Scott and White Health PlanTexas Rx Plan PDP

Patient Care Pharmacist Gabrillo Evelyn

1-254-298-6152

1-254-298-6189

egabrillo@swmail.sw.org

4236 Lowes Drive Suite 100 Temple TX 76502

TexasSELECTCARE HEALTH PLANS, INC.

TexasFirst Health Plans Local CCP

TexasSELECTCARE OF TEXAS, L.L.C.

SelectCare of Texas, LLC Local CCP

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Texas SHA, L.L.C FirstCare Advantage Local CCP

Director of Pharmacy Services Crognale III Louis

1-512-257-6206

1-512-257-6016

lcrognale@FirstCare.com

12940 North Highway 183 Austin TX 78750

1-702-877-8377

1-866-443-0934

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

1-314-810-6102

TexasSUPERIOR HEALTH PLAN, INC.

Advantage by SuperiorHealthPlan Local CCP

1-732-476-1047

1-732-549-5824

mpica@centene.com

TexasTEXAS HEALTHSPRING LLC Texas HealthSpring Local CCP

1-615-565-8110

1-615-234-2154

1-765-526-2515

1-972-569-3646

1-972-569-3679

1-949-252-4339

1-949-474-4237

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

1-949-221-9994

1-949-747-4237

1-949-252-4339

1-949-474-4237

1-800-546-5677 1110

VALLEY BAPTIST INSURANCE COMPANY

Valley Baptist Health Plans Local CCP

Directory of Pharmacy Services Crognale III Louis

1-512-257-6206

1-512-257-6016

lcrognale@firstcare.com

12940 N. Highway 183 Austin TX 78750

1-813-290-6200 6620

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

TexasWELLCARE OF TEXAS, INC. WellCare Local CCP

1-813-290-6200 6620

Qiana.Rackley@wellcare.com

1-813-290-6200 5119

1-386-963-2543

1-860-754-1481

1-386-963-2543

1-860-754-1481

UtahALTIUS HEALTH PLANS, INC. (UTAH) Altius Advantra Local CCP

1-801-954-3043

rlwilliams@cvty.com

1-215-988-6835

1-215-557-7437

1-860-226-6731

yi.zheng@cigna.com

1-801-954-3043

rlwilliams@cvty.com

Educators Mutual Insurance Association PFFS Gedge Nathan

1-801-262-7476 2974

ngedge@educatorsmutual.com

Educators Mutual Insurance Association PDP Gallegos Jennifer

1-801-262-7476

jgallegos@educatorsmutual.com

1-330-405-8080 6320

1-330-405-8081

1-801-954-3043

rlwilliams@cvty.com

1-801-954-3043

rlwilliams@cvty.com

1-916-463-9603

1-916-463-9750

1-615-565-8110

1-615-234-2154

UtahHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

UtahHUMANA MEDICAL PLAN OF UTAH

Humana Medical Plan of Utah Local CCP Ewing Joy

1-502-580-3538

jewing@humana.com

1-201-269-6717

1-201-269-1008

MOLINA HEALTHCARE OF UTAH, INC.

Molina Healthcare of Utah Local CCP

1-801-858-0466

1-801-748-0536

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

1-401-333-3987 7941

1-800-373-0238

REGENCE BLUECROSS BLUESHIELD OF UT

Regence BlueCross BlueShield of Utah Local CCP

1-208-395-7732

1-208-395-7744

rjleona@regence.com

REGENCE LIFE AND HEALTH INSURANCE COMPANY

Regence Life and Health PDP

1-208-395-7732

1-208-395-7744

rjleona@regence.com

Utah RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

1-702-877-8377

1-866-443-0934

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

1-314-810-6102

1-765-526-2515

1-972-569-3646

1-972-569-3679

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

1-949-221-9994

1-949-747-4237

1-949-252-4339

1-949-474-4237

UtahUNITEDHEALTHCARE OF UTAH, INC.

1-949-221-9994

1-949-747-4237

1-800-546-5677 1110

1-813-290-6200 6620

1-813-290-6200 5119

Vermont

1-386-963-2543

1-860-754-1481

Vermont

1-386-963-2543

1-860-754-1481

Vermont

Vermont BLUE MEDICARERX Blue MedicareRx PDPClinical Pharmacist Hettich Lisa

1-765-526-2515

Vermont

1-860-226-6731

yi.zheng@cigna.com

Vermont

1-860-226-6731

yi.zheng@cigna.com

Vermont

1-330-405-8080 6320

1-330-405-8081

Vermont

1-801-954-3043

rlwilliams@cvty.com

Vermont

1-801-954-3043

rlwilliams@cvty.com

Vermont

1-916-463-9603

1-916-463-9750

Vermont

1-615-565-8110

1-615-234-2154

VermontHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

VermontHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Vermont

1-201-269-6717

1-201-269-1008

Vermont

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Vermont

1-401-333-3987 7941

1-800-373-0238

Vermont RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Vermont

1-866-443-0934

Vermont

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Vermont

1-314-810-6102

Vermont

1-765-526-2515

Vermont

1-765-526-2515

Vermont

1-972-569-3646

1-972-569-3679

Vermont

1-949-252-4339

1-949-474-4237

Vermont

1-949-221-9994

1-949-747-4237

Vermont

1-949-252-4339

1-949-474-4237

Vermont

1-813-290-6200 5119

Virgin Islands

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Virgin Islands

1-949-252-4339

1-949-474-4237

Virgin Islands

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Virginia AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Virginia

1-386-963-2543

1-860-754-1481

Virginia

1-386-963-2543

1-860-754-1481

Virginia

1-386-963-2543

1-860-754-1481

Virginia

ANTHEM HEALTH PLANS OF VIRGINIA, INC.

1-765-526-2515

VirginiaANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

VirginiaANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

Virginia

1-215-988-6835

1-215-557-7437

Virginia

1-860-226-6731

yi.zheng@cigna.com

Virginia

1-860-226-6731

yi.zheng@cigna.com

Virginia

1-801-954-3043

rlwilliams@cvty.com

Virginia

1-801-954-3043

rlwilliams@cvty.com

VirginiaDAVITA VILLAGE HEALTH, INC.

DaVita VillageHealth of Virginia, Inc. Local CCP

1-518-932-4416

Virginia

1-330-405-8080 6320

1-330-405-8081

Virginia

1-801-954-3043

rlwilliams@cvty.com

Virginia

1-916-463-9603

1-916-463-9750

Virginia

1-916-463-9603

1-916-463-8056

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Virginia

1-615-565-8110

1-615-234-2154

VirginiaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

Virginia

1-301-816-6835

Virginia

1-201-269-6717

1-201-269-1008

VirginiaMENNONITE MUTUAL AID ASSOCIATION

1-847-559-3999

1-847-559-4733

Virginia

OPTIMA HEALTH INSURANCE COMPANY Optima Medicare Local CCP

Clinical Pharmacist Brusig Elizabeth

1-757-552-7519

1-757-552-7516

elbrusig@sentara.com

4417 Corporation Lane Virginia Beach VA 23462

Virginia

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Virginia

1-401-333-3987 7941

1-800-373-0238

Virginia

Virginia RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Virginia

1-702-877-8377

Virginia

1-866-443-0934

Virginia

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Virginia

1-314-810-6102

Virginia

1-765-526-2515

Virginia

1-765-526-2515

Virginia

1-972-569-3646

1-972-569-3679

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Virginia

1-949-252-4339

1-949-474-4237

Virginia

1-949-221-9994

1-949-747-4237

Virginia

1-949-221-9994

1-949-747-4237

Virginia

1-949-221-9994

1-949-747-4237

Virginia

1-949-221-9994

1-949-747-4237

Virginia

1-949-252-4339

1-949-474-4237

Virginia

1-949-221-9994

1-949-747-4237

VirginiaVIRGINIA PREMIER HEALTH PLAN, INC. Virginia Premier Gold Local CCP

Supervisor Pharmacy DUR/MTM Lawson Mark

1-215-937-5352

1-215-937-8450

Virginia

1-813-290-6200 6620

Virginia

1-813-290-6200 5119

Washington

1-386-963-2543

1-860-754-1481

Washington

1-386-963-2543

1-860-754-1481

WashingtonARCADIAN HEALTH PLAN

Spokane Community Care Local CCP

1-909-971-6816

1-909-971-6866

WashingtonASURIS NORTHWEST HEALTH

Asuris Northwest Health Local CCP

1-208-395-7732

1-208-395-7744

rjleona@regence.com

WashingtonASURIS NORTHWEST HEALTH

Asuris Northwest Health PDP

1-208-395-7732

1-208-395-7744

Washington

1-215-988-6835

1-215-557-7437

Washington

COMMUNITY HEALTH PLAN OF WASHINGTON

Community HealthFirst Medicare Advantage Plan Local CCP Hirsch Jeff

1-314-810-6102

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Washington

1-860-226-6731

yi.zheng@cigna.com

Washington

1-801-954-3043

rlwilliams@cvty.com

Washington

1-330-405-8080 6320

1-330-405-8081

Washington ESSENCE L.L.P. Essence Healthcare Local CCP Director of QA Keys Mary Kay1-314-851-3664

1-314-851-3610

Washington

1-801-954-3043

rlwilliams@cvty.com

Washington

1-801-954-3043

rlwilliams@cvty.com

WashingtonFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

WashingtonGROUP HEALTH COOPERATIVE

Group Health Cooperative Local CCP

Associate Director of Clinical Pharmacy Operations Reitz Shirley

1-206-901-4334 reitz.sj@ghc.org

Group Health Cooperative

12400 E. Marginal Way South Seattle WA 98168

Washington

1-916-463-9603

1-916-463-9750

Washington

Health Net Medicare Advantage Local CCP

Vice President, Operations - HNPS

1-916-463-9603

Mail Top: CA-175-02-02 Rancho Cordova CA 95670

Washington

1-916-463-9603

1-916-463-8056

Washington

1-615-565-8110

1-615-234-2154

WashingtonHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

WashingtonHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

WashingtonKAISER FOUNDATION HP OF THE N W

1-503-261-7980

Steve.Logan@kp.org

WashingtonKAISER FOUNDATION HP OF THE N W

1-503-261-7980

Steve.Logan@kp.org

Washington

1-201-269-6717

1-201-269-1008

Washington

MOLINA HEALTHCARE OF WASHINGTON, INC.

Molina Healthcare of Washington, Inc. Local CCP

1-801-858-0466

1-801-748-0536

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

WashingtonODS HEALTH PLAN, INC. ODS Health Plan, Inc. PDP

1-503-265-4719

1-503-265-4790

WashingtonPACIFICARE OF WASHINGTON, INC.

1-949-221-9994

1-949-747-4237

Washington

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Washington

1-401-333-3987 7941

1-800-373-0238

WashingtonPROVIDENCE HEALTH PLAN Providence Health Plan Local CCP

PHARMACY DIRECTOR NOONAN HELEN M

1-503-574-5708

1-503-574-8646

HELEN.NOONAN@PROVIDENCE.ORG PO BOX 3125 PORTLAND OR 97208

Washington

PUGET SOUND HEALTH PARTNERS, INC.

Puget Sound Health Partners Local CCP Pharmacist Low Jeff

1-801-961-6000

221 N Charles Lindbergh Dr Salt Lake City UT 84116

Washington

WashingtonREGENCE BLUE SHIELD OF IDAHO

Regence BlueShield Of Idaho Local CCP

1-208-395-7732

1-208-395-7744

rleona@regence.com

Washington

REGENCE BLUECROSS BLUESHIELD OF OR

Regence BlueCross BlueShield of Oregon Local CCP

1-208-395-7732

1-208-395-7744

rjleona@regence.com

WashingtonREGENCE BLUESHIELD Regence BlueShield Local CCP

Clinical Pharmacist Consultant III Leonard Ruth J

1-208-395-7732

1-208-395-7744

Washington RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Washington

1-702-877-8377

Washington

1-866-443-0934

Washington

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Washington

1-314-810-6102

Washington

1-765-526-2515

Washington

1-765-526-2515

Washington

1-972-569-3646

1-972-569-3679

Washington

1-949-252-4339

1-949-474-4237

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Washington

1-949-221-9994

1-949-747-4237

Washington

1-949-221-9994

1-949-747-4237

Washington

1-949-221-9994

1-949-747-4237

Washington

1-949-252-4339

1-949-474-4237

Washington

1-813-290-6200 6620

Washington

1-813-290-6200 5119

Washington D.C. AETNA HEALTH INC. Aetna Medicare Local CCP

1-386-963-2543

1-860-754-1481

Washington D.C.

1-386-963-2543

1-860-754-1481

Washington D.C.

1-386-963-2543

1-860-754-1481

Washington D.C.

1-386-963-2543

1-860-754-1481

Washington D.C.

1-386-963-2543

1-860-754-1481

Washington D.C.BRAVO HEALTH MID- ATLANTIC INC. Bravo Health PFFS

1-410-864-4583

1-866-464-0709

Washington D.C.BRAVO HEALTH MID- ATLANTIC INC. Bravo Health Local CCP

1-800-625-9432

1-866-464-0709

Washington D.C.

1-860-226-6731

yi.zheng@cigna.com

Washington D.C.

1-801-954-3043

rlwilliams@cvty.com

Washington D.C.

1-801-954-3043

rlwilliams@cvty.com

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Washington D.C.DAVITA VILLAGEHEALTH, INC.

DaVita VillageHealth of DC, Inc. Local CCP

1-518-932-4416

Washington D.C.

1-330-405-8080 6320

1-330-405-8081

Washington D.C. FIRST CARE, INC.Medi-CareFirst BlueCross BlueShield PDP

1-410-528-7897

Washington D.C.

1-801-954-3043

rlwilliams@cvty.com

Washington D.C.

1-916-463-9603

1-916-463-9750

Washington D.C.

1-615-565-8110

1-615-234-2154

Washington D.C.HUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Washington D.C.

1-301-816-6835

Washington D.C.

1-201-269-6717

1-201-269-1008

Washington D.C.

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Washington D.C.

1-401-333-3987 7941

1-800-373-0238

Washington D.C. RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Washington D.C.

1-702-877-8377

Washington D.C.

1-866-443-0934

Washington D.C.

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Washington D.C.

1-314-810-6102

Washington D.C.

1-765-526-2515

Washington D.C.

1-765-526-2515

Washington D.C.

1-972-569-3646

1-972-569-3679

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Washington D.C.

1-949-252-4339

1-949-474-4237

Washington D.C.

1-949-221-9994

1-949-747-4237

Washington D.C.

1-949-221-9994

1-949-747-4237

Washington D.C.

1-949-221-9994

1-949-747-4237

Washington D.C.

1-949-252-4339

1-949-474-4237

Washington D.C.

1-813-290-6200 6620

Washington D.C.

1-813-290-6200 5119

West Virginia

1-386-963-2543

1-860-754-1481

West Virginia

1-386-963-2543

1-860-754-1481

West Virginia

West VirginiaAVALON INSURANCE COMPANY

Avalon Insurance Company PDP

1-717-703-8466

lisa.frost@securerx.com

West Virginia

1-800-625-9432

1-866-464-0709

West Virginia

1-860-226-6731

yi.zheng@cigna.com

West Virginia

COVENTRY HEALTH AND LIFE INS. COMPANY Carelink Advantra PPO Local CCP

1-801-954-3043

rlwilliams@cvty.com

2650 S. Decker Ln. Salt Lake City UT 84119

West Virginia

1-801-954-3043

rlwilliams@cvty.com

West Virginia

1-801-954-3043

rlwilliams@cvty.com

West Virginia

1-330-405-8080 6320

1-330-405-8081

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

West Virginia

1-801-954-3043

rlwilliams@cvty.com

West Virginia

GEISINGER INDEMNITY INSURANCE COMPANY Geisinger Gold PDP

1-570-214-9606

1-570-214-6768

West Virginia

1-916-463-9603

1-916-463-9750

West Virginia

HEALTH PLAN OF THE UPPER OHIO VALLEY The Health Plan Local CCP

1-740-695-7638

1-740-695-7925

West Virginia

1-615-565-8110

1-615-234-2154

West Virginia

HIGHMARK HEALTH INSURANCE COMPANY

Highmark Health Insurance Company Local CCP

Manager -- Clinical Services Culley Eric

1-412-544-4005

1-412-544-7546

West VirginiaHIGHMARK SENIOR RESOURCES INC.

Highmark Senior Resources Inc. PDP

1-412-544-4005

1-412-544-4092

120 Fifth Avenue Ste. 1812 Pittsburgh PA 15222

West Virginia

HM HEALTH INSURANCE COMPANY

Highmark Health Insurance Company PFFS

1-412-544-4005

1-412-544-4092

120 Fifth Avenue, Ste. 1812 Pittsburgh PA 15222

West VirginiaHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

West Virginia

1-201-269-6717

1-201-269-1008

West Virginia

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

West Virginia

1-401-333-3987 7941

1-800-373-0238

West Virginia

QCC INS CO D/B/A AMERIHEALTH INS CO

AmeriHealth Advantage PDP

1-215-937-5352

West Virginia

QCC INS CO D/B/A AMERIHEALTH INS CO AmeriHealth Rx PDP

1-215-241-7928

1901 Market Street 22nd Floor Philadelphia PA 19103

West Virginia RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

West Virginia

1-702-877-8377

West Virginia

1-866-443-0934

West Virginia

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

West Virginia

1-314-810-6102

West VirginiaTHP INSURANCE COMPANY

Health Plan SecureChoice Local CCP

1-740-695-7638

1-740-695-7925

West VirginiaTHP INSURANCE COMPANY

Health Plan SecureFreedom PFFS

1-740-695-7638

1-740-695-7925

West Virginia

1-765-526-2515

West Virginia

1-765-526-2515

West Virginia

1-972-569-3646

1-972-569-3679

West Virginia

1-949-252-4339

1-949-474-4237

West Virginia

1-949-221-9994

1-949-747-4237

West Virginia

1-949-252-4339

1-949-474-4237

West VirginiaUPMC HEALTH BENEFITS, INC UPMC Health Plan PDP

1-412-454-5539

West Virginia

1-813-290-6200 6620

West Virginia

1-813-290-6200 5119

WisconsinABRI HEALTH PLAN, INC Today's Health Local CCP

Wisconsin

1-386-963-2543

1-860-754-1481

Wisconsin

1-386-963-2543

1-860-754-1481

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

WisconsinANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

WisconsinANTHEM INSURANCE COMPANIES, INC.

1-765-526-2515

WisconsinANTHEM INSURANCE COMPANIES, INC. Blue MedicareRx PDP

1-765-526-2515

WisconsinCARE WISCONSIN HEALTH PLAN, INC.

Care Wisconsin Health Plan, Inc. Local CCP Pharmacist Hetzel Jean

1-608-245-3037

1-608-245-3077

hetzelj@carewisc.org

2802 InternationalLane Madison WI 53704

WisconsinCARE WISCONSIN HEALTH PLAN, INC.

Care Wisconsin Health Plan, Inc. Local CCP Pharmacist Hetzel Jean

1-608-245-3037

1-608-245-3077

hetzelj@carewisc.org

2802 InternationalLane Madison WI 53704

Wisconsin

1-215-988-6835

1-215-557-7437

WisconsinCOMMUNITY CARE HEALTH PLAN, INC Community Care Local CCP

Clinical Pharmacist Supervisor Mueller Richard J

1-414-902-2397

1-414-274-8490

richard.mueller@communitycareinc.org

1555 S. Layton Blvd. Milwaukee WI 53215

WisconsinCOMMUNITY CARE HEALTH PLAN, INC. Community Care Local CCP

Clinical Pharmacist SUpervisor Mueller Richard

1-414-902-2397

richard.mueller@communitycareinc.org

1555 S. Layton Blvd Milwaukee WI 53215

Wisconsin

COMPCARE HEALTH SERVICES INSURANCE CORPORATION

1-765-526-2515

Wisconsin

1-860-226-6731

yi.zheng@cigna.com

Wisconsin

1-801-954-3043

rlwilliams@cvty.com

Wisconsin

1-801-954-3043

rlwilliams@cvty.com

WisconsinDEAN HEALTH INSURANCE, INC.

Dean Health Insurance,Inc. PDP Staresnic Anthony

1-608-827-7513

anthony.staresnic@navitus.com

999 Fourier Drive, Suite 301 Madison WI 53717

Wisconsin

1-330-405-8080 6320

1-330-405-8081

Wisconsin

1-801-954-3043

rlwilliams@cvty.com

Wisconsin

GUNDERSEN LUTHERAN HEALTH PLAN

Gundersen Lutheran Health Plan, Inc. Local CCP Pharmacy Director Schuth Grant C

1-608-775-8059 58059

1-608-775-8790

gcschuth@gundluth.org

1900 South Avenue

Mail Stop NCA2-01 La Crosse WI 54601

Wisconsin

1-916-463-9603

1-916-463-9750

Wisconsin

HEALTHPARTNERS INSURANCE COMPANY

HealthPartners Liberty Medicare PFFS

1-952-967-5818

Wisconsin

1-615-565-8110

1-615-234-2154

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

WisconsinHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

1-502-580-3538

jewing@humana.com

WisconsinINDEPENDENT CARE HEALTH PLAN, INC. iCare Local CCP Tirado Breanne

1-414-231-1087

1-414-231-1075

btirado@icare-wi.org

1555 N Rivercenter Drive Suite 202A Milwaukee WI 53212

Wisconsin

MANAGED HEALTH SERVICES, WISCONSIN

Advantage by Managed Health Services Local CCP

1-732-476-1047

1-732-549-5824

mpica@centene.com

Wisconsin

1-201-269-6717

1-201-269-1008

Wisconsin

MEDICA HEALTH PLAN S OF WISCONSIN

Medica Health Plans of Wisconsin PFFS Weiss Justin

1-952-992-2469

WisconsinMEDICA INSURANCE COMPANY

1-952-992-2469

Wisconsin

NETWORK HEALTH INSURANCE CORPORATION

Network Platinum Medicare Products Local CCP

Director Pharmaceutical Benefits Rynearson Chuck

1-920-720-1603

1-920-720-1906

crynearson@networkhealth.com

1570 Midway Place PO Box 120 Menasha WI 54952

WisconsinPARTNERSHIP HEALTH PLAN, INC.

Community Health Partnership Local CCP Pharmacist Maslonkowski Chris

1-715-858-7008

cmaslonkowski@chpmail.net

2240 EastRidge Center Eau Claire WI 54701

Wisconsin

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Wisconsin

1-401-333-3987 7941

1-800-373-0238

Wisconsin

Wisconsin RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Wisconsin

SECURITY HEALTH PLAN OF WISCONSIN, INC

Security Health Plan Of Wisconsin, Inc Local CCP

Clinical Pharmacy Specialist Proudfit Jennifer

1-715-221-9920

1-715-221-9989

proudfit.jennifer@securityhealth.org

1515 Saint Joseph Avenue Marshfield WI 54449

Wisconsin

1-866-443-0934

Wisconsin

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Wisconsin

1-314-810-6102

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

WisconsinUCARE WISCONSIN INSURANCE UCare Local CCP Medical Director Christianson Craig

1-612-676-3375

1-612-676-6501

Wisconsin

1-765-526-2515

Wisconsin

1-765-526-2515

Wisconsin

1-972-569-3646

1-972-569-3679

Wisconsin

1-949-252-4339

1-949-474-4237

Wisconsin

1-949-221-9994

1-949-747-4237

Wisconsin

1-949-252-4339

1-949-474-4237

Wisconsin

UNITED HEALTHCARE OF WISCONSIN, INC

1-949-221-9994

1-949-747-4237

WisconsinUNITEDHEALTHCARE OF WISCONSIN

UnitedHealthcare of WI/Personal Care Plus Local CCP

1-713-599-5773

leah_f_cormier@uhc.com

Wisconsin

1-813-290-6200 6620

Wisconsin

1-813-290-6200 5119

Wisconsin

WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION WPS Health Insurance PDP

Director Pharmacy Benefits Armstrong David

1-608-226-7883

dave.armstrong@wpsic.com

1717 West Broadway

PO Box 8190 Madison WI 53708

Wyoming

1-386-963-2543

1-860-754-1481

Wyoming

1-386-963-2543

1-860-754-1481

Wyoming

ALTIUS HEALTH PLANS, INC. (WYOMING) Altius Advantra Local CCP

1-801-954-3043

rlwilliams@cvty.com

Wyoming

1-651-662-8758

1-651-662-6009

Wyoming

1-651-662-8758

1-651-662-6009

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Wyoming

1-860-226-6731

yi.zheng@cigna.com

Wyoming

1-801-954-3043

rlwilliams@cvty.com

Wyoming

1-330-405-8080 6320

1-330-405-8081

Wyoming

1-801-954-3043

rlwilliams@cvty.com

Wyoming

1-801-954-3043

rlwilliams@cvty.com

WyomingFOX INSURANCE COMPANY

1-646-340-1016

1-866-369-7978

sv@foxrxcare.com

Wyoming

1-916-463-9603

1-916-463-9750

Wyoming

1-615-565-8110

1-615-234-2154

WyomingHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

WyomingHUMANA INSURANCE COMPANY

1-502-580-3538

jewing@humana.com

Wyoming

1-201-269-6717

1-201-269-1008

Wyoming

1-440-248-8448 135

1-440-248-1729

srajan@mhrx.com

Wyoming

1-401-333-3987 7941

1-800-373-0238

WyomingROCKY MOUNTAIN HEALTH PLANS

Rocky Mountain Health Plans 1876 Cost Pharmacy Director Nolan Steve

1-970-244-7760 5182

Wyoming RXAMERICA, LLC RxAmerica PDP

1-801-961-6251

1-801-961-6313

Wyoming

1-866-443-0934

Wyoming

1-360-647-9080 29098

1-360-647-8632

2219 Rimland Drive

Wyoming

1-314-810-6102

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

Wyoming

1-765-526-2515

Wyoming

1-765-526-2515

Wyoming

1-972-569-3646

1-972-569-3679

Wyoming

1-949-252-4339

1-949-474-4237

Wyoming

1-949-221-9994

1-949-747-4237

Wyoming

1-949-252-4339

1-949-474-4237

Wyoming

1-813-290-6200 6620

Wyoming

1-813-290-6200 5119

ASOCIACION DE MAESTROS DE PUERTO RICO

Employer/Union Only Direct Contract PFFS Sandoval Alma

1-469-524-5801

1-480-661-2771

alma.sandoval@caremark.com

750 West John Carpenter Freeway Ste. 500 Irving TX 75039

C AND O EMPLOYEES HOSPITAL ASSOCIATION

Employer/Union Only Direct Contract PDP Marks Iny

1-516-605-6966

1-412-322-2066

imarks@nmhc.com

600 Waterfront Drive Suite 225 Pittsburgh PA 15222

CARPENTER'S HEALTH AND WELFARE TRUST FUND OF STL

Employer/Union Only Direct Contract PDP

Medicare D Coordinator Sickemier Carol

1-314-644-7226

1-314-644-0200 cs@carpdc.org

1419 Hampton Avenue St Louis MO 63139

CDPHP UNIVERSAL BENEFITS, INC. PDP

1-518-641-3225

1-518-641-3208

swinn@cdphp.com

EXPRESS SCRIPTS INSURANCE CO. PDP Hirsch Jeff

1-314-810-6102

GROUP HOSPITALIZATION AND MEDICAL SERVICES, INC. PFFS

1-410-528-7897

HAWAII MEDICAL SERVICES ASSOCIATION PDP

Clinical Pharmacist Nishimura Rachel

1-808-948-6808

1-808-948-5510

rachel_nishimura@hmsa.com 5 - PBM

818 Keeaumoku St Honolulu HI 96814

HEALTH ALLIANCE MEDICAL PLANS PFFS

1-800-851-3379 8078

1-217-255-4598

HORIZON BLUE CROSS BLUE SHIELD OF NJ PFFS

1-973-466-4575

3 Penn Plaza East - PP 13Q Newark NJ 7105

IBT VOLUNTARY EMPLOYEE BENEFITSTRUST

Employer/Union Only Direct Contract PDP Andrews Sheela

1-949-475-3302

1-949-474-4268

sheela.andrews@rxsol.com 2300 Main St

MS CA 134-1000 Irvine CA 92614

PHONE EXT FAX EMAIL

STREET ADDRESS

2 CITY STATE ZIP

MO DOT AND MSHP MEDICAL AND LIFE INS PLAN

Employer/Union Only Direct Contract PDP Anderson Brian

1-636-614-1344

brian.anderson@ipc-inc.com

1061 Peruque Crossing Ct. Ofallon MO 63366

NATIONAL RURAL ELECTRIC COOPERATIVE ASSOCIATION

Employer/Union Only Direct Contract PDP Moyna Audrey

1-847-559-3999

1-847-559-4733

NMHC GROUP SOLUTION INSURANCE, INC. PDP

DIRECTOR, CLINICAL MEDICARE SERVICES MARKS INY R

1-516-605-6966

1-412-322-2066

IMARKS@NMHC.COM

600 WATERFRONT DR. STE 225 PITTSBURGH PA 15222

OKLAHOMA STATE AND EDUCATION EMP GRP INS BOARD

Employer/Union Only Direct Contract PDP Hamer Marti

1-405-717-8842

1-405-717-8965

mhamer@sib.state.ok.us

3545 NW 58th Street, Suite 110 Oklahoma City OK 73112

PSERS HOP PROGRAM

Employer/Union Only Direct Contract PDP Anderson Brian

1-636-614-1344

brian.anderson@ipc-inc.com

1061 Peruque Crossing Ct Ofallon MO 63366

QCC INS CO D/B/A AMERIHEALTH INS CO PDP

1-215-241-7928

1901 Market Street 22nd Fl. Philadelphia PA 19103

ROCHESTER AREA HEALTH MAINTENANCE ORGANIZATION PFFS

Clinical Pharmacy Coordinator Colin Wendy

1-585-327-2577

wcolin@preferredcare.org 259 Monroe Ave Rochester NY 14607

THE PORT OF AUTHORITY OF NEW YORK AND NEW JERSEY

Senior Account Director Cromer Keith

1-973-503-1039

1-973-560-5610

keith.cromer@express-scripts.com

711 Ridgedale Avenue East Hanover NJ 7936

UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS

Director of Pharmacy Services Johnson Ben R

1-801-595-4364

1-801-595-2064

brj@uphealth.com PO Box 161020

1040 North 2200 West Suite 200 Salt Lake City UT 84116

Direct employer contracts and “800-series only” contracts that only offer employer plans may cover retirees in any state. Therefore, this list does not associate a specific state with these organizations and their respective MTMP contact. The state field has been left blank.

street organization phone street address state …...programs stern jody l 1-386-963-2543...

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