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Pharmacy Directory for More Information, Please Contact: Medicare Plus Blue PPO Essential, Vitality, Signature, Assure Phone: 1‑877‑241‑2583 Hours: 8 A.M

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Pharmacy Directory for More Information, Please Contact: Medicare Plus Blue PPO Essential, Vitality, Signature, Assure Phone: 1‑877‑241‑2583 Hours: 8 A.M 2014 Medicare Plus BlueSM PPO Essential, Vitality, Signature, Assure Medicare Plus BlueSM Group PPO Prescription BlueSM PDP Prescription BlueSM Group PDP Pharmacy Directory For more information, please contact: Medicare Plus Blue PPO Essential, Vitality, Signature, Assure Phone: 1-877-241-2583 Hours: 8 a.m. to 8 p.m. Monday through Friday. TTY: 711 Web: www.bcbsm.com/medicare Prescription Blue PDP Phone: 1-800-565-1770 Hours: 8 a.m. to 8 p.m. Monday through Friday. TTY: 711 Web: www.bcbsm.com/medicare Medicare Plus Blue Group PPO Prescription Blue Group PDP Phone: 1-866-684-8216 Hours: 8:30 a.m. to 5 p.m. Monday through Friday. TTY: 711 Web: www.bcbsm.com/medicare Beneficiaries must use network pharmacies to access their prescription drug benefit. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2015. This Pharmacy Directory was updated on August 1, 2014. Medicare Plus Blue and Medicare Plus Blue Group are PPO plans with a Medicare contract. Enrollment in Medicare Plus Blue and Medicare Plus Blue Group depends on contract renewal. Prescription Blue and Prescription Blue Group are PDP plans with Medicare contracts. Enrollment in Prescription Blue and Prescription Blue Group depends on contract renewal. This document is available in alternate formats. For more information, call the Member Services number above. DB 13338 SEP 13 H9572 S5584_C_14PPOPDPPharmDirIG CMS Accepted 091413 Introduction Medicare Plus Blue PPO Essential, Vitality, Signature and Assure Plan Members This booklet provides a list of Medicare Plus Blue PPO’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Medicare Plus Blue PPO’s formulary. If you have additional questions, please call our Member Services at 1-877-241-2583, 8 a.m. to 8 p.m. Monday through Friday. TTY users should call 711. Or, visit www.bcbsm.com/medicare. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Medicare Plus Blue PPO. In most cases, your prescriptions are covered under Medicare Plus Blue PPO only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network or there may be newer pharmacies in our network that are not listed. This list is current as of August 1, 2014. For the most current list, please contact us. Our contact information appears on the front and back cover pages. You can go to all pharmacies on this list, but your costs may be less at certain pharmacies in this list, which we have marked with a “P”. We call these pharmacies preferred pharmacies and they may offer lower cost-sharing than non-preferred pharmacies. If you have any questions about any of the above, please see the front and back cover pages of this directory for information on how to contact us. Medicare Plus Blue PPO’s Network Pharmacies To choose a pharmacy to meet your needs, first select the type of pharmacy, found at the top of each page, then look for the county, city and pharmacy name. You can also search the index at the back of this directory to locate a pharmacy by name. Prescription Blue PDP Members: Phone: 1-800-565-1770 Hours: 8 a.m. to 8 p.m. Monday through Friday. TTY: 711 Web: www.bcbsm.com/medicare i Medicare Plus Blue Group PPO If your employer or union plan provides Part D prescription drug benefits through this Medicare Plus Blue Group PPO plan, the following provides a list of network pharmacies. You will find a complete description of your prescription coverage, including how to fill your prescriptions, in the Evidence of Coverage and Medicare Plus Blue Group PPO’s formulary. If you have additional questions, please call our Member Services at 1-866-684-8216, Monday through Friday from 8:30 a.m. to 5 p.m. Eastern time. TTY users should call 711. Or, visit www.bcbsm.com/medicare. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Medicare Plus Blue Group PPO. In most cases, your prescriptions are covered under Medicare Plus Blue Group PPO only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network or there may be newer pharmacies in our network that are not listed. This list is current as of August 1, 2014. For the most current list, please contact us. Our contact information appears on the front and back cover pages. You can go to all pharmacies on this list, but your costs may be less at certain pharmacies in this list, which we have marked with a “P”. We call these pharmacies preferred pharmacies and they may offer lower cost-sharing than non-preferred pharmacies. If you have any questions about any of the above, please see the front and back cover pages of this directory for information on how to contact us. Medicare Plus Blue Group PPO’s Network Pharmacies To choose a pharmacy to meet your needs, first select the type of pharmacy, found at the top of each page, then look for the county, city and pharmacy name. You can also search the index at the back of this directory to locate a pharmacy by name. ii CHAIN PHARMACIES Costco Pharmacies (P) Toll-free: (800) 774-2678 TTY: 771 www.costco.com CVS Pharmacies (NP Toll-free: (800) 746-7287 TTY: 771 www.cvs.com Kmart Pharmacies (P) Toll-free: (866) 562-7848 TTY: 771 www.kmart.com Kroger Co Of Michigan Pharmacies (P) CHAIN PHARMACIES Toll-free: (800) 576-4377 TTY: 771 www.kroger.com/pharmacy Meijer Pharmacies (P) Toll-free: (616) 453-3499 TTY: 771 www.meijer.com/pharmacy Rite Aid Pharmacies (P) Toll-free: (800) 748-3243 TTY: 771 www.riteaid.com Sams Club Pharmacies (NP) Toll-free: (888) 746-7726 TTY: 771 www.samsclub.com Target Pharmacies (P) Toll-free: (800) 440-0680 TTY: (800) 755-5852 www.target.com/pharmacy Walgreens Pharmacies (P) Toll-free: (800) 925-4733 TTY: 711 www.walgreens.com/ pharmacy Wal-Mart Pharmacies (NP) Toll-free: (800) 925-6278 TTY: 771 www.walmart.com/pharmacy (NP)–Non-Preferred 90-day fill available (P)–Preferred 90-day fill available 1 Out of State Pharmacies = (NP) Non-Preferred RETAIL PHARMACIES ALCONA COUNTY ALLEGAN COUNTY HAMILTON HARRISVILLE ALLEGAN Hamilton Family Pharmacy (P) 3416 M-40 Richard’s Pharmacy (NP) Allegan Community Hamilton, MI 49419 117 Main Street Pharmacy (NP) (269) 751-8482 Harrisville, MI 48740 115 Locust Street (989) 724-5178 Allegan, MI 49010 (269) 673-4188 HOLLAND RETAIL PHARMACIES LINCOLN Allegan Medical Center Pharmacy (P) Family Fare Pharmacy #123 551 Linn St - Suite 120 (P) Alcona Health Center Allegan, MI 49010 1185 S Washington Avenue Pharmacy (P) (269) 673-4700 Holland, MI 49423 177 North Barlow Rd Rite Aid Pharmacy #1534 (616) 392-7504 Lincoln, MI 48742 (P) (989) 736-9888 Pauls Pharmacy (NP) 560 Jenner Drive 803 Lincoln Lincoln Pharmacy (NP) Allegan, MI 49010 Holland, MI 49423 301 Second Street (269) 673-2181 (616) 396-5233 Lincoln, MI 48742 Value Drugs Allegan (NP) (989) 736-8138 100 Monroe Allegan, MI 49010 MARTIN (269) 673-6749 ALGER COUNTY Carman Pharmacy DORR 1598 S Main Street MUNISING Martin, MI 49070 (269) 672-5543 Dorr Community Pharmacy Putvins Drug Store (NP) (NP) OTSEGO 119 Elm Avenue 1730 142nd Ave Munising, MI 49862 Dorr, MI 49323 (906) 387-2248 (616) 681-9947 Harding’s Pharmacy (P) Snyder Drug #207 (P) 114 South Farmer Street 415 East M-28 FENNVILLE Otsego, MI 49078 Munising, MI 49862 (269) 692-6011 (906) 387-4855 Alexander’s Drug Store PLAINWELL (NP) 211 East Main Fennville, MI 49408 Campbell Pharmacy (P) (269) 561-4411 102 South Main Street Plainwell, MI 49080 (269) 685-6808 2 (NP)–Non-Preferred 90-day fill available (P)–Preferred 90-day fill available Out of State Pharmacies = (NP) Non-Preferred RETAIL PHARMACIES Community Pharmacy Wal-Mart Pharmacy ALPENA COUNTY 533 Allegan Street #10-2358 (NP) Plainwell, MI 49080 1180 M-32 West RETAIL PHARMACIES (269) 685-5847 ALPENA Alpena, MI 49707 Meijer Pharmacy #191 (P) (989) 354-0731 1195 M-89 Plainwell, MI 49080 Alcona Health Center OSSINEKE (269) 685-3810 Pharmacy Services (NP) Walgreens #07484 (P) 1185 Us 23 North 1277 M 89 Alpena, MI 49707 Ossineke Pharmacy (NP) Plainwell, MI 49080 (989) 358-3950 11745 South Us 23 (269) 685-5623 Alpena Regional Medical Ossineke, MI 49766 (989) 471-2339 Wal-Mart Pharmacy Center (P) #10-2061 (NP) 1501 West Chisholm Street Alpena, MI 49707 412 Cross Oaks Mall ANTRIM COUNTY Plainwell, MI 49080 (989) 356-7375 (269) 685-9820 Kmart Pharmacy #7733 (P) 2355 Us 23 South BELLAIRE Alpena, MI 49707 SAUGATUCK (989) 356-2263 Lefave Pharmacy & Home Bellaire Pharmacy (NP) Saugatuck Drug (NP) Medical Equipment, Inc.
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