BlueCross BlueShield Retiree Pharmacy PDP and BlueCross BlueShield Employer Group PDP 2020 Pharmacy Directory This pharmacy directory was updated on September 28, 2020. For more recent information or other questions, please contact Retiree Pharmacy PDP and Employer Group PDP Member Services at 1-877-461-9218 or, for TTY users, 711, October 1 st - March 31st 8 a.m. to 8 p.m. 7 days a week. April 1st - September 30th 8 a.m. to 8 p.m. Monday through Friday, or visit www.bcbswny.com. Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at www.bcbswny.com. You may also call Member Services for updated provider information. This document may be available in other formats such as Braille, large print or other alternate formats. The pharmacy network may change at any time. You will receive notice when necessary. Y0086_EG249_C TABLE OF CONTENTS Section 1 - Introduction.............................................................................................................................3 Section 2 - List of Network Pharmacies...................................................................................................5 RETAIL PHARMACIES, INCLUDING CHAIN PHARMACIES................................................................5 MAIL ORDER PHARMACY................................................................................................................158 HOME INFUSION PHARMACIES......................................................................................................160 LONG-TERM CARE PHARMACIES...................................................................................................165 INDIAN HEALTH SERVICE / TRIBAL / URBAN INDIAN HEALTH PROGRAM (I/T/U) .....................182 PHARMACIES Section 1 - Introduction This booklet provides a list of Retiree Pharmacy PDP and Employer Group PDP’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 Retiree Pharmacy PDP and Employer Group PDP’s formulary. When this pharmacy directory refers to “we,” “us”, or “our,” it means BlueCross BlueShield of Western New York. When it refers to “plan” or “our plan,” it means Retiree Pharmacy PDP and Employer Group PDP. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under Retiree Pharmacy PDP and Employer Group PDP only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of September 28, 2020. For the most current list, please contact us. Our contact information appears on the front and back cover pages. Your plan may include a tiered pharmacy network. With this benefit you can go to all the pharmacies on this list, but your costs for some drugs may be less at pharmacies in this list that offer preferred cost-sharing. We have marked these pharmacies with “P” to distinguish them from other pharmacies in our network that offer standard cost-sharing. If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact us. 3 To assist you in using our directory we have illustrated a pharmacy listing. Provider Name & Title 123 Street Address, State 12345 (999)999-9999 x PS Please use this table as a reference for the symbols used throughout this directory ý 90 day supply at retail pharmacy. P Preferred cost-sharing pharmacies S Standard cost-sharing pharmacies 4 Section 2 - List of Network Pharmacies RETAIL PHARMACIES, INCLUDING CHAIN PHARMACIES - Totals by County ALBANY 60 ALLEGANY 9 BRONX 438 BROOME 47 CATTARAUGUS 15 CAYUGA 15 CHAUTAUQUA 25 CHEMUNG 18 CHENANGO 8 CLINTON 20 COLUMBIA 11 CORTLAND 8 DELAWARE 10 DUTCHESS 56 ERIE 198 ESSEX 8 FRANKLIN 9 FULTON 11 GENESEE 13 GREENE 11 HERKIMER 10 JEFFERSON 18 KINGS 798 LAKE 1 LEWIS 3 LIVINGSTON 11 MADISON 14 MONROE 127 MONTGOMERY 13 5 What you need to know about RETAIL PHARMACIES, INCLUDING CHAIN PHARMACIES You may use any network pharmacy listed in this directory to obtain covered prescription drugs. Please check your Evidence of Coverage (EOC) for more information on your cost-share at network pharmacies. 6 RETAIL PHARMACIES, INCLUDING CHAIN PHARMACIES ALBANY City/Town of ALBANY CVS #00778 1170 WESTERN AVE, ALBANY NY 12203 (518)459-0795 TTY: 711 x P WAL-MART #2152 141 WASHINGTON AVENUE EXT, ALBANY NY 12205 (518)869-4697 TTY: 711 x P CVS #00417 885 CENTRAL AVE, ALBANY NY 12206 (518)459-4550 TTY: 711 x P WALGREENS #21158 33 NEW SCOTLAND AVE STE C, ALBANY NY 12208 (518)649-9672 TTY: 711 x P CAPITAL DIST PSYCHTRC CTR PHCY 75 NEW SCOTLAND AVE, ALBANY NY 12208 (518)447-9611 TTY: 711 S CRESTWOOD PHARMACY 26A PICOTTE DR, ALBANY NY 12208 (518)435-2315 TTY: 711 S CENTRAL AVE PHARMACY 346 CENTRAL AVE, ALBANY NY 12206 (518)621-7748 TTY: 711 x P TOWN TOTAL HEALTH 728 MADISON AVE STE B1, ALBANY NY 12208 (518)257-7294 TTY: 711 x P CVS #05030 1475 WESTERN AVE, ALBANY NY 12203 (518)482-8759 TTY: 711 x P CVS #00680 153 CENTRAL AVE, ALBANY NY 12206 (518)463-1362 TTY: 711 x P CVS #00744 613 NEW SCOTLAND AVE, ALBANY NY 12208 (518)482-4996 TTY: 711 x P CVS #00134 16 NEW SCOTLAND AVE, ALBANY NY 12208 (518)434-0677 TTY: 711 x P CVS #00413 1026 MADISON AVE, ALBANY NY 12208 (518)489-8516 TTY: 711 x P CVS #00600 415 DELAWARE AVE STE 419, ALBANY NY 12209 (518)463-2986 TTY: 711 x P ANTHEM HEALTH SERVICES 57 KARNER RD STE B, ALBANY NY 12205 (518)690-1060 TTY: 711 S RITE AID #10691 1225 WESTERN AVE, ALBANY NY 12203 (518)458-8691 TTY: 711 x P HANNAFORD FOOD AND DRUG #367 900 CENTRAL AVE, ALBANY NY 12206 (518)438-2152 TTY: 711 x P COLLEGE PARKSIDE PHARMACY 920 LARK DR, ALBANY NY 12207 (518)694-8522 TTY: 711 x P CHEM RX #7042 16 WALKER WAY, ALBANY NY 12205 (518)452-7795 TTY: 711 S BRIOVARX INFUSION SERVICES 100 25 POST RD STE 5, ALBANY NY 12205 (518)218-1772 TTY: 711 S WALGREENS #09971 41 HOLLAND AVE, ALBANY NY 12208 (518)426-2976 TTY: 711 x P CVS #01895 2040 WESTERN AVE STE 155, ALBANY NY 12203 (518)869-0249 TTY: 711 x P RITE AID #162 444 A BROADWAY, ALBANY NY 12204 (518)462-4233 TTY: 711 x P CORAM 12 JUPITER LN, ALBANY NY 12205 (518)689-2900 TTY: 711 S PRICE CHOPPER PHARMACY #188 475 SHAKER RD, ALBANY NY 12211 (518)915-7900 TTY: 711 x P PRICE CHOPPER PHARMACY #104 1892 CENTRAL AVE, ALBANY NY 12205 (518)456-9360 TTY: 711 x P PRICE CHOPPER PHARMACY #183 1706 WESTERN AVE, ALBANY NY 12203 (518)456-0742 TTY: 711 x P LINCOLN PHARMACY 300 MORTON AVE, ALBANY NY 12209 (518)465-2253 TTY: 711 x P City/Town of ALTAMONT HANNAFORD FOOD AND DRUG #393 5239 WESTERN TPKE, ALTAMONT NY 12009 (518)355-7411 TTY: 711 x P City/Town of COHOES CVS #02743 485 COLUMBIA ST, COHOES NY 12047 (518)235-7251 TTY: 711 x P MARRA'S PHARMACY 217 REMSEN ST, COHOES NY 12047 (518)237-2110 TTY: 711 x P CARING WELLNESS PHARMACY 1097 LOUDEN, COHOES NY 12047 (518)783-1210 TTY: 711 x P 7 RETAIL PHARMACIES, INCLUDING CHAIN PHARMACIES City/Town of COLONIE WALGREENS #09154 1850 CENTRAL AVE, COLONIE NY 12205 (518)456-1356 TTY: 711 x P CVS #02702 465 SAND CREEK RD, COLONIE NY 12205 (518)482-2835 TTY: 711 x P HANNAFORD FOOD AND DRUG #362 96 WOLF RD, COLONIE NY 12205 (518)482-1925 TTY: 711 x P RITE AID #4928 1863 CENTRAL AVE, COLONIE NY 12205 (518)456-0418 TTY: 711 x P CVS #16615 1440 CENTRAL AVE, COLONIE NY 12205 (518)489-0233 TTY: 711 x P City/Town of DELMAR FOUR CORNERS PHARMACY LLC 360 DELAWARE AVE, DELMAR NY 12054 (518)439-8200 TTY: 711 x P CVS #00375 260 DELAWARE AVE, DELMAR NY 12054 (518)439-9356 TTY: 711 x P HANNAFORD FOOD AND DRUG #339 180 DELAWARE AVE, DELMAR NY 12054 (518)478-9942 TTY: 711 x P City/Town of GLENMONT WAL-MART #3583 311 RT 9W, GLENMONT NY 12077 (518)432-1747 TTY: 711 x P PRICE CHOPPER PHARMACY #196 329 GLENMONT RD, GLENMONT NY 12077 (518)433-4711 TTY: 711 x P CVS #01090 392 FEURA BUSH RD, GLENMONT NY 12077 (518)462-5507 TTY: 711 x P City/Town of GUILDERLAND WALGREENS #09153 2061 WESTERN AVE, GUILDERLAND NY 12084 (518)869-1520 TTY: 711 x P PRICE CHOPPER PHARMACY #28 2080 WESTERN AVE, GUILDERLAND NY 12084 (518)724-6752 TTY: 711 x P City/Town of LATHAM HANNAFORD FOOD AND DRUG #386 579 TROY SCHENECTEDY RD, LATHAM NY 12110 (518)782-1754 TTY: 711 x P CVS #05047 584 LOUDON RD NEWTON PLZ RTE 9, LATHAM NY 12110 (518)785-8086 TTY: 711 x P CVS #00415 750 NEW LOUDON RD, LATHAM NY 12110 (518)785-5878 TTY: 711 x P CVS #17033 675 TROY SCHENECTADY RD, LATHAM NY 12110 (518)782-1360 TTY: 711 x P PRICE CHOPPER PHARMACY #138 873 NEW LOUDON RD, LATHAM NY 12110 (518)782-0227 TTY: 711 x P FALLON WELLNESS PHARMACY 1057 TROY SCHENECTADY RD, LATHAM NY 12110 (518)220-2005 TTY: 711 x P WAL-MART #1997 800 LOUDEN RD, LATHAM NY 12110 (518)783-4397 TTY: 711 x P SAM'S CLUB #6440 579 TROY SCHENECTADY RD, LATHAM NY 12110 (518)783-1692 TTY: 711 x P City/Town of LOUDONVILLE RITE AID #10695 463 ALBANY SHAKER RD, LOUDONVILLE NY 12211 (518)458-1205