Provider Name Provider Phone Number Provider ... - Aetna Medicare [PDF]

(907) 895-6244. 2730 ALASKA HWY. DELTA JUNCTION. AK. 99737. FAMILY PHARMACY. (907) 694-7007. 11432 BUSINESS BLVD STE 10.

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Idea Transcript


The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ANCHORAGE MEDSET PHARMACY, INC ANTHC INTERNAL MED PHARMACY ANTHC OUTPATIENT SURG CNTR PHCY BERNIES PHARMACY INC.

Provider Name

(907) 770-6081 (907) 729-2112 (907) 729-4807 (907) 562-2138

4101 ARCTIC BLVD STE B 3900 AMBASSADOR DR STE 311 3801 UNIVERSITY LAKE DR 4100 LAKE OTIS PKWY STE 200

ANCHORAGE ANCHORAGE ANCHORAGE ANCHORAGE

AK AK AK AK

99503-5702 99508-5922 99508 99508-5230

GENEVA WOODS SPECIALTY PHARMACY GENOA-QOL HEALTHCARE GREAT LAND INFUSION PHCY INC MEDSET PHARMACY

(907) 334-8535 (907) 891-7079 (907) 561-2421 (907) 770-6081

501 W INTL AIRPORT RD STE 5B 4020 FOLKER ST STE 5 2421 E TUDOR RD STE 107 4101 ARCTIC BLVD STE 107

ANCHORAGE ANCHORAGE ANCHORAGE ANCHORAGE

AK AK AK AK

99518-1106 99508-5321 99507-1128 99503-5702

PROVIDENCE MEDICAL ARTS PHARMACY RELIANCE MEDSETS FAMILY MEDICAL CENTER INTERIOR ALASKA PHARMACY FAMILY PHARMACY DENALI PHARMACY FAIRBANKS CANCER CARE PHYS PRESCRIPTION CENTER PROFESSIONAL PHARMACY CROSS ROAD PHARMACY SEARHC HAINES PHARMACY ALASKA FAMILY PHARMACY EAGLE PHARMACY SCOTTS FAMILY PHARMACY ULMERS DRUG & HARDWARE FOODLAND PHARMACY JUNEAU DRUG CO SEARHC JUNEAU PHARMACY THREE BEARS PHARMACY ALICIA ROBERTS MEDICAL CTR PHY NORTH POLE PRESCRIPTION LAB THREE BEARS PHARMACY SEARHC MT EDGECUMBE HOSPITAL RX PENINSULA COMMUNITY PHARMACY

(907) 212-5090 (907) 770-0649 (907) 895-5100 (907) 895-6244 (907) 694-7007 (907) 458-5615 (907) 452-4768 (907) 452-1514 (907) 452-2556 (907) 822-3336 (907) 766-6300 (907) 683-3636 (907) 226-1060 (907) 226-2580 (907) 235-8594 (907) 796-2280 (907) 586-1233 (907) 463-4023 (907) 335-2061 (907) 755-4800 (907) 488-8555 (907) 746-3891 (907) 966-8347 (800) 800-4178

3300 PROVIDENCE DR STE 101 1035 W FIREWEED LN STE 100 2360 SERVICE ST 2730 ALASKA HWY 11432 BUSINESS BLVD STE 10 1650 COWLES ST 1640 COWLES ST STE 1 1919 LATHROP ST STE 109 1001 NOBLE ST STE 420 MILE 187 GLENN HWY 131 FIRST AVE S 248.1 MILE PARKS HIGHWAY 90 STERLING HWY 4014 LAKE ST STE 101 3858 LAKE ST STE 5 615 W WILLOUGHBY AVE 202 FRONT STREET 1200 SALMON CREEK RD 10575 KENAI SPUR HWY 7300 A KLAWOCK-HOLLIS HWY 167 SANTA CLAUS LANE 8151 E PALMER WASILLA HWY 222 TONGASS DR 230 E MARYDALE ST STE 100

ANCHORAGE ANCHORAGE DELTA JUNCTION DELTA JUNCTION EAGLE RIVER FAIRBANKS FAIRBANKS FAIRBANKS FAIRBANKS GLENNALLEN HAINES HEALY HOMER HOMER HOMER JUNEAU JUNEAU JUNEAU KENAI KLAWOCK NORTH POLE PALMER SITKA SOLDOTNA

AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK AK

99508-4619 99503-1701 99737 99737 99577-7740 99701-5925 99701-5925 99701-5937 99701 99588 99827 99743 99603-7439 99603 99603-7684 99801-1731 99801-1228 99801-7861 99611-7812 99925 99705 99645 99835-9416 99669

SOLDOTNA PROFESSIONAL PHARMACY, INC ANNIKKAN INUIT ILUQUTAAT PHCY GENEVA WOODS MAT SU PHARMACY GENEVA WOODS MATSU MEDSET PHCY GENEVA WOODS PHARMACY OUR DOCTOR'S PHARMACY THREE BEARS PHARMACY

(907) 262-3800 (907) 624-5423 (907) 376-8200 (907) 376-8200 (907) 352-2870 (907) 376-5700 (907) 376-4511

299 N BINKLEY ST 189 AIRPORTWAY 3674 E COUNTRY FIELD CIR STE A 3674 E COUNTRY FIELD CIR # B 950 E BOGARD RD STE 229 3190 E MERIDIAN PARK LOOP STE 3950 KNIK GOOSE BAY RD

SOLDOTNA UNALAKLEET WASILLA WASILLA WASILLA WASILLA WASILLA

AK AK AK AK AK AK AK

99669-7523 99684 99654-5101 99654-5101 99654-7172 99654-7294 99623

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 1 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ABBEVILLE PHARMACY MIKE'S DISCOUNT PHARMACY BROOKLERE PHARMACY ADDISON DISCOUNT PHARMACY HYATT'S MARKET PHARMACY BROOKLERE PHARMACY MEDSHOP PHARMACY INC U SAVE PHARMACY ALBERTVILLE DISCOUNT PHARMACY BRINDLEY'S FAMILY PHARMACY FOODLAND DISCOUNT PHARMACY PILL BOX PHARMACY CARLISLE DRUG COMPANY INC JACKSON DRUGS MEDICINE SHOPPE PHARMACY DOWNEY DRUG ALEXANDRIA LLC GENTRY DRUGS SNEAD DISCOUNT PHARMACY BAILEY'S PHARMACY, INC. DARBY'S MEDICAL CENTER PHARMACY DARBYS VILLAGE PHARMACY MALLETTE DRUG COMPANY INC

Provider Name

(334) 585-0246 (334) 585-2288 (205) 674-1400 (256) 747-6342 (256) 747-6066 (205) 664-1200 (205) 621-8407 (205) 605-0499 (256) 878-1515 (256) 878-2111 (256) 878-6930 (256) 660-1111 (256) 329-0900 (256) 234-2538 (256) 215-8014 (256) 820-4540 (205) 373-6688 (205) 466-7990 (334) 582-2222 (334) 582-3784 (334) 222-8825 (334) 222-1141

615 OZARK ROAD STE B 201 KIRKLAND ST 3633 GRAY AVE 30910 HIGHWAY 278 70 MCHANN RD 205 BUCK CREEK PLZ 7895 HIGHWAY 119 STE 1 120 COLONIAL PROMENADE PKWY 422 N BROAD ST 305 N CARLISLE ST 313 SAND MOUNTAIN DR E 8425 US HIGHWAY 431 839 AIRPORT DR 1974 CHEROKEE RD 1144 AIRPORT DR 658 VALLEY CUB DR 551 MEMORIAL PARKWAY EAST 87458 US HIGHWAY 278 811A W BYPASS 822A S THREE NOTCH ST 301A E THREE NOTCH ST 837 S THREE NOTCH ST

ABBEVILLE ABBEVILLE ADAMSVILLE ADDISON ADDISON ALABASTER ALABASTER ALABASTER ALBERTVILLE ALBERTVILLE ALBERTVILLE ALBERTVILLE ALEXANDER CITY ALEXANDER CITY ALEXANDER CITY ALEXANDRIA ALICEVILLE ALTOONA ANDALUSIA ANDALUSIA ANDALUSIA ANDALUSIA

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36310 36310-2408 35005-2238 35540-2253 35540-2138 35007-7004 35007-7554 35007 35950-1761 35950-1731 35950-2329 35950-0167 35010-3450 35010-3437 35010-3435 36250-4200 35442 35952-9638 36420-4736 36420-5310 36420-3124 36420-5321

ANNISTON QUALITY HEALTH CARE PHCY CCMHB PHARMACY DOWNEY DRUG MARTIN'S PHARMACY MARTIN'S PHARMACY JONES DISCOUNT PHARMACY, INC. LATHAM PHARMACY PARKWAY PHARMACY JONES DRUG COMPANY PAYLESS AT FREDS PHARMACY

(256) 439-6393 (256) 236-3403 (256) 237-9426 (256) 403-0500 (256) 403-1107 (256) 586-3179 (256) 586-4132 (256) 586-4120 (256) 423-2155 (256) 423-8989

1316 NOBLE ST STE 1C 331 E 8TH ST 2427 AL HIGHWAY 202 1801 QUINTARD AVE 3345 HENRY RD 1036 N BRINDLEE MOUNTAIN PKWY 178 S MAIN ST 606 N BRINDLEE MOUNTAIN PKWY 30508 ARDMORE AVE 29930 ARDMORE AVE

ANNISTON ANNISTON ANNISTON ANNISTON ANNISTON ARAB ARAB ARAB ARDMORE ARDMORE

AL AL AL AL AL AL AL AL AL AL

36201-4643 36207 36201-5324 36201-3848 36207-6343 35016-1064 35016-1351 35016-1068 35739-7443 35739-7450

WIREGRASS COMMUNITY PHARMACY INC. ASHLAND PHARMACY INC THE DRUG STORE ASHVILLE DRUGS SHELTON PHARMACY ALH COMMUNITY PHARMACY ATHENS CREEKSIDE DRUGS ATHENS PHARMACY

(334) 899-3100 (256) 354-2166 (256) 354-3784 (205) 594-7088 (205) 594-3160 (256) 262-6745 (256) 232-8274 (256) 232-2242

430 BROADWAY AVE 83074 HIGHWAY 9 83871 HIGHWAY 9 35767 US HIGHWAY 231 37177 US HIGHWAY 231 STE 4 700 W MARKET ST 605 US HIGHWAY 31 S 705 W MARKET ST

ASHFORD ASHLAND ASHLAND ASHVILLE ASHVILLE ATHENS ATHENS ATHENS

AL AL AL AL AL AL AL AL

36312-4318 36251-7975 36251-7981 35953-3056 35953-7343 35611-2457 35611-3656 35611

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 2 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name EASTSIDE PHARMACY AND CUSTOM COMPOU HOMETOWN PHCY LIMESTONE CNTY LIMESTONE DRUGS WESTSIDE PHARMACY BUY RITE DRUGS GENOA-QOL HEALTHCARE RICK'S DISCOUNT DRUGS OUR HOME PHARMACY THE DRUG STORE U-SAVE PHARMACY #73 AUTAUGA PHARMACY BELL'S HOMETOWN PHARMACY GSI PHARMACY OF BAY MINETTE NORTH BALDWIN FAMILY PHARMACY RX EXPRESS OF BAYOU LA BATRE BERRY DISCOUNT APOTHECARY EASTERN VALLEY DRUGS FAMILY MEDICAL SERVICES PHCY HEAVENLY CARE PHARMACY HINKLE PHARMACY HOMETOWN PHARMACY SERVICES LLC J & J DISCOUNT PHARMACY MEDICAL CENTER PHARMACY ROCK CREEK PHARMACY STEPHENS PHARMACY ACCURX PHARMACY ACIPCO HEALTH SERVICES PHCY ALABAMA RX LLC BAPTIST PHARMACY HOOVER BARNES HEALTHCARE SERVICES BEAUMONT PHARMACY BHC RAPID CARE PHARMACY BIRMINGHAM APOTHECARY INC BROOKWOOD MEDICAL PLUS CAHABA PHARMACY CHRIST HEALTH CENTER CITIZEN EXPRESS PHARMACY CRESTLINE PHARMACY DOUBLE OAK MOUNTAIN PHARMACY EASTWOOD PHARMACY GENTRY HEALTH MART PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (256) 233-7070 (256) 232-8448 (256) 232-3811 (256) 233-2307 (229) 435-4571 (256) 413-4455 (256) 538-5850 (334) 887-8780 (334) 821-4493 (334) 758-2025 (334) 358-1774 (251) 202-9444 (864) 815-1816 (251) 937-9623 (251) 824-7455 (205) 689-4777 (205) 425-5258 (205) 424-3194 (205) 434-1427 (205) 425-3039 (205) 426-1922 (205) 426-1221 (205) 426-3784 (205) 497-8777 (205) 425-4592 (205) 769-6300 (205) 325-8081 (205) 263-9735 (205) 380-9764 (205) 667-9193 (205) 991-7171 (205) 212-5777 (205) 251-4248 (205) 877-2319 (205) 977-9299 (205) 380-9435 (205) 323-8374 (205) 871-0317 (205) 991-0800 (205) 319-4700 (205) 970-1983

Provider Street 22335 US HIGHWAY 72 100 US HIGHWAY 31 S 200 W MARKET ST 1204 W MARKET ST 400 MEDICAL PARK DR 425 5TH AVE NE RM 92 1433 3RD ST SW 2320 MOORES MILL RD 464 N DEAN RD 1902 SOUTH COLLEGE STREET 209 S WASHINGTON ST 619 MCMEANS AVE 300 FAULKNER DR 2012 HAND AVE 13286 N WINTZELL AVE 31 DEPOT ST 1310 EASTERN VALLEY RD 1817 13TH AVE N 617 9TH AVE N 1090 9TH AVE SW 519 W TOWN PLZ 6405 AVENUE K 995 9TH AVE SW STE 100 6817 WARRIOR RIVER RD 2600 15TH STREET RD 2633 VALLEYDALE RD STE 150 3200 16TH ST N 2728 10TH AVE S STE 340 817 PRINCETON AVE SW STE 107A 120 OXMOOR BLVD STE 100 264 INVERNESS CENTER DR 1600 20TH ST S STE E 1032 20TH ST S 2010 BROOKWOOD MEDICAL CTR DR 3135 CAHABA HEIGHTS RD 5720 1ST AVE S 1513 5TH AVE N 60 CHURCH ST 5510 HIGHWAY 280 S STE 123 4500 MONTEVALLO RD STE E103 4700 CAHABA RIVER RD STE B

Page 3 of 679

Provider City ATHENS ATHENS ATHENS ATHENS ATMORE ATTALLA ATTALLA AUBURN AUBURN AUBURN AUTAUGAVILLE BAY MINETTE BAY MINETTE BAY MINETTE BAYOU LA BATRE BERRY BESSEMER BESSEMER BESSEMER BESSEMER BESSEMER BESSEMER BESSEMER BESSEMER BESSEMER BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35613-2602 35611-2890 35611-2555 35611-4769 36502-3004 35954-2214 35954-1132 36830-8402 36830-5148 36832 36003-2535 36507-3346 36507-2771 36507-4115 36509-2146 35546 35020-8609 35020-3246 35020 35022-4530 35020-5347 35020-2540 35022-4527 35023 35023-3606 35244-2722 35207-4202 35205-1202 35211-1340 35209-5921 35242-4834 35205-4939 35205-2606 35209-6804 35243-5244 35212-2522 35203-1840 35213-3734 35242-6582 35210-3128 35243-2325

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name GIBSON DISCOUNT PHARMACY GILMER DRUG COMPANY INC GREEN VALLEY DRUGS HARBIN DISCOUNT PHARMACY HARBIN PHARMACY KESSLERS PHARMACY LAKESHORE PHARMACY INC MEDAUS PHARMACY MILLS DISCOUNT PHARMACY PARKWAY DISCOUNT DRUGS PAYLESS DRUGS PEDS RX PHARMACY SOLUTIONS PHARMACY LINK INC PHARMSOUTH SOLUTIONS RX PHARMACY ST VINCENTS PHARMACY BHAM ST VINCENTS PHARMACY EAST STEPHENS PHARMACY TOTAL SKIN AND BEAUTY PHARMACY TYNER'S PHARMACY U SAVE PHARMACY U SAVE PHARMACY U SAVE PHARMACY U SAVE PHARMACY UAB HIGHLANDS APOTHECARY VACCA DISCOUNT DRUGS VESTAVIA HILLS APOTHECARY VULCAN RX LLC BLOUNTSVILLE PHARMACY BOAZ DISCOUNT DRUGS CLARK'S PHARMACY MILL STREET PHARMACY FAMILY DISCOUNT PHARMACY INC MEDICAL CENTER PHARMACY KILGORE EXPRESS PHARMACY HOME TOWN PHARMACY PONDERS MOUNTAIN PHARMACY MR DISCOUNT DRUGS OF BUTLER WILLARDS MEDICAL ARTS PHCY BIRMINGHAM VITAL CARE COWART DRUG COMPANY U-SAVE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (205) 787-4692 (205) 787-4671 (205) 822-1151 (205) 871-2196 (205) 323-2474 (205) 841-6421 (205) 945-8081 (205) 981-2352 (205) 591-7800 (205) 453-9889 (205) 252-4179 (205) 983-8727 (866) 332-6966 (205) 991-5265 (205) 776-8585 (205) 533-9112 (205) 533-9112 (205) 408-4484 (205) 380-6170 (205) 856-3784 (205) 201-7777 (205) 979-1427 (205) 228-0080 (205) 201-7295 (205) 984-7862 (205) 956-3300 (205) 979-4444 (205) 783-5986 (205) 429-3351 (256) 593-6546 (256) 840-1100 (256) 593-5279 (251) 867-3001 (251) 867-5454 (256) 495-9300 (205) 556-1600 (256) 597-4020 (205) 459-2990 (205) 459-3710 (205) 605-7633 (205) 668-1723 (205) 319-8005

Provider Street 1133 LOMB AVE SW 413 19TH STREET ENSLEY 1915 HOOVER CT 57 CHURCH ST 521 SOUTH 21ST ST 1152 E LAKE BLVD 1 W LAKESHORE DR STE 102 6801 CAHABA VALLEY RD # 116 6501 1ST AVE N 9709 PARKWAY EAST STE F 3102 26TH ST N 1600 7TH AVE S 3648 VANN RD STE 116 BLDG 2 34 MANNING PLACE 2705 4TH AVE SOUTH 2700 10TH AVE SOUTH STE 106 50 MEDICAL PARK EAST DRIVE 13521 OLD HIGHWAY 280 STE 245 2100 16TH AVE S STE 112 5616 CHALKVILLE RD 200 MONTGOMERY HWY STE 100 1680 MONTGOMERY HWY 5892 TRUSSVILLE CROSSING PKWY 5410 HIGHWAY 280 1201 11TH AVE S 7633 GEORGIA RD 1062 MONTGOMERY HWY 2496 ROCKY RIDGE RD 69005 MAIN ST 10460 AL HIGHWAY 168 STE 1 241 BILLY DYAR BLVD 10639 ALABAMA HWY 168 2117 DOUGLAS AVE 1121 BELLEVILLE AVE 50452 AL HIGHWAY 277 16114 HIGHWAY 216 STE A 29812 AL HIGHWAY 71 604 E PUSHMATAHA ST 313 E PUSHMATAHA ST 300 AIRPORT COMMONS DR STE 304 8320 HIGHWAY 31 72 HIGHWAY 304

Page 4 of 679

Provider City BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BIRMINGHAM BLOUNTSVILLE BOAZ BOAZ BOAZ BREWTON BREWTON BRIDGEPORT BROOKWOOD BRYANT BUTLER BUTLER CALERA CALERA CALERA

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35211-1246 35218-1601 35226-3606 35213-3701 35233-2129 35217-2402 35209-7269 35242-2670 35206-5009 35215-7853 35207-4504 35233-1711 35235-3274 35242-1800 35233-2707 35205-1247 35235 35242-1406 35205-5021 35235-2149 35216-1892 35216-4906 35235-8633 35242-6508 35205-3423 35212-2925 35216-2806 35243 35031-6828 35957-1951 35957-7102 35957-0000 36426-1163 36426-1505 35740-6517 35444-3756 35958-5240 36904-2620 36904-2533 35040-7010 35040-6909 35040

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WHITAKER DRUGS, LLC KENNETH GUIN DRUG INC VICKERS PHARMACY CARROLLTON DRUGS JOHNSON RX PHARMACY LAKE SIDE PHARMACY ALACO PHARMACY DEAN'S DRUGS INC J & S DRUGS INC B & F DRUGS CHELSEA APOTHECARY SNIDERS DISCOUNT PHARMACY PEOPLES DRUGS & VARIETY INC MEDICAL VILLAGE PHARMACY J & J CHILDERSBURG PHCY CITRONELLE DRUG COMPANY CHANDLER DRUG CO INC WRIGHT DRUG & GIFT SHOP INC CLEVELAND PHARMACY COLLINSVILLE DRUGS BEASLEY PHARMACY DAVIS DRUG COMPANY CORDOVA DRUG COTTONWOOD DRUGS COURTLAND DISCOUNT PHARMACY CROSSVILLE DRUGS BORDEN FAMILY PHARMACY CULLMAN DISCOUNT PHARMACY ED HOLCOMBE DISCOUNT PHARMACY GOOD HOPE PHARMACY GRAND POINTE HEALTHMART PHCY HERITAGE PHARMACY HOPPER'S FAMILY PHARMACY HOSPITAL DISCOUNT PHARMACY HOSPITAL DISCOUNT PHARMACY WEST HOSPITAL DISCOUNT PHCY EAST MCSWAINS PHARMACY MEDICAL ARTS APOTHECARY SPECIALTY PHARMACY TPB VILLAGE DISCOUNT DRUGS CULLMAN JIM'S PHARMACY AT THE LAKE

NR_0009_10823 10/2017

Provider Phone Number (334) 456-1589 (205) 924-9616 (205) 924-9999 (205) 367-2476 (256) 779-3000 (256) 422-5010 (256) 927-8539 (256) 927-5569 (205) 926-7621 (251) 847-2250 (205) 678-7755 (205) 678-3899 (256) 359-6242 (251) 456-4172 (256) 378-7761 (251) 866-5522 (205) 755-8009 (205) 755-3350 (205) 274-8000 (256) 524-2981 (334) 696-4611 (205) 669-6713 (205) 483-7811 (334) 691-3784 (256) 637-8050 (256) 528-7124 (256) 734-7535 (256) 734-4251 (256) 734-1083 (256) 841-5958 (256) 737-1330 (256) 737-3773 (256) 796-6500 (256) 734-6013 (256) 734-7658 (256) 734-2325 (256) 734-1662 (256) 734-4933 (256) 734-3146 (256) 255-1142 (256) 775-7455 (256) 373-3449

Provider Street 20 CAMDEN BYPASS 31946 NW 1ST AVE 31040 1ST AVE NE STE 5 25700 HIGHWAY 17 4055 AL HIGHWAY 9 STE F 10005 AL HIGHWAY 9 N 1490 CHESNUT BYP 699 CEDAR BLUFF RD 1130 WALNUT ST 16900 JORDON ST 16688 HIGHWAY 280 15582 HIGHWAY 280 8260 HIGHWAY 72 426 S CRAFT HWY 33637 US HIGHWAY 280 19240 N MOBILE ST 914 7TH ST S 204 7TH ST S 36321 STATE HIGHWAY 79 STE 2 588 S VALLEY AVE 111 E CHURCH ST 111 S MAIN ST 430 SCHOOL ST 13182 COTTONWOOD RD 369 HAMILTON ST 15192 AL HIGHWAY 68 3190 ALABAMA HWY 157 1407 2ND AVE SW 106 2ND AVE SW 1167 COUNTY RD 437 2045 2ND AVE NW 1701 MAIN AVE SW STE C 7467 AL HIGHWAY 69 N 209 4TH AVE NE 1201 4TH ST SW 1557 3RD ST NE 1910 MAIN AVE SW 124 7TH ST SW 2104 ALABAMA HWY 157 1800 AL HWY 157 STE 101 1726A CHEROKEE AVE 8212 COUNTY ROAD 34

Page 5 of 679

Provider City CAMDEN CARBON HILL CARBON HILL CARROLLTON CEDAR BLUFF CEDAR BLUFF CENTRE CENTRE CENTREVILLE CHATOM CHELSEA CHELSEA CHEROKEE CHICKASAW CHILDERSBURG CITRONELLE CLANTON CLANTON CLEVELAND COLLINSVILLE COLUMBIA COLUMBIANA CORDOVA COTTONWOOD COURTLAND CROSSVILLE CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN CULLMAN DADEVILLE

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36726-1770 35549-0000 35549 35447 35959-5030 35959-2231 35960-2815 35960-1631 35042-2811 36518 35043-8326 35043-8360 35616-4402 36611-2213 35044-3015 36522-2122 35045-3718 35045-3704 35049-3556 35961-3535 36319-0000 35051-5357 35550-6000 36320-4224 35618-3313 35962-3452 35058-6001 35055-5310 35055-3418 35055 35058-0472 35055-5250 35058-1260 35055-1904 35055-3922 35055-2053 35055-5219 35055-4262 35058 35058 35055-5382 36853-4690

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LAKE MARTIN PHARMACY LAKESHORE DISCOUNT PHCY CENTER DRUGS OF DALEVILLE COASTAL PHARMACY DAPHNE PHARMACY MARIAN PHARMACEUTICALS ADAMS DRUGS LAKE PHARMACY BENDALLS PHARMACY INC GUICE PHARMACY MED-SURG PHARMACY INC PAY-LESS PHARMACY PAY-LESS PHARMACY EXPRESS PAY-LESS PHARMACY EXPRESS PERSONAL TOUCH PHARMACY PILL BOX PHARMACY PRICEVILLE PHARMACY, LLC RIVER CITY PHARMACY THE MEDICINE SHOPPE THE PILL BOX PHARMACY VALLEY DRUG COMPANY INC VALLEY DRUGS WESTMEADE PHARMACY BOONES PHARMACY F & F DRUGS DORA DISCOUNT PHARMACY KEN GLOVER DRUG BOWEN PHARMACY BRANNON STAND DRUGS CIRCLE PHARMACY DOCTORS CENTER PHARMACY DOTHAN BEHAVIORAL MED CL PHCY DOTHAN HEM & ONCOLOGY PC DOTHAN RX EASTSIDE PHARMACY GENOA-QOL HEALTHCARE JACKS DRUGS DOTHAN MIKE'S SOUTHSIDE PHARMACY NORTHCUTT DRUG COMPANY INC PMO PHARMACY MGMT DOTHAN SCOTT COOK PHARMACY SOUTHEAST ALABAMA MED CTR PHCY

NR_0009_10823 10/2017

Provider Phone Number (256) 825-7822 (256) 825-0063 (334) 598-4242 (251) 625-6896 (251) 509-0616 (251) 473-2222 (334) 351-9550 (334) 569-2112 (256) 353-2021 (256) 355-7743 (256) 355-2828 (256) 353-5011 (256) 355-1815 (256) 351-7006 (256) 351-0404 (256) 353-1121 (256) 350-2588 (256) 445-5400 (256) 350-3338 (256) 353-0100 (256) 355-6225 (256) 355-8015 (256) 355-8211 (334) 289-8989 (334) 289-3295 (205) 648-4292 (205) 648-9918 (334) 794-4211 (334) 446-5300 (334) 792-2717 (334) 793-1316 (334) 479-0541 (334) 792-9500 (334) 305-0055 (334) 446-6261 (334) 699-3858 (334) 836-0890 (334) 794-3174 (334) 793-9538 (334) 699-3900 (334) 712-2000 (334) 793-8116

Provider Street 301 MARIARDEN RD STE A 221 E SOUTH ST 181 HIGHWAY 84 W 29653 ANCHOR CROSS BLVD # A101 2101 US HIGHWAY 98 28691 US HIGHWAY 98 STE D1 2175 B HIGHWAY 31 N 95 LIGHTWOOD RD 1317 14TH AVE SE 1416 6TH AVE SE UNIT D 2828 HIGHWAY 31 S STE 150 1207 MEDICAL DR SE 1517 MOULTON ST W 2122 DANVILLE RD SW 824 6TH AVE SE 2422 DANVILLE RD SW STE J 2941 POINT MALLARD PKWY STE A 2717 SPRING AVE SW 2006 DANVILLE RD SW STE C 474 HIGHWAY 67 S 1101 16TH AVE SE 1302 SOMERVILLE RD SE 2104 DANVILLE RD SW 951 B US HWY 80 WEST 112 US HIGHWAY 80 E 2165 HIGHWAY 78 STE 102 27 MIDWAY PLZ # 78E 1906 FAIRVIEW AVE 1971 S BRANNON STAND RD STE 1 2021 ALEXANDER DR 4119 W MAIN ST 408 HEALTHWEST DR 4300 W MAIN ST STE 405 287 HEALTHWEST DR 2115 E MAIN ST STE #4 134 PREVATT RD 1909 HONEYSUCKLE RD 1023 S OATES ST 1774 W MAIN ST 3119 WESLEY WAY STE 6 1233 WESTGATE PKWY 1108 ROSS CLARK CIR

Page 6 of 679

Provider City DADEVILLE DADEVILLE DALEVILLE DAPHNE DAPHNE DAPHNE DEATSVILLE DEATSVILLE DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DECATUR DEMOPOLIS DEMOPOLIS DORA DORA DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN DOTHAN

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36853-6254 36853-1923 36322-9113 36526-9594 36526-4295 36526-7196 36022 36022-3494 35601-4314 35601-4247 35603-1561 35601-4330 35601-2149 35601-4617 35601-3022 35603-4221 35603-5760 35603-1245 35601-4640 35603-6300 35601-3594 35601-4337 35601-4642 36732 36732-3600 35062-4548 35062-9340 36301-3008 36305-6985 36301-3003 36305-1023 36303-2054 36305-1086 36303 36301 36301-5427 36305-4227 36301-3543 36301-1318 36305-2000 36303-2151 36301-3022

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WESTSIDE PHARMACY INC GATEWAY FAMILY PHARMACY HARRISON DRUG DOUGLAS DISCOUNT PHARMACY BYNUM DRUG INC ECLECTIC FAMILY PHARMACY INC BRYAN PHARMACY ELBA ELBERTA PHARMACY ELKMONT PHARMACY LLC BRYAN PHARMACY BRYAN PHARMACY SOUTHSIDE BRYARS-WARREN DRUG CO CENTER DRUGS HOLLEY PHARMACY EUFAULA DRUGS PRICE DRUG COMPANY SCARBOROUGH DRUG COMPANY THE MEDICINE SHOPPE QUALITY DISCOUNT DRUGS PAYLESS DRUGS INC FAIRHOPE PHARMACY TH RX4U BOLLING PHARMACY CANNON APOTHECARY DEBBIE'S DRUGS FLOMATON MED CENTER PHARMACY FLORALA PHARMACY BARNES HEALTH CARE CENTRAL HEIGHTS PHARMACY, INC CHADS PAYLESS PHARMACY INC FIRST CHOICE PHARMACY FLORENCE PHARMACY GENOA-QOL HEALTHCARE MASSEY DRUGS MASSEY DRUGS AT NORTHWOOD MILNER RUSHING DRUGS MILNER-RUSHING EXPRESS NORTHGATE PHARMACY TIMS DISCOUNT DRUGS WATSON RX SOLUTIONS, INC. MAGNOLIA SPRINGS PHARMACY PURE LIFE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (334) 699-6337 (205) 489-2572 (205) 489-8806 (256) 593-1750 (256) 237-7533 (334) 541-2522 (334) 897-5222 (251) 986-8115 (256) 732-4565 (334) 347-5111 (334) 417-4111 (334) 347-2506 (334) 347-4242 (334) 393-0086 (334) 687-3591 (334) 687-3537 (334) 687-2061 (334) 687-0021 (256) 796-7131 (205) 785-4343 (251) 928-8822 (251) 279-2255 (205) 932-4513 (205) 932-8969 (205) 932-7455 (251) 296-2001 (334) 858-3291 (256) 764-3961 (256) 766-4200 (256) 766-3298 (256) 272-5375 (256) 766-0600 (256) 764-7201 (256) 718-3500 (256) 767-3100 (256) 764-4700 (256) 740-5515 (256) 766-1224 (256) 766-7170 (256) 246-2433 (251) 965-6273 (251) 424-1544

Provider Street 4440 W MAIN ST STE 1 26289 HIGHWAY 195 25372 HIGHWAY 195 9107 ALABAMA HWY 75 1926 BYNUM BLVD 575 CLAUD RD STE 2000 991 ALABAMA HIGHWAY 203 24980 STATE ST 25462 AL HIGHWAY 127 804 GLOVER AVE 6580 BOLL WEEVIL CIR 112 N MAIN ST 607A BOLL WEEVIL CIR 612 N MAIN ST STE A 146 E BROAD ST 206 EAST BROAD STREET 139 E BROAD ST 542 S EUFAULA AVE 4109 EVA RD 4901 GARY AVE 398 FAIRHOPE AVE 750 MORPHY AVE 101 TEMPLE AVE S 106 16TH ST NE 1716 TEMPLE AVE N 174 HIGHWAY 113 23355 5TH AVE 221 N COURT ST 11350 HIGHWAY 20 501 W COLLEGE ST 7385 HIGHWAY 43 3301 VETERANS DR 4131 HELTON DR 3501 CLOVERDALE RD 1702 N WOOD AVE 869 FLORENCE BLVD 2602 HOUGH RD 3522 CLOVERDALE RD 2401 HELTON DR 1106 BRADSHAW DR 12547 CTY RD 49N 1502 N MCKENZIE ST STE 114

Page 7 of 679

Provider City DOTHAN DOUBLE SPRINGS DOUBLE SPRINGS DOUGLAS EASTABOGA ECLECTIC ELBA ELBERTA ELKMONT ENTERPRISE ENTERPRISE ENTERPRISE ENTERPRISE ENTERPRISE EUFAULA EUFAULA EUFAULA EUFAULA EVA FAIRFIELD FAIRHOPE FAIRHOPE FAYETTE FAYETTE FAYETTE FLOMATON FLORALA FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FOLEY FOLEY

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36305-1064 35553-2554 35553-2356 35964-0000 36260-5431 36024-6318 36323-4228 36530-2573 35620-6608 36330-2018 36330-9424 36330-2537 36330-2733 36330-1775 36027-2024 36027 36027-2023 36027-2306 35621-7648 35064-1348 36532-2318 36532-1812 35555-2711 35555 35555-1309 36441-4556 36442-3818 35630-4735 35633-2702 35630-5311 35634-4223 35630-4173 35630-6207 35633-1301 35630-2153 35630-4870 35630-1747 35633-1339 35630-1067 35630-1438 36535 36535-2272

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STACEY DRUG STORE C & H DISCOUNT DRUGS C & H DISCOUNT DRUGS KILGORE EXPRESS PHARMACY KILGORE EXPRESS PHARMACY #2 FRISCO CITY PHARMACY NORWOOD APOTHECARY FYFFE PHARMACY ALACO DISCOUNT PHARMACY CORNERSTONE FAMILY PHARMACY GADSDEN CITY PHARMACY GREGERSON'S PHARMACY HUGHS PHARMACY JERRY'S DISCOUNT PHARMACY PARKS PHARMACY PHYSICIANS APOTHECARY PHYSICIANS APOTHECARY NOCCALULA RIVERSIDE PHARMACY INC ROBERTA WATTS MEDICAL CTR PHCY

Provider Name

(251) 943-7191 (256) 845-2004 (256) 845-0242 (256) 845-3402 (256) 845-6640 (251) 267-2111 (205) 502-1010 (256) 623-2944 (256) 492-4900 (256) 456-5850 (256) 547-4479 (256) 543-7777 (256) 492-7407 (256) 547-1221 (334) 420-0191 (256) 547-8631 (256) 543-0062 (256) 546-3784 (256) 439-6357

121 W LAUREL AVE 1916 GAULT AVE N 1702 GLENN BLVD SW 1614 GLENN BLVD SW 103 GREENHILL BLVD NW 3749 BOWDEN ST 341 WALKER CHAPEL PLAZA # 109 44 BLACKWELL ST 544 MAIN ST W 851 GOODYEAR AVE 911 RAINBOW DR 278 N 3RD ST 100 MEDICAL CENTER DR STE 102 300 WALL ST 825 W MEIGHAN BLVD 1011 FORREST AVE 102 ELBE ST # A 401B S 1ST ST 1020 TUSCALOOSA AVE

FOLEY FORT PAYNE FORT PAYNE FORT PAYNE FORT PAYNE FRISCO CITY FULTONDALE FYFFE GADSDEN GADSDEN GADSDEN GADSDEN GADSDEN GADSDEN GADSDEN GADSDEN GADSDEN GADSDEN GADSDEN

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36535-1966 35967-3418 35968-3523 35968-3522 35967-3701 36445-3655 35068 35971-3254 35905-1060 35903-1133 35901-5309 35901-3201 35903-1134 35904-1938 35901 35901-3539 35904-3933 35901-5358 35901-3005

GARDENDALE HEALTH MART PHARMACY J & J DRUG INC U-SAVE PHARMACY CENTER DRUGS CO GILSTRAP DRUGS GERALDINE DRUGS HOMETOWN PHARMACY LLC GOODWATER PHARMACY GRAND BAY PHARMACY GRANT PHARMACY PLAZA DISCOUNT APOTHECAR INC BOONE'S PHARMACY MEDICINE SHOPPE CITY DRUGS THE MEDICINE CHEST MCGUIRE DRUG COMPANY GULF SHORES FAMILY PHARMACY ISLAND DRUG BUNCH PHARMACY HARALSON DRUGS COMPANY INC NORTH ALA HOME HEALTH SORTER'S PHARMACY, INC.

(205) 631-8989 (205) 631-8731 (205) 285-2022 (229) 435-4571 (334) 684-2272 (256) 659-2117 (251) 843-2400 (256) 839-6361 (251) 865-5555 (256) 728-4217 (205) 674-0680 (334) 624-7151 (334) 382-6574 (251) 275-3669 (251) 275-1000 (205) 468-3402 (251) 968-3784 (251) 967-1100 (256) 582-5700 (256) 582-3661 (256) 571-7115 (256) 753-2994

835 ODUM RD STE 101 1318 MAIN ST 919 ODUM RD 702 W MAPLE AVE 1008 W MAPLE AVE 41554 ALA HWY 75 69 W MAIN ST 21338 AL HIGHWAY 9 12475 US HIGHWAY 90 5421 MAIN ST 1461 S MAIN ST 850 TUSCALOOSA ST STE D 211 CEDAR ST 123 S JACKSON ST 210 S JACKSON ST 1116 12TH AVE 251 CLUBHOUSE DR 3645 GULF SHORES PKWY STE 107 1800 HENRY ST 1941 PATTERSON ST 3656 AL HIGHWAY 69 8095 AL HIGHWAY 69

GARDENDALE GARDENDALE GARDENDALE GENEVA GENEVA GERALDINE GILBERTOWN GOODWATER GRAND BAY GRANT GRAYSVILLE GREENSBORO GREENVILLE GROVE HILL GROVE HILL GUIN GULF SHORES GULF SHORES GUNTERSVILLE GUNTERSVILLE GUNTERSVILLE GUNTERSVILLE

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35071-4111 35071-2496 35071-3600 36340-1632 36340-1638 35974 36908-2045 35072-6621 36541-5707 35747-8322 35073-1725 36744-1562 36037-2205 36451 36451-3232 35563-0000 36542-3415 36542-2721 35976-1613 35976-2060 35976-7196 35976-7140

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 8 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KILGORE EXPRESS PHARMACY HACKLEBURG PHARMACY RAY PHARMACY HALEY'S PHARMACY MAJORS DISCOUNT DRUGS MEDICAL ARTS DRUGS ROBERTS HOMETOWN PHARMACY FREDS PHARMACY HAMILTON PHARMACY BLUE & GRAY DRUGS HANCEVILLE DRUG COMPANY LLC HERITAGE PHCY OF DODGE CITY LAKESIDE PHARMACY DALTON PHARMACY GILCHRIST PHARMACY INC SOUTHERN CARE PHARMACY JOES PHARMACY SUR-SAV PHARMACY HAYDEN HEALTH MART

Provider Name

(256) 776-4430 (205) 935-3392 (205) 935-3124 (205) 486-4700 (205) 486-4534 (205) 486-3133 (205) 486-4663 (205) 921-3193 (205) 921-1881 (256) 352-4371 (256) 352-4110 (256) 287-3333 (256) 287-9099 (334) 588-2442 (256) 773-1998 (256) 502-8550 (256) 230-3416 (256) 858-9677 (205) 590-1515

5999 HIGHWAY 72 E 34863 US HIGHWAY 43 34885 US HWY 43 1625 21ST ST 1025 HIGHWAY 13 42322 HIGHWAY 195 E 2415 11TH AVE STE A 797 MILITARY ST S 1508 MILITARY ST S 804 MAIN ST NE 101 COMMERCIAL ST SE 561 AL HIGHWAY 69 S 445 AL HIGHWAY 69 S STE D 112 S 4TH AVE 404 SPARKMAN ST NW 1635 HIGHWAY 31 NW STE A 27691 CAPSHAW RD 6046 HIGHWAY 53 4086 STATE HWY 160

GURLEY HACKLEBURG HACKLEBURG HALEYVILLE HALEYVILLE HALEYVILLE HALEYVILLE HAMILTON HAMILTON HANCEVILLE HANCEVILLE HANCEVILLE HANCEVILLE HARTFORD HARTSELLE HARTSELLE HARVEST HARVEST HAYDEN

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35748-9460 35564-4281 35564-0000 35565-2039 35565-1638 35565 35565-1627 35570-4737 35570-5006 35077-5461 35077-5516 35077-3403 35077-3437 36344-1615 35640-2326 35640-4426 35749-7403 35749-9538 35079-6551

HAYNEVILLE DRG A #FOSTER DRG CO INC HAZEL GREEN PHARMACY MIKE'S PHARMACY OF HEADLAND CLEBURNE PHARMACY HEFLIN QUALITY PHARMACY WRIGHT DRUG COMPANY CAMP DRUGS LLC HOKES BLUFF DRUG SHOPPE MURPHY'S PHARMACY BGA PHARMACY HOMEWOOD PHARMACY OMNICARE OF BIRMINGHAM THE COMPOUNDING SHOPPE HOOVER HOMETOWN PHARMACY OPTION CARE ROBERT'S DISCOUNT PHARMACY PHARMACY XPRESS WELDON PHARMACY INC CCI PHARMACY CHASE PHARMACY INC HEALTH CENTER PHARMACY HEALTHMART PHARMACY

(334) 548-2125 (256) 813-0150 (334) 693-3324 (256) 463-2197 (256) 393-4063 (256) 463-2188 (256) 657-5187 (256) 494-1918 (256) 796-4449 (844) 594-6095 (205) 871-9000 (205) 802-0699 (205) 870-3150 (205) 650-1960 (205) 982-9401 (205) 823-9500 (205) 744-4480 (205) 491-2805 (256) 327-5900 (256) 851-1345 (256) 534-4533 (256) 715-7475

12 LAFAYETTE ST 13574 HIGHWAY 231 431 N STE B 202 HOLMAN DR 875 ROSS ST 64 GILES ST 960 ROSS ST 17171 AL HIGHWAY 75 5702 US HIGHWAY 278 E 11069 US HWY 278 E 1 INDEPENDENCE PLAZA STE 900A 940 OXMOOR RD 1119 ROYAL TOWER DR 3349 INDEPENDENCE DR STE 102 2801 JOHN HAWKINS PWY STE 101A 2100 RIVERCHASE CTR STE 430 758 SHADES MOUNTAIN PLZ 2910 ALLISON BONNETT MEM DR 1280 HUEYTOWN RD 3601 CCI DR NW 1762 WINCHESTER RD NE 301 GOVERNORS DR SW 2599 SPARKMAN DR

HAYNEVILLE HAZEL GREEN HEADLAND HEFLIN HEFLIN HEFLIN HENAGAR HOKES BLUFF HOLLY POND HOMEWOOD HOMEWOOD HOMEWOOD HOMEWOOD HOOVER HOOVER HOOVER HUEYTOWN HUEYTOWN HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36040-2089 35750-8642 36345 36264-1131 36264 36264-1164 35978-5663 35903-7204 35083 35209-2643 35209 35209-6822 35209-8313 35244-4021 35244-2937 35226-1513 35023 35023-2602 35805-2606 35811-9191 35801 35810-3868

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 9 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HEART CENTER PHARMACY HUNNINGTON PHARMACY HUNTSVILLE HOSP EMPLOYEE PHCY MED MALL PHARMACY PHARMACY FIRST PROPST DISCOUNT DRUGS QUICKCARE SPARKMAN PHARMACY AT WELLSTONE STAR DISCOUNT PHARMACY STAR DISCOUNT PHARMACY SURE SAVE PHARMACY THE MEDICINE SHOPPE TVPC PHARMACY IDER DISCOUNT DRUGS TURENNE PHARMEDCO, INC. BAYOU PHARMACY MAC'S DRUGS CROW DRUG STORE JACKSONVILLE DISCOUNT PHARMACY AFTER HOURS RX BOWIE'S DISCOUNT PHARMACY CURRY DISCOUNT PHARMACY EAST POINT PHARMACY ENGLISH PLAZA PHARMACY FIVE POINTS PHARMACY AND DOLLAR GLOVER DRUG URGENTCARE NW GLOVER DRUG WALKER BAPTIST HOSPITAL DISCOUNT JASPER PRIORITY CARE PHARMACY PROFESSIONAL PHARMACY SAM GLOVER DRUGS SON'S DISCOUNT PHARMACY INC SOUTHERN PHARMACEUTICAL LTC HAYES DRUGS BREWER FAMILY PHARMACY GREENHILL PHARMACY KILLEN CORNER DRUG LOWE'S PHARMACY GREENE SUPER DRUG MCKINNON PHARMACY PATTERSON PHARMACY THE MEDICINE SHOPPE

NR_0009_10823 10/2017

Provider Phone Number (256) 265-0130 (205) 994-4507 (256) 265-3400 (256) 265-3800 (256) 533-9314 (256) 539-7443 (256) 517-8317 (256) 705-6499 (256) 534-1118 (256) 650-2335 (256) 230-6200 (256) 536-1910 (256) 265-3115 (256) 657-5151 (800) 278-1777 (251) 824-7979 (251) 246-2271 (256) 435-7931 (256) 706-6845 (205) 387-7811 (205) 221-4090 (205) 221-6330 (205) 221-5595 (205) 221-3090 (205) 295-1750 (205) 387-1800 (205) 221-6487 (205) 387-1403 (205) 221-1008 (205) 221-4564 (205) 387-1481 (205) 387-0526 (205) 397-4660 (205) 688-2032 (256) 757-0088 (256) 757-9800 (256) 757-2166 (334) 864-7781 (334) 644-3154 (205) 699-5195 (205) 699-5113 (256) 526-6337

Provider Street 930 FRANKLIN ST SE 11220 MEMORIAL PKWY SW STE R 101 SIVLEY RD SW 1963 MEMORIAL PKWY SW 2302 WHITESBURG DR S 717 PRATT AVE NE 202 GOVERNORS DR 4040 MEMORIAL PKWY SW STE L 704 PRATT AVE NE 7900 BAILEY COVE RD SE STE R 30694 US HWY 72 WEST SUITE A 2701 PATTON RD SW STE E 201 GOVERNORS DR SW STE 305 10705 ALABAMA HWY 75 4941 MONTEVALLO RD 12855 PADGETT SWITCH RD 201 COMMERCE ST 7 PUBLIC SQ E 1642 PELHAM RD SOUTH 1800 BIRMINGHAM AVE 5100 CURRY HWY STE 150 5558 CURRY HWY 1442 JONES DAIRY RD 1640 HIGHWAY 78 E 41 CURRY HWY 2708 HIGHWAY 78 3400 HIGHWAY 78 E STE 101 201 19TH ST E 4330 HWY 78 E STE 109 2001 N AIRPORT RD 408 18TH ST W 400 9TH AVE 1100 7TH AVE 24724 US HIGHWAY 31 1161 HIGHWAY 72 357 HIGHWAY 64 1621 HIGHWAY 72 339 9TH AVE SW 701 N GILMER AVE 8420 1ST AVE 7513 PARKWAY DR 270 INDUSTRIAL BLVD

Page 10 of 679

Provider City HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE HUNTSVILLE IDER IRONDALE IRVINGTON JACKSON JACKSONVILLE JACKSONVILLE JASPER JASPER JASPER JASPER JASPER JASPER JASPER JASPER JASPER JASPER JASPER JASPER JASPER JASPER JEMISON KILLEN KILLEN KILLEN LAFAYETTE LANETT LEEDS LEEDS LEESBURG

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35801-4312 35803-2184 35801-4421 35801 35801-3818 35801-3645 35801-2745 35802-4364 35801-3644 35802-3330 35756 35805-4325 35801-5170 35981-4627 35210-2418 36544-4015 36545-2717 36265-2572 36265-3312 35501-5461 35503-5868 35503-5845 35501-6164 35501-4034 35503-7542 35501-3430 35501 35501-5457 35501 35504-7068 35501-5346 35501-3732 35501-4377 35085-4428 35645-9101 35645-4829 35645-9142 36862-2803 36863 35094-2150 35094-4813 35983-3737

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LEIGHTON PHARMACY LEXINGTON DISCOUNT DRUG STORE LILLIAN PHARMACY LINCOLN PHARMACY LITTLE DRUG COMPANY YOUNGS DRUG COMPANY LLC THE DRUG STORE CO INC LOCUST FORK PHARMACY LLC LOXLEY PHARMACY B & B DISCOUNT DRUGS CRENSHAW DRUGS INC FOSTER DRUG COMPANY INC MADISON HEALTH MART PHARMACY QC PHARMACY LLC STAR DISCOUNT PHARMACY INC U SAVE PHARMACY MAPLESVILLE PHARMACY COLLEGE CITY DRUG COMPANY CURREN PHARMACY PHARMACY AT THE PIG MCINTOSH DRUGS STAR DISCOUNT PHARMACY MIDFIELD DISCOUNT DRUGS JACKS DISCOUNT DRUGS ADAMS DRUGS MILLBROOK SPRING VIEW DRUGS INC JOE GOLDEN DRUG MILLRY DRUGS ADVANCED CARE PHARMACY BAUER'S DRUG INC CHRISTOPHER PHARMACY LLC DAWES POINTE PHARMACY FAMILY PHARMACY CARE FAMILY PHARMACY OF SPRING HILL FRANKLIN PRIMARY PHARMACY GENOA-QOL HEALTHCARE HEALTH CLINIC PHARMACY HERITAGE COMPOUNDING PHARMACY HPC INTERNATIONAL IH RX4U STORE INTEGRATED HEALTHCARE PHARMACY LADAS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (256) 446-6527 (256) 229-5550 (251) 962-3777 (205) 763-7759 (334) 295-4270 (256) 396-5632 (205) 652-9595 (205) 680-2222 (251) 964-5332 (334) 335-3758 (334) 335-5888 (334) 335-6553 (256) 325-1139 (256) 964-8338 (256) 721-0739 (256) 562-0855 (334) 366-2425 (334) 683-6166 (205) 410-7759 (205) 477-1007 (251) 944-2563 (256) 829-0209 (205) 925-7000 (334) 983-4191 (334) 386-3501 (334) 285-6705 (205) 662-3817 (251) 846-9290 (251) 241-0071 (251) 471-5326 (251) 288-4612 (251) 607-9800 (215) 405-3099 (251) 300-3003 (251) 436-7676 (251) 665-4521 (251) 690-8817 (251) 472-0814 (251) 441-1990 (251) 435-6337 (251) 450-1400 (251) 432-5601

Provider Street 2230 RAILROAD ST 11601 HIGHWAY 101 34023 US HIGHWAY 98 99 MAGNOLIA ST S 310 S MAIN ST 88960 HWY 9 108 LAFAYETTE ST 29984 ST HWY 79 STE 600 2140 E RELHAM DR 98 S FOREST AVE 1440 S FOREST AVE 1554 S FOREST AVE 8498 MADISON BLVD STE A 7500 HIGHWAY 72 W 7950 HIGHWAY 72 W 7559 HIGHWAY 72 W 9081 AL HIGHWAY 22 304 WASHINGTON ST 22586 HIGHWAY 216 4750 EASTERN VALLEY RD 7771 HWY 43 12078 HIGHWAY 231 431 N 30A PHILLIPS DR 15073 S US HIGHWAY 231 185 ASHTON PLAZA ST 4810 MAIN ST 13532 HIGHWAY 96 EAST 30282 HWY 17 580 PROVIDENCE PARK DR 728 DAUPHIN ISLAND PKWY 590 SCHILLINGER RD S 8650 COTTAGE HILL RD STE 101 869 HILLCREST RD 4415 OLD SHELL RD 1303 DR MARTIN L KING JR AVE 3456 HILLCREST RD BLDG B STE D 251 N BAYOU ST 15 MIDTOWN PARK E 63 S ROYAL ST STE 800 5 MOBILE INFIRMARY CIR 2400 GORDON SMITH DR 1050 S BROAD ST

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Provider City LEIGHTON LEXINGTON LILLIAN LINCOLN LINDEN LINEVILLE LIVINGSTON LOCUST FORK LOXLEY LUVERNE LUVERNE LUVERNE MADISON MADISON MADISON MADISON MAPLESVILLE MARION MC CALLA MC CALLA MCINTOSH MERIDIANVILLE MIDFIELD MIDLAND CITY MILLBROOK MILLBROOK MILLPORT MILLRY MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35646 35648 36549-4053 35096-6102 36748-1726 36266 35470-0000 35097-0000 36551-2402 36049-1514 36049-7330 36049-7332 35758 35758-9554 35758-6416 35758-8749 36750-3221 36756-2332 35111-2706 35111-3406 36553 35759-1225 35228 36350-6305 36054-1880 36054-2408 35576-2522 36558 36695-4614 36606-1231 36695-8905 36695-3612 36695-3909 36608-1911 36603-5341 36695-3195 36603-5827 36606 36602-3235 36607-3513 36617-2319 36603-1038

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MIDTOWN PHARMACY RX EXPRESS PHARMACY SKYLAND DISCOUNT DRUGS SOLEO HEALTH INC SPRINGHILL PHARMACY,LLC THREE NOTCH PHARMACY MONROE DRUGS THE MEDICINE SHOPPE MONTEVALLO DRUG CO SMITHERMANS PHARMACY ADAMS DRUG ADAMS DRUGS ADAMS DRUGS ADAMS DRUGS PERRY HILL PLACE ADAMS DRUGS-EAST ADAMS DRUGS-SOUTH ADAMS DRUGS-TAYLOR BAPTIST TOWER PHARMACY BOONE'S PHARMACY CITY DRUG GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE JONES DRUGS JONES DRUGS MCC APOTHECARY MEDICAL ADVOCACY AND OUTREACH MONTGOMERY VA CLINIC PHARMACY PARAGON INFUSION PARKS PHARMACY INC RICHARDSON'S PHARMACY SPECIALTY PHARMACY SERVICES PARKWAY PHARMACY PAYLESS DRUGS LOGAN PHARMACY STEVES DISCOUNT DRUGS INC TOWN & COUNTRY PHARMACY HARLAND DRUGS KC DRUG MOUNT VERNON PHARMACY RITCH'S PHARMACY AVALON DISCOUNT DRUGS DALTON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (251) 479-2424 (251) 662-2525 (251) 666-0176 (251) 234-6074 (251) 410-3870 (251) 661-0066 (251) 743-2575 (251) 575-9656 (205) 665-1261 (205) 665-2575 (334) 277-4800 (334) 386-7068 (334) 264-3496 (334) 386-8813 (334) 272-0802 (334) 281-1671 (334) 386-9370 (334) 286-3200 (334) 280-4740 (334) 263-6144 (334) 819-4581 (334) 356-7627 (334) 676-2900 (334) 264-1110 (334) 273-2281 (334) 280-3349 (334) 272-4670 (888) 588-1072 (334) 264-1416 (334) 262-5775 (334) 557-0400 (205) 640-1881 (205) 647-0515 (256) 974-1770 (256) 974-7663 (256) 905-0030 (205) 371-9031 (205) 371-8755 (251) 829-6628 (205) 871-1141 (256) 314-1001 (256) 978-5102

Provider Street 2152 AIRPORT BLVD STE 106 5638 THREE NOTCH RD 3968 GOVERNMENT BLVD 2866 DAUPHIN ST STE H 3715 DAUPHIN ST STE 1E 4880 LAKELAND DR STE F 360 S ALABAMA AVE 1465A S ALABAMA AVE 3990 HIGHWAY 25 703 MAIN ST 8189 VAUGHN RD 9168 EASTCHASE PARKWAY 934 ADAMS AVE 1633 PERRY HILL RD 35 MITCHELL DR 3016 MCGEHEE RD 7200 COPPERFIELD DR STE A 2055 E SOUTH BLVD STE 107 2020 E SOUTH BLVD 11 DEXTER AVENUE 2140 UPPER WETUMPKA RD 3480 EASTERN BLVD 59 WEST FAIRVIEW AVE 1751 UPPER WETUMPKA RD 4145 CARMICHAEL RD STE A 2900 MCGEHEE RD 8105 VETERANS WAY 5331 PERIMETER PKWY 1323 MULBERRY ST STE A 1069 WOODLEY RD 3801 OAK GROVE DR UNIT 103 1021 CROSSROADS PLAZA DR 584 MORRIS MAJESTIC RD 15190 COURT ST STE A 11809 AL HIGHWAY 157 STE A 22747 AL HIGHWAY 24 16061 HIGHWAY 69 S 40870 AL HWY 69 STE D 19390 HIGHWAY 43 2714 CAHABA RD 2400 AVALON AVE 1640 S WILSON DAM RD STE A

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Provider City MOBILE MOBILE MOBILE MOBILE MOBILE MOBILE MONROEVILLE MONROEVILLE MONTEVALLO MONTEVALLO MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY MOODY MORRIS MOULTON MOULTON MOULTON MOUNDVILLE MOUNDVILLE MOUNT VERNON MOUNTAIN BRK MUSCLE SHOALS MUSCLE SHOALS

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36606-1751 36619-1724 36693-4723 36606-2482 36608-1783 36619-1122 36460-1806 36460-3029 35115-4161 35115-3714 36116-6705 36117 36104-4422 36106 36109-2923 36111-2203 36117-7100 36116-2002 36116-2408 36104 36107-1342 36116-1700 36105 36107-1225 36106 36111-2151 36117-9998 36116-5125 36106-1545 36106-2429 36116-1169 35004-2615 35116-1245 35650-1428 35650-2708 35650-8109 35474-6209 35474 36560-3450 35223-2304 35661-3187 35661-2768

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FORD CITY PHARMACY MILNER RUSHING DISCOUNT DRUGS MK INFUSION PHARMACY, LLC

Provider Name

(256) 446-8400 (256) 386-5220 (256) 320-7611

14490 COUNTY LINE RD STE B 202 W AVALON AVE 307 W STATE ST

MUSCLE SHOALS MUSCLE SHOALS MUSCLE SHOALS

AL AL AL

35661-4412 35661-2804 35661-2835

NORTH ALABAMA INFSN & COMPOUNDING VILLAGE DISCOUNT DRUGS CAPSTONE PHARMACY NEW HOPE FAMILY PHARMACY NEW MARKET DISCOUNT DRUGS NATURAL RX NORTHPORT PHARMACY TUSCALOOSA DRUG NORTH HADDER PHARMACY MARGARET PHARMACY ODENVILLE DRUGS OHATCHEE DRUG ALACO DISCOUNT PHARMACY J AND M PHCY AND COMPD CTR LLC

(256) 389-9297 (256) 381-8060 (205) 724-9053 (256) 723-4112 (256) 379-4670 (205) 339-3993 (205) 339-5800 (205) 409-6410 (205) 622-3030 (205) 319-1999 (205) 629-6303 (256) 892-0653 (205) 274-2194 (205) 274-2740

2711 2ND ST 1001 AVALON AVE 156 3RD AVE 10155 HIGHWAY 431 S 5324 WINCHESTER RD 2801 LURLEEN WALLACE BLVD #3 909 MCFARLAND BLVD 13620 HIGHWAY 43 N STE A 10303 MAIN STREET 145 JEFFERY WILSON DR 140 COUNCIL DR 7814 AL HWY 77 27550 STATE HIGHWAY 75 STE 107 2040 2ND AVE E STE C

MUSCLE SHOALS MUSCLE SHOALS NAUVOO NEW HOPE NEW MARKET NORTHPORT NORTHPORT NORTHPORT OAKMAN ODENVILLE ODENVILLE OHATCHEE ONEONTA ONEONTA

AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35661-1388 35661-2401 35578 35760-9390 35761-7430 35476 35476-3373 35475-4411 35579 35120-5575 35120-4495 36271 35121-3272 35121-2731

ADAMS PHARMACY AND HOME CARE INC BEAUREGARD DRUGS INC BUBBA'S MEDICINE SHOP EAST AL MENTAL HEALTH CTR EAST ALABAMA MED CNTR OP PHCY MEDICAL ARTS PHARMACY THOMAS PHARMACY LARRY'S PRESCRIPTIONS INC T & C PHARMACY INC MARTIN'S PHARMACY QUICK MEDS PHARMACY BUY-RITE DRUGS DALE PHARMACY DALTON PHARMACY PROGRESSIVE PHARMACY GROSS DRUG CO INC SON'S PHARMACY OF PARRISH NEIL'S PHARMACY VITAL RX J'S PHARMACY MAINSTREET DRUGS NORTHSIDE APOTHECARY PELL CITY PHARMACY

(334) 745-3881 (334) 364-9993 (334) 749-3426 (334) 742-2733 (334) 528-2293 (334) 745-5756 (334) 745-3632 (334) 493-3549 (334) 493-4517 (256) 831-6116 (256) 832-6337 (334) 774-8505 (334) 774-7979 (334) 803-8240 (334) 350-3671 (205) 686-9945 (205) 686-3111 (205) 988-5023 (866) 209-5540 (205) 884-4550 (205) 338-4903 (205) 753-4000 (205) 338-6080

1961 1ST AVE 7667 AL HWY 51 STE A 512 2ND AVE 2506 LAMBERT DR 2000 PEPPERELL PKWY 121 N 20TH ST STE 1 1713 PEPPERELL PKWY 801 N MAIN ST 101 PARISH AVE 610 QUINTARD DR 1542 HAMRIC DR E 591 S UNION AVE 1548 S US HIGHWAY 231 STE A6 986 E BROAD ST 1970 ANDREWS AVE 6456 HWY 269 49 NEW OAKMAN HWY 1573 CAHABA VALLEY RD 237 CAHABA VALLEY PKWY 760 MARTIN ST S STE A 2319 COGSWELL AVE 72 PLAZA DR 1027 MARTIN ST S

OPELIKA OPELIKA OPELIKA OPELIKA OPELIKA OPELIKA OPELIKA OPP OPP OXFORD OXFORD OZARK OZARK OZARK OZARK PARRISH PARRISH PELHAM PELHAM PELL CITY PELL CITY PELL CITY PELL CITY

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36801-5403 36804 36801-4316 36801-7237 36801 36801-5454 36801-5548 36467 36467-1613 36203-1840 36203-2016 36360-1834 36360-4515 36360 36360-3726 35580 35580 35124-3251 35124-1146 35128-2116 35125-1734 35125-9314 35128-2360

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 13 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name U-SAVE PHARMACY GLENN'S PHARMACY MEDICAL PARK PHARMACY U SAVE IT PHARMACY PHIL CAMPBELL DRUGS ALACO DISCOUNT PHARMACY BUCKELEWS DEERFOOT PHARMACY CARROLL PHARMACY PINSON DISCOUNT DRUGS PISGAH PHARMACY SPARTAN DISCOUNT DRUGS ADAMS DRUGS - PRATTVILLE THE MEDICINE SHOPPE RAGLAND PHARMACY INC PINNACLE PHARMACY SUPER BEE PHARMACY HAYMON DRUGS, INC RAINSVILLE DRUGS REDMONT PHARMACY EMERGING HOME CARE PHARMACY LINEVILLE CLINIC PHARMACY LLC LEE DRUG STORE INC BARNETT DRUG COMPANY CROSSROADS PHARMACY FAMILY PHARMACY OF LITTLEVILLE FAMILY PHCY OF RUSSELLVILLE HOMETOWN PHARMACY RUSSELLVILLE DRUGS KING DRUG COMPANY SARALAND PHARMACY THE MEDICINE SHOPPE MC CONAGHY DRUG STORE ALLYSCRIPTS BIG C DISCOUNT DRUGS BIG C DISCOUNT DRUGS SKYLINE FOODLAND PHARMACY SB, LLC PARKS AVENUE DRUGS SCOTTSBORO FAMILY PHARMACY SECTION PHARMACY INC BROWN DRUG COMPANY CARTER DRUG COMPANY DALLAS AVENUE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (205) 338-8017 (334) 298-2577 (334) 298-4010 (334) 298-8390 (205) 993-4123 (256) 447-7779 (205) 681-5445 (205) 680-5557 (205) 680-3737 (256) 451-3283 (205) 744-0447 (334) 358-5353 (334) 358-1630 (205) 472-2171 (256) 467-6337 (256) 442-2592 (256) 638-4142 (256) 638-2255 (256) 356-9000 (334) 863-7511 (334) 863-6337 (251) 947-7378 (256) 247-5451 (256) 247-5833 (256) 332-4021 (256) 332-5545 (256) 332-7400 (256) 331-1919 (334) 898-2115 (251) 675-3333 (251) 679-9095 (251) 675-2070 (844) 309-7171 (256) 574-5520 (256) 587-3332 (256) 259-1011 (256) 999-0410 (256) 259-9300 (256) 228-7179 (334) 872-2326 (334) 875-7223 (334) 872-3255

Provider Street 20 HAZELWOOD DR 2413 CRAWFORD RD 1623 21ST CT 1108 13TH ST 2936 HIGHWAY 237 702 HWY 278 BYPASS EAST 6735 DEERFOOT PKWY 6767 OLD SPRINGVILLE RD 6662 HIGHWAY 75 STE 118 6049 COUNTY ROAD 88 847-A PARK RD 103 S MEMORIAL DR 959 E MAIN ST STE A 1560 MAIN ST 113 RAINBOW INDUSTRIAL BLVD 3354 RAINBOW DR 128 WEST MAIN ST 503 MAIN ST W 1102 4TH ST NW 3868 HIGHWAY 431 3705 HIGHWAY 431 18530 FLORIDA ST 1661 LEE ST 2800 HIGHWAY 101 1369B GEORGE WALLACE HWY 455 UNDERWOOD RD 609 GANDY ST NE 14001 HIGHWAY 43 STE 13 7 N BROAD ST 106A SARALAND LOOP RD 311 SHELTON BEACH RD 5565 HIGHWAY 43 201 LONNIE E CRAWFORD BLVD #B 106 PARKS AVE 21549 AL HIGHWAY 79 1402 COUNTY PARK RD STE 1 410 PARKS AVE STE F 201 VETERANS DR STE 101 5295 TAMMY LITTLE DR 1631 BROAD ST 133 BROAD ST 1402 W DALLAS AVE

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Provider City PELL CITY PHENIX CITY PHENIX CITY PHENIX CITY PHIL CAMPBELL PIEDMONT PINSON PINSON PINSON PISGAH PLEASANT GROVE PRATTVILLE PRATTVILLE RAGLAND RAINBOW CITY RAINBOW CITY RAINSVILLE RAINSVILLE RED BAY ROANOKE ROANOKE ROBERTSDALE ROGERSVILLE ROGERSVILLE RUSSELLVILLE RUSSELLVILLE RUSSELLVILLE RUSSELLVILLE SAMSON SARALAND SARALAND SATSUMA SCOTTSBORO SCOTTSBORO SCOTTSBORO SCOTTSBORO SCOTTSBORO SCOTTSBORO SECTION SELMA SELMA SELMA

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35125-3382 36867-3648 36867-3727 36867 35581-3529 36272 35126-3093 35126-3039 35126-3200 35765 35127-1676 36067-3621 36066-5618 35131-3315 35906 35906-6250 35986-4555 35986-5944 35582-3941 36274-2640 36274-1430 36567-0929 35652 35652-6046 35654-3281 35653 35653-1911 35653-2849 36477-1101 36571-2419 36571-2717 36572-2108 35769-7408 35768-2504 35768-5917 35769-3968 35768-2437 35768-2122 35771-7203 36701-4202 36701-4606 36701-7017

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name INTERLINK APOTHECARY MED CENTER PHARMACY PILCHER-MCBRYDE DRUG CO SWIFT DRUG COMPANY INC SEMMES PHARMACY COLBERT PHARMACY KELLER COMMUNITY PHARMACY MEDICAL CENTER PHARMACY SHOALS PHARMACY 2 DALTON DRUG SMITHS STATION PHARMACY U SAVE IT PHARMACY KLEIN DRUG SHOPPE SOUTHSIDE FAMILY PHARMACY MEDICAP PHARMACY SPRINGVILLE DISCOUNT PHARMACY NORTH JACKSON PHARMACY FAMILY HEALTH PHARMACY BROOKLERE PHARMACY FORT WILLIAMS PHARMACY HUBBARD PHARMACY MARBLE CITY PHARMACY INC SYLVANIA PHARMACY EXPRESS PHARMACY PROFESSIONAL APOTHECARY EAST TALLASSEE PHARMACY HERREN HILL PHARMACY, INC THE APOTHECARY INC SOUTHSIDE PHARMACY, INC. CONWELL'S PHARMACY FAMILY MEDICINE PHARMACY THORSBY DRUGS BRACKIN DRUGS INVERNESS APOTHECARY TRINITY MEDTOWN PHARMACY TRINITY DISCOUNT DRUGS BYRD DRUG COMPANY INC DALTON PHARMACY SYNCO DRUGS ARGO PHARMACY LLC GATEWAY PHARMACEUTICALS LLC NELMS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (334) 875-7686 (334) 874-9495 (334) 875-7208 (334) 874-4651 (251) 645-7979 (256) 389-9900 (256) 386-4600 (256) 381-4311 (256) 383-4473 (334) 886-2442 (334) 408-6106 (334) 297-1505 (205) 466-3636 (256) 413-4473 (251) 625-1311 (205) 467-7988 (256) 437-2248 (205) 698-9770 (205) 648-6059 (256) 207-2007 (256) 245-7708 (256) 245-4446 (256) 638-6070 (256) 362-1120 (256) 362-8328 (334) 252-1688 (334) 252-8800 (334) 283-3120 (256) 232-6588 (251) 973-0805 (334) 636-9809 (205) 688-3784 (256) 685-3530 (256) 260-3350 (256) 353-8997 (256) 350-3365 (334) 566-0100 (334) 697-4920 (334) 566-2610 (205) 467-2223 (205) 508-5500 (205) 655-6133

Provider Street 618 MEDICAL CENTER PKWY STE B 101 SAMUEL O MOSELEY DR 101 BROAD ST 217 BROAD ST 4154 WULFF RD E SUITE E 500 S MONTGOMERY AVE STE 108 1300 S MONTGOMERY AVE 507 N COLUMBIA AVE 340 COX BOULEVARD 141 S DALTON ST 2828 LEE ROAD 430 2463 LEE ROAD 430 87490 US HIGHWAY 278 1250 HIGHWAY 77 6941 SPANISH FORT 460 WALKER DR 85 BANK ST 55298 HWY 17 385 BRYAN RD 401 W FORT WILLIAMS ST 1351 W FORT WILLIAMS ST 264 W FORT WILLIAMS ST 14 INDUSTRIAL LN 320 BATTLE ST W 210 NORTH ST W 4366 NOTASULGA RD 24 HERREN HILL RD 1405 GILMER AVE 11964 ESCUE DR STE A 10835 DAUPHIN ISLAND PKWY 470 SAFFORD AVE W 4 MINNESOTA AVE 2721 AL HIGHWAY 20 24333 AL HIGHWAY 24 24333 ALABAMA HWY 24 SUITE A 1380 OLD HIGHWAY 24 81 N COURT SQ 1412 ELBA HWY 200 N THREE NOTCH ST 247 US HWY 11 3532 VANN RD STE 106B 108 WATTERSON PKWY

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Provider City SELMA SELMA SELMA SELMA SEMMES SHEFFIELD SHEFFIELD SHEFFIELD SHEFFIELD SLOCOMB SMITHS STATION SMITHS STATION SNEAD SOUTHSIDE SPANISH FORT SPRINGVILLE STEVENSON SULLIGENT SUMITON SYLACAUGA SYLACAUGA SYLACAUGA SYLVANIA TALLADEGA TALLADEGA TALLASSEE TALLASSEE TALLASSEE TANNER THEODORE THOMASVILLE THORSBY TOWN CREEK TRINITY TRINITY TRINITY TROY TROY TROY TRUSSVILLE TRUSSVILLE TRUSSVILLE

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

36701-6704 36701-6730 36701-4606 36701-4501 36575 35660-3858 35660-6334 35660 35660 36375-5483 36877 36877-4316 35952-9638 35907-0405 36527 35146-9372 35772-3781 35586 35148-3436 35150-2435 35150-2775 35150-2432 35988 35160-2431 35160-2083 36078-6035 36078-1254 36078-2321 35671-3665 36582-7453 36784-3112 35171-8218 35672-3829 35673-5380 35673 35673-5600 36081-2607 36079-6020 36081-2012 35173-4258 35235-3263 35173-2306

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name TRUSSVILLE TOTAL CARE PHARMACY 15TH STREET PHARMACY DUNKIN'S PHARMACY PATIENT CARE PHARMACY THE PHARMACY AT MIDTOWN TUSCALOOSA DRUG 5 POINTS TUSCALOOSA DRUG CAPSTONE MASSEY DRUGS SHOALS PHARMACY SPECIALTY PHCY OF THE SHOALS TRADING POST DISCOUNT DRUGS BIG BEAR DISCOUNT DRUGS TUSKEGEE QUALITY PHARMACY MAIN DRUG STORE UNION SPRINGS PHARMACY INC UNION DRUGS FAIRFAX DRUG COMPANY HOOD'S PHARMACY VALLEY PHCY & DME OF EAST AL VALLEY GRANDE PHARMACY VALLEY HEAD DRUGS BEASLEYS PHARMACY DURHAM PHARMACY KIDSMEDS PHARMACY TMK ENTERPRISES LLC THE MEDICINE CHEST WEST POINT FAMILY PHARMACY CORNER DISCOUNT DRUGS R & R DRUGS INC SHIPP'S DISCOUNT PHARMACY WARRIOR PHARMACY H & M DRUG INC LAKESIDE PHCY OF ALABAMA, INC. JACK'S DISCOUNT PHARMACY ADAM'S DRUGS JOE'S PHARMACY WETUMPKA PHARMACY, LLC CAFFEYS PHARMACY ROCKYS DRUG & MERCANTILE ODEN-SHIREY DRUG CO WAKEFIELD'S PHARMACY WINFIELD DRUGS

NR_0009_10823 10/2017

Provider Phone Number (205) 655-3455 (205) 345-3180 (205) 345-4410 (205) 752-2045 (205) 752-0627 (205) 248-2220 (205) 469-9669 (256) 381-8383 (256) 389-9800 (256) 389-1358 (256) 381-2400 (334) 727-2150 (256) 393-4063 (334) 738-2020 (334) 738-2320 (334) 628-2241 (334) 756-2305 (334) 756-3219 (334) 756-2037 (334) 875-2271 (256) 635-6812 (205) 695-0144 (205) 695-9611 (205) 824-0775 (205) 259-7100 (205) 672-1955 (256) 775-6085 (205) 647-3900 (205) 647-0574 (205) 590-1100 (205) 647-0528 (256) 357-4614 (256) 357-2315 (205) 938-9588 (334) 567-5136 (334) 567-5315 (334) 567-5442 (251) 456-2273 (251) 645-4000 (205) 487-6700 (205) 487-4199 (205) 487-3079

Provider Street 115 N CHALKVILLE RD 445 15TH ST 7700 HWY 69 SOUTH STE A 1825 MCFARLAND BLVD N STE 200 1800 MCFARLAND BLVD E, STE 334 4301 VETERANS MEMORIAL PKWY 1236 MCFARLAND BLVD NE 218 E 5TH ST STE 1 859 E HOBSON ST 1404 E AVALON AVE 103 S WATER ST 203 W LEE ST 707 W MARTIN LUTHER KING HWY 302 PRAIRIE ST N 204 PRAIRIE ST N 117 WATER ST 89 TRAMMELL BLOCK 4500 20TH AVE 4103 20TH AVE 7171 ALABAMA HWY 22 NORTH 114 COMMERCE AVE 170 5TH ST SW 44801 HWY 17 1936 OLD ORCHARD RD 3346 MORGAN DR 42747 HIGHWAY 25 11784 ALABAMA HWY 157 10107 CORNER SCHOOL RD 300 MAIN ST N 88 WHITE OAK TRAIL 219 MAIN ST N 17216 HIGHWAY 431 17054 HIGHWAY 431 23010 HIGHWAY 5 5268 US HIGHWAY 231 809 JACKSON TRACE RD 13 CAMBRIDGE CT 3707 B ST STEPHENS RD 13170 MOFFETT RD 970 US HIGHWAY 43 145 STATE HIGHWAY 253 STE C 186 MEDICAL DR

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Provider City TRUSSVILLE TUSCALOOSA TUSCALOOSA TUSCALOOSA TUSCALOOSA TUSCALOOSA TUSCALOOSA TUSCUMBIA TUSCUMBIA TUSCUMBIA TUSCUMBIA TUSKEGEE TUSKEGEE UNION SPRINGS UNION SPRINGS UNIONTOWN VALLEY VALLEY VALLEY VALLEY GRANDE VALLEY HEAD VERNON VERNON VESTAVIA VESTAVIA VINCENT VINEMONT WARRIOR WARRIOR WARRIOR WARRIOR WEDOWEE WEDOWEE WEST BLOCTON WETUMPKA WETUMPKA WETUMPKA WHISTLER WILMER WINFIELD WINFIELD WINFIELD

State

ZIP code

AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL

35173-1376 35401-3552 35405-8784 35406-2251 35404-5874 35404-5185 35406-2206 35674-2520 35674-1773 35674-1773 35674-2424 36083-1720 36083 36089-1417 36089-1617 36786 36854-4903 36854-3541 36854-3448 36701 35989-4259 35592-5215 35592-0509 35216-2247 35216-3052 35178-6106 35179 35180-3083 35180-1349 35180 35180-1332 36278-4574 36278-4572 35184 36092-3169 36092-1504 36093 36612 36587-4410 35594-4711 35594 35594-5002

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WOODSTOCK DRUG INC YORK DRUG INC ALMA PHARMACY INC COLEMAN PHARMACY OF ALMA ALLCARE FAMILY DISC PHCY ASH FLAT PHARMACY USA DRUG EXPRESS ATKINS FAMILY PHARMACY BILLS PHARMACY CLARK DRUG STORE THE HEALTH DEPOT BRYANTS PHARMACY CLINIC DRUG STORE INC ECONO-MART PHARMACY OAK PARK PHARMACY SAV-ON PHARMACY THE MEDICINE SHOPPE WILSON WIL-SAV PHARMACY BEARDEN PHARMACY BURROW REXALL DRUG STORE INC HEALTH-WAY SAVE-ON DRUGS CORNERSTONE PHARM OF B V BIRCH TREE COMM,INC PHCY FINLEY PHARMACY SALEM PHARMACY, INC. SMITH-CALDWELL WEST SIDE PHARMACY COLLIER DRUG-BENTONVILLE HARPS PHARMACY INFINITY COMPOUNDING SOLUTIONS ECONOMY DRUG POYNOR DRUG ROSE PHARMACY ROTHROCK DRUG COMPANY INC BIG WORLD PHARMACY WINNINGHAM PHARMACY ARCARE PHARMACY FREDS PHARMACY THE PHARMACY AT BROOKLAND BRYANT FAMILY PHARMACY CORNERSTONE PHARMACY BRYANT MEDIC PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (205) 938-9221 (205) 392-5201 (479) 632-2011 (479) 632-2248 (870) 246-3044 (870) 994-7377 (870) 898-5151 (479) 641-7878 (870) 347-2620 (501) 724-3261 (479) 452-1237 (870) 793-3999 (870) 793-5170 (870) 793-4179 (870) 698-1974 (870) 793-4770 (870) 793-2161 (870) 251-2432 (870) 687-3814 (501) 882-5425 (501) 882-6471 (479) 876-6200 (501) 303-1634 (501) 315-5100 (501) 316-1600 (501) 315-7700 (501) 778-3151 (479) 876-8300 (479) 273-5541 (888) 414-5805 (870) 423-2094 (870) 423-2737 (870) 762-4545 (870) 763-4451 (479) 675-3900 (501) 344-2763 (870) 734-1100 (870) 734-1138 (870) 206-9920 (501) 847-2880 (501) 481-8964 (501) 847-3596

Provider Street 28891 HIGHWAY 5 583 4TH AVE 108 HIGHWAY 71 N 18 HWY 162 SOUTH 3002 PINE ST 970 ASH FLAT DR 191 W MAIN ST 408 N CHURCH ST 601 MAIN ST 2116 HIGHWAY 367 N 1610 FORT ST 2000 HARRISON ST 1700 HARRISON ST STE D 1595 HARRISON ST 1305 WHITE DR 1610 HARRISON ST 2080 HARRISON ST STE A 5 ALLEN CHAPEL RD 26 NW 1ST ST 45 HIGHWAY 64 W 1903 W DEWITT HENRY DR 1 MERCY WAY STE 50 1718 OLD HOT SPRINGS HWY 1016 W SOUTH ST 1208 SALEM RD 414 N MAIN ST 620 W SOUTH ST STE C 2900 MEDICAL CTR PKWY STE 120 1209 N WALTON BLVD 1204 SE 28TH ST STE 2 1006 W TRIMBLE AVE 408 PUBLIC SQUARE 1003 N 6TH ST 700 N 6TH ST 1531 E MAIN ST 232 E MAIN ST 615 N MAIN ST 1311 N CHARLYNE AVE 406B HONEY SUCKLE 3801 HIGHWAY 5 NORTH 2203 N REYNOLDS RD 101 NW 3RD ST STE A

Page 17 of 679

Provider City WOODSTOCK YORK ALMA ALMA ARKADELPHIA ASH FLAT ASHDOWN ATKINS AUGUSTA BALD KNOB BARLING BATESVILLE BATESVILLE BATESVILLE BATESVILLE BATESVILLE BATESVILLE BATESVILLE BEARDEN BEEBE BEEBE BELLA VISTA BENTON BENTON BENTON BENTON BENTON BENTONVILLE BENTONVILLE BENTONVILLE BERRYVILLE BERRYVILLE BLYTHEVILLE BLYTHEVILLE BOONEVILLE BRADFORD BRINKLEY BRINKLEY BROOKLAND BRYANT BRYANT BRYANT

State

ZIP code

AL AL AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

35188-3614 36925-2008 72921-5024 72921 71923-5325 72513-9533 71822-2714 72823-4149 72006-2444 72010-9443 72923-2018 72501-7442 72501-7315 72501-7222 72501-9467 72501 72501-7447 72501-9787 71720 72012-9500 72012-2028 72714 72019 72015-4051 72019-8340 72015-3714 72015-4235 72712-3212 72712-4130 72712-3887 72616 72616 72315-1707 72315-2412 72927-4921 72020-9264 72021 72021-2001 72417-8980 72022-9028 72022-2533 72022-3458

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name THOMAS LAKESIDE PHARMACY ARCARE PHARMACY EXPRESS RX OF CABOT GREYSTONE RX HEARTLAND PHARMACY CABOT PRICE CUTTER PHARMACY CAMDEN DRUG GARDEN OAKS PHARMACY M AND S PHARMACY MORRISON'S CLINIC PHARMACY MORRISON'S PHARMACY SUPER D DRUGS MEDSKERS FAMILY PHARMACY CAVE CITY PHARMACY COLLIER DRUG STORES INC MEDISAV HOMECARE PHARMACY ECONO-MED PHARMACY POLK PHARMACY BOBBY TEETER'S DRUG STORE INC CLARKSVILLE FAMILY PHARMACY ROSE DRUG OF CLARKSVILLE AMERICAN HOME PHARMACY LLC CLINTON DRUG AMITY ROAD PHARMACY BAKER DRUG STORE, INC CONWAY MEDCARE PHARMACY CONWAY MEDICAL PARK PHARMACY CORNERSTONE PHARMACY CONWAY HARPS PHARMACY MEDICINE SHOPPE SAV-ON DRUGS SMITH FAMILY PHARMACY US COMPOUNDING INC CATE PHARMACY GOODMAN DRUG COMPANY PLLC BAKERS PHARMACY GAMMEL'S CLINIC PHARMACY ALLCARE PHARMACY SUPER D DRUGS BERRY DRUG OF DARDANELLE ROSE DRUG OF DARDANELLE

NR_0009_10823 10/2017

Provider Phone Number (870) 445-7188 (501) 941-3116 (855) 553-9777 (501) 286-6054 (501) 941-4400 (501) 843-3374 (870) 836-9303 (870) 836-8176 (870) 836-2212 (870) 836-2727 (870) 836-8132 (870) 836-4157 (870) 552-7837 (870) 283-5589 (479) 795-8199 (479) 965-2244 (870) 856-4696 (870) 747-3304 (479) 754-2196 (479) 647-3138 (479) 754-2180 (501) 745-4266 (501) 745-8414 (501) 358-3863 (501) 329-5626 (501) 358-3498 (501) 358-6212 (501) 328-3282 (501) 329-3733 (501) 327-8088 (501) 327-6777 (501) 336-8188 (501) 327-1222 (870) 857-6766 (870) 857-0551 (870) 364-5155 (870) 364-5100 (877) 420-9400 (479) 495-5444 (479) 229-4811 (479) 229-4040

Provider Street 902 CENTRAL BLVD 502 RICHIE RD 1848 W MAIN ST STE B 15361 HIGHWAY 5 STE F 2006 S PINE ST STE F 801 N 2ND ST 1005 W WASHINGTON ST 200 GARDEN OAKS DR SW 415 HOSPITAL DR 353 CASH RD 1286 HIGHWAY 278 BYP 424 CALIFORNIA AVE SW 121 N COURT ST 301 S MAIN STE C 911 W CENTERTON BLVD 621 E MAIN ST 1 CHOCTAW CENTER 333 MADISON ST 200 W MAIN ST 510 S ROGERS ST STE 3 211 E MAIN ST 129 BONE ST 2526 HIGHWAY 65 S 500 AMITY RD STE 5 #B 924 FRONT ST 2521 COLLEGE AVE 650 UNITED DRIVE SUITE 110 815 HOGAN LN STE 10 1120 E GERMAN RD 2125 COLLEGE AVE STE 1 1014 HARKRIDER ST STE 65 2235 DAVE WARD DR STE 108 2515 COLLEGE AVE 500 N MISSOURI AVE 1109 W MAIN 300 MAIN ST 909 UNITY RD 708 E 8TH ST 300 E 8TH ST 417 UNION ST 1176 STATE HIGHWAY 22 W

Page 18 of 679

Provider City BULL SHOALS CABOT CABOT CABOT CABOT CABOT CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CARLISLE CAVE CITY CENTERTON CHARLESTON CHEROKEE VILLAGE CLARENDON CLARKSVILLE CLARKSVILLE CLARKSVILLE CLINTON CLINTON CONWAY CONWAY CONWAY CONWAY CONWAY CONWAY CONWAY CONWAY CONWAY CONWAY CORNING CORNING CROSSETT CROSSETT DANVILLE DANVILLE DARDANELLE DARDANELLE

State

ZIP code

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72619-3223 72023 72023-2745 72023 72023-8179 72023-2547 71701-3828 71701-3733 71701-4615 71701-0000 71701-4552 71701-4216 72024-0000 72521-0147 72719 72933-9328 72529 72029-2717 72830-3010 72830-3792 72830-3723 72031-6609 72031-6588 72032-5932 72032-4304 72034-6135 72032 72034-7959 72032-4555 72034-6387 72032-4404 72034-7040 72034-6135 72422-1616 72422-2040 71635-2928 71635-9444 72833 72833-8800 72834-3429 72834-3006

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DEQUEEN HEALTH AND WELLNESS PHCY HARRIS DRUG PRUETTS FOOD-PHARMACY DEAN'S PHARMACY TOMMY'S REXALL DRUG DELTA DRUG OF DERMOTT,INC. PALACE DRUG STORE DIERKS PHARMACY ROSE DRUG INC OF DOVER FREDS XPRESS LEE'S SUPER DRUG STORE CLARKS FAMILY PHARMACY ALLCARE PHARMACY MEDIC PHARMACY OF EL DORADO MELVINS DISCOUNT PHARMACY INC MIDSOUTH PHARMACY SAMA CLINIC PHARMACY SUPER D DRUGS HARPS PHARMACY POLK PHARMACY MEDICAL PARK PHARMACY SMITH DRUG AND COMPANY FAIRFIELD BAY PHARMACY COLLIER DRUG-FARMINGTON CLEARMED SOLUTIONS, LLC COLLIER DRUG ELKINS COLLIER DRUG-DICKSON CORNERSTONE SPECIALTY PHARMACY HARPS PHARMACY HARPS PHARMACY HARPS PHARMACY HIGHLANDS PHARMACY MEDICAL ARTS PHARMACY MEDICAL ARTS PHARMACY ELKINS NORTH DRUG-NORTH HILLS SOUTHGATE IGA PHARMACY THE PRESCRIPTION STORE WATSON PHARMACY PRICE HARRIS PHARMACY ANDERSON'S DISCOUNT PHARMACY CENTRAL DISCOUNT PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (870) 642-2400 (870) 584-3555 (870) 642-5680 (870) 946-2381 (870) 946-4221 (870) 538-5510 (870) 256-4317 (870) 286-3131 (479) 331-2133 (870) 382-2955 (870) 382-4007 (870) 792-7177 (870) 863-8111 (870) 862-4931 (870) 863-4155 (870) 864-0730 (870) 639-3929 (870) 881-8434 (479) 643-2362 (501) 842-2575 (479) 253-9751 (479) 253-9175 (501) 884-3388 (479) 267-4303 (479) 439-4544 (479) 442-6060 (479) 442-6262 (479) 444-7200 (479) 251-9130 (479) 571-1214 (479) 444-7967 (479) 695-1199 (479) 443-3411 (479) 296-6041 (479) 443-9200 (479) 443-4747 (870) 352-8631 (870) 352-2161 (870) 633-7474 (479) 782-2881 (479) 452-8686

Provider Street 1357 W COLLIN RAYE DR 205 W DEQUEEN AVE 500 E COLLIN RAY DR 1640 S WHITEHEAD DR 220 COURT SQ 111 E PEDDICORD ST 313 MAIN 323 MAIN ST 8880 MARKET ST 611 US HWY 65 SOUTH, SUITE A 105 W CHOCTAW ST 621 COMMERCE ST 102 E ELM ST 347 W OAK ST 828 W HILLSBORO ST 3215 N WEST AVE 600 S TIMBERLANE STE 101 701 W GROVE ST 1951 N CENTER ST 104 STUTTGART HWY 121 E VAN BUREN STE C 133 E VAN BUREN 367 DAVE CREEK PKWY 197 E MAIN ST 1450 E ZION RD STE 3 2491 N CENTER ST 100 W DICKSON ST 1450 E ZION RD STE 1 1274 N COLORADO DR 1780 N CROSSOVER RD 1189 N GARLAND AVE 3232 N NORTHHILLS BLVD 2515 E HUNTSVILLE RD 2127 N. CENTER ST. SUITE 1 3380 N FUTRALL DR STE 2 1620 S SCHOOL AVE 1115 W 4TH ST 908 W 4TH ST 313 ARKANSAS ST 700 LEXINGTON AVE 5400 ELLSWORTH RD

Page 19 of 679

Provider City DE QUEEN DE QUEEN DE QUEEN DE WITT DE WITT DERMOTT DES ARC DIERKS DOVER DUMAS DUMAS EARLE EL DORADO EL DORADO EL DORADO EL DORADO EL DORADO EL DORADO ELKINS ENGLAND EUREKA SPRINGS EUREKA SPRINGS FAIRFIELD BAY FARMINGTON FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FORDYCE FORDYCE FORREST CITY FORT SMITH FORT SMITH

State

ZIP code

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

71832-2946 71832-2809 71832-8048 72042-2994 72042-2057 71638-2314 72040-0000 71833 72837-9111 71639 71639-2005 72331-1419 71730-6102 71730-4564 71730-7047 71730-2732 71730-6990 71730-4415 72727-2900 72046-1557 72632-3658 72632-3653 72088-3631 72730-3023 72703-4988 72701-9455 72701-5219 72703-5041 72704 72701-2724 72703-1682 72703-4005 72701-7329 72701-9449 72703-4815 72701-7149 71742-2001 71742-2216 72335 72901-4738 72903-3220

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

COLEMAN PHARMACY COOPER CLINIC PA GENOA-QOL HEALTHCARE HARPS PHARMACY HARPS PHARMACY HARPS PHARMACY HERRAKA LLC LAWS DRUG STORE MEDI SAV HOMECARE PHARMACY MEDISAV HOMECARE PHARMACY MIDLAND DRUG INC NATIONAL FAMILY PHARMACY PHCY SPECIALTIES GROUP (PSG) PRINCE DRUG STORE INC SOUTHSIDE SPECIALTY PHARMACY THE HEALTH DEPOT TRUCARE PHARMACY VAUGHN PRESCRIPTION GENUINE CARE PHARMACY CORNERSTONE PHARMACY GENTRY SMITH DRUG PLLC BUCK'S PHARMACY PHILS EASTSIDE PHARMACY WOODARD FAMILY PHARMACY AUSTIN DRUGS TEASLEY DRUG HARPS PHARMACY AMERICAN DRUGS HARPS PHARMACY THE HEALTH DEPOT

Provider Name

(479) 783-5171 (479) 274-2951 (479) 755-2652 (479) 452-0993 (479) 783-3699 (479) 646-5505 (479) 441-5565 (479) 452-6116 (479) 646-2971 (479) 452-0278 (479) 783-0221 (479) 783-6135 (479) 648-0000 (479) 782-9210 (479) 242-2894 (479) 646-7875 (479) 922-2253 (479) 782-8209 (870) 435-5757 (479) 525-6200 (479) 736-2241 (870) 356-2288 (870) 356-7445 (870) 356-2193 (479) 787-5432 (479) 787-5966 (870) 438-5614 (501) 679-2211 (501) 679-0470 (479) 996-9898

3610 GRAND AVE 7301 ROGERS AVE 3111 S 70TH ST STE 100 3401 S 74TH ST 3100 GRAND AVE 2507 MARKET TRACE 1001 TOWSON AVE 6802 ROGERS AVE STE 2 5701 JENNY LIND RD 8820 ROGERS AVE 4900 KELLEY HWY 1615 DODSON AVE 12110 HIGHWAY 71 S # A 1112 TOWSON AVE 3416 OLD GREENWOOD RD STE A 7700 HIGHWAY 271 S 7206 HIGHWAY 271 S 507 LEXINGTON AVE 7337 HIGHWAY 62 W 560 S GENTRY BLVD 695 E 3RD ST 408 NORTH 1ST STREET 253 HIGHWAY 70 E 210 E BROADWAY 118 MAIN ST NE 205 ATLANTA SE ST 309 E MAIN ST 1 E MAIN ST 15 N BROADVIEW ST 1530 W CENTER ST

FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH FORT SMITH GASSVILLE GENTRY GENTRY GLENWOOD GLENWOOD GLENWOOD GRAVETTE GRAVETTE GREEN FOREST GREENBRIER GREENBRIER GREENWOOD

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72904-6842 72903 72903-5017 72903-5025 72904-6709 72908-8677 72901 72903-4010 72908-7435 72903-5245 72904-5000 72901-5129 72916-8405 72901-5002 72903-5462 72908-8028 72908-8017 72901-4640 72635-8636 72734 72734 71943-0000 71943-8801 71943-9243 72736-8719 72736 72638-2432 72058-9208 72058-9331 72936-3400

CORNERSTONE PHARMACY AT GREERSFERRY THOMERSON DRUG STORE HAMBURG PHARMACY LAGRONE DRUG HAMPTON MEDICAL PHARMACY FOOD GIANT DISCOUNT PHARMACY COUNTRY MART PHARMACY HARPS PHARMACY NIKKI'S HOMETOWN PHARMACY SAM ALEXANDER PHARMACY SULLIVAN PHARMACY-MAIN STREET

(501) 825-6265 (870) 353-4442 (870) 853-2191 (870) 853-8666 (870) 798-4247 (870) 578-5200 (870) 741-2118 (870) 365-0586 (870) 741-7455 (870) 741-6511 (870) 741-2119

8470 EDGEMONT RD 113 N 1ST ST 302 S MAIN ST 201 N MAIN ST 344 S LEE 605 N ILLINOIS ST 611 HWY 62 & 65 NORTH 5015 HIGHWAY 62 E 324 W. BOWER AVENUE 127 N MAIN ST 731 N MAIN ST STE B

GREERS FERRY GURDON HAMBURG HAMBURG HAMPTON HARRISBURG HARRISON HARRISON HARRISON HARRISON HARRISON

AR AR AR AR AR AR AR AR AR AR AR

72067-9742 71743-1201 71646-3230 71646-3264 71744 72432-1249 72601 72601-9157 72601 72601-4227 72601-2912

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 20 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name FREDS PHARMACY PRESCRIPTION SHOP ALLCARE PHARMACY FAMILY DISCO PHARMACY INC HARPS PHARMACY HECTOR PHARMACY BENZER PHARMACY HICKORY HILL PHARMACY M-C DRUG STORE, LLC DAVIS DRUG STORE ALLCARE FAMILY DISCOUNT SUPER ONE PHARMACY HORSESHOE HEALTH AND MEDICINE HARPS PHARMACY HARPS PHARMACY HARVEST FOODS PHARMACY HOT SPRINGS PHARMACY OAK PARK PHARMACY SMITH DRUG AND COMPOUNDING INC SUPER DRUGS VILLAGE HEALTH MART DRUG CRAWFORD PHARMACY BUDGET PHARMACY GENESIS CANCER CENTER GENOA-QOL HEALTHCARE HOMETOWN PHARMACY LAKESIDE PHARMACY INC NATIONAL PARK PHARMACY THE MEDICINE SHOPPE VILLAGE HEALTHMART DRUG ECONOMY DRUG HARPS PHARMACY CORNERSTONE PHCY JACKSONVILLE CSI PHARMACY FAMILY FIRST PHARMACY MARSHALL ROAD PHARMACY JASPER PHARMACY ALLCARE PHARMACY CAMP'S MEDICAL PHARMACY, INC COUNTRY MART PHARMACY GIBSONS PHARMACY HILLTOP MARKET PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (501) 778-7505 (870) 255-4403 (877) 420-9400 (501) 362-5853 (501) 206-0146 (479) 284-2011 (870) 338-6464 (870) 338-8351 (870) 338-3414 (870) 856-3080 (870) 777-4643 (870) 777-6989 (870) 670-4580 (501) 760-1283 (501) 520-0026 (501) 767-1919 (501) 760-2444 (501) 623-2222 (501) 767-2220 (501) 463-9922 (501) 922-0909 (501) 624-4636 (501) 321-1617 (501) 624-7700 (501) 762-8919 (501) 760-5667 (501) 262-5400 (501) 623-2280 (501) 984-6101 (501) 922-0777 (479) 738-2620 (479) 738-2202 (501) 986-4249 (501) 392-5160 (501) 985-5916 (501) 982-3551 (870) 446-5515 (870) 935-6364 (870) 910-5550 (870) 933-2016 (870) 972-9125 (870) 336-8310

Provider Street 6027 US HWY 67 158 LIVERMORE ST 600 W MAIN ST 120 S 4TH ST 901 W MAIN ST 11167 SR 27 300 PERRY STREET 109 HICKORY HILLS DR 533 PORTER ST 1645 HIGHWAY 62 412 318 W 3RD ST 825 N HERVEY ST 600 MARKET ST 146 THORNTON FERRY RD 5536 CENTRAL AVE 1739 AIRPORT RD 1200 AIRPORT RD 105 SAWTOOTH OAK 1629 AIRPORT RD STE D 5500 CENTRAL AVENUE 399 PONCE DE LEON STE 2 107 CRAWFORD ST 117 GREENWOOD AVE 133 HARMONY PARK 125 DONS WAY STE 268 2228 ALBERT PIKE RD STE B 998 SHADY GROVE RD UNIT 1-H 1534 MALVERN AVE STE B 4545 N HIGHWAY 7 4440 N HIGHWAY 7 601 N GASKILL ST 115 LEE ST 315 S JAMES ST 607 WEST MAIN ST 1300 BRADEN ST 811 MARSHALL RD 200 WEST CHURCH 1112 WINDOVER RD 800 S CHURCH ST STE 103 3106 SOUTHWEST DR 403 E MATTHEWS AVE 3605 E JOHNSON AVE

Page 21 of 679

Provider City HASKELL HAZEN HEBER SPRINGS HEBER SPRINGS HEBER SPRINGS HECTOR HELENA HELENA HELENA HIGHLAND HOPE HOPE HORSESHOE BEND HOT SPRINGS HOT SPRINGS HOT SPRINGS HOT SPRINGS HOT SPRINGS HOT SPRINGS HOT SPRINGS HOT SPRINGS HOT SPRINGS NATIONAL HOT SPRINGS NATIONAL PARK HOT SPRINGS NATIONAL PARK HOT SPRINGS NATIONAL PARK HOT SPRINGS NATIONAL PARK HOT SPRINGS NATIONAL PARK HOT SPRINGS NATIONAL PARK HOT SPRINGS VILLAGE HOT SPRINGS VILLAGE HUNTSVILLE HUNTSVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JASPER JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO

State

ZIP code

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72015 72064-8258 72543 72543-3810 72543 72843-8791 72342-3325 72342-2301 72342-3217 72542-9540 71801-5101 71801-2611 72512 71913-2544 71913-9712 71913 71913 71901-7160 71913 71913 71909-8103 71913-6136 71913-4428 71913-5417 71913-6478 71913-4089 71901-8058 71901-6503 71909-9600 71909-9301 72740-6001 72740-8059 72076-4315 72076-4431 72076-3719 72076-3744 72641 72401-6038 72401-4154 72404-8404 72401-3142 72401-1808

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MID-SOUTH HEALTH SYSTEM INC NORTHCENTRAL IV AND RSP SPEC PARKER ROAD SPECIALITY PHCY PAT'S SUPER V DRUG STORE INC PLAZA PHARMACY SOO'S DRUG STORE INC SOO'S WEST END PHARMACY STONES PHARMACY INC SUPER D DRUGS THE MEDICINE SHOPPE WOODSPRINGS PHARMACY HEALTH-WAY PHARMACY RIVERSIDE PHARMACY ST FRANCIS PHARMACY HUNTERS PHARMACY LAKE VILLAGE DRUG STORE HEALTH-WISE PHARMACY LEACHVILLE DISCOUNT DRUGS LEPANTO DISCOUNT DRUGS

Provider Name

(870) 972-4038 (870) 932-0150 (870) 935-6400 (870) 972-6470 (870) 972-1751 (870) 932-6930 (870) 932-4742 (870) 935-5538 (870) 935-2242 (870) 935-1340 (870) 972-8310 (501) 729-3670 (870) 237-8010 (870) 237-8215 (870) 265-2220 (870) 265-5555 (479) 674-2222 (870) 539-6831 (870) 475-2617

2707 BROWNS LN 202 E WASHINGTON AVE 1109 W PARKER RD 1000 E MATTHEWS AVE STE A 3001 APACHE DR 2822 E NETTLETON AVE 619 W NETTLETON AVE 417 E MATTHEWS AVE 2608 E NETTLETON AVE 325 STE A SOUTHWEST DR 1807 WOODSPRINGS RD 803 HIGHWAY 367 N 803 HIGHWAY 18 STE B 210 COBEAN BLVD # 10 401 MAIN ST 2907 HWY 65-82 SOUTH 1800 W MAIN ST 109 S MAIN ST 216 GREENWOOD AVE

JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO JONESBORO JUDSONIA LAKE CITY LAKE CITY LAKE VILLAGE LAKE VILLAGE LAVACA LEACHVILLE LEPANTO

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72401-7213 72401 72404-9583 72401-4344 72401-7432 72401-4531 72401-3970 72401-3142 72401-4515 72401 72401-0903 72081-9190 72437-9603 72437-9704 71653-1731 71653-2120 72941-3802 72438-0000 72354-3213

BELL PHARMACY OF NORTHWEST ARKANSAS HARPS PHARMACY ALLCARE PHARMACY ARCH STREET PHARMACY BAPTIST MEDICAL TOWERS PHARMACY BLANDFORD PHARMACY CITY PHARMACY INC CORNERSTONE PHARMACY CORNERSTONE PHARMACY AT CHENAL CORNERSTONE PHARMACY MAIN, LLC CORNERSTONE PHARMACY MARKHAM CORNERSTONE PHCY OTTER CREEK D&D PHARMACY DONS PHARMACY INC DRUG EMPORIUM EAST END PHARMACY EXPRESS RX ON CANTRELL FAMILY MEDICAL CENTER PHCY INC FREIDERICA PHARMACY GENOA-QOL HEALTHCARE KAVANAUGH PHARMACY LANDMARK PHARMACY

(479) 824-3256 (479) 824-3265 (501) 217-8880 (501) 261-7181 (501) 202-2462 (501) 664-4466 (501) 374-6565 (501) 223-2224 (501) 821-2300 (501) 246-5451 (501) 904-4299 (501) 455-1900 (501) 801-8068 (501) 225-2222 (501) 223-2262 (501) 888-2830 (501) 410-4111 (501) 562-3314 (501) 374-2207 (501) 712-4395 (501) 664-3844 (501) 888-2223

113 BOYER 310 WEST PRIDEMORE DRIVE 10620 COLONEL GLEN RD STE 300 11200 ARCH STREET SUITE 1 9601 BAPTIST HEALTH DR STE 109 5 SAINT VINCENT CIR 1801 BROADWAY ST 4220 N RODNEY PARHAM RD STE 10 16115 ST VINCENT WAY STE 120 1701 MAIN ST 11414 W MARKHAM ST STE D 10320STAGE COACH RD 8908 KANIS RD STE 350 8609 W MARKHAM ST 9112 N RODNEY PARHAM RD # 110 20381 ARCH ST 7612 CANTRELL RD 4202 S UNIVERSITY AVE 400 W CAPITOL AVE 4 EXECUTIVE CENTER CT STE A 5008 KAVANAUGH BLVD 3401 ATWOOD RD STE E

LINCOLN LINCOLN LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72744 72744 72204-8048 72206 72205-6323 72205-5412 72206-1222 72212-2466 72223 72206-1471 72211-2806 72210-5746 72205-6414 72205-2312 72205-1648 72206-9218 72227-3320 72204-7841 72201-3436 72211-4487 72207-4747 72206-6012

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 22 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LITTLE ROCK COM MNTL HLTH CTR MARKET PLACE PHARMACY MEDIC PHARMACY INC MEDIC PHARMACY, INC PARK WEST PHARMACY PHARMACY OF OTTER CREEK REMEDY DRUG RHEA DRUG STORE SMITHS COUNTRY CLUB DRUG INC SUPER D DRUGS TANGLEWOOD DRUG STORE THE DRUG STORE THE PHARMACY AT WELLINGTON UAMS OUTPATIENT PHARMACY LACKIE DRUG STORE LYONS DRUG STORE LOWELL PHARMACY FREDS PHARMACY COUNTY DISCOUNT PHARMACY ALLCARE FAMILY DISCOUNT MILLER'S PHARMACY PRINCE PHARMACY WILSON-BEARDEN PHARMACY MILLER'S DRUG STORE INC YOUNG'S HEALTHMART PHARMACY PALACE DRUG DELTA DRUG INC WAGNER PHARMACY CORNERSTONE PHARMACY MANSFIELD HEALTH-WISE PHCY OF MANSFIELD DEANS PHARMACY MEDRELIEF PHARMACY FAMILY CARE PHARMACY MARMADUKE FAMILY PHARMACY BAKER PHARMACY MARSHALL MEDIC PHARMACY THE MARVELL PHARMACY INC MAUMELLE HEALTHMART PHARMACY MEDICINE SHOPPE FREDS PHARMACY KELLEY DRUG & SELECTIONS SAV-MART PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (501) 686-9052 (501) 225-5056 (501) 562-3740 (501) 664-3907 (501) 224-3499 (501) 455-2522 (501) 313-4480 (501) 663-4131 (501) 663-4118 (501) 664-4121 (501) 664-4444 (501) 223-2636 (501) 708-4320 (501) 686-5530 (501) 676-6566 (501) 676-2247 (479) 770-0111 (501) 455-1086 (479) 969-2727 (870) 234-8120 (870) 234-2011 (870) 234-7292 (870) 234-1062 (501) 332-2351 (501) 337-4901 (870) 625-3222 (870) 561-3113 (870) 561-1500 (479) 269-6161 (479) 928-4499 (870) 295-4100 (870) 739-1700 (870) 358-2484 (870) 597-2911 (870) 448-3336 (870) 448-3614 (870) 829-1044 (501) 803-9400 (501) 851-4949 (501) 470-9174 (870) 222-5071 (870) 222-6676

Provider Street 1100 N UNIVERSITY STE 240 11316 HURON LN 6221 COLONEL GLENN RD STE 2 5901 W 12TH ST 904 AUTUMN RD 10506 STAGECOACH RD STE F 8511 W MARKHAM 2801 KAVANAUGH BLVD 5114 KAVANAUGH BLVD 500 S UNIVERSITY AVE 6815 CANTRELL RD 11715 RAINWOOD RD 15400 CHENAL PKWY STE 100 4301 W MARKHAM ST # 547-10 719 N CENTER ST 115 W FRONT ST 114 HARRISON AVE STE #A 13907 HIGH RD 48 S GARLAND 107 E NORTH ST 111 S COURT SQ 211 E STADIUM ST 134 N WASHINGTON ST 231 S MAIN ST 1304 S MAIN ST 270 MAIN ST 257 S HWY 18 BYPASS 3644 W STATE HWY 18 607 HIGHWAY 71 E STE B 213 E HOWARD ST 311 W CHESTNUT ST 2895 STATE HWY 77 S STE 3 98 HIGHWAY 63B STE A 11901 HIGHWAY 49 N 101 MAIN ST 243 HIGHWAY 65 N 406 S MILL ST 1900 CLUB MANOR DR STE 101 1701 CLUB MANOR DR STE D 652 HIGHWAY 365 104 HOLLY ST 1007 HIGHWAY 65 S

Page 23 of 679

Provider City LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LITTLE ROCK LONOKE LONOKE LOWELL MABELVALE MAGAZINE MAGNOLIA MAGNOLIA MAGNOLIA MAGNOLIA MALVERN MALVERN MAMMOTH SPG MANILA MANILA MANSFIELD MANSFIELD MARIANNA MARION MARKED TREE MARMADUKE MARSHALL MARSHALL MARVELL MAUMELLE MAUMELLE MAYFLOWER MC GEHEE MC GEHEE

State

ZIP code

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72207-6358 72211-1856 72204-7760 72204-1608 72211-3702 72210-8939 72205-2432 72205-3849 72207-4607 72205-5302 72207-4134 72212-3951 72211 72205-7101 72086-2547 72086-3117 72745-9047 72103-3212 72943 71753-2822 71753-3511 71753-2032 71753-2856 72104-3736 72104-5228 72554 72442-0000 72442 72944 72944 72360-2131 72364-2371 72365-1614 72443-9598 72650-0000 72650-7859 72366-0000 72113-7443 72113-7400 72106-9630 71654-2249 71654-9417

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BEST DRUG STORE CORNER DRUG STORE FREEDOM PHARMACY HEALTHY CONNECTIONS COMMUNITY PHAMA MEDI SHOP PHARMACY SUPER D DRUGS MCFARLIN PHARMACY INC MONETTE DISCOUNT DRUG CITY DRUG OF MONTICELLO THE PRESCRIPTION PAD PHARMACY HARPS PHARMACY HEALTH CARE PHARMACY LEMONS PRESCRIPTION SHOP LLC MOUNT IDA PHARMACY WAGNER'S MOUNT IDA PHARMACY HARPS PHARMACY HARPS PHARMACY HEARTLAND PHCY MTN HOME MEDI-SAVE PHARMACY PONDER HEALTH ALLCARE

Provider Name

(870) 731-2251 (870) 368-7171 (479) 437-3089

906 N EDMONDS 830 MAIN ST 710 4TH ST

MCCRORY MELBOURNE MENA

AR AR AR

72101 72556-8205 71953-3314

(479) 437-6023 (479) 394-3254 (479) 394-5144 (870) 486-5220 (870) 486-2111 (870) 367-5301 (870) 367-4227 (501) 477-5048 (501) 354-1460 (501) 354-3318 (870) 867-3174 (870) 867-3174 (870) 425-4127 (870) 508-0054 (870) 425-2221 (870) 424-4010 (870) 425-5145

136 HEALTH PARK DRIVE STE 100 204 HIGHWAY 71 S 703 HIGHWAY 71 N 101 W DREW 214 W DREW AVE 201 E GAINES 539 HIGHWAY 425 S 100 SOUTH SAINT JOSEPH ST 10 HOSPITAL DR 1713 E HARDING ST 744 HIGHWAY 270 E 744 HIGHWAY 270 E 924 HIGHWAY 62 E 2089 HIGHWAY 62 W 200 E 7TH ST 116 HIGHWAY 201 N 400 S COLLEGE ST

MENA MENA MENA MONETTE MONETTE MONTICELLO MONTICELLO MORRILTON MORRILTON MORRILTON MOUNT IDA MOUNT IDA MOUNTAIN HOME MOUNTAIN HOME MOUNTAIN HOME MOUNTAIN HOME MOUNTAIN HOME

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

71953 71953-4638 71953-4395 72447-0000 72447 71655-4903 71655-4674 72110 72110-4510 72110-4507 71957-8003 71957-8003 72653-3214 72653-7656 72653 72653 72653-3923

BEST DRUG STORE OF N CENTRAL AR INC MITCHELL'S MAIN STREET PHCY MEDI QUIK PHARMACY PEOPLES PHARMACY POWER PHARMACY NEWARK PHARMACY DARLING MEDI-SAVE PHARMACY ICARERX PHARMACY NORMAN & BAKER PHARMACY CORNERSTONE PHARMACY LAKEWOOD OAK GROVE PHARMACY JFK THE MEDICINE SHOPPE ARGENTA DRUG COMPANY BAKER REXALL DRUGS CORNERSTONE PHARMACY JFK, LLC MEDICINE MAN PHARMACY OAK GROVE PHARMACY OSCEOLA PHARMACY THE PILL PEDDLER PHARMACY BURNS DRUG STORE, INC

(870) 269-4329 (870) 269-3253 (479) 997-8033 (870) 285-2111 (870) 845-1413 (870) 799-3411 (870) 523-5888 (870) 523-5555 (870) 523-9472 (501) 353-1984 (501) 907-2095 (501) 758-1010 (501) 374-4851 (501) 945-3264 (501) 246-5035 (501) 758-7581 (501) 851-3636 (870) 563-6516 (870) 563-0777 (479) 667-3131

415 E MAIN ST 214 E MAIN 442 N MAIN ST 317 E 13TH ST 1310 S 4TH ST 503 VINE ST 1303 MCLAIN ST 1117 MCLAIN ST STE 400 2200 MALCOLM AVE STE D 2609 MCCAIN BLVD 5308 JOHN F KENNEDY BLVD STE 3 3836 JOHN F KENNEDY BLVD 324 MAIN ST 4133 E BROADWAY ST 5328 JOHN F KENNEDY BLVD 2520 MAIN ST 11114 MACARTHUR DR 600 W LEE AVE 1740 S US HIGHWAY 61 615 W COMMERCIAL ST

MOUNTAIN VIEW MOUNTAIN VIEW MULBERRY MURFREESBORO NASHVILLE NEWARK NEWPORT NEWPORT NEWPORT NO LITTLE ROCK NO LITTLE ROCK NO LITTLE ROCK NORTH LITTLE ROCK NORTH LITTLE ROCK NORTH LITTLE ROCK NORTH LITTLE ROCK NORTH LITTLE ROCK OSCEOLA OSCEOLA OZARK

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72560-9769 72560-6401 72947-8574 71958-9541 71852-3007 72562-9711 72112-3633 72112-3545 72112-3668 72116-8013 72116-6704 72116-8248 72114-5326 72117-4120 72116-6704 72114-2316 72118 72370-3002 72370-2943 72949-3113

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 24 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MEDI QUICK HEALTH MART PHCY VILLAGE PHARMACY CITY DRUG COMPANY HYDE PHARMACY MCHANEY DRUG PA OAK GROVE RX EXPRESS PRESCRIPTION CORNER DRUG INC WALDEN DRUG ALLCARE PHARMACY ARCARE PHARMACY PERRY COUNTY FOOD & DRUG ROLAND'S DRUG STORE FREDS PHARMACY HOLCOMB'S PHARMACY ALLCARE EXPRESS PHARMACY CHAPEL PHARMACY DOCTOR'S ORDERS PHARMACY DRUG ROOM FREDS PHARMACY USA DRUG USA DRUG PLAINVIEW CORNER DRUG CITY PHARMACY FUTRELL PHARMACY MED CENTER PHARMACY RANDOLPH COUNTY DRUG PORTLAND DRUG POTTSVILLE PHARMACY COLLIER DRUG-PRAIRE GROVE STERLING DRUG CO INC ALLCARE FAMILY DISCOUNT JOHNSON PHARMACY, INC RECTOR DOWNTOWN DRUG REDFIELD PHARMACY RISON PHARMACY ALLCARE PHARMACY PLUS CORNERSTONE PHARMACY AT ROGERS DEBBIE'S FAMILY PHARMACY HARPS PHARMACY HIGHLANDS PHARMACY PRICE CUTTER PHARMACY C & D DRUG STORE

NR_0009_10823 10/2017

Provider Phone Number (479) 667-4145 (479) 667-2101 (870) 236-8501 (870) 239-4036 (870) 236-3180 (870) 586-9200 (870) 239-9535 (870) 236-6118 (877) 420-9400 (870) 755-2838 (501) 889-3399 (501) 889-5111 (870) 598-1700 (870) 598-3183 (877) 420-9400 (870) 879-1490 (870) 671-4914 (870) 536-3980 (870) 879-3948 (870) 536-7140 (870) 850-6084 (479) 272-4291 (870) 892-5517 (870) 892-5615 (870) 892-4495 (870) 202-2536 (870) 737-2813 (479) 498-4130 (479) 846-2195 (479) 846-2135 (870) 887-6664 (501) 589-2890 (870) 595-3523 (501) 397-5400 (870) 325-6262 (479) 621-0400 (479) 631-0204 (479) 271-6300 (479) 631-7013 (479) 878-1818 (479) 631-0210 (479) 968-2456

Provider Street 810 W COMMERCIAL ST 500 W COMMERCIAL ST 1512 LINWOOD DR 1001 W KINGSHIGHWAY 1400 W HUNT ST 4763 HIGHWAY 135 N 320 W KINGSHIGHWAY 320 S 12TH ST 1211 E WALNUT ST 5787 HWY 64 112 HOUSTON AVE 116 N PINE ST 303 E MAIN ST 231 W MAIN ST 3006 W 28TH AVE 3800 CAMDEN RD STE 1 2302 W 28TH AVE 1700 W 42ND AVE 2809 S CAMDEN RD 1607 E HARDING AVE 2503 W 28TH AVE 102 WEST MAIN ST 606 S PARK ST 115 E BROADWAY ST 2901 MEDICAL CENTER DR 567 HIGHWAY 67 S 105 HWY 165 S 5395 W ASH ST STE 9 801 E DOUGLAS ST 125 E BUCHANAN ST 310 E ELM ST 6124 HEBER SPRINGS RD W 403 S MAIN ST 1017 SHERIDAN RD 300 PINE ST 216 S 13TH ST 1735 W WALNUT ST 5403 PINNACLE POINT DR 715 N 2ND ST 808 S 52ND ST 103 N DIXIELAND RD 121 N COMMERCE AVE

Page 25 of 679

Provider City OZARK OZARK PARAGOULD PARAGOULD PARAGOULD PARAGOULD PARAGOULD PARAGOULD PARIS PARKIN PERRYVILLE PERRYVILLE PIGGOTT PIGGOTT PINE BLUFF PINE BLUFF PINE BLUFF PINE BLUFF PINE BLUFF PINE BLUFF PINE BLUFF PLAINVIEW POCAHONTAS POCAHONTAS POCAHONTAS POCAHONTAS PORTLAND POTTSVILLE PRAIRIE GROVE PRAIRIE GROVE PRESCOTT QUITMAN RECTOR REDFIELD RISON ROGERS ROGERS ROGERS ROGERS ROGERS ROGERS RUSSELLVILLE

State

ZIP code

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72949-3010 72949-3112 72450-5814 72450-4142 72450-3574 72450-9085 72450-4229 72450-4122 72855-4125 72373-9003 72126-9451 72126-9709 72454-2820 72454-2039 71603-4803 71603-8481 71603 71603-7008 71603-4628 71601-6823 71603-5053 72857 72455-3132 72455-3402 72455-9438 72455-3773 71663 72858-9228 72753-2737 72753-2900 71857-2436 72131-8995 72461-1706 72132-9356 71665-8835 72758-4204 72756-3323 72758-8118 72756-6637 72758 72756-3203 72801-3741

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name COBBS WESTSIDE PHARMACY NEWTON'S PHARMACY ROSE DRUG LESLIE DRUGS PALACE DRUG OF SALEM HARPS PHARMACY JOE'S PHARMACY EXPRESS LOWERY DRUG MART MEDICAL CENTER PHARMACY STANLEY PHARMACY STANLEY PHCY COMPOUNDING CTR STOTTS DRUG COMPANY INC USA DRUG #15819 MCCOY TYGART DRUG INC BRIAN'S PHARMACY EXPRESS RX OF SHERWOOD PREMIER PHARMACY CARE LLC JEPSON DRUG & GIFT PRICE CUTTER PHARMACY SMACKOVER PHARMACY LLC CITY PHARMACY COLLIER DRUG-HAR-BER COLLIER DRUG-WILLOW CREEK COMMUNITY PHCY OF SPRINGDALE GENOA-QOL HEALTHCARE HARPS PHARMACY HARPS PHARMACY HARPS PHARMACY MCKINNEY DRUG PREMIER PHARMACY CARE, LLC SPRINGDALE FAMILY PHARMACY WESTSIDE HEALTHMART PHARMACY PEOPLES DRUG & GIFTS BEARD DRUG INC NEWSOM'S FAMILY PHARMACY BUERKLE DRUG COMPANY COKER-HAMPTON DRUG DEANS PHARMACY PROFESSIONAL PHARMACY ALBERTSON'S PHARMACY ALLCARE FAMILY DISCOUNT COLLEGE HILL DRUG

NR_0009_10823 10/2017

Provider Phone Number (479) 968-7180 (479) 968-1157 (479) 968-1050 (870) 895-2681 (870) 895-3811 (501) 268-4171 (501) 268-9400 (501) 268-1900 (501) 268-3311 (501) 305-1000 (501) 305-4108 (501) 268-2536 (501) 268-5315 (870) 942-5121 (501) 392-6412 (501) 819-6300 (501) 992-1006 (479) 524-4311 (479) 549-3200 (870) 725-2220 (479) 751-2072 (479) 361-5727 (479) 521-7876 (479) 750-2220 (479) 419-9285 (479) 361-1950 (479) 751-0882 (479) 927-3379 (479) 751-4536 (479) 927-6100 (479) 751-7408 (479) 756-3232 (870) 533-4311 (870) 628-4277 (870) 797-2011 (870) 673-3784 (870) 673-2691 (870) 672-4790 (870) 673-1741 (870) 773-5521 (870) 773-6789 (870) 772-6969

Provider Street 108 SKYLINE DR STE B 715 W MAIN ST 3103 W MAIN PL 105 HWY 62 EAST 106 W HWY 62 2525 W BEEBE CAPPS EXPY 2412 E RACE STE F 123 CENTRAL AVE 2900 HAWKINS DR 2007 W BEEBE CAPPS EXPY 2413 WEST BEEBE CAPPS EXP 103 W ARCH AVE 1540 E RACE AVE 821 N ROCK ST 4201 EAST KIEHL AVE 102 BROCKINGTON RD 2400 E KIEHL AVE 623 S MOUNT OLIVE ST 201 HIGHWAY 412 W 1402 PERSHING HWY 701 S THOMPSON 171 N MAESTRI RD STE 3 5201 WILLOW CREEK DR 610A E EMMA AVE STE 170 2400 S 48TH ST 1007 JONES RD 2894 W SUNSET AVE 1945 BUTTERFIELD COACH RD 601 W MAPLE AVE STE 201 834 E HENRI DE TONTI BLVD 400 W EMMA AVE 3819 W SUNSET AVE 237 MAIN ST 614 S LINCOLN AVE 9661 STRONG HWY 202 S MAIN ST 218 S MAIN ST 803 N BUERKLE ST 1515 N MEDICAL DR 3710 N STATE LINE AVE 711 EAST ST 100 EAST ST

Page 26 of 679

Provider City RUSSELLVILLE RUSSELLVILLE RUSSELLVILLE SALEM SALEM SEARCY SEARCY SEARCY SEARCY SEARCY SEARCY SEARCY SEARCY SHERIDAN SHERWOOD SHERWOOD SHERWOOD SILOAM SPRINGS SILOAM SPRINGS SMACKOVER SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE SPRINGDALE STAMPS STAR CITY STRONG STUTTGART STUTTGART STUTTGART STUTTGART TEXARKANA TEXARKANA TEXARKANA

State

ZIP code

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR

72801-3306 72801-3616 72801-3360 72576-0000 72576-8059 72143-4909 72143-4730 72143-7329 72143-4802 72143-5014 72143 72143-7701 72143-4662 72150-7623 72120 72120-3542 72120-3136 72761-3610 72761-4632 71762-2300 72764 72762-9818 72762-0876 72764-4634 72762-6683 72762-0705 72762-4940 72764-7320 72764-5397 72762 72764-4471 72762-4959 71860-2827 71667-5802 71765-0000 72160-4355 72160-4355 72160-3009 72160-3284 71854-1934 71854-6805 71854

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name GENOA-QOL HEALTHCARE ROBERTSON'S NORTH HEIGHTS PHCY ALLCARE PHARMACY PRICE CHOPPER PHARMACY HUDSON LEGEND PHARMACY LANGSTON DRUG STORE MANES PHARMACY, INC PHARMACY EXPRESS PRICE CUTTER PHARMACY VILONIA FAMILY PHARMACY HARPS PHARMACY USA DRUG EXPRESS ECONO-MED PHARMACY FAMILY CLINIC PHARMACY, LLC ROGERS PHARMACY SEXTON PHARMACY DOLORES' FAMILY PHARMACY,INC. GANNAWAY DRUG USA DRUG #4 WEINER PHARMACY HARPS PHARMACY SCHUBACH PHARMACY CITY DRUG STORE DOCTOR'S ORDERS PHARMACY USA DRUG #5 WOODLANDS PHARMACY INC WILSON PHARMACY CALDWELL DISCOUNT DRUG CO INC WYNNE APOTHECARY WYNNE MEDICAL PHARMACY FRYS PHARMACY BASHAS' UNITED DRUGS FRY'S FOOD & DRUG GENOA-QOL HEALTHCARE SUN LIFE FAMILY HLTH CTR PHCY FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG GENOA-QOL HEALTHCARE NEWSPRING PHARMACY LLC XPRESS CARE PHARMACY THE MEDICINE SHOPPE

NR_0009_10823 10/2017

Provider Phone Number (870) 397-8985 (870) 774-3666 (877) 420-9400 (870) 483-8015 (479) 474-1193 (479) 474-3431 (479) 474-5028 (479) 474-7171 (479) 471-0800 (501) 796-2204 (479) 466-8181 (479) 637-4197 (870) 886-5200 (870) 886-8100 (870) 886-5700 (870) 886-3461 (870) 226-9800 (870) 226-3751 (870) 226-3746 (870) 684-2214 (479) 839-4365 (870) 572-7770 (870) 735-1653 (870) 850-8010 (870) 534-7868 (870) 247-3900 (870) 655-8415 (870) 238-7085 (870) 238-8511 (870) 238-8531 (623) 551-7221 (480) 357-9280 (480) 288-2143 (480) 282-6278 (480) 339-2853 (623) 772-0502 (623) 925-0851 (623) 907-6161 (602) 899-4911 (623) 932-9800 (623) 535-5822 (520) 586-1299

Provider Street 2904 ARKANSAS BLVD STE 116 1201 E 35TH ST 322 HIGHWAY 463 S 801 HIGHWAY 463 N 1609 MAIN ST 1202 E MAIN 2215 ALMA HWY 1515 FAYETTEVILLE RD 120 CLOVERLEAF PLZ 1122 MAIN ST STE 14 1350 W 6TH ST 1125 W 2ND ST 1045 W MAIN STE B 1208 W MAIN ST 221 SW 2ND ST 218 W MAIN ST 1008 E CHURCH ST 101 N MAIN ST 310 S MARTIN ST 212 N VAN BUREN 266 THREE DOG LN 806 N SEBASTIAN 1701 E BROADWAY ST 1600 W HOLLAND AVE STE 101A 4720 DOLLARWAY RD 7197 SHERIDAN RD STE 109 5 N JEFFERSON 804 FALLS BLVD S 411 FALLS BLVD S 718 FALLS BLVD S 39508 N DAISY MOUNTAIN DR 10715 E APACHE TRL 185 W APACHE TRL 625 N PLAZA DR 2080 W SOUTHERN AVE 10675 W INDIAN SCHOOL RD 1575 N DYSART RD 11425 W BUCKEYE RD 824 N 99TH AVE STE 106 10750 W MCDOWELL RD BLD C #300 13055 W MCDOWELL RD BLD E-103 795 W 4TH ST

Page 27 of 679

Provider City TEXARKANA TEXARKANA TRUMANN TRUMANN VAN BUREN VAN BUREN VAN BUREN VAN BUREN VAN BUREN VILONIA WALDRON WALDRON WALNUT RIDGE WALNUT RIDGE WALNUT RIDGE WALNUT RIDGE WARREN WARREN WARREN WEINER WEST FORK WEST HELENA WEST MEMPHIS WHITE HALL WHITE HALL WHITE HALL WILSON WYNNE WYNNE WYNNE ANTHEM APACHE JUNCTION APACHE JUNCTION APACHE JUNCTION APACHE JUNCTION AVONDALE AVONDALE AVONDALE AVONDALE AVONDALE AVONDALE BENSON

State

ZIP code

AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AR AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

71854-2536 71854-2746 72472-2146 72472-1636 72956-4735 72956-4555 72956-5009 72956-2246 72956-5042 72173-8902 72958-2600 72958-7455 72476 72476-1005 72476-2335 72476-1933 71671-3509 71671 71671-2818 72479-8948 72774-3017 72390-1821 72301-3444 71602-9636 71602-4126 71602-3261 72395-1127 72396-3505 72396-3501 72396-3514 85086 85120-3307 85120 85120-5501 85120-7455 85392 85392 85323-6810 85323-5315 85392-5960 85392 85602-6431

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BLACK CANYON COMMUNITY PHCY FRYS FOOD & DRUG XPRESS CARE PHARMACY EZYFAST PHARMACY SMITH'S PHARMACY CLARENCE WESLEY HLTH CTR PHCY BANNER FAMILY PHCY-CASA GRANDE CASA GRANDE PHARMACY FRY'S FOOD & DRUG FRYS PHARMACY GENOA-QOL HEALTHCARE GRAND PHARMACY SUN LIFE FAMILY HEALTH CENTER FRYS FOOD AND DRUG STORE INFINITE CARE PHARMACY ALBERTSON'S PHARMACY

Provider Name

(623) 374-5067 (623) 691-6633 (623) 474-6888 (928) 219-5912 (928) 763-8777 (928) 475-1290 (520) 381-6400 (520) 836-4646 (520) 836-0901 (520) 426-4701 (520) 413-0262 (520) 518-5720 (520) 381-0363 (480) 538-7132 (480) 656-3349 (480) 899-7713

19251 E OASIS DR 1300 S WATSON RD 4290 S MILLER RD STE 101 2580 HIGHWAY 95 STE 106 1775 E LAKESIDE DR 101 MEDICINE DR 1800 E FLORENCE BLVD 1485 E FLORENCE BLVD 1385 E FLORENCE BLVD 2858 N PINAL AVE 121 W 2ND ST STE 1 1659 E FLORENCE BLVD STE 7 865 N ARIZOLA RD 29411 N CAVE CREEK RD 28248 N TATUM BLVD STE B4 3145 S ALMA SCHOOL RD

BLACK CANYON CITY BUCKEYE BUCKEYE BULLHEAD CITY BULLHEAD CITY BYLAS CASA GRANDE CASA GRANDE CASA GRANDE CASA GRANDE CASA GRANDE CASA GRANDE CASA GRANDE CAVE CREEK CAVE CREEK CHANDLER

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85324-8878 85326 85326-6307 86442-7324 86442-5732 85530 85122-5303 85122-4797 85122 85122 85122-4406 85122-4785 85122 85331 85331-6343 85248-3756

BANNER FAMILY PHARMACY-CHANDLER BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS BEST CARE PHARMACY BRISMA PHARMACY CHANDLER DRUGS EAST VALLEY DERMATOLOGY RX FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S PHARMACY MEDMETRICS PHARMACY OSCO DRUG OSCO PHARMACY SNS PHARMACY CHINO VALLEY PHARMACY FRY'S FOOD & DRUG GENOA-QOL HEALTHCARE FOOD CITY GENOA-QOL HEALTHCARE SUN LIFE FAMILY HEALTH CENTER, INC FLAGSTAFF PHARMACY FRY'S FOOD & DRUG GENOA-QOL HEALTHCARE

(602) 747-2418 (480) 963-1162 (480) 883-2241 (480) 219-3885 (480) 719-8798 (480) 855-7123 (480) 821-8888 (480) 917-8546 (480) 814-0178 (480) 821-2298 (480) 883-6533 (480) 566-8880 (480) 883-3809 (480) 802-1980 (480) 491-1510 (480) 812-3725 (928) 515-0046 (928) 634-9338 (928) 203-5425 (520) 364-3770 (412) 931-3131 (520) 381-0355 (928) 773-2565 (928) 774-3389 (928) 714-6486

7300 W DETROIT ST 1920 W CHANDLER BLVD 4940 S GILBERT RD 1020 E PECOS RD STE 5 590 N ALMA SCHOOL RD STE 3 2055 W FRYE RD STE 3 1100 S DOBSON RD STE 223 2010 S ALMA SCHOOL RD 1950 W RAY RD 981 W ELLIOT RD 985 E RIGGS RD 2929 E OCOTILLO RD 4995 S ALMA SCHOOL RD STE 4 2935 E RIGGS RD 4060 W RAY RD 2080 N DOBSON RD STE 3 1932 N STATE ROUTE 89 1100 S HIGHWAY 260 STE A 651 W MINGUS AVE 1300 SAN ANTONIO AVE 1701 N DOUGLAS AVE 205 N STUART BLVD 77 W FOREST AVE STE 104 201 N SWITZER CANYON DR 2695 E INDUSTRIAL DR

CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHANDLER CHINO VALLEY COTTONWOOD COTTONWOOD DOUGLAS DOUGLAS ELOY FLAGSTAFF FLAGSTAFF FLAGSTAFF

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85226-2410 85224-6173 85249-4552 85225-2424 85224 85224 85286-6160 85286 85224-9008 85225-1881 85249-4259 85249 85248-5647 85249-3671 85226-2103 85224-2391 86323-5643 86326-4643 86326-4006 85607-2422 85607-1019 85131-2507 86001-1490 86001-4836 86004-6109

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 28 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MORTAR & PESTLE NORTHERN AZ UNIV/FRONSKE PHCY WADHAMS APOTHECARY INC FORT DEFIANCE INDIAN HOSPITAL ALTHEA PHARMACY SMITH'S FOOD & DRUG BASHAS' UNITED DRUGS FRY'S FOOD & DRUG BANNER FAMILY PHARMACY BMDACC BANNER FAMILY PHARMACY-GATEWAY BASHAS' UNITED DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRYS FOOD AND DRUG GENOA-QOL HEALTHCARE MEDICAL ARTS LTC PHCY MIXTURES PHCY, LLC GILBERT OSCO PHARMACY SAROUJA GILBERT PHARMACY SAV-ON DRUGS ARIZONA ONCOLOGY ASSOCIATES AZ ONCOLOGY ASSOC PC ASU BANNER FAMILY PHCY THUNDERBIRD FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRYS PHARMACY OSCO PHARMACY

Provider Name

(928) 526-2446 (928) 523-6300 (928) 774-5004 (928) 729-8328 (928) 577-2526 (520) 330-3704 (480) 391-4021 (480) 836-7313 (480) 256-5450 (480) 543-3060 (480) 926-5221 (480) 726-3813 (480) 539-3733 (480) 813-7762 (480) 892-2217 (480) 988-6301 (480) 654-9337 (480) 840-9562 (480) 566-6503 (480) 253-3100 (480) 300-5279 (480) 558-0369 (480) 887-0244 (480) 988-7285 (623) 487-4822 (602) 357-2400 (602) 865-2378 (623) 931-3739 (623) 435-7197 (623) 937-4771 (602) 978-4998 (602) 938-2600 (623) 334-2973 (623) 825-3311 (623) 561-5092 (623) 934-9243 (602) 843-0351

2708 N 4TH ST STE C-2 824 S SAN FRANCISCO ST 3100 N WEST ST STE 200A CORNER OF HWY N7 & N12 5225 S HIGHWAY 95 STE 9 4747 HIGHWAY 95 16605 E PALISADES BLVD 14845 E SHEA BLVD 2943 E BANNER GATEWAY DR 1900 N HIGLEY RD 99 S HIGLEY RD 87 E WILLIAMS FIELD RD 1845 E BASELINE RD 855 W WARNER RD 3751 E BASELINE RD 3261 E PECOS RD 714 S VAL VISTA DR 6470 S HIGLEY RD 5222 E BASELINE RD STE 101 1580 N FIESTA BLVD # 103 2730 S VAL VISTA DR #102 861 E WARNER RD 3570 S VAL VISTA DR STE 108 8454 S POWER RD 7200 W BELL RD BLDG A 6320 W UNION HILLS DR STE 1600 5555 W THUNDERBIRD RD 4329 W NORTHERN AVE 4353 W BETHANY HOME RD 5116 W OLIVE AVE 5771 W THUNDERBIRD RD 4315 W BELL RD 6611 W BELL RD 20220 N 59TH AVE 6535 W HAPPY VALLEY RD 6710 W BETHANY HOME RD 5040 W CACTUS RD

FLAGSTAFF FLAGSTAFF FLAGSTAFF FORT DEFIANCE FORT MOHAVE FORT MOHAVE FOUNTAIN HILLS FOUNTAIN HILLS GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GILBERT GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

86004-1829 86011 86004-1651 86504 86426-9111 86426-9377 85268-3716 85268-5937 85234 85234-1604 85296-1168 85295 85233-1545 85233-7267 85234-2648 85295-1200 85296-3140 85298 85234-2963 85233-1032 85295 85296-2963 85297-7327 85297-8027 85308-8529 85308-1370 85306 85301-1647 85301-5483 85302-4209 85306-4635 85308-3530 85308-3607 85308-6844 85310-2606 85303-4402 85304-2237

TOTAL WELLNESS PHARMACY - GLENDALE BASHAS' UNITED DRUGS UPTOWN DRUG GOLDEN VALLEY FRYS PHARMACY

(480) 245-6133 (480) 474-9406 (928) 565-3900 (623) 925-4442

18555 N 79TH AVE STE D107 5311 S SUPERSTITION MOUNTAIN D 4263 E HWY 68 STE B 16380 W YUMA RD

GLENDALE GOLD CANYON GOLDEN VALLEY GOODYEAR

AZ AZ AZ AZ

85308-6040 85118-1918 86413 85338-3100

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 29 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KEY HEALTH PHARMACY WELLS UNITED DRUGS WESTERN REGIONAL MED CNT RTL PHY AZ ONCOLOGY ASSC GREEN VALLEY PHARMBLUE ARIZONA LLC DR. MOHTASEBS CANCER CENTER SMITH'S PHARMACY UPTOWN DRUG UPTOWN DRUG NORTH BASHAS' UNITED DRUGS #116 FOOD CITY LISKAS APOTHECARY SHOP SMITH'S PHARMACY FRY'S FOOD & DRUG BASHAS' UNITED DRUGS FRY'S PHARMACY OSCO DRUG FRYS PHARMACY BASHAS' UNITED DRUGS FRYS PHARMACY SUN LIFE FAMILY HEALTH CENTER SPRING VALLEY PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALLURERX BANNER FAMILY PHARMACY DESERT

Provider Name

(623) 271-8577 (623) 932-3040 (623) 207-3202 (520) 625-6600 (800) 609-1575 (928) 681-1234 (928) 757-3338 (928) 753-2226 (928) 753-2226 (928) 854-9551 (928) 855-2494 (928) 855-0106 (928) 680-4449 (602) 237-7001 (623) 547-4581 (623) 334-7740 (623) 535-7153 (520) 572-6041 (520) 836-4401 (520) 568-6233 (520) 350-7646 (928) 632-4080 (480) 986-4660 (480) 924-8928 (480) 830-5185 (480) 396-3838 (480) 981-1214 (480) 412-4250

560 N ESTRELLA PKWY 239 N LITCHFIELD RD 14200 W CELEBRATE LIFE WAY 1315 S LA CANADA DR 1260 S CAMPBELL AVE STE 100 1755 AIRWAY AVE 3490 N STOCKTON HILL RD 2820 E ANDY DEVINE AVE 4495 N BANK ST STE 1 3269 MARICOPA AVE STE 120 1831 KIOWA AVE 1840 MESQUITE AVE STE E 80 NO ACOMA BLVD 5140 W BASELINE RD 5115 N DYSART RD 13830 W CAMELBACK RD 12970 W INDIAN SCHOOL RD 12100 N THORNYDALE RD 21044 N JOHN WAYNE PKWY 20797 N JOHN WAYNE PARKWAY 44572 WEST BOWLIN ROAD 17301 E SPRING VALLEY RD STE A 9243 E BASELINE RD 325 S POWER RD 441 N VAL VISTA DR 2727 N POWER RD 1818 E BASELINE RD 1400 S DOBSON RD

GOODYEAR GOODYEAR GOODYEAR GREEN VALLEY GREEN VALLEY KINGMAN KINGMAN KINGMAN KINGMAN LAKE HAVASU CITY LAKE HAVASU CITY LAKE HAVASU CITY LAKE HAVASU CITY LAVEEN LITCHFIELD PARK LITCHFIELD PARK LITCHFIELD PARK MARANA MARICOPA MARICOPA MARICOPA MAYER MESA MESA MESA MESA MESA MESA

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85338-9315 85338-1249 85338-3007 85622-1915 85614-0503 86409-3620 86409 86401-4205 86409 86406-5788 86403-2461 86403-5771 86403 85339 85340-3032 85340 85340-5153 85658 85139-2916 85139 85138 86333-4263 85209 85206-5216 85213-7001 85215-1681 85204-6814 85202

BANNER FAMILY PHARMACY-BAYWOOD BASHAS UNITED DRUG BASHAS' UNITED DRUG BASHAS' UNITED DRUGS BAYWOOD PHARMACY COMMUNITY CLINICAL PHARMACY FATIMA PHARMACY LLC FREEDOM PHARMACY OF ARIZONA FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG

(602) 747-2338 (480) 984-3431 (480) 357-2634 (480) 654-0200 (480) 830-8907 (480) 969-0600 (480) 664-7101 (480) 565-7222 (480) 833-8838 (480) 610-4173 (480) 464-4742 (480) 218-8573 (480) 924-0868

6644 E BAYWOOD AVE 1133 N ELLSWORTH RD 9925 E BASELINE RD 2864 N POWER RD 6641 E BAYWOOD AVE STE A1 1450 S DOBSON RD STE A102 66 S DOBSON RD STE 104 8035 E BROWN RD, BLDG 4, STE-C 1245 W MAIN ST 1935 N STAPLEY DR 2727 E BROADWAY RD 4440 E MAIN ST 1915 S POWER RD

MESA MESA MESA MESA MESA MESA MESA MESA MESA MESA MESA MESA MESA

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85206-1747 85207 85209-8325 85215-1675 85206 85202-4718 85202-1175 85207 85201-7018 85203-2749 85204-1530 85205-7902 85206-4301

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 30 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE NEIGHBORHOOD MARKET OSCO PHARMACY RED MOUNTAIN PHARMACY STAPLEY PHARMACY SUN PHARMACY FRY'S FOOD & DRUG WALTON DRUG OF MORENCI FOOD CITY #60 FRY'S FOOD & DRUG FRY'S FOOD & DRUG

Provider Name

(480) 380-3868 (480) 969-6234 (480) 830-6343 (480) 481-7505 (480) 845-6769 (480) 281-2930 (480) 898-2849 (480) 456-4850 (480) 325-5522 (480) 404-9160 (520) 510-0144 (928) 425-8165 (928) 865-9946 (520) 287-3984 (520) 877-9269 (520) 742-6667

435 E ELLSWORTH RD 554 W BASELINE RD 5941 E MCKELLIPS RD 2724 S SIGNAL BUTTE RD 1705 W MAIN ST 1255 W BASELINE RD STE 138 2725 E MCKELLIPS RD 1951 W BASELINE RD 6828 E BROWN RD STE 101 1245 E SOUTHERN AVE STE 21 4838 E BASELINE RD 127 2115 US HIGHWAY 60 SUITE 200 408 BURRO ALLEY 450 N GRAND COURT PLZ 10450 N LA CANADA DR 10661 N ORACLE RD

MESA MESA MESA MESA MESA MESA MESA MESA MESA MESA MESA MIAMI MORENCI NOGALES ORO VALLEY ORO VALLEY

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85208-2305 85210-6019 85215-2754 85209 85201-6920 85202-5821 85213-3016 85202-9002 85207-3761 85204 85206 85539 85540 85621-2748 85737-7027 85737-9322

CANYONLANDS COMMUNITY HEALTHCARE THE APOTHECARY UNITED DRUG BASHAS' UNITED DRUGS #54 GENOA-QOL HEALTHCARE ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BANNER FAMILY PHARMACY-PEORIA BASHAS' UNITED DRUG BASHAS' UNITED DRUGS DESERT SKY PHARMACY FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S PHARMACY POTTERS HOUSE APOTHECARY SUN CITY PHARMACY INC WESTGATERX PHARMACY SAN CARLOS APACHE HLTH AFFILIATED DERMATOLOGY ALBERTSON'S PHARMACY ARIZONA ONCOLOGY ASSOCIATES, PC AVELLA OF DEER VALLEY INC AVELLA OF DEER VALLEY INC AVELLA PHOENIX III INC

(928) 645-8123 (928) 669-2147 (928) 474-7039 (928) 238-3024 (623) 572-5744 (623) 876-8935 (623) 465-6090 (623) 334-2081 (623) 537-2321 (623) 209-0870 (623) 979-1383 (623) 486-0441 (623) 561-5196 (623) 972-8425 (520) 348-7130 (623) 362-9322 (623) 322-6664 (623) 249-4900 (928) 475-1290 (480) 556-0446 (602) 678-0594 (602) 283-7977 (877) 792-7684 (877) 719-6349 (602) 257-1133

467 VISTA AVENUE 1002 W ARIZONA AVE 142 E STATE HIGHWAY 260 404 W AERO DR 8240 W DEER VALLEY RD 8950 W BELL RD 13640 N PLAZA DEL RIO BLVD 7586 W THUNDERBIRD RD 20351 N LAKE PLEASANT RD 6750 W THUNDERBIRD RD STE 103 9043 W OLIVE AVE 7455 W CACTUS RD 8375 W DEER VALLEY RD 9245 W UNION HILLS DR 25401 N LAKE PLEASANT PKWY 21755 N 77TH AVE STE 1100 9133 W THUNDERBIRD RD STE 101 8914 N 91ST AVE STE 100C 103 MEDICINE WAY RD 19646 N 27TH AVE STE 305 8035 N 19TH AVE 2222 E. HIGHLAND AVE. STE 400 23620 N 20TH DR #12 24416 N 19TH AVE 1101 N CENTRAL AVE STE 202

PAGE PARKER PAYSON PAYSON PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PEORIA PERIDOT PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

86040 85344-5744 85541-4948 85541-5407 85382-2125 85382-3714 85381-4846 85381-6077 85382-9703 85381-5046 85345-7049 85381-5399 85382-2460 85382-8154 85383-1351 85382-2111 85381 85345-8390 85542 85027-4027 85021-5159 85016 85085-0621 85085-1887 85004-1818

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 31 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

AZ ONCOLOGY ASSOC PC DEER VALLEY BANNER FAMILY PHARMACY BANNER FAMILY PHCY ESTRELLA BANNER FAMILY PHCY UNI MED CTR BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS #113 BGH PHARMACY CUSTOMCEUTICAL COMPOUNDING EXPRESS AID PHARMACY FAIRMONT PHARMACY FOOD CITY FOOD CITY

Provider Name

(623) 587-4868 (602) 521-5000 (623) 327-6170 (602) 839-2300 (602) 277-6133 (480) 940-6396 (602) 652-9521 (623) 455-3368 (480) 516-0272 (602) 995-8999 (602) 275-5719 (623) 872-6201 (602) 278-8831

19646 N 27TH AVE #406 1441 N 12TH ST 9201 W THOMAS RD 1111 E MCDOWELL RD 5555 N 7TH ST STE 130 4855 E WARNER RD 731 E UNIONS HILLS 3544 W GLENDALE AVE SUITE E 4611 E SHEA BLVD BLDG 3 #180 2316 W BETHANY HOME RD STE 119 5068 N CENTRAL AVE 9020 W THOMAS RD 3442 W VAN BUREN ST

PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85027 85006 85037 85006 85014-2531 85044-3308 85024 85051-8359 85028-4258 85015-1850 85012-1521 85037 85009-4708

FOOTHILLS PROFESSIONAL PHARMACY LTD FREEDOM PHARMACY FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD STORES FRY'S FOOD STORES GENOA-QOL HEALTHCARE

(480) 496-4444 (623) 800-7222 (480) 575-0694 (602) 415-5733 (602) 279-9337 (602) 263-0771 (602) 468-9188 (602) 952-1491 (602) 216-1473 (602) 335-2273 (602) 993-6610 (480) 367-3973 (602) 439-9045 (602) 866-5453 (602) 765-4633 (602) 953-3540 (623) 846-1533 (623) 245-7353 (602) 243-3014 (602) 305-4421 (623) 907-2472 (480) 706-0609 (480) 706-7373 (602) 896-2533 (602) 375-0193 (602) 594-5035 (480) 994-6235 (602) 282-8006

4545 E CHANDLER BLVD STE 100 2734 W BELL RD STE 1340 4815 E CAREFREE HWY 4230 W MCDOWELL RD 744 W CAMELBACK RD 4724 N 20TH ST 3036 E THOMAS RD 4505 E THOMAS RD 850 E HATCHER RD 1815 W GLENDALE AVE 18420 N 19TH AVE 4707 E SHEA BLVD 4202 W CACTUS RD 3511 W PEORIA AVE 3246 E BELL RD 4025 E THUNDERBIRD RD 6601 W INDIAN SCHOOL RD 8325 W INDIAN SCHOOL RD 520 E BASELINE RD 2250 E BASELINE RD 2626 S 83RD AVE 3616 E RAY RD 3949 E CHANDLER BLVD 2727 W BELL RD 3421 W THUNDERBIRD RD 1311 E BELL RD 2800 W DOVE VALLEY RD 1209 S 1ST AVE

PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85048-7644 85053-7528 85085 85009-2096 85013-2207 85016-4704 85016-8014 85018-7614 85020-2616 85021-8582 85023-1361 85028-3042 85029-2924 85029-4037 85032-2727 85032-5836 85033-3339 85037-2125 85042-6554 85042-6947 85043-7207 85044-7114 85048-0302 85053-3059 85053-5602 85022-2724 85085-5246 85003-2605

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 32 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GRACE REXALL DRUGS GREENWAY TANTRA DRUGSTORE

Provider Name

(602) 244-9591 (602) 358-0078 (480) 422-3283 (602) 892-5155 (480) 566-6497 (602) 384-9992 (602) 230-2443 (602) 993-0766

4909 E MCDOWELL RD 3864 N 27TH AVE 3001 N 33RD AVE RM 210 11221 N 28TH DR BLDG E 4616 N 51ST AVE STE 108 10240 N 31ST AVE STE 210 1102 W INDIAN SCHOOL RD 3361 W GREENWAY RD STE 2

PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX

AZ AZ AZ AZ AZ AZ AZ AZ

85008-7735 85017-4703 85017-5202 85029-5615 85031-1720 85051-9565 85013-3107 85053-7641

JOHN C LINCOLN MED CTR SPEC PHARMAC M-D PHARMACY MELROSE PHARMACY MERCY REXALL DRUGS METIER PHARMACY MG UNITED DRUGS MIXTURES PHCY & COMPOUNDING CTR OSCO DRUG OSCO PHARMACY OSCO PHARMACY PALO VERDE CANCER SPECIALISTS PHOENIX PHARMACY PHX CHILDRENS OUTPATIENT PHCY QUICK PHARMACY ROSYS FARMACIA LA ESPERANZA S & G UNITED DRUGS SAFETY DRUGS SALIBA'S EXTENDED CARE PHARMACY SPECTRUM MEDICAL GROUP, PC ST JOSEPHS MCAULEY PHARMACY SUNWEST LTC PHARMACY THE COMPOUNDING CENTER TOPICAL SOLUTIONS PHARMACY UA CANCER CNTR DIGNITY HLTH VALLEY OF THE SUN PHARMACY XPRESS CARE PHARMACY AVE MARIA PHARMACY PLLC FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG GENOA-QOL HEALTHCARE INTOWN PHARMACY BASHAS' UNITED DRUGS #46

(602) 674-6222 (623) 846-1888 (602) 277-4714 (602) 264-4288 (602) 899-6960 (602) 439-3366 (480) 706-0620 (623) 582-2743 (480) 443-4286 (602) 494-7424 (480) 949-7808 (602) 237-6677 (602) 933-2048 (623) 937-9800 (602) 331-5323 (602) 375-3377 (602) 252-1299 (623) 815-8965 (602) 604-9500 (602) 406-3970 (602) 396-7330 (602) 971-6950 (602) 535-2225 (602) 406-0350 (602) 896-0454 (602) 973-0777 (928) 772-8674 (928) 778-3181 (928) 778-6887 (928) 445-0607 (928) 583-6411 (928) 927-8747 (480) 279-5701

9109 N. CENTRAL AVE 4700 N 51ST AVE STE 1 704 W MONTECITO AVE 3330 N 2ND ST #211 4214 E INDIAN SCHOOL RD #103 4025 W BELL RD STE 1A 16515 S 40TH ST STE 123 3130 W CAREFREE HWY 10665 N TATUM BLVD 18411 N CAVE CREEK RD 9250 W THOMAS RD STE 150 1701 E THOMAS RD STE 105 1919 E THOMAS RD 7725 N 43RD AVE STE 311 1111 E NORTHERN AVE STE A 3201 W PEORIA AVE STE B401 2630 E MOHAWK LN STE 128 21025 N 8TH WAY BLG 8 52 E MONTEREY WAY 500 W THOMAS RD STE 190 1300 N 12TH ST STE 406 4045 E BELL RD STE 163 20612 N CAVE CREEK RD #150 625 N 6TH ST 15600 N BLACK CANYON HWY 2007 W BETHANY HOME RD 1945 COMMERCE CENTER CIR # C 3198 WILLOW CREEK RD 950 FAIR ST 3100 N GLASSFORD HILL RD 3347 N WINDSONG DR 60 W MAIN 23760 S POWER RD

PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PHOENIX PRESCOTT PRESCOTT PRESCOTT PRESCOTT VALLEY PRESCOTT VALLEY QUARTZSITE QUEEN CREEK

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85020 85031 85013-2814 85012-2369 85018-5339 85053-2748 85048-0559 85086-3200 85028-3057 85032-1006 85037 85016-7672 85016-7710 85051-5770 85020-4119 85029-4610 85050-4637 85024 85012-2628 85013-4237 85006-2848 85032-2240 85024-4440 85004 85053-4055 85015-2444 86301-7411 86301-6610 86305-1806 86314-2285 86314-2283 85346-5000 85142-6151

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 33 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name FRY'S FOOD & DRUG RIO RICO PHARMACY LLC MEDICAP PHARMACY THRIFTEE FOOD AND DRUG FRYS PHARMACY SANTA TERESA PHARMACY FRYS FOOD & DRUG AFFILIATED DERMATOLOGY AJ'S ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALL CARE PHARMACY AVELLA OF SCOTTSDALE INC AZ CENTER OF CANCER CARE AZ ONCOLOGY ASSOC PC-SCOTTSDALE BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS BIORX CENTER FOR DERMATOLOGY PC CIVIC CENTER PHARMACY FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRYS FOOD AND DRUG STORE INTEGRITY RX SPECIALTY PHCY PINNACLE PHARMACY RANCH PHARMACY RSVP RX #200 SCOTTSDALE PROF PHARMACY LTD SOUTHWEST SPECIALTY PHARMACY TOTAL WELLNESS PHARMACY BASHAS' UNITED DRUGS #28 WEBER'S IGA PHARMACY GENOA-QOL HEALTHCARE FOOD CITY FRY'S FOOD & DRUG GENOA-QOL HEALTHCARE SIERRA HEALTHMART PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (480) 888-1781 (520) 761-3338 (928) 428-6366 (928) 428-1156 (520) 648-7701 (928) 328-1000 (480) 474-6001 (480) 556-0446 (480) 998-2378 (480) 911-9557 (480) 947-7574 (480) 270-6700 (480) 451-3771 (480) 949-7808 (480) 860-2540 (480) 663-1043 (480) 419-6186 (480) 745-3200 (480) 905-8485 (480) 945-9519 (480) 994-0212 (480) 425-0601 (480) 368-8940 (602) 867-4060 (480) 941-4704 (480) 661-0238 (480) 657-6433 (480) 419-2273 (800) 321-9956 (877) 509-5050 (480) 443-4656 (877) 965-4800 (480) 946-9477 (480) 947-0630 (480) 245-6191 (928) 282-9541 (928) 284-2202 (928) 537-7002 (520) 439-6081 (520) 458-0997 (520) 226-3020 (520) 459-0705

Provider Street 542 E HUNT HWY 1103 CIRCULO MERCADO STE A 1520 W THATCHER BLVD 755 S CENTRAL AVE 15950 S RANCHO SAHUARITA BLVD 1896 BABBIT LANE 155 W COMBS RD 20401 N 73RD ST STE 230 7141 E LINCOLN DR 6965 N HAYDEN RD 2785 N SCOTTSDALE RD 8415 N PIMA RD STE 125 9777 N 91ST ST STE 102 3501 N SCOTTSDALE RD STE 300 10460 N 92ND ST STE 400 8035 E INDIAN SCHOOL RD 10111 E BELL RD 9045 E PIMA CTR PKWY STE 1 14275 N 87TH ST STE 110 7331 E OSBORN DR 7628A E INDIAN SCHOOL RD 6080 E THOMAS RD 6321 E GREENWAY RD 4842 E BELL RD 7770 E MCDOWELL RD 10450 N 90TH ST 8900 E VIA LINDA 20427 N HAYDEN RD 8425 N 90TH ST STE 8 17255 N 82ND ST STE 130 10769 N FRANK LLOYD WRIGHT BLV 1525 N GRANITE REEF RD STE 5 10900 N SCOTTSDALE RD 3225 N 75TH ST 200-S 9787 N 91ST ST STE 101A 160 COFFEE POT DR 100 VERDE VALLEY SCHOOL RD 2500 E SHOW LOW LAKE RD 85 S HIGHWAY 92 4351 E HIGHWAY 90 4755 CAMPUS DR 2085 E FRY BLVD

Page 34 of 679

Provider City QUEEN CREEK RIO RICO SAFFORD SAFFORD SAHUARITA SAN LUIS SAN TAN VALLEY SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SCOTTSDALE SEDONA SEDONA SHOW LOW SIERRA VISTA SIERRA VISTA SIERRA VISTA SIERRA VISTA

State

ZIP code

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85143 85648-6402 85546-3309 85546-2722 85629 85349 85140-9108 85255-4153 85253-4417 85250-7969 85257-1326 85258 85258-5087 85251-5638 85258 85251-2617 85260-2187 85258 85260-3696 85251-6435 85251-3608 85251-7508 85254-1910 85254-6000 85257-3744 85258-4406 85258-5404 85255-3874 85258-4393 85255-6339 85259-2682 85257-3998 85254-5216 85251-6909 85258-5088 86336-4505 86351-9053 85901-7994 85635-3637 85635-2431 85635-2449 85635-2708

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

OLD PUEBLO UNITED DRUGS AL'S DRUG FRY'S FOOD & DRUG FRY'S FOOD STORES RIGHTWAY PHARMACY

Provider Name

(520) 455-0058 (623) 455-3368 (623) 876-8220 (623) 930-5050 (623) 266-0021

3272 HWY 82 10147 GRAND AVE STE B-3 10660 GRAND AVE 19403 N R H JOHNSON BLVD 10503 W THUNDERBIRD BLVD STE 1

SONOITA SUN CITY SUN CITY SUN CITY SUN CITY

AZ AZ AZ AZ AZ

85637-5314 85351-3435 85351-3433 85375 85351-2719

BANNER FAMILY PHARMACY DEL E WEBB BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS #43 ALBERTSON'S PHARMACY ARIZONA PHARMACY BASHAS' UNITED DRUGS FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRYS PHARMACY WEST VALLEY PHARMACY LLC SILVERCREEK PHCY MED SHOPPE BASHAS' UNITED DRUGS FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG GENOA-QOL HEALTHCARE ONEPOINT PATIENT CARE OSCO PHARMACY PHARMCARE USA OF GREATER PHX SOLEO HEALTH INC VALLEYMED PHARMACY

(623) 524-6550 (623) 975-6221 (480) 802-7182 (623) 546-4085 (623) 939-1120 (623) 214-6461 (623) 546-2565 (623) 537-9663 (623) 455-7902 (623) 533-6514 (928) 536-2044 (480) 897-2980 (480) 858-9044 (480) 829-1857 (480) 752-9733 (602) 438-2807 (480) 838-0448 (480) 783-6233 (480) 296-0097 (480) 240-1111 (480) 820-4478 (602) 438-9301 (480) 296-0222 (480) 699-8044

14502 W MEEKER BLVD 13940 W MEEKER BLVD 10325 E RIGGS RD 14551 W GRAND AVE 13991 W GRAND AVE STE 100 15367 W WADDELL RD 15510 W BELL RD 13982 W WADDELL RD 15215 N COTTON LN 12851 W BELL RD STE 110 718 N MAIN ST STE B 1761 E WARNER RD 3232 S MILL AVE 3255 S RURAL RD 5100 S MCCLINTOCK DR 2700 W BASELINE RD 1835 E GUADALUPE RD 9900 S RURAL RD 1642 S PRIEST DR BLDG 6 # 101 3006 S PRIEST DR 750 E GUADALUPE RD 2727 W BASELINE RD STE 1 415 SOUTH 48TH ST STE 101 1845 E BROADWAY RD #120

SUN CITY WEST SUN CITY WEST SUN LAKES SURPRISE SURPRISE SURPRISE SURPRISE SURPRISE SURPRISE SURPRISE TAYLOR TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE TEMPE

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85375-5282 85375-4492 85248-7623 85374-7100 85374-3065 85379-5132 85374-3439 85379-8718 85388-9607 85378-9602 85939 85284-4558 85282-3656 85282-3853 85282-7374 85283-1072 85283-3277 85284-4116 85281-6204 85282-3400 85283-2912 85283-1068 85281 85282-1633

ARIZONA ONCOLOGY ASSOC-CRAYCROFT AVELLA OF TUCSON INC AZ ONCOLOGY ASSC - ST MARYS AZ ONCOLOGY ASSC WILMOT AZ ONCOLOGY ASSOC - RUDASILL

(520) 324-2409 (520) 918-0044 (520) 624-7445 (520) 886-0206 (520) 797-4468

2625 N CRAYCROFT RD STE 200 4512 E CAMP LOWELL DR 1620 W SAINT MARYS RD 603 N WILMOT RD STE 151 2070 W RUDASILL RD STE 130

TUCSON TUCSON TUCSON TUCSON TUCSON

AZ AZ AZ AZ AZ

85712-2268 85712-1282 85745-2624 85711-2701 85704-7891

AZ ONCOLOGY ASSOC PC ORANGE GROVE BANNER FAMILY PHARMACY-UNIVERS

(520) 531-8967 (520) 694-7049

1845 W ORANGE GROVE BLDG 2 1501 N CAMPBELL AVE

TUCSON TUCSON

AZ AZ

85704 85724-0001

BANNER FAMILY PHARMACY-UNIVERSITY M BASHAS' UNITED DRUGS

(520) 874-4062 (520) 690-3681

2800 E AJO WAY 2000 W RIVER RD

TUCSON TUCSON

AZ AZ

85713-6204 85704-1686

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 35 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS BASHAS' UNITED DRUGS FIRST CARERX FOOD CITY FOOD CITY FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRY'S FOOD & DRUG FRYS FOOD AND DRUG STORES FRY'S PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GREEN PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY PHARMCARE USA OF TUSCON TUCSON MEDICAL CENTER OP PHCY BASHAS' UNITED DRUGS #55 WICKENBURG RGNL MED CTR PHCY MEDICINE SHOPPE WINSLOW INDIAN HEALTH CARE CTR FRY'S FOOD & DRUG

NR_0009_10823 10/2017

Provider Phone Number (520) 323-5821 (520) 575-7301 (520) 744-1370 (520) 299-3378 (520) 884-3459 (520) 887-4422 (520) 434-6921 (520) 628-9428 (520) 885-3540 (520) 790-9492 (520) 721-9250 (520) 571-2080 (520) 323-2695 (520) 327-7016 (520) 624-6936 (520) 294-7165 (520) 889-6551 (520) 293-8997 (520) 745-3003 (520) 744-2777 (520) 744-7832 (520) 663-1961 (623) 907-4932 (520) 917-0768 (520) 327-4505 (520) 428-7277 (520) 834-8794 (520) 257-1539 (312) 351-4269 (520) 696-0340 (520) 571-9252 (520) 885-9192 (520) 327-6767 (520) 575-0662 (520) 751-7549 (520) 867-7434 (520) 324-1890 (928) 684-2726 (928) 684-4380 (520) 766-1299 (928) 289-6215 (928) 782-2529

Provider Street 3275 N SWAN RD 15310 N ORACLE RD 8360 N THORNYDALE RD 6900 E SUNRISE DR 1735 N 11TH AVE 3923 FLOWING WELLS RD 1221 W IRVINGTON RD 555 E GRANT RD 7812 E SPEEDWAY BLVD 7050 E 22ND ST 9401 E 22ND ST 4150 E 22ND ST 3920 E GRANT RD 2480 N SWAN RD 3640 S 16TH AVE 2001 E IRVINGTON RD 902 W IRVINGTON RD 4036 N 1ST AVE 7050 E GOLF LINKS RD 3770 W INA RD 7870 N SILVERBELL RD 8080 S HOUGHTON RD 1795 W VALENCIA RD 2435 N CASTRO AVE 630 N ALVERNON WAY STE 161 FL 4891 E GRANT RD STE P 1210 E PENNSYLVANIA ST 1075 E FORT LOWELL RD 5523 E GRANT RD 5085 N LA CANADA DR 6363 E 22ND ST 6600 E GRANT RD 2854 N CAMPBELL AVE 7300 N LA CHOLLA BLVD 9595 E BROADWAY BLVD 1835 S ALVERNON WAY STE 202 5301 E GRANT RD 275 N TEGNER ST 520 ROSE LN 902 W REX ALLEN DR 500 INDIANA AVE 500 W 24TH ST

Page 36 of 679

Provider City TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON TUCSON WICKENBURG WICKENBURG WILLCOX WINSLOW YUMA

State

ZIP code

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ

85712-1228 85739-9426 85741-1102 85750-0830 85705-6527 85705 85714-1167 85705-5770 85710-1649 85710-5113 85710-7343 85711-5335 85712-2558 85712-5701 85713-6001 85714-1847 85714-2437 85719-1005 85730-1000 85741-2093 85743-8230 85747-9308 85746-6533 85705-5060 85711-1895 85712-2704 85714-1675 85719-2159 85712-2209 85704-1508 85710-5119 85715-3803 85719-2811 85741-2305 85748-3210 85711-5693 85712-2805 85390-2415 85390-1447 85643 86047-2169 85364-6430

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FRY'S FOOD STORES GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE KACHINA PHARMACY SANT UNITED DRUGS SAV-ON DRUGS ACTON VALE PHARMACY CROWN VALLEY PHARMACY SUPER RX PHARMACY

Provider Name

(923) 342-1332 (928) 726-5900 (928) 318-6153 (928) 726-4081 (928) 783-7856 (928) 343-2311 (661) 269-9911 (661) 269-9500 (760) 246-3524

11203 S FRONTAGE RD 2545 S ARIZONA AVE BLDG B 2851 S AVENUE B STE 1102 2180 S 4TH AVE STE B 419 W 8TH ST 2378 W 24TH ST 3630 SMITH AVE 3720 W SIERRA HWY STE G 14168 US HWY 395

YUMA YUMA YUMA YUMA YUMA YUMA ACTON ACTON ADELANTO

AZ AZ AZ AZ AZ AZ CA CA CA

85367-7875 85364-7332 85364-7745 85364-6478 85364-2957 85364-6124 93510-1957 93510 92301

KANAN PHARMACY & MEDICAL SUPPLIES KRAMERS PHARMACY MIDTOWN PHARMACY PROF CORP VERSAILLES PHARMACY A-1 PHARMACY ABC PHARMACY ALHAMBRA PROFESSIONAL PHARMACY ALPHA MEDICAL PHARMACY BEST BUY PHARMACY INC CHENG PHARMACY E & J PHARMACY HUNG JEN PHARMACY KECK MED OF USC SPECIALTY PHAR MAIN PHARMACY MAX PHARMACY MED-CARE PHARMACY MODERN CARE PHARMACY PAYLESS PHARMACY SAV-ON DRUGS VALLEY SQUARE PHARMACY SAV-ON PHARMACY MATS PHARMACY WEBSTER PHARMACY LAST FRONTIER PHARMACY ACARE PHARMACY ALPHA UNITED DRUGS ALPHA UNITED DRUGS ANAHEIM HILLS MEDICAL PHARMACY ANAHEIM PHARMACY ANAHEIM PLAZA PHARMACY INC ANAHEIM PRO-CARE PHARMACY AUM RX II

(818) 889-3070 (818) 706-8099 (510) 864-4199 (510) 523-4907 (626) 281-3633 (626) 457-8888 (626) 458-8909 (626) 289-1990 (626) 872-0199 (626) 281-9222 (626) 281-9913 (626) 571-2928 (855) 885-2600 (626) 576-0890 (626) 281-1818 (626) 281-7870 (626) 289-0018 (626) 457-8878 (626) 576-3900 (626) 576-8622 (619) 445-0601 (626) 794-7197 (626) 797-1163 (530) 233-4884 (714) 534-4633 (714) 821-8959 (714) 220-0373 (714) 279-1111 (714) 844-2592 (714) 220-0720 (714) 833-5723 (714) 495-2779

5847 KANAN RD 29525 CANWOOD ST 2173 HARBOR BAY PKWY 2801 ENCINAL AVE 935 S GARFIELD AVE 841 W VALLEY BLVD STE 101 330 S GARFIELD AVE STE 104 703 W VALLEY BLVD 2881 W VALLEY BLVD 600 W MAIN ST STE 106 1234 S GARFIELD AVE STE 102 1336 WEST VALLEY BLVD # 8 1000 S. FREMONT AVE #10150 103 N GARFIELD AVE STE D 333 S GARFIELD AVE STE C 1048 S GARFIELD AVE 150 S RAYMOND AVE 1118 S GARFIELD AVE STE 101 2400 W COMMONWEALTH AVE 1227 E VALLEY BLVD 2955 ALPINE BLVD 2264 LINCOLN AVE 2450 LAKE AVE 120 S MAIN STREET 9860 KATELLA AVE 515 S BEACH BLVD 1240 S MAGNOLIA AVE 500 S ANAHEIM HILLS RD STE 100 1020 S ANAHEIM BLVD SUITE 106 184 E LIBERTY AVE 1801 W ROMNEYA DR STE 108 710 N EUCLID ST SUITE 103

AGOURA HILLS AGOURA HILLS ALAMEDA ALAMEDA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALHAMBRA ALPINE ALTADENA ALTADENA ALTURAS ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91301-1651 91301-4233 94502-3019 94501-4726 91801-4442 91803-3251 91801-3893 91803-3232 91803-1818 91801-3362 91801-5068 91803 91803 91801-3576 91801 91801-4768 91801-3166 91801-4713 91803-1305 91801-5235 91901 91001-5432 91001-2442 96101 92804-6418 92804-1812 92804-5116 92807-4761 92805 92801-1011 92801-1824 92801-4115

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 37 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ELIM PHARMACY HEALTH FIRST PHARMACY LIFE CARE PHARMACY MADISON HOME PHARMACY MED CHOICE PHARMACY MEDCARE PHARMACY MEDICAL ARTS REXALL PHARMACY NEW VISTA PHARMACY PACIFIC CANCER MEDICAL CENTER INC PAVILIONS PHARMACY PHARMACY FOR LIVING WELL PHARMACY PLUS SAV-ON PHARMACY SPECTRUM PHARMACY-ANAHEIM SUN RX PHARMACY THE MEDICINE SHOPPE THE PHARMACY TRU CARE PHARMACY YORBA LINDA PHARMACY FERRYS PHARMACY OWENS HEALTHCARE ANTELOPE PHARMACY BEL AIR PHARMACY EPIC CARE RALEY'S DRUG CENTER SAVE MART PHARMACY A FAMILY PHARMACY-APPLE VALLEY COMMUNITY CARE PHARMACY JONATHAN'S PHARMACY QUEENS PHARMACY RANCHO DRUGS SAV-ON DRUGS SUPER RX PHARMACY FRANKS PHARMACY ARCADIA CENTER PHARMACY ARCADIA MEDICAL PHARMACY HEALTHCOM PHARMACY HEALTHCOM WELLNESS PHARMACY LUCKY PHARMACY MITRY PHARMACY PAVILIONS PHARMACY SAV-ON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (714) 220-1139 (714) 236-5777 (714) 533-2157 (714) 772-2453 (714) 533-3080 (714) 491-7472 (714) 776-2800 (714) 905-9861 (714) 999-1465 (714) 282-7056 (714) 224-0164 (714) 956-3741 (714) 533-4820 (714) 826-6246 (714) 827-6979 (714) 995-0071 (714) 995-4161 (714) 576-5875 (714) 993-1458 (530) 365-3388 (530) 365-2778 (916) 729-6884 (916) 725-6940 (925) 778-0679 (925) 754-5288 (925) 754-8585 (760) 242-5452 (760) 242-2559 (760) 983-2599 (760) 946-4700 (760) 242-4900 (760) 242-1323 (760) 247-1123 (831) 685-1100 (626) 446-3300 (626) 446-0612 (626) 348-8553 (626) 348-8094 (626) 445-1888 (626) 317-5052 (626) 446-9261 (626) 446-1902

Provider Street 3340 W BALL RD 3010 W ORANGE AVE STE 101 947 S ANAHEIM BLVD STE 108 1811 W KATELLA AVE STE 229 621 N. EUCLID STREET STE B 1285 N EUCLID ST 1120 W LA PALMA AVE STE 1 932 S EUCLID ST 1801 W ROMNEYA DR STE 203 8010 E SANTA ANA CANYON RD 1313 S HARBOR BL, BLD H-8 2FLR 1012 N EUCLID ST 810 S STATE COLLEGE BLVD 1236 N MAGNOLIA AVE 2415 W LINCOLN AVE STE B 2795 W LINCOLN AVE STE K 3055 W ORANGE AVE STE 108 2571 W LA PALMA AVE # A 5596 E LA PALMA AVE 2940 EAST ST 2995 EAST ST 4207 ELVERTA RD STE 109 7901 WALERGA RD 12604 HIDDENCREEK WAY STE C 3636 LONE TREE WAY 3190 CONTRA LOMA BLVD 15863 KASOTA RD STE C 16070 TUSCOLA RD STE 102 19341 BEAR VALLEY RD STE 103 18522 US HIGHWAY 18 STE 103 17798 WIKA RD 20261 US HIGHWAY 18 12253 APPLE VALLEY RD 7518 SOQUEL DR 631 W DUARTE RD 612 W DUARTE RD STE 102 289 W HUNTINGTON DR STE 101 301 W HUNTINGTON DR STE 116 1108 S BALDWIN AVE STE 8 145 E DUARTE RD STE D 745 W NAOMI AVE 298 E LIVE OAK AVE

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Provider City ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANAHEIM ANDERSON ANDERSON ANTELOPE ANTELOPE ANTIOCH ANTIOCH ANTIOCH APPLE VALLEY APPLE VALLEY APPLE VALLEY APPLE VALLEY APPLE VALLEY APPLE VALLEY APPLE VALLEY APTOS ARCADIA ARCADIA ARCADIA ARCADIA ARCADIA ARCADIA ARCADIA ARCADIA

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92804-3729 92804-3170 92805-5583 92804 92801 92801-1954 92801-2820 92802-1523 92801-1824 92808-1110 92802-2309 92801-3634 92806-4663 92801-2607 92801-6490 92801-6334 92804-3152 92801-2622 92807-2108 96007-3411 96007-3481 95843-4735 95843-5722 94531 94509-6001 94509-5400 92307-4507 92307-1691 92308-5152 92307-2321 92307-1200 92307-2953 92308-6702 95003-3820 91007-7332 91007-9221 91007-3492 91007-3462 91007-7508 91006-6691 91007-7517 91006-5629

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUNNY BAY PHARMACY BARNES ARCATA FAMILY DRUG UNITED INDIAN HLTH SRVC PHCY PMQ ARLETA PHARMACY MEADOWMONT PHARMACY BESTCARE PHARMACY FAMILY MEDICAL PHARMACY KARE PHARMACY KOAM PHARMACY MERCY LTC AND SPECIALTY PHA THE MEDICINE SHOPPE WELCOME PHARMACY CHC PHARMACY ATASCADERO EN SOLEIL PHARMACY, INC. CASTLE PHARMACY SAVE MART PHARMACY BEL AIR PHARMACY

Provider Name

(626) 445-9100 (707) 822-1717 (707) 825-5020 (818) 830-7398 (209) 795-1155 (805) 481-1961 (562) 402-0500 (562) 809-8656 (562) 402-3636 (562) 402-0542 (562) 402-1000 (562) 860-6336 (805) 792-1420 (805) 460-9600 (209) 723-1888 (209) 357-2956 (530) 889-8003

450 E HUNTINGTON DR 1080 G ST 1600 WEEOT WAY 8902 WOODMAN AVE 2182 HIGHWAY 4 UNIT C230 1051 E GRAND AVE 18009 NORWALK BLVD 12146 SOUTH ST STE C 18102 PIONEER BLVD STE 101 17621 PIONEER BLVD 17623 PIONEER BLVD 18379 PIONEER BLVD 7524 MORRO RD 5735 EL CAMINO REAL STE H 3605 HOSPITAL RD STE H 1701 BELLEVUE RD 2222 GRASS VALLEY HWY

ARCADIA ARCATA ARCATA ARLETA ARNOLD ARROYO GRANDE ARTESIA ARTESIA ARTESIA ARTESIA ARTESIA ARTESIA ATASCADERO ATASCADERO ATWATER ATWATER AUBURN

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91006-3748 95521-5816 95521-4734 91331-6401 95223-9908 93420 90701-4255 90701-6844 90701-3997 90701 90701-4008 90701-5532 93422-4404 93422-3350 95301-5173 95301-2604 95603-2536

CHAPA-DE INDIAN HEALTH PROGRAM INC GREATER PLACER PHARMACY RALEY'S DRUG CENTER SIERRA COMPOUNDING PHARMACY LEO'S CATALINA DRUG TOMER DRUG COMPANY BC PHARMACY BFMC PHARMACY BRIMHALL PHARMACY CAREPHARM PHARMACY

(530) 887-2836 (530) 885-8582 (530) 885-7989 (530) 823-5200 (310) 510-0189 (559) 386-5143 (661) 432-7922 (661) 633-1100 (661) 588-5555 (661) 836-7557

11670 ATWOOD RD 3133 PROFESSIONAL DR # 17 13386 LINCOLN WAY 1101 MAIDU DR STE 200 401 CRESCENT AVE 317 E KINGS ST 2528 CHESTER AVE 4570 CALIFORNIA AVE STE 110 8305 BRIMHALL RD STE 1603 4700 PANAMA LN STE 116

AUBURN AUBURN AUBURN AUBURN AVALON AVENAL BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD

CA CA CA CA CA CA CA CA CA CA

95603-9522 95603-2463 95603-3239 95603-5808 90704-0000 93204-1630 93301-2013 93309-1143 93312-2243 93313-3481

COMPREHENSIVE BLOOD AND CANCER CTR DIMAS PHARMACY DOWNTOWN PHARMACY EL TEJON DRUG CO EL TEJON DRUG CO EXPRESS PHARMACY EXPRESS PHARMACY EXPRESS PHARMACY FAMILY PHARMACY FAMILY PHARMACY HINA'S HOMECARE PHARMACY HINAS MERCY SOUTHWEST UNITED D HINAS PHARMACY

(661) 322-2206 (661) 489-4000 (661) 322-5700 (661) 325-7284 (661) 399-2901 (661) 381-7600 (661) 829-7870 (661) 829-7861 (661) 637-1000 (661) 535-8080 (661) 664-7979 (661) 663-0977 (661) 282-8805

6501 TRUXTUN AVE 3805 SAN DIMAS ST STE A 2700 F ST STE 200 2900 BRUNDAGE LN 2819 N CHESTER AVE 9802 STOCKDALE HWY STE 106B 3400 CALLOWAY DR STE 302 9902 BRIMHALL RD STE 100 1707 27TH ST 309 N CHESTER AVE 9508 STOCKDALE HWY STE 130 500 OLD RIVER RD 6300 WHITE LN STE N

BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD

CA CA CA CA CA CA CA CA CA CA CA CA CA

93309-0633 93301-5725 93301-1849 93304-2430 93308-1587 93311-3653 93312-2513 93312-2801 93301 93308-4441 93311-3623 93311-9504 93309

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KOMOTO MEDICAL PHARMACY LEES CLINICAL PHARMACY LEES NILES DRUG STORE MING & H DRUGS NORTH CHESTER PHARMACY OPTION CARE PEOPLE'S PHARMACY SAVE MART PHARMACY SAV-ON DRUGS SAV-ON PHARMACY SAV-ON PHARMACY SILVER SPRAY UNITED DRUGS SOUTHWEST PHARMACY THE MEDICINE SHOPPE TRUXTON PHARMACY WIBLE PHARMACY WISE BUYS DRUGS YOUR DRUG STORE ZOHA'S PHARMACY BIG 8 PHARMACY PREMIER PHARMACY PREMIER PHARMACY SERVICES CROAL'S REXALL DRUG PRESCRIPTION SHOPPE TEPLOW DRUGS

Provider Name

(661) 327-7524 (661) 323-7006 (661) 327-9317 (661) 831-4050 (661) 399-3337 (661) 615-6000 (661) 493-0408 (661) 587-2301 (661) 328-0854 (661) 587-2890 (661) 587-0158 (661) 327-4248 (661) 837-5700 (661) 871-8881 (661) 324-7979 (661) 835-7979 (661) 327-8444 (661) 325-2487 (661) 322-7979 (626) 851-8108 (626) 626-9400 (626) 626-9400 (760) 256-8968 (760) 256-5614 (760) 256-2726

2110 TRUXTUN AVE STE 100 1201 24TH ST STE B-120 1405 NILES ST 1717 MING AVE 1822 N CHESTER AVE 5800 DISTRICT BLVD UNIT 200 5913 NILES ST STE 2 9600 HAGEMAN RD 1520 BRUNDAGE LN 6045 COFFEE RD 13045 ROSEDALE HWY 2191 NILES ST 3400 PANAMA LN STE L 5645 AUBURN ST # B 5925 TRUXTUN AVE 2400 WIBLE RD STE 1 2 H ST 2303 NILES PT 5458 CALIFORNIA AVE 4318 MAINE AVE STE C 410 CLOVERLEAF DR 410 CLOVER LEAF DR 901 E WILLIAMS ST 400 S 2ND AVE STE 101 404 E MAIN ST

BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BAKERSFIELD BALDWIN PARK BALDWIN PARK BALDWIN PARK BARSTOW BARSTOW BARSTOW

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

93301-3703 93301-2310 93305-4731 93304-4522 93308-2565 93313-2148 93306-7407 93312-3958 93304-2949 93308-9414 93314-9496 93305-5007 93313-3699 93306-2870 93309-0432 93304-4732 93304-2908 93306-4025 93309-1618 91706-3326 91706-6511 91706 92311-3049 92311-2805 92311-2326

LOMA LINDA U-HIGHLAND SPRINGS PHCY TOTAL CARE PHARMACY YOUR PHARMACY BELL DRUGS MEDICAL ARTS UNITED DRUGS THE MEDICINE CABINET APPLE RX PHARMACY B&B PHARMACY

(951) 849-3378 (951) 769-3105 (951) 845-8252 (323) 562-1006 (323) 771-1112 (323) 773-1261 (562) 220-2586 (562) 866-8363

81 HIGHLAND SPRINGS AVE #90 1657 E 6TH ST 1680 E 6TH ST STE A 3809 GAGE AVE 5101 FLORENCE AVE 6399 ATLANTIC AVE 17601 LAKEWOOD BLVD 10244 ROSECRANS AVE

BEAUMONT BEAUMONT BEAUMONT BELL BELL BELL BELLFLOWER BELLFLOWER

CA CA CA CA CA CA CA CA

92223-3170 92223-5765 92223-5756 90201-1026 90201-3801 90201 90706 90706

BELLWOOD MEDICAL CENTER PHARMACY MEDIC PHARMACY ST. LUKE PHARMACY TCC PMQ PHARMACY 1 TOP CARE PHARMACY RALEY'S DRUG CENTER ALTA BATES SUMMIT OUTPT PHCY

(562) 866-8281 (562) 925-6505 (562) 202-9838 (562) 264-3124 (562) 461-0891 (707) 746-5565 (510) 204-6550

10230 ARTESIA BLVD STE 101 16900 BELLFLOWER BLVD 16317 CLARK AVE 17660 LAKEWOOD BLVD 10251 E ARTESIA BLVD STE A 892 SOUTHAMPTON RD 2001 DWIGHT WAY STE 2182

BELLFLOWER BELLFLOWER BELLFLOWER BELLFLOWER BELLFLOWER BENICIA BERKELEY

CA CA CA CA CA CA CA

90706-6768 90706-5904 90706-5209 90706-6410 90706 94510-1907 94704-2608

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DRATE PHARMACY PHARMACA INTERGRATIVE PHARMACY UNITED PHARMACY RALPHS ABC PHARMACY OF BEVERLY HILLS ACE MEDICAL PHARMACY AHF HEALTHCARE CENTER-WESTSIDE BEVERLY HILLS APOTHECARY BEVERLY HILLS CANCER CENTER BEVERLY HILLS MED PLAZA PHARMACY BEVERLY HILLS PHARMACY FAMILY PHCY SVCS BEVERLY HILLS GARFIELD PHARMACY HEPPS PRESCRIPTION PHARMACY HERBERTS PHARMACY MICKEY FINE PHARMACY MILART PRESCRIPTION PHARMACY OLYMPIC BOULEVARD PHARMACY PHARMACY 90210 PLANET PHARMACY INC PRESCRIPTION CENTER PHCY ROBERTSON CENTER PHARMACY ROXBURY PHARMACY RX UNLIMITED LLC SUPER CARE DRUGS - BEVERLY HILLS

Provider Name

(510) 848-1010 (510) 526-2452 (510) 843-3201 (760) 200-0843 (310) 777-0052 (310) 385-9128 (310) 854-2330 (310) 741-4596 (310) 432-8900 (310) 657-5551 (310) 652-3784 (323) 653-4070 (310) 274-0144 (310) 652-0550 (310) 859-3887 (310) 271-6123 (310) 553-0225 (310) 274-8080 (310) 777-2000 (310) 657-7707 (310) 274-7113 (310) 278-2948 (310) 277-6266 (310) 360-0000 (310) 271-2111

3219 ADELINE ST 1744 SOLANO AVE 2929 TELEGRAPH AVE 42150 WASHINGTON ST 9033 WILSHIRE BLVD STE 102 9171 WILSHIRE BLVD STE B 99 N LA CIENEGA BLVD STE 200 432 N BEDFORD DR 8900 WILSHIRE BLVD 150 N ROBERTSON BLVD STE 104 8500 WILSHIRE BLVD STE 101 8314 WILSHIRE BLVD 9400 BRIGHTON WAY 240 S LA CIENEGA BLVD # 100 9001 WILSHIRE BLVD STE 101 433 N ROXBURY DR 300 S BEVERLY DR 8950 W OLYMPIC BLVD STE 106 9735 WILSHIRE BLVD STE 110 121 N ROBERTSON BLVD 9730 WILSHIRE BLVD STE 103 250 N ROBERTSON BLVD #107 9101 W OLYMPIC BLVD 8641 WILSHIRE BLVD STE 120 220 N CANON DR

BERKELEY BERKELEY BERKELEY BERMUDA DUNES BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94703-2467 94707-2213 94705-2017 92203-9611 90211-1800 90210-5560 90211-2285 90210-4301 90211-1958 90211-2142 90211-3110 90211-2304 90210 90211-3324 90211-1839 90210-5001 90212-4808 90211-3575 90212-2107 90211-2103 90212-2003 90211 90212-3507 90211-2919 90210-5302

WILSHIRE LE DOUX MEDICAL PHARMACY WILSHIRE MEDICAL PHARMACY YASMIN'S PHARMACY DWAYNE'S FRIENDLY PHARMACY AUSTIN'S PHARMACY INC BANDY'S PHARMACY BLYTHE DRUG SALINAS PHARMACY BORREGO MEDICAL CENTER PHARMAC BOULDER CREEK PHARMACY AMERI MEX PHARMACY FARMACIA DEL PUEBLO VALLEY MEDICAL PHARMACY WHITE CROSS PHARMACY FISHERS BREA PHARMACY SAV-ON PHARMACY

(310) 657-4090 (310) 657-0750 (310) 358-0200 (760) 872-2522 (760) 921-2017 (760) 922-5165 (760) 922-3511 (760) 921-2378 (760) 767-3047 (831) 338-2144 (760) 344-2400 (760) 344-2000 (760) 344-6303 (760) 344-3131 (714) 529-2113 (714) 671-0656

8536 WILSHIRE BLVD STE 101 8920 WILSHIRE BLVD STE 108 99 N LA CIENEGA BLVD STE 104 644 W LINE ST 1345 W HOBSONWAY 707 W HOBSONWAY 301 W HOBSON WAY 507 E HOBSONWAY 655 PALM CANYON DR STE B 13081 HIGHWAY 9 610 S BRAWLEY AVE 653 MAIN ST 630 MAIN ST 602 MAIN ST 385 W CENTRAL AVE STE E 2500 E IMPERIAL HWY

BEVERLY HILLS BEVERLY HILLS BEVERLY HILLS BISHOP BLYTHE BLYTHE BLYTHE BLYTHE BORREGO SPRINGS BOULDER CREEK BRAWLEY BRAWLEY BRAWLEY BRAWLEY BREA BREA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90211-3103 90211-2001 90211-2286 93514-3315 92225-1425 92225-1514 92225-1639 92225-1736 92004-5001 95006-9119 92227-3124 92227 92227-2548 92227 92821-3000 92821-6122

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 41 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CITY CENTER PHARMACY BRENTWOOD RALEY'S DRUG CENTER A PLUS PHARMACY BEACH MEDICAL PHARMACY BEST CARE PHARMACY CAREMAX PHARMACY EARTH VILLAGE PHARMACY FAMILY CARE PHARMACY RIVER'S EDGE SPECIALTY PHCY SAV-ON PHARMACY AMC PHARMACY BURBANK COMPOUNDING PHARMACY BURBANK MEDICAL PHARMACY BURBANK TOWER PHARMACY BURBANK VILLAGE CMPDING PHCY CARRIE'S PHARMACY DANA DRUGS DE LA STAR PHARMACY GLENOAKS RX PHARMACY KAREN PHARMACY KAY PHARMACY INC KD PHARMACY LANDMARK SPECIALTY PHARMACY MAGNOLIA PHARMACY NOBLE PHARMACY OPTION CARE PAVILIONS PHARMACY

Provider Name

(925) 240-9777 (925) 513-8844 (714) 821-7788 (714) 739-8811 (714) 670-7979 (562) 902-2622 (714) 228-9212 (714) 521-3535 (714) 690-0349 (714) 947-9980 (818) 841-0423 (818) 563-2120 (818) 559-7401 (818) 859-7179 (818) 260-0062 (818) 567-1114 (818) 562-1177 (818) 566-7262 (818) 846-9011 (818) 842-1511 (818) 736-5841 (818) 847-8600 (818) 260-0010 (818) 238-0100 (818) 563-6655 (800) 800-4852 (818) 567-0086

50 EAGLE ROCK WAY STE C 2400 SAND CREEK RD 6888 LINCOLN AVE STE J 5230 BEACH BLVD 5317 BEACH BLVD 8271 COMMONWEALTH AVE 5161 BEACH BLVD STE C 5742 BEACH BLVD 6301 BEACH BLVD STE 105 8800 VALLEY VIEW ST 2625 W ALAMEDA AVE 201 S BUENA VISTA ST STE 110 2701 W ALAMEDA AVE STE 100 140 N SAN FERNANDO BLVD 337 E MAGNOLIA BLVD 501 N GLENOAKS BLVD 317 N PASS AVE 1721 W MAGNOLIA BLVD 303 S GLENOAKS BLVD STE 16 1730 W VERDUGO AVE 2313 W OLIVE AVE 10970 SHERMAN WAY STE 110 1208 W MAGNOLIA BLVD 2211 W MAGNOLIA BLVD STE 115 321 E ALAMEDA AVE STE L 1026 N LAKE ST 1110 W ALAMEDA AVE

BRENTWOOD BRENTWOOD BUENA PARK BUENA PARK BUENA PARK BUENA PARK BUENA PARK BUENA PARK BUENA PARK BUENA PARK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94513-4949 94513-7058 90620-4107 90621-1230 90621-1231 90621-2537 90621-1129 90621-2043 90621-4030 90620-3588 91505-4806 91505-4570 91505-4402 91502-1207 91502-1132 91502-1123 91505-3859 91506-1839 91502-1319 91506-2148 91506-2627 91505-1003 91506 91506-1758 91502-3328 91502-1624 91506-2806

PREMIER MEDICAL CENTER OF BURBANK PROVIDENCE PHARMACY QUALITY HOME INFUSION RALPHS RX BIOTECH SPECIALTY PHARMACY SCOTT DRUGS ST JOSEPH PHARMACY TOWER PHARMACY UMC PHARMACY A AND O PENINSULA PHCY CALABASAS PHARMACY SAV-ON PHARMACY CALEXICO PHARMACY FARMACIA DEL PUEBLO

(818) 842-7145 (818) 748-4950 (818) 848-8112 (818) 845-5112 (800) 657-2212 (818) 845-8313 (818) 736-5290 (818) 848-0220 (818) 559-2223 (650) 692-6569 (818) 223-8656 (818) 880-8807 (760) 357-1200 (760) 768-6000

201 S BUENA VISTA ST STE 325 181 S BUENA VISTA ST 212 W MAGNOLIA BLVD 1100 N SAN FERNANDO BLVD 315 W VERDUGO AVE 2200 N. GLENOAKS BLVD 2519 W. BURBANK BLVD 350 S GLENOAKS BLVD 4318 W VICTORY BLVD 1828 EL CAMINO REAL STE 104 22277 MULHOLLAND HWY 26521 AGOURA RD 420 E 2ND ST 801 BIRCH ST STE 4

BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURBANK BURLINGAME CALABASAS CALABASAS CALEXICO CALEXICO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91505-4580 91505-4504 91502-1724 91504-4330 91502 91504 91505 91502-1318 91505-1334 94010-3104 91302-5156 91302-1958 92231-2847 92231

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HOPE PHARMACY CALIFORNIA CITY PHARMACY SILVERADO PHARMACY FACTOR SUPPORT NETWORK PHCY IN LANTANA PHARMACY MEDICINE SHOPPE NEIGHBORHOOD PHARMACY INC RALPHS SEENA PHARMACY ST JOHNS PLEASANT VALLEY HOSP VU PHARMACY CAMBRIA DRUG AND GIFT BEL AIR PHARMACY EL DORADO COMMUNITY PHCY CAMDEN PHARMACY DIRECT MEDS PHARMACY SOUTHERN INDIAN HEALTH SOUTHERN INDIAN HEALTH COUNCIL AAA CARE PHARMACY CANOGA PARK PHARMACY CLINISHARE PHARMACY DESOTO UNITED DRUGS RALPHS RALPHS TRUE CARE FAMILY PHARMACY JJ TRINITY COMPOUNDING PHARMACY TOTAL CARE PHARMACY LAUDEN PHARMACY CARLSBAD VILLAGE PHARMACY GELSON'S PHARMACY NORTH COAST MEDICAL SUPPLY PHARMACA INTEGRATIVE PHARMACY PRICE RITE PHARMACY SUPER RX PHARMACY CARMEL DRUG STORE SAVE MART PHARMACY BEL AIR PHARMACY CARMICHAEL VILLAGE PHARMACY FAMILY DISCOUNT PHARMACY OPTIMAL PHARMACEUTICAL MGMT RALEY'S DRUG CENTER SAVE MART PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (760) 357-9500 (760) 373-9279 (707) 942-5115 (805) 388-9336 (805) 388-5888 (805) 389-5311 (805) 388-0800 (805) 445-1431 (805) 419-2686 (805) 389-5916 (805) 383-8340 (805) 927-7283 (530) 676-4833 (530) 556-2007 (408) 371-0111 (408) 871-2900 (619) 445-1188 (619) 445-1188 (818) 914-4194 (818) 348-6600 (818) 835-9627 (818) 341-9515 (818) 713-8014 (818) 716-1275 (818) 878-3227 (661) 298-9610 (661) 250-3800 (831) 462-9880 (760) 729-2405 (760) 633-0037 (800) 730-9887 (760) 444-3810 (760) 893-8331 (760) 929-7912 (831) 624-3819 (831) 624-7339 (916) 483-2695 (916) 436-4731 (916) 481-6900 (916) 978-0866 (916) 483-0419 (916) 979-9100

Provider Street 420 HEFFERNAN AVE STE A 9160 CALIFORNIA CITY BLVD 1473 LINCOLN AVE STE D 900 AVENIDA ACASO STE A 2412 N PONDEROSA DR STE B106 2173 PICKWICK DR 4557 PLEASANT VALLEY RD 674 LAS POSAS RD 3901 LAS POSAS RD STE 101 2309 ANTONIO AVE 424 ARNEILL ROAD STE D 2222 MAIN ST 3510 PALMER DR 3100 PONTE MORINO DR STE 120 3189 S BASCOM AVE 281 E HAMILTON AVE STE 9 36350 CHURCH RD 36350 CHURCH RD 6729 VARIEL AVE 22330 SHERMAN WAY STE C3 23719 ROSCOE BLVD 20914 ROSCOE BLVD 22333 SHERMAN WAY 22915 VICTORY BLVD 22030 SHERMAN WAY STE 100 27141 HIDAWAY AVE STE 101 19409 SOLEDAD CANYON RD 1820 41ST AVE STE F 1005 CARLSBAD VILLAGE DR STE D 7660 EL CAMINO REAL 2544 CAMPBELL PL STE 150 6985 EL CAMINO REAL STE 103 6010 HIDDEN VALLEY RD STE 135 2687 GATEWAY RD OCEAN AVE & NW SAN CARLOS 555 CARMEL RANCHO BLVD 4005 MANZANITA AVE 6633 COYLE AVE STE 1 5830 JAMESON CT STE B 6110 FAIR OAKS BLVD 5157 FAIR OAKS BLVD 4708 MANZANITA AVE

Page 43 of 679

Provider City CALEXICO CALIFORNIA CITY CALISTOGA CAMARILLO CAMARILLO CAMARILLO CAMARILLO CAMARILLO CAMARILLO CAMARILLO CAMARILLO CAMBRIA CAMERON PARK CAMERON PARK CAMPBELL CAMPBELL CAMPO CAMPO CANOGA PARK CANOGA PARK CANOGA PARK CANOGA PARK CANOGA PARK CANOGA PARK CANOGA PARK CANYON COUNTRY CANYON COUNTRY CAPITOLA CARLSBAD CARLSBAD CARLSBAD CARLSBAD CARLSBAD CARLSBAD CARMEL CARMEL CARMICHAEL CARMICHAEL CARMICHAEL CARMICHAEL CARMICHAEL CARMICHAEL

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92231-2742 93505-2820 94515-1479 93012-8749 93010-2474 93010-6426 93012-5185 93010-5716 93010-1505 93010-1414 93010 93428-3018 95682-8202 95682-7450 95008-6728 95008-0232 91906-2715 91906-2715 91303 91303-1095 91304-3041 91304-4308 91303-1050 91307-3533 91303-1897 91351 91351-2632 95010-2516 92008-1883 92009 92009-1700 92009-4148 92011-4217 92009-1726 93921 93923-8708 95608-1770 95608-6346 95608-0821 95608-3302 95608-5750 95608-0823

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SIERRA HEMATOLOGY & ONCOLOGY SAV-ON PHARMACY CROWN DRUG SAV-ON PHARMACY SAV-ON PHARMACY CARUTHERS PHARMACY RALPHS CLAYWORTH HEALTHCARE PHCY BORREGO PHARMACY CAYUCOS PHARMACY CERES DRUG STORE GILL PHARMACY MID VALLEY HEALTH SERVICES SAVE MART PHARMACY ACCESS IV BETTERX PHARMACY CERRITOS MEDICAL PHARMACY MEDICINE MAN PHARMACY RALPHS PHARMACY VM PHARMACY CARE-A-LOT PHARMACY PANACEA PHARMACY

Provider Name

(916) 962-1544 (805) 684-8367 (310) 323-6193 (310) 834-2561 (310) 513-6800 (559) 864-3177 (661) 702-6937 (510) 537-9402 (760) 507-3300 (805) 995-3538 (209) 537-0718 (209) 537-4455 (209) 531-1858 (209) 566-7485 (562) 263-5600 (562) 444-5545 (562) 926-5900 (562) 404-3100 (562) 924-2838 (562) 809-8679 (747) 202-3222 (818) 727-7530

6555 COYLE AVE STE 301 1018 CASITAS PASS RD 657 E UNIVERSITY DR 110 E CARSON ST 200 E SEPULVEDA BLVD 2436 W TAHOE 29675 THE OLD RD 20353 LAKE CHABOT RD 68555 RAMON RD BLDG D # 105 72 SOUTH OCEAN AVE 2929 4TH ST 2600 MITCHELL RD STE G 2800 MITCHELL RD STE S 2920 E WHITMORE AVE 870 MARKET ST STE 1028 11855 E SOUTH STREET 13325 ARTESIA BLVD 13737 ARTESIA BLVD #202 13321 SOUTH ST 12626 SOUTH ST 21413 DEVONSHIRE ST 9800 TOPANGA CANYON BLVD STE B

CARMICHAEL CARPINTERIA CARSON CARSON CARSON CARUTHERS CASTAIC CASTRO VALLEY CATHEDRAL CITY CAYUCOS CERES CERES CERES CERES CERRITOS CERRITOS CERRITOS CERRITOS CERRITOS CERRITOS CHATSWORTH CHATSWORTH

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95608 93013-2109 90746-1966 90745-2702 90745-6323 93609 91384-4570 94546-5392 92234-3310 93430 95307-3222 95307-9466 95307-9463 95307 90703-2137 90703 90703 90703 90703-7308 90703-7232 91311 91311-4075

BIDWELL PHARMACY AND MEDICAL SUPPLY CHICO PHARMACY ENLOE O/P CENTER PHARMACY KINDCARE PHCY AND MED SUPPLY OPTION CARE RALEY'S DRUG CENTER RALEY'S DRUG CENTER SAVE MART PHARMACY CAREMORE PHARMACY CHINO MEDICAL PHARMACY CHINO VALLEY PHARMACY EXCEL CARE PHARMACY GRANDVIEW PHARMACY K'S PHARMACY SANTA FE PHARMACY SUPER RX PHARMACY VIP PHARMACY

(530) 891-0388 (530) 343-4440 (530) 332-6470 (530) 592-3917 (530) 893-1337 (530) 899-3790 (530) 895-0895 (530) 343-3399 (909) 927-8323 (909) 591-6038 (909) 591-8444 (909) 313-0100 (909) 548-6186 (909) 591-7420 (909) 342-9181 (909) 627-1472 (909) 573-0123

1200 MANGROVE AVE STE A 251 COHASSET RD STE 100 888 LAKESIDE VLG COMMONS 230 WALNUT ST STE B 15 DECLARATION DR 211 W EAST AVE 2485 NOTRE DAME BLVD STE 340 146 W EAST AVE 13085 CENTRAL AVE STE 2 5365 WALNUT AVE STE D 12144 CENTRAL AVE. 5272 FRANCIS ST 13768 ROSWELL AVE STE 111 12582 CENTRAL AVE 12916 CENTRAL AVE 6989 SCHAEFER AVE 13193 CENTRAL AVE STE 120

CHICO CHICO CHICO CHICO CHICO CHICO CHICO CHICO CHINO CHINO CHINO CHINO CHINO CHINO CHINO CHINO CHINO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95926-3528 95926-2235 95928-3979 95928-5280 95973-4902 95926-7202 95928-7161 95926-7200 91710-4184 91710-2622 91710 91710 91710-1402 91710-3507 91710-4121 91710-9110 91710-4179

CHINO HILLS PROFESSIONAL PHARMACY

(909) 364-9244

2140 GRAND AVE STE 130

CHINO HILLS

CA

91709-6802

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 44 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MED-PLAZA PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY LOYALTY PHARMACY SAVE MART PHARMACY CHULA VISTA PHARMACY COMMUNITY MEDICAL CTR PHCY WEST MEDICAL CENTER PHARMACY MEDICAL CENTER PHARMACY OTAY LAKES PHARMACY PARK MEDICAL PHARMACY RALPH'S PHARMACY SAV-ON PHARMACY SHARP REES STEALY PHARMACY SHARP REES-STEALY PHARMACY SOLARA MEDICAL SUPPLIES

Provider Name

(909) 465-6562 (909) 606-8185 (909) 590-8373 (559) 715-4516 (559) 665-9479 (619) 781-8177 (619) 421-1131 (619) 427-1444 (619) 585-0665 (619) 326-9034 (619) 422-9291 (619) 397-0466 (619) 420-8313 (619) 397-3072 (619) 420-7120 (619) 551-7777

3110 CHINO AVE STE 100 15970 LOS SERRANOS CTRY CL DR 3255 GRAND AVE 327 TRINITY AVE 1225 E ROBERTSON BLVD 384 H ST STE 100 750 MEDICAL CTR CT STE 1 480 4TH AVE 855 3RD AVE STE 1102 945 OTAY LAKES RD STE J 340 4TH AVE STE 1 659 PALOMAR ST 720 3RD AVE 1400 E PALOMAR ST 525 3RD AVE STE A 2084 OTAY LAKES RD STE 102

CHINO HILLS CHINO HILLS CHINO HILLS CHOWCHILLA CHOWCHILLA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA CHULA VISTA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91709-1294 91709 91709-1488 93610-2860 93610-8540 91910 91911 91910-4410 91911-1350 91913-3055 91910-3882 91911-2623 91910-5804 91913-1800 91910-5616 91915-1368

SOUTH COUNTY HEMATOLOGY ONCOLOGY VETERANS HOME OF CHULA VISTA RALEY'S DRUG CENTER CONCOURSE RX SUPER CARE WEST COVINA PHARMACY APHA DRUGSTORE CLAREMONT PHARMACY HENDRICKS PHARMACY MD PHARMACY LAKE PHARMACY MORAN'S PHARMACY CLOVERDALE PHARMACY MEDICINE SHOPPE SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SCRIPT LIFE PHARMACY

(619) 482-8430 (619) 482-6020 (916) 722-1755 (626) 965-5988 (800) 206-4880 (626) 839-9882 (909) 625-0872 (909) 929-7228 (909) 624-1611 (909) 949-6337 (707) 994-3141 (707) 994-6440 (707) 894-4414 (559) 297-0251 (559) 297-0174 (559) 298-1707 (559) 322-0123 (559) 324-1808

752 MEDICAL CENTER CT STE 304 700 E NAPLES CT 7849 LICHEN DR 18575 GALE AVE STE 158 16017 VALLEY BLVD 1661 HANOVER RD # 104B 1011 AMADOR ST 358 S INDIAN HILL BLVD 137 HARVARD AVE 1601 MONTE VISTA AVE SUITE 130 15230 LAKESHORE DR 15175 LAKESHORE DR 790 S CLOVERDALE BLVD 195 W SHAW AVE #101 1157 N WILLOW AVE 2179 SHAW AVE 850 HERNDON AVE 255 W HERNDON AVE STE 101

CHULA VISTA CHULA VISTA CITRUS HEIGHTS CITY OF INDUSTRY CITY OF INDUSTRY CITY OF INDUSTRY CLAREMONT CLAREMONT CLAREMONT CLAREMONT CLEARLAKE CLEARLAKE CLOVERDALE CLOVIS CLOVIS CLOVIS CLOVIS CLOVIS

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91911-6660 91911-6821 95621-1074 91748-1340 91744-5424 91748-1796 91711-3600 91711-5223 91711 91711 95422-8107 95422-8106 95425-4010 93612 93611-4408 93611-8937 93612-0489 93612-0204

SCRIPTCARE RX AND MEDICAL SUPPLIES LA BOTICA PHARMACY LA BUENA VIDA PHARMACY RX CARE PHARMACY COARSEGOLD PHARMACY SIERRA MARKET PHARMACY

(559) 298-0600 (760) 296-3468 (760) 398-8866 (559) 935-8833 (559) 692-2479 (530) 346-3714

159 W SHAW AVE 49281 GRAPEFRUIT BLVD STE 2 51-335 HARRISON ST, STE 116 155 S 5TH SUITE A 35300 HIGHWAY 41 STE 101 575 S AUBURN ST

CLOVIS COACHELLA COACHELLA COALINGA COARSEGOLD COLFAX

CA CA CA CA CA CA

93612-3726 92236-1486 92236 93210-9665 93614-8718 95713-9799

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 45 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

COLTON PHARMACY & MEDICAL SUPPLIES COOLEY HEALTH PHARMACY LARSON AND HUB CITY DRUG DAVISON DRUGS & STATIONERY ACARIAHEALTH PHARMACY #13, INC. OLYMPIC GERHART PHARMACY COMPTON COMMUNITY PHARMACY INTRA DRUGS ARTESIA SAV-MOST PHARMACY WEST ALONDRA MEDICAL PHARMACY BACON EAST PHARMACY

(909) 422-0444 (909) 514-1730 (909) 825-1950 (530) 458-2188 (323) 262-9403 (323) 722-1515 (310) 537-2337 (310) 639-1653 (310) 537-6060 (310) 631-8674 (925) 687-0565

518 W VALLEY BLVD 1280 E COOLEY DR STE 23 142 W H ST 640 MARKET ST 3302 GARFIELD AVE. 5724 E OLYMPIC BLVD 555 W COMPTON BLVD STE 102 403 S LONG BEACH BLVD STE C 1852 W ROSECRANS AVE 1410 W ALONDRA BLVD 2425 EAST ST STE 5

COLTON COLTON COLTON COLUSA COMMERCE COMMERCE COMPTON COMPTON COMPTON COMPTON CONCORD

CA CA CA CA CA CA CA CA CA CA CA

92324-2249 92324-3986 92324-2923 95932-2441 90040-3102 90022-5120 90220-3087 90221-3492 90220-1003 90220-3533 94520-1925

MT DIABLO SOLANO ONC GRP MED ASSOC SAVE MART PHARMACY SOLANO PHARMACY SYCAMORE MEDICAL PHARMACY COPPEROPOLIS PHARMACY R & M DRUG OLD TIME DRUGS OLIVE CITY PHARMACY WEST-END PHARMACY CARE PHARMACY COLES VILLAGE PHARMACY CORONA SPECIALTY PHARMACY MAIN STREET PHARMACY INC MED-REX DRUG PALMIERI PHARMACY RALPHS RALPHS SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SUPERIOR CARE PHARMACY TRUCARE PHARMACY CDM DRUGS

(925) 674-2353 (925) 680-5121 (925) 332-5141 (925) 682-5600 (209) 785-8787 (559) 992-2138 (530) 824-0800 (530) 824-0954 (530) 824-4901 (951) 268-9644 (951) 444-7057 (951) 278-1008 (951) 279-3125 (951) 735-2525 (951) 737-3511 (951) 734-8010 (909) 371-4868 (951) 279-4773 (909) 734-9765 (909) 340-2040 (619) 785-3993 (951) 817-1005 (949) 644-7575

2571 PARK AVE 5190 CLAYTON RD 2172 SOLANO WAY 2485 HIGH SCHOOL AVE STE 114 49 COSMIC CT STE C 1115 WHITLEY AVE 1322 SOLANO ST 954 HIGHWAY 99W 965 HIGHWAY 99W SUITE 127 129 N MCKINLEY ST STE 102 223 E THIRD ST ST 1280 CORONA POINTE CT STE 114 823 S MAIN ST STE 102 707 S MAIN ST 800 MAGNOLIA AVE STE 116 12660 LIMONITE AVE 2661 GREEN RIVER RD 7070 ARCHIBALD ST 1260 E ONTARIO AVE 260 W FOOTHILL PKWY 9064 PULSAR COURT STE G&H 1875 CALIFORNIA AVE 2865 E COAST HWY STE 150

CONCORD CONCORD CONCORD CONCORD COPPEROPOLIS CORCORAN CORNING CORNING CORNING CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA DEL MAR

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94520 94521-3102 94520-4700 94520-1816 95228-9300 93212-2325 96021-3053 96021 96021 92879-6593 92879 92879-1770 92882-3421 92882-3419 92879 92880 92882-7428 92880 92881-3600 92882-8540 92883 92881-6477 92625

SHARP CORONADO COMMUNITY PHARMACY HARBOR COMP AND HOME HLTH PHCY HOME CARE-RX, INC. PREFERRED PHARMACY RALPHS

(619) 522-3996 (949) 642-0106 (714) 545-5455 (714) 497-2778 (949) 645-1277

230 PROSPECT PL STE 110 2000 HARBOR BLVD STE C100 3303 HARBOR BLVD STE C2 3303 HARBOR BLVD STE H7 380 E 17TH ST

CORONADO COSTA MESA COSTA MESA COSTA MESA COSTA MESA

CA CA CA CA CA

92118-1980 92627-2601 92626 92626-1523 92627-3252

NR_0009_10823 10/2017

Page 46 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RAMSAY REXALL DRUGS WHITE FRONT PHARMACY COTTONWOOD DRUGS BTN PHARMACY, INC CALIX DRUGS PHARMACY INC CNC ROSE PHARMACY COMMUNITY MEDICAL PHARMACY COVINA PHARMACY INC EO PHARMACY GLESENER PHARMACY MED-PLUS PHARMACY OMEGA PHARMACY LAKE GREGORY PHARMACY AMERICAN HOME PHARMACY CITY PHARMACY JUELLE & LIMA PHARMACY

Provider Name

(949) 646-7744 (714) 540-2882 (530) 347-3721 (626) 214-2562 (626) 859-6611 (626) 966-9888 (626) 859-2573 (626) 915-6615 (626) 446-6088 (626) 966-3691 (626) 339-5557 (626) 967-2641 (909) 338-1875 (323) 562-1578 (323) 537-8970 (323) 562-1577

2246 NEWPORT BLVD 801 B BAKER ST 20635 GAS POINT RD 1433 N HOLLENBECK AVE STE 103 942-944 N GRAND AVE 420 W ROWLAND STREET 315 N 3RD AVE STE 101 174 W BADILLO ST 820 W SAN BERNARDINO RD 321 N CITRUS AVE 227 E ROWLAND ST 246 W COLLEGE ST STE 100 580 FOREST SHADE DR #7 4566 E FLORENCE AVE STE 4 7643 S ATLANTIC AVE STE A 4566 FLORENCE AVE STE 9

COSTA MESA COSTA MESA COTTONWOOD COVINA COVINA COVINA COVINA COVINA COVINA COVINA COVINA COVINA CRESTLINE CUDAHY CUDAHY CUDAHY

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92627-1752 92626-4347 96022-9295 91722-1558 91724-2045 91723 91723-1901 91723-2015 91722-3622 91723-2095 91723-3147 91723-1910 92325 90201 90201 90201-4347

LAS PHARMACY AND MEDICAL EQUIPMENT ST JAMES PHARMACY BROTMAN MEDICAL PHARMACY CRESCENT DRUGS INC IV LEAGUE MEMORIAL MEDICAL CENTER PHCY PAVILIONS PHARMACY PRECISE COMPOUNDING PHARMACY RALPHS PHARMACY KML PHARMACY INC BIOLOGIC INFUSION PHARMACY SAVE MART PHARMACY SAV-ON PHARMACY DANVILLE SAN RAMON PHARMACY GELSONS PHARMACY KOMOTO PHARMACY TRUXTUN PHARMACY DELANO HOT SPRINGS PHARMACY COMPLETE CARE COMPOUNDING GRACE PHARMACY JJ'S PHARMACY SAV-ON PHARMACY DINUBA PHARMACY PIONEER DRUG COMMUNITY PHARMACY

(323) 771-2633 (323) 773-1700 (310) 204-1111 (800) 469-4343 (310) 645-1500 (310) 837-6158 (310) 398-8044 (310) 559-5555 (310) 836-2684 (408) 873-8123 (855) 855-3221 (650) 992-9490 (949) 496-9490 (925) 820-4603 (858) 481-4029 (661) 725-9489 (661) 778-0111 (760) 251-2222 (909) 861-6900 (909) 839-0001 (909) 595-4003 (909) 861-9433 (559) 725-4525 (209) 392-1048 (562) 869-0965

7705 ATLANTIC AVE STE H 7611 ATLANTIC AVE 3831 HUGHES AVE STE 100 5915 BLACKWELDER ST 6076 BRISTOL PKWY STE 104 9806 VENICE BLVD 11030 JEFFERSON BLVD 10844-46 WASHINGTON BLVD 10772 JEFFERSON BLVD 1655 S DE ANZA BLVD STE 2 8851 WATSON ST 6843 MISSION ST 33601 DEL OBISPO ST 905 SAN RAMON VALLEY BLVD 2707 VIA DE LA VALLE 1017 ELLINGTON ST 1228 JEFFERSON ST 13313 PALM DR STE A 351 S DIAMOND BAR BLVD 20627 GOLDEN SPRINGS DR. #2C 21010 GOLDEN SPRINGS DR 1235 S DIAMOND BAR BLVD 172 N L ST 1428 CENTER AVE 10401 LAKEWOOD BLVD

CUDAHY CUDAHY CULVER CITY CULVER CITY CULVER CITY CULVER CITY CULVER CITY CULVER CITY CULVER CITY CUPERTINO CYPRESS DALY CITY DANA POINT DANVILLE DEL MAR DELANO DELANO DESERT HOT SPRINGS DIAMOND BAR DIAMOND BAR DIAMOND BAR DIAMOND BAR DINUBA DOS PALOS DOWNEY

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90201-5073 90201-5019 90232-6834 90232-7305 90230-6600 90232-2718 90230-5520 90232 90230-4933 95014-5319 90630-2243 94014-2006 92629-2103 94526-4035 92014-1905 93215-2621 93215-2204 92240-5980 91765 91789 91789 91765-4121 93618-2104 93620-2320 90241-2744

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 47 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DOWNEY PLAZA PHARMACY MEDICINE SHOPPE PHARMACY MRX PHARMACY PACIFIC PHARMACY RALPHS SAV-ON PHARMACY THE ONCOLOGY INSTI OF HOPE & I ZWEBER APOTHECARY ZWEBER APOTHECARY INC PAX PHARMACY PAX PHARMACY II DREW CENTER PHARMACY ASMAR COMMUNITY PHARMACY CLARKS GRNFLD PHARMACY INC DMK PHARMACY EL CAJON EXPRESS PHARMACY EL CAJON PHARMACY MEDCO DRUGS NUDO'S PHARMACY PALM CARE PHARMACY SAV-ON DRUGS SAV-ON PHARMACY SUPERIOR CARE PHARMACY EL CENTRO PHARMACY FARMACIA DEL PUEBLO PREFERRED PHARMACY SAVE MART PHARMACY RALEY'S DRUG CENTER ALLCARE PHARMACY ANA PHARMACY CNC AURORA PHARMACY CROWN CARE PHARMACY EL MONTE COMMUNITY PHARMACY EL MONTE PHARMACY MIDWAY DRUGS PROFESSIONAL ARTS PHARMACY RALPH'S PRESCRIPTION DRUGS ROSA 1 PHARMACY

Provider Name

(562) 861-5010 (562) 869-9200 (562) 803-1312 (562) 862-1302 (562) 622-9238 (562) 869-9655 (562) 869-1201 (562) 861-1203 (562) 923-1256 (626) 357-8500 (626) 531-7552 (650) 321-1449 (619) 447-9900 (619) 383-2757 (619) 561-5602 (619) 334-3307 (619) 446-6444 (619) 440-3448 (619) 442-0303 (619) 457-0545 (619) 670-7880 (619) 579-3463 (844) 633-7279 (760) 592-4542 (760) 353-9000 (760) 592-4650 (510) 524-8280 (916) 933-0374 (626) 442-8135 (626) 350-1719 (626) 542-3374 (626) 442-7696 (626) 579-6277 (626) 448-2507 (626) 448-7659 (626) 443-8987 (626) 448-9884 (626) 448-9956

11480 BROOKSHIRE AVE STE 102 11003 LAKEWOOD BLVD STE 101 12101 WOODRUFF AVE STE C 11525 BROOKSHIRE AVE STE 100 8626 FIRESTONE BLVD 7676 FIRESTONE BLVD 11480 BROOKSHIRE AVE STE 309 10800 PARAMOUNT BLVD STE 101 11411 BROOKSHIRE AVE STE 107 931 BUENA VISTA ST STE 104 931 BUENA VISTA ST STE 101 2111 UNIVERSITY AVE # B 436 S MAGNOLIA AVE STE 102 1685 E MAIN ST STE 101 8575 LOS COCHES RD SUITE 5 330 S MAGNOLIA AVE #102 505 N MOLLISON AVE # 101A 1252 BROADWAY 455 N MAGNOLIA AVE 505 N MOLLISON AVE STE 102 2899 JAMACHA RD 1608 BROADWAY ST 161 E MAIN ST STE 104 325 WAKE AVE 1692 S 4TH ST STE F 1601 N IMPERIAL AVE STE B 1000 EL CERRITO PLZ 3935 PARK DR STE B 11028 LOWER AZUSA RD 3513 JOHNSON AVE 11245 LOWER AZUSA RD STE B 3208 SANTA ANITA AVE # 101 10808 RAMONA BLVD 3948 PECK RD STE 5 10410 LOWER AZUSA RD 3131 SANTA ANITA AVE STE 101 10728 RAMONA BLVD STE F 10050 GARVEY AVE STE 117

DOWNEY DOWNEY DOWNEY DOWNEY DOWNEY DOWNEY DOWNEY DOWNEY DOWNEY DUARTE DUARTE EAST PALO ALTO EL CAJON EL CAJON EL CAJON EL CAJON EL CAJON EL CAJON EL CAJON EL CAJON EL CAJON EL CAJON EL CAJON EL CENTRO EL CENTRO EL CENTRO EL CERRITO EL DORADO HILLS EL MONTE EL MONTE EL MONTE EL MONTE EL MONTE EL MONTE EL MONTE EL MONTE EL MONTE EL MONTE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90241-5021 90241-3876 90241-5628 90241-4982 90241-5243 90241-4206 90241-5025 90241-3300 90241-5008 91010-1780 91010-1780 94303-1715 92020-5219 92021-5225 92021-8807 92020-5221 92021-6159 92021-4904 92020-3606 92021-6159 92019-4397 92021-5201 92020-3993 92243-9651 92243-4747 92243-1399 94530-4015 95762-4561 91731-1440 91731-3211 91731-1553 91733 91731-2628 91732-2256 91731-1277 91733-1369 91731-2601 91733-2089

SANTA MARIA COMMUNITY PHARMACY SAV-NOW PHARMACY RALPHS

(626) 443-3089 (626) 579-1270 (310) 615-3025

11004 VALLEY MALL 9814 GARVEY AVE # 24-25 500 N SEPULVEDA BLVD

EL MONTE EL MONTE EL SEGUNDO

CA CA CA

91731 91733-1290 90245-4447

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 48 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ST ANTONY PHARMACY ACCESS MYRX PHARMACY, LLC BEL AIR BEL AIR PHARMACY BEL AIR PHARMACY ELK GROVE PHARMACY LAGUNA MEDICAL PHARMACY LAGUNA PHARMACY INC RALEYS N-COAST MED UNITED DRUGS SCRIPPS HLTH ENCINITAS AMBLTRY ABC COMPOUNDING PHARMACY BIOCARE RX SPECIALTY PHARMACY CENTRAL CARE PHARMACY ENCINO CARE ENCINO FAMILY PHARMACY ENCINO PHARMACY FAMILYCARE PHARMACY & MEDICAL RALPHS PHARMACY RUBIO PHARMACY INC SCRIPTSRUS PHARMACY SHALOM COMPOUNDING PHARMACY TELE HEALTH PHARMACY VENTURA CENTRAL PHARMACY WEST VAL PHARMACY ZELZAH PHARMACY INC VINEYARD PHARMACY & GIFTS DRUGCO PHARMACY EL NORTE PHARMACY ESCONDIDO PHARMACY & DME FELICITA PHARMACY HOSPICARE PHARMACY SAN DIEGO MERCY CARE PHARMACY PALOMAR PHARMACY SAV-ON PHARMACY TRILLIUM PHARMACY CLONEYS PRESCRIPTION PHARMACY CLONEYS RED CROSS PHARMACY LIMA'S PROFESSIONAL PHARMACY RALEY'S DRUG CENTER RALEY'S DRUG CENTER GATEWAY PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (310) 524-9244 (916) 509-9834 (916) 714-6955 (916) 681-5790 (916) 684-7007 (916) 667-3852 (916) 684-9922 (916) 684-9922 (916) 683-0720 (760) 943-1191 (858) 964-1012 (818) 783-0422 (818) 382-3500 (818) 386-1888 (818) 377-6900 (818) 387-8119 (818) 788-5858 (818) 975-8612 (818) 728-4515 (818) 990-5100 (818) 536-5420 (818) 774-1800 (877) 797-9793 (818) 990-1444 (818) 788-2411 (818) 609-0692 (209) 838-0511 (760) 745-6672 (760) 233-2100 (760) 480-1081 (760) 432-8520 (760) 738-4676 (760) 294-0014 (760) 294-0790 (760) 735-5864 (760) 480-4080 (707) 443-7086 (707) 443-1614 (707) 441-8500 (916) 966-2241 (916) 966-2266 (707) 422-0500

Provider Street 310 E GRAND AVE STE 105 9632 EMERALD OAK DRIVE, STE G 9435 ELK GROVE BLVD 8425 ELK GROVE FLORIN RD 5100 LAGUNA BLVD 8470 ELK GROVE BLVD STE 150 9390 BIG HORN BLVD STE 110 8112 SHELDON RD STE 300 4900 ELK GROVE BLVD 477 N EL CAMINO REAL 310 SANTA FE DR STE 109 16311 VENTURA BLVD STE 110 5435 BALBOA BLVD STE 210 16260 VENTURA BLVD STE 100 16025 VENTURA BLVD STE 100 16060 VENTURA BLVD #109 17071 VENTURA BLVD 18075 VENTURA BLVD STE 112 16325 VENTURA BLVD 16550 VENTURA BLVD 15630 VENTURA BLVD 18000 VENTURA BLVD STE 2 17200 VENTURA BLVD STE 116 16661 VENTURA BLVD STE 111 5353 BALBOA BLVD 17911 VENTURA BLVD 1900 MCHENRY AVE SUITE 202 307 N ASH ST 200 W EL NORTE PKWY STE 11 909 E VALLEY PKWY 625 W CITRACADO PKWY STE 106 910 E OHIO AVE #101A 488 E VALLEY PKWY STE 101 1955 CITRACADO PKWY STE 101 1505 E VALLEY PKWY 239 S JUNIPER ST 2515 HARRISON AVE 525 5TH ST 2097 HARRISON AVE 8870 MADISON AVE 4830 SAN JUAN AVE 1330 GATEWAY BLVD STE B2

Page 49 of 679

Provider City EL SEGUNDO ELK GROVE ELK GROVE ELK GROVE ELK GROVE ELK GROVE ELK GROVE ELK GROVE ELK GROVE ENCINITAS ENCINITAS ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ENCINO ESCALON ESCONDIDO ESCONDIDO ESCONDIDO ESCONDIDO ESCONDIDO ESCONDIDO ESCONDIDO ESCONDIDO ESCONDIDO EUREKA EUREKA EUREKA FAIR OAKS FAIR OAKS FAIRFIELD

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90245-3811 95624 95624-5013 95624-9518 95758-4159 95758-5925 95758-7979 95758-5913 95758 92024-1328 92024-5124 91436-4307 91316-1579 91436-2207 91436-4466 91436-4427 91316-4130 91316-3599 91436-2101 91436-2004 91436 91316-3533 91316 91436-1920 91316-2804 91316-3618 95320 92027-3015 92026-2529 92025-3428 92025 92025-3439 92025 92029-4111 92027-2326 92025-4220 95501-3220 95501-1032 95501-3211 95628-3908 95628-4719 94533-6915

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MERCURY PHARMACY RALEY'S DRUG CENTER RALEY'S DRUG CENTER SENIOR CARE PHARMACY SERVICES INC SAV-ON PHARMACY VILLAGE PHARMACY RINGS PHARMACY MEDICAL PLAZA PHARMACY WEST SIDE DRUG COMPANY BEL AIR FOLSOM MEDICAL PHARMACY

Provider Name

(707) 862-7300 (707) 421-9010 (707) 429-8310 (707) 673-9800 (760) 723-8178 (760) 645-3021 (707) 786-4511 (805) 524-0052 (559) 659-2159 (916) 983-8044 (916) 983-4900

480 CHADBOURNE RD STE 101 3330 N TEXAS ST 3007 TRAVIS BLVD 4950 FULTON DR STE A & B 1133 S MISSION RD 587 E ELDER ST STE C 362 MAIN ST 353 CENTRAL AVE 1101 O ST 2760 E BIDWELL ST 1300 E BIDWELL ST STE 105

FAIRFIELD FAIRFIELD FAIRFIELD FAIRFIELD FALLBROOK FALLBROOK FERNDALE FILLMORE FIREBAUGH FOLSOM FOLSOM

CA CA CA CA CA CA CA CA CA CA CA

94534-9641 94533-9758 94534-3442 94534 92028-3222 92028-3089 95536-9416 93015-1920 93622-2224 95630-6414 95630-3527

INNOVATIVE COMPOUNDING PHARMACY RALEY'S DRUG CENTER RALEY'S PHARMACY A1 CARE PHARMACY CARE PHARMACY COLE'S VILLAGE PHARMACY FARMACIA M FINLEYS REXALL DRUG RALPHS PHARMACY SIERRA SAN ANTONIO PHARMACY ST MINA PHARMACY ST MINA PHARMACY AND HOME CARE ST. HELEN'S MEDICAL PHARMACY SUPER RX PHARMACY SUPER RX PHARMACY

(916) 984-9222 (916) 983-6574 (916) 351-0303 (909) 281-3600 (909) 429-4497 (909) 877-4224 (909) 427-1853 (909) 822-2288 (909) 357-2525 (909) 574-9620 (909) 350-3200 (909) 823-2515 (909) 428-9842 (909) 803-2632 (909) 428-4558

820 WALES DR STE 3 715 E BIDWELL ST 25025 BLUE RAVINE RD 7470 CHERRY AVE STE 111 16137 FOOTHILL BLVD 17691 SAN BERNARDINO AVE 7965 SIERRA AVE STE G 8554 SIERRA AVE 16225 SIERRA LAKES PKWY 16465 SIERRA LAKES PKWY #110 8110 MANGO AVE STE 105 16701 VALLEY BLVD STE E 17577 ARROW BLVD STE 101 15222 SUMMIT AVE 11225 SIERRA AVE

FOLSOM FOLSOM FOLSOM FONTANA FONTANA FONTANA FONTANA FONTANA FONTANA FONTANA FONTANA FONTANA FONTANA FONTANA FONTANA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95630-5546 95630-3341 95630-5279 92336-4272 92335-3374 92335-5911 92336-3329 92335 92336-1245 92336-1242 92335-3603 92335-6696 92335-4011 92336-0231 92337-7529

FOOTHILL RANCH MEDICAL PLAZA PHCY RALPHS PHARMACY FORESTVILLE PHARMACY MENDOCINO COAST PHARMACY GREENS FORTUNA PHARMACY SAVE MART PHARMACY CARE ONE PHARMACY COASTLINE CARE PHARMACY DIRECTCARE PHARMACY

(949) 586-6337 (949) 457-0690 (707) 887-2260 (707) 962-0800 (707) 725-4431 (650) 572-1167 (714) 962-4010 (714) 962-7192 (714) 465-9410

26750 TOWNE CENTRE DR STE C 26751 PORTOLA PKWY 6652 FRONT ST 350 CYPRESS ST 906 MAIN STREET 919 EDGEWATER BLVD 9055 GARFIELD AVE 18120 BROOKHURST ST STE 57 18436 BROOKHURST ST

FOOTHILL RANCH FOOTHILL RANCH FORESTVILLE FORT BRAGG FORTUNA FOSTER CITY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY

CA CA CA CA CA CA CA CA CA

92610-2841 92610-1713 95436-9688 95437-5408 95540-2009 94404-3760 92708-6560 92708-6727 92708-6706

FOUNTAIN VALLEY CENTRAL PHARMACY FOUNTAIN VALLEY MED CNTR PHCY HARBOR PHARMACY ORANGE COAST MEMORIAL OP PHCY

(714) 839-5115 (714) 979-9600 (714) 531-9988 (714) 378-5701

11055 WARNER AVE 11100 WARNER AVE SUITE 1 16040 HARBOR BLVD STE K 18035 BROOKHURST ST STE 1400

FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY

CA CA CA CA

92708-4007 92708-7506 92708-1327 92708

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 50 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PRESTIGE MEDICAL PHARMACY QLT CARE PHARMACY RIVER'S EDGE COMMUNITY PHARMACY SAV-ON EXPRESS TAO WELLNESS PHARMACY TLC XPRESS PHARMACY TRINITY MISSION PHARMACY INC WARNER VILLAGE PHARMACY WELLCARE RX FRAZIER PARK PHARMACY VALLE VERDE UNITED DRUGS CAPSULE PHARMACY

Provider Name

(714) 361-1012 (714) 531-1888 (714) 884-3574 (714) 378-0174 (714) 593-5654 (714) 465-2431 (714) 839-3033 (714) 963-3300 (714) 841-6700 (661) 245-3771 (831) 728-2239 (510) 896-8121

17150 EUCLID ST STE 222A 16055-D BROOKHURST ST 11190 WARNER AVE STE 111 18545 BROOKHURST ST 16931 BUSHARD ST 10810 WARNER AVE STE 3 16569 BROOKHURST ST 10900 WARNER AVE STE 114 9114 EDINGER AVE 3544 MT PINOS WAY 240 GREEN VALLEY RD 2557 MOWRY AVE #11

FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FOUNTAIN VALLEY FRAZIER PARK FREEDOM FREMONT

CA CA CA CA CA CA CA CA CA CA CA CA

92708-4092 92708-1544 92708 92708-6746 92708-2819 92708-3848 92708-2344 92708-3846 92708-1437 93225 95019-3137 94538-1614

HALLER'S PHARMACY AND MEDICAL SUPPL JADE PHARMACY MOWRY MEDICAL PHARMACY MOWRY PLAZA PHARMACY RALEY'S DRUG CENTER SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY BK PHARMACY CORP BK PHARMACY CORP BROOKS HEALTH CARE BUKER AND COLSON MEDICINE CHEST BULLARD PHARMACY CANCER CARE ASSOCIATES CARE CENTER PHARMACY CARE RX PHARMACY

(510) 797-2772 (510) 792-4742 (510) 793-5011 (510) 745-9900 (510) 791-0657 (510) 744-9330 (510) 657-5280 (510) 794-9735 (559) 438-0259 (559) 438-2888 (559) 221-4800 (559) 237-4171 (559) 438-0111 (559) 326-1222 (559) 437-7370 (559) 261-9888

37323 FREMONT BLVD 34460 FREMONT BLVD SUITE B 1999 MOWRY AVE STE 2A 668 MOWRY AVE 39196 PASEO PADRE PKWY 5000 MOWRY AVE 40055 MISSION BLVD 34101 FREMONT BLVD 540 E HERNDON AVE STE 101 540 E HERNDON AVE #103 5070 N 6TH ST STE 169 1300 N FRESNO ST STE 200B 2026 W BULLARD AVE 1791 E FIR AVE 1570 E HERNDON AVE 302 E BULLARD AVE

FREMONT FREMONT FREMONT FREMONT FREMONT FREMONT FREMONT FREMONT FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94536-3702 94555 94538-1706 94536-4113 94538-1612 94538-1045 94539-3680 94555-2230 93720 93720-2993 93710-7508 93703-3845 93711-1210 93720-3840 93720-3303 93710-5299

CEDAR PHARMACY & MED SUPPLIES INC CHESTNUT PHARMACY

(559) 437-3700 (559) 317-6720

6767 N CEDAR AVE 7075 N CHESTNUT AVE STE 104

FRESNO FRESNO

CA CA

93710-4402 93720-0356

DISCOUNT PHARMACY AND MEDICAL SUPPL FRESNO PHARMACY GKN RX MANOR DRUGS MODERN DRUG MYMED PHARMACY NORTHWEST MEDICAL PHARMACY PILL BOX PHARMACY PRIMARY CARE PHARMACY

(559) 268-0712 (559) 255-8085 (559) 321-8608 (559) 431-4142 (559) 266-0701 (559) 325-6633 (559) 271-6370 (559) 492-2162 (559) 452-0420

703 N FULTON ST STE 201 4917 E KINGS CANYON RD STE 102 7072 N CEDAR AVE 5795 N 1ST ST 3044 TULARE ST 7141 N. CEDAR AVE SUITE 104 7355 N PALM AVE STE 100 2608 E ASHLAN AVE 5551 E KINGS CANYON RD STE 101

FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO

CA CA CA CA CA CA CA CA CA

93728-3405 93727-3812 93720-3300 93710-6203 93721-1415 93720 93711-5770 93726 93727-4528

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 51 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name RAY FISHER PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SUNNYSIDE PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE TOU'S PHARMACY UNIVERSITY MEDICAL CENTER PHCY VINA PHARMACY VISTA PHARMACY WELLPLUS PHARMACY WINTONS PROFESSIONAL PHARMACY BE WELL PHARMACY BENS VAL MESA PHARMACY CENTRAL DRUGS FULLERTON MEDICAL PHARMACY HOWARD'S SHOPRITE UNTDDRG KINGS PHCY AND COMPOUNDING CT QUALITY PHARMACY RALPHS SAV-ON DRUGS SAV-ON PHARMACY SUNNY HILLS PHARMACY SUNRISE VILLAGE PHARMACY GALT PHARMACY RALEY'S VALLEY PHARMACY EXPRESS KEITHS PHARMACY ACACIA PHARMACY ADVANCED HEALTHCARE PHARMACY AMERICARE PLUS PHARMACY AN PHARMACY ANA PHARMACY APPLE PHARMACY CAL PHARMACY CALI CARE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (559) 437-3800 (559) 435-7903 (559) 439-1211 (559) 446-0715 (559) 433-0283 (559) 261-4126 (559) 251-8601 (559) 226-1201 (559) 226-1201 (559) 222-6276 (559) 255-3301 (559) 268-8258 (559) 268-2547 (559) 459-4592 (559) 224-5210 (559) 255-3071 (559) 765-4364 (559) 435-1950 (714) 449-9300 (714) 992-1234 (714) 515-1530 (714) 992-4908 (714) 996-4642 (714) 879-5464 (714) 449-0448 (714) 992-6313 (714) 792-0990 (714) 992-6739 (714) 871-8190 (714) 441-1765 (209) 251-7535 (209) 745-4881 (209) 745-2564 (707) 923-2461 (714) 982-6979 (714) 530-8088 (714) 530-3833 (714) 638-5565 (714) 530-3784 (714) 537-8099 (714) 636-1881 (714) 537-7291

Provider Street 6629 N BLACKSTONE AVE 5750 N 1ST ST 7075 N MARKS AVE 659 E NEES AVE 1107 E CHAMPLAIN DR 6797 N MILBURN AVE 5689 E KINGS CANYON RD 4009 N MARKS AVE 4009 N MARKS AVE 2484 E GETTYSBURG AVE 4845 E BUTLER AVE 219 E OLIVE AVE 3250 E OLIVE AVE STE B 290 N WAYTE LANE 1ST FLOOR 2308 N FRESNO ST 4233 E TULARE ST 3005 W. BULLARD AVE 1377 E HERNDON AVE STE 102 105 N LAWRENCE AVE 100 E VALENCIA MESA DR STE 106 1955 SUNNYCREST DR STE 100 1401 S BROOKHURST RD STE 101 731 N PLACENTIA AVE 1950 SUNNYCREST DR STE 1200 2605 W ORANGETHORPE AVE 1121 N HARBOR BLVD 1930 N PLACENTIA AVE 2291 W MALVERN AVE 1907 SUNNYCREST DR 1823 N EUCLID ST 1000 C ST STE 35 10430 TWIN CITIES RD 835 C ST STE 180 875 REDWOOD DR 11033 ACACIA PARKWAY 13129 BROOKHURST ST 14211 EUCLID ST STE A 10963 WESTMINSTER AVE 10191 WESTMINSTER AVE 12440 BROOKHURST ST 9746 WESTMINSTER AVE STE D4 10278 WESTMINSTER AVE

Page 52 of 679

Provider City FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FRESNO FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON FULLERTON GALT GALT GALT GARBERVILLE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

93710-3503 93710-6204 93711-0261 93720-2106 93720-4223 93722-2132 93727-4650 93722 93722-4555 93726-0322 93727-5015 93728-3129 93702-1023 93701 93703-2239 93702-3036 93711 93720-3022 92832 92835 92835 92833-4492 92831-3290 92835-3618 92833-4209 92832-1312 92831-1522 92833-2106 92835-3626 92835-3343 95632-1749 95632-9032 95632-2801 95542 92840 92843-1079 92843-4992 92843-4929 92843 92840-4712 92844-2984 92843-4830

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CAREMAX PHARMACY DSK INC FORBES PHARMACY

Provider Name

(714) 530-2888 (714) 537-6619 (714) 462-1271

10741 WESTMINSTER AVE UNIT C 9580 GARDEN GROVE BLVD STE 108 10872 UNIT B-1 FORBES AVE

GARDEN GROVE GARDEN GROVE GARDEN GROVE

CA CA CA

92843-4919 92844-1589 92843

GARDEN GROVE COMMUNITY PHARMACY GILBERT DRUGS GLOBAL EXPRESS PHARMACY GROVE HARBOR MED CTR PHARMACY HARBOR PHARMACY HAU GIANG PHARMACY HONGS PHARMACY KAJU PHARMACY KIM PHARMACY LAM PHARMACY MANNA PHARMACY MARIA PHARMACY MAXINE PHARMACY MED PROS PHCY & MED SUPPLIES MODERN DRUG MTM PHARMACY NATICO PHARMACY NHAN HOA PHARMACY OC PHARMACY PACIFIC COAST PHARMACY PROCARE PHARMACY PX DRUGSTORE SAIGON PHARMACY TRAN PHARMACY TRAN PHARMACY TRUCARE PHARMACY VAN UNITED DRUGS VN DRUGS WESTMED DIAL PHARMACY ECONO PHARMACY GARDENA CENTER PHARMACY GARDENA PHARMACY GARDENA PROFESSIONAL PHARMACY MEIJI PHARMACY PRESCRIPTIONS UNLIMITED PHCY RALPHS SAV-ON PHARMACY

(714) 530-1130 (714) 638-8230 (714) 462-4480 (714) 636-0593 (714) 537-0333 (714) 839-1115 (714) 890-0331 (714) 539-6631 (714) 534-4555 (714) 537-0325 (714) 534-4133 (714) 554-4754 (714) 590-6046 (714) 638-4843 (714) 867-6502 (714) 705-6992 (714) 534-1020 (714) 248-9663 (714) 590-9401 (714) 260-9094 (714) 899-1111 (818) 769-0313 (714) 531-1740 (714) 554-3320 (714) 539-3900 (714) 583-9550 (714) 775-1789 (714) 638-2888 (714) 867-6494 (310) 515-8425 (310) 353-2699 (310) 767-1522 (424) 329-3904 (310) 532-0222 (310) 538-2885 (310) 515-1881 (310) 538-9116 (310) 380-4650

12665 GARDEN GROVE BLVD # 108 9240 GARDEN GROVE BLVD STE 20 10596 GARDEN GROVE BLVD 12555 GARDEN GROVE BLVD 10900 WESTINSTER AVE SUITE 3 14411 BROOKHURST ST STE F 8883 WESTMINSTER AVE 8887 GARDEN GROVE BLVD 9828 GARDEN GROVE BLVD STE 101 10224 WESTMINSTER AVE 10402 WESTMINSTER AVE STE C 13872 HARBOR BLVD STE 1A 10106 WESTMINSTER AVE 12582 GARDEN GROVE BLVD 10672 CHAPMAN AVE STE 5 12666 BROOKHURST ST STE 110 10212 WESTMINSTER AVE STE 109 7761 GARDEN GROVE BLVD 14150 BROOKHURST ST 10515 MCFADDEN AVE STE 104 9191 WESTMINSTER AVE 7373 LINCOLN WAY 14384 BROOKHURST ST 14291 EUCLID ST STE D104 9856 WESTMINSTER AVE # 123 12918 HARBOR BLVD 14441 BROOKHURST ST 13075 HARBOR BLVD 8342 GARDEN GROVE BLVD #2 101 W WALNUT ST STE 123 15435 S WESTERN AVE 15407 S WESTERN AVE 15418 CRENSHAW BLVD 1045 W REDONDO BEACH BLVD #140 1630 W REDONDO BEACH BLVD #14 1141 W REDONDO BEACH BLVD #100 2201 W REDONDO BEACH BLVD 1735 W ARTESIA BLVD

GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDEN GROVE GARDENA GARDENA GARDENA GARDENA GARDENA GARDENA GARDENA GARDENA GARDENA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92843-1915 92844-1400 92843-1163 92843-1902 92843 92843-4667 92844-2608 92844-1249 92844-1652 92843 92843 92843-4000 92843-4753 92843-1907 92840-3103 92840-4866 92843-4800 92841-4200 92843-4657 92843 92844-2751 92841-1428 92843-4608 92843-4980 92844-2907 92840-5809 92843-4646 92843-1739 92844-1151 90248-3103 90249-4323 90249-4318 90249-4524 90247-4104 90247-3200 90247-3586 90247-3626 90248-3220

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 53 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GILROY MEDICAL PHARMACY GLOBAL CANCER RSRCH INST, INC MEDICAL PAVILION PHARMACY NOB HILL PHARMACY ABM PHARMACY AGAPI PHARMACY INC ARARAT PLAZA PHARMACY ARDEN MEDICAL PHARMACY ARIANNA MEDICAL PHARMACY INC ARMEN PHARMACY INC ASAP PHARMACY ASTRO PHARMACY AVS PHARMACY CENTRAL AVE PHARMACY CENTRAL DRUGS CITI PHARMACY COMFORTCARE PHARMACY CONFIDENTIAL PHARMACY SERVICES DELTA DRUGS DORAN PHARMACY INC DRUG CENTER PHARMACY DRUG CENTER PHARMACY II EAST REMEDY PHARMACY ENOVEX PHARMACY EXPRESS CARE PHARMACY FIFTEEN SIXTY UNITED DRUG GLENDALE HAN KUK PHARMACY INC

Provider Name

(408) 842-3196 (408) 384-9284 (408) 842-2001 (408) 847-6777 (818) 242-4216 (818) 246-4433 (818) 637-2177 (818) 247-1842 (818) 957-9200 (818) 551-0082 (818) 543-1800 (818) 551-9010 (818) 484-8680 (818) 242-8838 (818) 956-1577 (818) 500-8660 (818) 247-7000 (888) 884-6337 (562) 222-2286 (818) 291-4099 (818) 246-7156 (818) 507-8466 (818) 507-0625 (818) 696-2501 (818) 244-3330 (818) 240-4971 (818) 637-7708

700 W 6TH ST STE G 9460 N NAME UNO STE 230 9460 NO NAME UNO #100 677 1ST ST 1385 E COLORADO ST 6501 SAN FERNANDO RD # K 1248 S GLENDALE AVE STE M 435 W ARDEN AVE STE 110 3600 N VERDUGO RD STE 103 1025 E BROADWAY 367 N CHEVY CHASE DR # B 617 E COLORADO ST 511 1/2 E BROADWAY 119 W CALIFORNIA AVE 730 S CENTRAL AVE 1013 S CENTRAL AVE 478 W COLORADO ST 230 N MARYLAND AVE STE 307 437 FERNANDO CT 525 N GLENDALE AVE 1127 E BROADWAY 1530 E CHEVY CHASE DR STE 102 816 E BROADWAY 1111 N BRAND BLVD STE M 801 E BROADWAY, UNIT A 1560 E CHEVY CHASE DR STE 110 831 N PACIFIC AVE #G

GILROY GILROY GILROY GILROY GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95020-6014 95020-3538 95020-3536 95020-5033 91205-1462 91201-2108 91205-3273 91203 91208-1243 91205-1205 91206-3843 91205-1709 91205-1110 91203-1916 91204-2061 91204-3910 91204-1504 91206 91204-2723 91206-3307 91205-1315 91206-4139 91205-1218 91202-3023 91205-4531 91206-4166 91203

GLENDALE MEDICAL EXPRESS PHARMACY GLENDALE PHARMACY GLENDALE SQUARE PHARMACY GLENDALE URGENT CARE PHCY GLENDALE WEST PHARMACY GLENMED PHARMACY GLENVISTA PHARMACY HAIG PHARMACY HARVARD FAMILY PHARMACY HAUGEN'S IDEA PHARMACY HEP-C PHARMACY HONOLULU PHARMACY HYE PHARMACY INC I & G PHARMACY

(818) 500-0411 (818) 244-3164 (818) 548-8040 (818) 502-9097 (818) 548-5157 (818) 409-9020 (818) 201-2900 (818) 500-0800 (818) 662-0700 (818) 246-1739 (818) 945-5799 (818) 242-2233 (818) 240-7152 (818) 500-0895

1030 S GLENDALE AVE #101-102 1122 N BRAND BLVD 1010 N GLENDALE SUITE 106 801 S CHEVY CHASE DR STE 111 1109 S GLENDALE AVE STE A& 1436 W GLENOAKS BLVD STE A 1415 E COLORADO ST #M 1106 S GLENDALE AVE 145 S GLENDALE AVE 1155 N CENTRAL AVE STE 106 900 W GLENOAKS BLVD STE G 450 S CENTRAL AVE 1200 S CENTRAL AVE 815 E COLORADO ST STE A

GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91205-2866 91202-2547 91206 91205 91205-5657 91201-1984 91205 91205-3203 91205-1108 91202-2562 91202-2664 91204-1602 91204-2504 91205-1293

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 54 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MAYERLING PHARMACY INC MED ZONE PHARMACY MEDICAL TERRACE UNTEDDRUG MEMORIAL MEDICAL PHARMACY NOOR PHARMACY OPTIMA CARE PHARMACY INC PACIFIC MEDICAL PHARMACY PACIFIC MEDICAL PHARMACY #2 PERSONS COMPOUNDING PHARMACY PET RUSH MED REMEDY DRUGS REMEDY DRUGS RILEYS PHARMACY ROYAL PHARMACY DRUGS RX 911 PHARMACY RX CENTRAL SAN JOSE PHARMACY SATELLITE MED DISPENSING SKILLED NURSING PHARMACY TOWER III PHARMACY TRUE CHOICE PHARMACY VERDUGO CLINIC PHARMACY VERDUGO HILLS PROF PHARMACY VERDUGO PLAZA PHARMACY WELL CARE PHARMACY WESTCO DRUGS WESTERN DRUG WESTERN DRUG WESTERN DRUG WESTERN DRUG MEDICAL SUPPLY ZNV INC APOTHECARY RX EVERGREEN SHOP PHARMACY FOOTHILL MEDICAL PLAZA PHCY GLENDORA MEDICAL PHARMACY HEALTHRX SPECIALTY PHARMACY MONARCH PHARMACY NELSONS DRUG STORE OWL REXALL DRUG SAV-ON PHARMACY SIERRA PHARMACY TRINITY PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (747) 221-7663 (818) 243-6605 (818) 409-8392 (818) 247-0526 (818) 507-8747 (818) 548-5488 (818) 548-1330 (818) 696-2213 (818) 243-3144 (818) 550-7874 (818) 549-1010 (818) 548-6165 (818) 244-1195 (818) 484-7484 (818) 945-5974 (818) 244-5152 (818) 247-3266 (818) 409-8517 (818) 658-5705 (818) 546-1400 (818) 696-1112 (818) 550-0218 (818) 952-2223 (818) 952-2108 (818) 551-0102 (818) 696-2099 (818) 242-5887 (818) 241-5996 (818) 243-2231 (818) 956-2104 (818) 839-7999 (626) 963-7689 (626) 335-2442 (626) 857-5500 (626) 335-0288 (626) 335-4777 (626) 335-0011 (626) 335-0221 (626) 962-1061 (626) 963-5368 (626) 335-2300 (626) 335-2700

Provider Street 213 N ORANGE ST STE C 418 E. GLENOAKS BLVD. #102 1505 WILSON TER STE 100 1510 S CENTRAL AVE STE 110 567 W GLENOAKS BLVD 1755 W GLENOAKS BLVD # E 1101 N PACIFIC AVE STE 101 808 E CALIFORNIA AVE 812 N GLENDALE AVE 1040 W KENNETH RD STE 1 1700 W GLENOAKS BLVD # E 459 W BROADWAY #4 411 N CENTRAL AVE STE 100 1101 1/2 W GLENOAKS BLVD 721 E BROADWAY SUITE B 800 S CENTRAL AVE #101A 222 W EULALIA ST STE 212 1509 WILSON TER 900 WESTERN AVE 620 S GLENDALE AVE # J 624 E COLORADO ST UNIT B 1540 E COLORADO ST 1808 VERDUGO BLVD STE 111 1809 VERDUGO BLVD STE 110 1108 1/2 W GLENOAKS BLVD 1217 N CENTRAL AVE STE AA 501 WESTERN AVE 445 W BROADWAY 416 E COLORADO ST 3604 SAN FERNANDO RD 1344 E COLORADO ST STE A 303 W FOOTHILL BLVD STE 10 150 S GRAND AVE UNIT K 415 W ROUTE 66 130 W ROUTE 66 1844 E ROUTE 66 707 W ROUTE 66 STE 103 159 N GLENDORA AVE 837 W ARROW HIGHWAY 133 W ROUTE 66 210 S GRAND AVE STE 116 1335 S GRAND AVE

Page 55 of 679

Provider City GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENDORA GLENDORA GLENDORA GLENDORA GLENDORA GLENDORA GLENDORA GLENDORA GLENDORA GLENDORA GLENDORA

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91203-2660 91207 91206-4074 91204-2575 91202-2858 91201-1500 91202-2315 91206-3705 91206 91202-1475 91201-1816 91204-1228 91203 91202-2651 91205 91204 91204-2850 91206-4007 91201-2353 91205-4163 91205 91205-1514 91208-1449 91208-1402 91202-2628 91202-3160 91201-2870 91204-1208 91205-5107 91204-2917 91205-1474 91741-3386 91741 91740-4335 91740-6249 91740-3868 91740-4175 91741-3342 91740 91740-6208 91741-4262 91740-5046

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BEL AIR PHARMACY SANTA BARBARA SPECIALTY PHCY GONZALES RX PHARMACY BALBOA PHARMACY DRUGS R US KAMASHIANS PHARMACY KNOLLWOOD PHARMACY

Provider Name

(916) 858-0481 (805) 770-2061 (831) 675-3643 (818) 831-2090 (818) 360-0206 (818) 360-2124 (818) 363-8107

2155 GOLDEN CENTRE LN 174 AERO CAMINO 338 ALTA ST 10700 BALBOA BLVD # 101 16229 DEVONSHIRE ST 10515 BALBOA BLVD 16911 SAN FERNANDO MISSION BLV

GOLD RIVER GOLETA GONZALES GRANADA HILLS GRANADA HILLS GRANADA HILLS GRANADA HILLS

CA CA CA CA CA CA CA

95670-4477 93117-3102 93926 91344-5001 91344-6910 91344-6343 91344-2798

PREFERRED COMPOUNDING PHARMACY, INC RALPHS THE MEDICINE SHOPPE RALEY'S DRUG CENTER CHAPA DE INDIAN HEALTH PHARMACY DOKIMOS EAST MAIN PHARMACY RALEY'S DRUG CENTER SAVE MART PHARMACY WESTERN SIERRA PHARMACY GREENFIELD PHARMACY VILLAGE DRUG COMPANY GROVELAND PHARMACY STARS PHARMACY LARK DRUGS PIONEER DRUG HACIENDA HEIGHTS PHARMACY HACIENDA PHARMACY HALLIBURTON PROFESSIONAL PHCY HEIDI'S PHARMACY MEDELLA PHARMACY PUENTE HILLS PHARMACY HALF MOON BAY PHARMACY EXPRESS PHARMACY R & M DRUG SAVE MART PHARMACY ALOHA UNITED DRUGS GRAND AVENUE PHARMACIES HAWTHORNE PROFESSIONAL PHCY PLAZA PHARMACY THANH PHARMACY, INC. CRESCENT HEALTHCARE INC MISSION PHARMACY PLEASANT CARE PHARMACY POSTMEDS

(818) 360-5004 (818) 831-4962 (818) 366-8857 (916) 791-8015 (530) 477-5968 (530) 274-0100 (530) 272-2496 (530) 477-6857 (530) 273-0182 (831) 674-5949 (530) 284-6618 (209) 962-5211 (805) 219-0770 (707) 869-9055 (209) 854-1007 (626) 839-8900 (626) 330-8832 (626) 369-6286 (626) 333-7878 (626) 333-1998 (626) 912-3311 (650) 726-5542 (559) 583-1480 (559) 469-0168 (559) 582-1697 (310) 679-1166 (310) 649-3774 (310) 675-6882 (310) 973-5200 (310) 973-0321 (800) 824-8400 (510) 581-8540 (510) 200-9984 (650) 353-5495

17547 CHATSWORTH ST 16940 DEVONSHIRE ST 16915 DEVONSHIRE ST 6845 DOUGLAS BLVD 1350 E MAIN ST 640 E MAIN ST STE 2 692A FREEMAN LN 12054 NEVADA CITY HWY 844 OLD TUNNEL RD 333 EL CAMINO REAL 225 MAIN ST 18638 MAIN ST 830 GUADALUPE ST. 16251 MAIN ST 397 5TH ST 17170 COLIMA RD STE F 3120 S HACIENDA BLVD STE 105 15932 HALLIBURTON RD 3150 COLIMA RD STE B 15578 E GALE AVE 1850 S AZUSA AVE STE 101 40 STONE PINE RD, STE I 365 CAMPUS DR SUITE 101 323 N 11TH AVE STE 101 715 W GRANGEVILLE BLVD 5055 W EL SEGUNDO BLVD 4455 W 117TH ST STE 101 4477 W 118TH ST STE 100 11930 HAWTHORNE BLVD 12923 INGLEWOOD AVE STE 2 2547 BARRINGTON CT 22138 MISSION BLVD 1652 B ST 31123 MISSION BLVD

GRANADA HILLS GRANADA HILLS GRANADA HILLS GRANITE BAY GRASS VALLEY GRASS VALLEY GRASS VALLEY GRASS VALLEY GRASS VALLEY GREENFIELD GREENVILLE GROVELAND GUADALUPE GUERNEVILLE GUSTINE HACIENDA HEIGHTS HACIENDA HEIGHTS HACIENDA HEIGHTS HACIENDA HEIGHTS HACIENDA HEIGHTS HACIENDA HEIGHTS HALF MOON BAY HANFORD HANFORD HANFORD HAWTHORNE HAWTHORNE HAWTHORNE HAWTHORNE HAWTHORNE HAYWARD HAYWARD HAYWARD HAYWARD

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91344-5845 91344-7406 91344-7407 95746 95945-5208 95945-5806 95949-9616 95945-8461 95945-8524 93927-5131 95947-9707 95321-0000 93434 95446-8300 95322-1126 91745 91745-6305 91745-3505 91745 91745 91745-6827 94019-8202 93230 93230-4511 93230-2713 90250-4156 90250-2240 90250-2256 90250-3016 90250-5139 94545-1134 94541-2645 94541-3020 94544-7603

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 56 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SAVE MART PHARMACY SAVE MART PHARMACY SOLEO HEALTH INC TEDS DRUGS TENNYSON PHARMACY AMC COMMUNITY PHARMACY COMMUNITY PHARMACY

Provider Name

(510) 538-7819 (510) 670-0821 (510) 362-7360 (510) 782-6494 (510) 266-0800 (707) 385-2336 (951) 658-0050

22555 MISSION BLVD 25151 SANTA CLARA ST 1324 W WINTON AVE 27453 HESPERIAN BLVD 589 WEST TENNYSON ROAD 1381 UNIVERSITY ST STE A 1288 E LATHAM AVE

HAYWARD HAYWARD HAYWARD HAYWARD HAYWARD HEALDSBURG HEMET

CA CA CA CA CA CA CA

94541-5115 94544-2109 94545-1408 94545-4258 94544 95448-3314 92543-4445

HEMATOLOGY ONCOLOGY CONSULTANTS INLAND PHARMACY INLAND VALLEY PHARMACY PRIDE PHARMACY SAIL DRUG THE CORNER DRUGSTORE THE MEDICINE SHOPPE SAVE MART PHARMACY TLC PHARMACY A FAMILY PHARMACY THE MEDICINE SHOPPE YOUR DRUG STORE ZEN PHARMACY COYOTE VALLEY PHARMACY HIGHLAND COMMUNITY PHARMACY SAV-ON PHARMACY WECARE SPECIALTY PHARMACY ANSR PHARMACY 101 ICARE PHARMACY 2 INC NOB HILL PHARMACY SAVE MART PHARMACY PARKERS PHARMACY CARRANZA PHARMACY INC. HUGHSON BEACH PROFESSIONAL PHARMACY BELLA TERRA PHARMACY

(951) 766-6460 (951) 658-7111 (951) 766-5100 (951) 765-9000 (951) 658-7247 (951) 658-7207 (951) 652-5988 (510) 245-1440 (310) 798-5400 (760) 244-3777 (760) 948-1000 (760) 949-9310 (760) 998-2991 (707) 987-8502 (909) 907-7915 (909) 425-1194 (909) 266-0016 (831) 630-3100 (831) 265-7733 (831) 637-7423 (831) 634-1887 (760) 356-2826 (209) 883-4911 (714) 848-4447 (949) 220-2554

301 N SAN JACINTO ST 1001 E LATHAM AVE STE P 3349 W FLORIDA AVE 2569 W FLORIDA AVE 156 N HARVARD ST 2087 E FLORIDA AVE 1121 S STATE ST 1590 SYCAMORE AVE 845 PACIFIC COAST HWY 11919 HESPERIA RD 15555 MAIN ST STE D8 17079 MAIN ST 16455 MAIN ST STE 8 18990 COYOTE VALLEY RD STE 2 4160 HIGHLAND AVE STE-D 7201 BOULDER AVE 7223 CHURCH ST SUITE #A-19 581 MCCRAY ST 920 SUNNYSLOPE RD 1700 AIRLINE HWY 291 MCCRAY ST 102 W 5TH ST 2431 3RD ST 17742 BEACH BLVD STE 100 16121 BEACH BLVD

HEMET HEMET HEMET HEMET HEMET HEMET HEMET HERCULES HERMOSA BEACH HESPERIA HESPERIA HESPERIA HESPERIA HIDDEN VALLEY LAKE HIGHLAND HIGHLAND HIGHLAND HOLLISTER HOLLISTER HOLLISTER HOLLISTER HOLTVILLE HUGHSON HUNTINGTON BEACH HUNTINGTON BEACH

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92543-3113 92543-4435 92545-3513 92545-4615 92543-4212 92544-4730 92543-7635 94547-1701 90254 92345-2158 92345-3423 92345-6071 92345-3500 95467 92346-2757 92346-3313 92346 95023 95023-5784 95023-5621 95023-4094 92250-1297 95326 92647-6800 92647

BLUE COAST PHCY & COMPOUNDING CTR BYRAM HEALTHCARE CENTERS, INC. MEDICAL TOWERS PHARMACY MTM PHARMACY BOLSA MEDICAL PACIFIC SIDE PHARMACY QUINN'S APOTHECARY PHARMACY RALPHS PHARMACY ROYAL PHARMACY

(714) 465-9334 (714) 799-1222 (714) 847-6084 (714) 916-5383 (714) 965-5203 (714) 916-0593 (714) 960-3102 (714) 962-0003

18700 MAIN ST #107 5302 RANCHO RD 17822 BEACH BLVD 6552 BOLSA AVE STE A 19582 BEACH BLVD STE 118 18502 BEACH BLVD STE 116 19081 GOLDENWEST ST 9106 ADAMS AVE

HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH

CA CA CA CA CA CA CA CA

92648 92647-2069 92647-7101 92647 92648-2996 92648-0924 92648-2151 92646-3405

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 57 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SUNCOAST PHARMACY INC THE DRUGGIST THE DRUGGIST TOTAL CARE RX PHARMACY WEST PHARMACY 986 PHARMACY AP9 PHARMACY CAMERON PHARMACY COURTESY DRUG HEALTHY FAMILY PHARMACY SAN MARTIN PHARMACY SLAUSON COMMUNITY PHARMACY SOUTHEAST PHARMACY ST. LUKE PHARMACY, INC. THE MEDICINE CABINET UNITED HEALTH CTRS PHY HURON IMPERIAL BEACH PHARMACY INDIO MEDICAL PHARMACY RALPHS TOWN SQUARE PHARMACY ALLIANCE PHARMACY FREEMAN MEDICAL PHARMACY LAX PHARMACY INC MEDICAL CENTER PHARMACY MEDRX INFUSION SOLEO HEALTH SPECIALIST MEDICAL PHARMACY SPECIALTY MED SERVICES UPTIMUM MEDICAL PHARMACY IONE PHARMACY BAYTREE PHARMACY, LLC CAREMEDS PHARMACY, INC. GLOBAL RX AND COMPOUNDING IMPRIMISRX IRVINE MEDICAL CENTER PHARMACY IRVINE PHARMACY

Provider Name

(714) 536-3679 (714) 964-7989 (714) 846-1381 (714) 848-0700 (714) 963-4552 (714) 846-0688 (714) 964-4004 (714) 842-5390 (323) 749-6500 (323) 487-4111 (323) 582-5171 (323) 583-4307 (323) 582-5286 (323) 582-6078 (323) 588-6000 (323) 589-7504 (323) 587-1200 (323) 581-9106 (559) 945-2541 (800) 999-7516 (760) 347-0659 (760) 777-4524 (760) 342-4933 (310) 419-4479 (310) 672-7000 (310) 674-1403 (310) 671-7636 (310) 671-2600 (310) 665-1121 (310) 674-4432 (888) 998-0697 (310) 644-8400 (209) 274-2432 (949) 344-2626 (949) 483-8363 (949) 552-3111 (866) 551-7195 (949) 453-9789 (949) 651-1111

7201 W YORKTOWN AVE 19640 BEACH BLVD 16600 BOLSA CHICA ST 18354 BEACH BLVD 21421 BROOKHURST ST 16881 ALGONQUIN ST 18682 BEACH BLVD STE 115 18061 BEACH BLVD 2670 E GAGE AVE STE 10A 1900 E SLAUSON AVE 7119 SEVILLE AVE STE D 3180 E FLORENCE AVE 7932 SEVILLE AVE 2699 E FLORENCE AVE 2701 E SLAUSON AVE 2675 E SLAUSON AVE 7024 SEVILLE AVE STE E 7119 RITA AVE STE B 16928 11TH ST 720 HIGHWAY 75 81893 DOCTOR CARREON BLVD 49908 JEFFERSON ST 81709 DOCTOR CARREON BLVD 323 N PRAIRIE AVE # 100 301 N PRAIRIE AVE STE 110 4457 LENNOX BLVD 501 E HARDY ST STE 130 415-417 N OAK ST 721 S GLASGOW AVE STE C 421 E BEACH AVE STE A 440 HINDRY AVE STE F 2220 W MANCHESTER BLVD 307 PRESTON AVE 18005 SKY PARK CIR STE E 17972 SKY PARK CIR STE F 4720 BARRANCA PKWY 9257 RESEARCH DR 16300 SAND CANYON AVE STE 101 14130 CULVER DR STE D

HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON BEACH HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HUNTINGTON PARK HURON IMPERIAL BEACH INDIO INDIO INDIO INGLEWOOD INGLEWOOD INGLEWOOD INGLEWOOD INGLEWOOD INGLEWOOD INGLEWOOD INGLEWOOD INGLEWOOD IONE IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92648-2465 92648-2905 92649-3583 92648-1311 92646-7354 92649-3810 92648 92648-1304 90255-7207 90255-2725 90255-4997 90255-5830 90255-6804 90255-4747 90255-3002 90255-2926 90255-4969 90255-4766 93234-0000 91932-1313 92201-5592 92201-9720 92201-5509 90301-4502 90301-4508 90304-2303 90301 90302 90301-3016 90302-3103 90301-2052 90305-2514 95640-9158 92614-6514 92614-4400 92604-4729 92618 92618-3704 92604-0321

KINGS PHARMACY & COMPOUNDING CTR MEDICAL CENTER PHARMACY

(949) 387-0780 (949) 857-2141

16205 SAND CANYON AVE #105 4950 BARRANCA PKWY STE 102

IRVINE IRVINE

CA CA

92618 92604-4630

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 58 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

MEDLIFE PHARMACY & COMPOUNDING OPTIMAL WELLNESS PHARMACY ORANGE COUNTY COMPOUNDING PHARMACY OSO HOME CARE, INC. PARS PHARMACY PAVILIONS PHARMACY RALPHS RIVERS EDGE SPECIALTY PHARMACY SAV-ON DRUGS SAV-ON PHARMACY SPECTRUM PHARMACY VALUE PHARMACY VALUE RX PHARMACY WALNUT VILLAGE PHARMACY RALEY'S DRUG CENTER STAR PHARMACY KELSEYVILLE PHARMACY UNITED HEALTH CNTRS PHCY KERMA THE DRUGSTORE MODEL DRUG, INC. THE MARSH VILLAGE PHARMACY FLINTRIDGE PHARMACY LA CRESCENTA PHARMACY, INC BI RITE QUALITY PHARMACY CENTRAL DRUGS

(949) 502-7272 (949) 861-3170

6644 IRVINE CENTER DR 4200 TRABUCO RD STE 190

IRVINE IRVINE

CA CA

92618-2117 92620

(949) 612-6088 (949) 660-7126 (310) 463-7326 (657) 273-5755 (949) 559-1739 (949) 393-5780 (949) 733-0945 (949) 854-8280 (949) 679-7288 (949) 486-6790 (949) 387-1133 (949) 551-4343 (209) 223-9190 (760) 366-3653 (707) 279-1561 (559) 846-6330 (760) 376-2216 (559) 897-5111 (818) 248-3643 (818) 790-1802 (818) 248-5851 (562) 691-0539 (562) 691-6754

6865 ALTON PKWY STE 120 17175 GILLETTE AVE 4050 BARRANCA PKWY STE 150 3901 PORTOLA PKWY 6300 IRVINE BLVD 17332 VON KARMAN AVE STE 110 14201 JEFFREY RD 4541 CAMPUS DR 18 ENDEAVOR STE 100 1150 MAIN ST STE D 22 ODYSSEY # 135 14433 CULVER DR 785 S STATE HIGHWAY 49 6448 HALLEE RD STE 2 3720 MAIN ST 517 S MADERA AVE 111 PIUTE DR 1506 DRAPER ST 2143 FOOTHILL BLVD 529 FOOTHILL BLVD 2764 FOOTHILL BLVD 340 N HARBOR BLVD 520 W LA HABRA BLVD

IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE IRVINE JACKSON JOSHUA TREE KELSEYVILLE KERMAN KERNVILLE KINGSBURG LA CANADA LA CANADA FLINTRIDGE LA CRESCENTA LA HABRA LA HABRA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92618-3740 92614-5602 92604-4785 92602-0833 92620 92614-6280 92620-3405 92612-2621 92618-3180 92614 92618-3193 92604 95642-2621 92252-1908 95451-7420 93630-1523 93238-0000 93631-1909 91011-1904 91011-3507 91214-3517 90631-4847 90631

CA CANCER ASSOC RESEARCH EXCELLENCE LA JOLLA DISC UNITED DRUG PHARMACA INTEGRATIVE PHARMACY RALPHS REGENTS PHARMACY SCRIPPS HLTH GN AMBLTRY PHCY UCSD MOORES CANCER CENTER ALVARADO PARKWAY INSTITUTE

(858) 552-1410 (858) 622-1800 (858) 454-1337 (858) 597-0108 (858) 281-5200 (858) 964-1011 (858) 822-6088 (619) 667-6070

9850 GENESEE AVE STE 830 9850 GENESEE AVE STE 160 7650 GIRARD AVE 8657 VILLA LA JOLLA DR 4150 REGENTS PARK ROW STE 155 10666 N TORREY PINES RD FL 2 3855 HEALTH SCIENCES DR # 0845 7050 PARKWAY DRIVE

LA JOLLA LA JOLLA LA JOLLA LA JOLLA LA JOLLA LA JOLLA LA JOLLA LA MESA

CA CA CA CA CA CA CA CA

92037-1219 92037-1226 92037-4420 92037-2356 92037-9179 92037-1027 92093-1503 91942

CANCER CENTER ONCOLOGY MEDICAL GRP

(619) 644-3030

5555 GROSSMONT CENTER DRIVE

LA MESA

CA

91942

GROSSMONT HOSPITAL OUTPATIENT PHARM GROSSMONT PHARMACY LA MESA PHARMACY

(619) 740-3220 (619) 462-2400 (619) 466-3246

5555 GROSSMONT CENTER DR # A21 5565 GROSSMONT CNTR DR # 150 8301 LA MESA BLVD

LA MESA LA MESA LA MESA

CA CA CA

91942-3019 91942 91942

NR_0009_10823 10/2017

Page 59 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDICAL ARTS PHARMACY SAV-ON DRUGS SHARP REES STEALY PHARMACY VILLAGE ROSE PHARMACY BRIGHT LA MIRADA PHARMACY IMPERIAL PHARMACY LA MIRADA PHARMACY GRACE COMMUNITY PHARMACY LA PALMA TOWERS PHARMACY GONZALEZ PHARMACY LISA PHARMACY VALLEY DRUGS PHARMACY OF THE DESERT SUPER RX PHARMACY 986 PHARMACY GELSON'S PHARMACY SAV-ON PHARMACY BUSHARD'S PHARMACY LAGUNA DRUG LAGUNA SUNSET DRUG PAVILIONS PHARMACY CUSTOM HEALTHCARE CMPND PHCY DIAL DRUG INC EL TORO PHARMACY INFUSION CARE SOUTH RALPHS

Provider Name

(619) 461-8551 (619) 667-9626 (619) 644-6650 (619) 741-1344 (562) 777-8175 (562) 902-5580 (562) 943-5888 (562) 860-0586 (714) 522-7791 (626) 918-4300 (626) 918-0929 (626) 964-2301 (760) 777-1115 (760) 771-9999 (909) 596-6168 (949) 364-1914 (949) 364-2098 (949) 494-1059 (949) 715-9202 (949) 494-6585 (949) 376-3383 (949) 595-2273 (949) 588-7900 (949) 586-3664 (949) 460-1610 (949) 951-1018

8851 CENTER DR STE 110 8920 FLETCHER PKWY 5525 GROSSMONT CENTER DR 7773 UNIVERSITY AVE 12675 LA MIRADA BLVD # 100 15074 IMPERIAL HWY 15651 IMPERIAL HWY STE 102A 4881 LA PALMA AVE 5451 LA PALMA AVE STE 17 1240 N HACIENDA BLVD STE 105 1840 N HACIENDA BLVD STE 1 17313 VALLEY BLVD 79440 HIGHWAY 111 STE 103 78630 US HIGHWAY 111 2143 FOOTHILL BLVD 25636 CROWN VALLEY PARKWAY 27702 CROWN VALLEY PKWY STE B 244 FOREST AVE 239 BROADWAY ST 944 GLENNEYRE ST 600 N COAST HWY 24022 CALLE DE LA PLATA # 510 24261 AVENIDA DE CARLOTA #Q2 23665 MOULTON PKWY STE A & C 23521 PASEO DE VALENCIA STE B1 25539 PASEO DE VALENCIA

LA MESA LA MESA LA MESA LA MESA LA MIRADA LA MIRADA LA MIRADA LA PALMA LA PALMA LA PUENTE LA PUENTE LA PUENTE LA QUINTA LA QUINTA LA VERNE LADERA RANCH LADERA RANCH LAGUNA BEACH LAGUNA BEACH LAGUNA BEACH LAGUNA BEACH LAGUNA HILLS LAGUNA HILLS LAGUNA HILLS LAGUNA HILLS LAGUNA HILLS

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91942 91942-3231 91942-3009 91942-4950 90638 90638-1301 90638-1600 90623 90623-1729 91744 91744-1143 91744-5653 92253-4500 92253-2048 91750-2942 92694 92694-0609 92651-2114 92651-1806 92651-2707 92651-1513 92653-3631 92653 92653 92653-3125 92653-5348

SADDLEBACK MEDICAL ARTS PHARMACY SADDLEBACK MEDICAL CENTER PHCY SADDLEBACK VALLEY PHARMACY SEENA PHARMACY

(949) 581-9840 (949) 452-3706 (949) 380-8700 (949) 462-9700

24953 PASEO DE VALENCIA STE 17 24411 HEALTH CENTER DR STE 102 23961 CALLE DE LA MAGDALENA 24731 ALICIA PKWY STE B

LAGUNA HILLS LAGUNA HILLS LAGUNA HILLS LAGUNA HILLS

CA CA CA CA

92653-4339 92653-3633 92653-3616 92653

TAJ MAHAL MEDICAL CENTER PHARMACY

(949) 586-4575

23521 PASEO DE VALENCIA #115A

LAGUNA HILLS

CA

92653-3137

UCLA HEMATOLOGY - ONCOLOGY IRVINE THE DRUGGIST LAGUNA COMPOUNDING PHARMACY BEEMANS LAKE ARROWHEAD PHCY PHARMACY OF THE WOODS EXPERT CMPD PHARMACY, INC DELTA DRUGS GEN-RX DRUG

(949) 458-8252 (949) 643-0740 (949) 215-8448 (909) 337-0747 (909) 336-3999 (818) 988-7979 (951) 245-2325 (951) 674-6836

24302 PASEO DE VALENCIA # 200 24022 ALISO CREEK RD 24902 MOULTON PKWY STE 110 29099 HOSPITAL RD STE 101 28200 ST HWY 189 #N-150 6744 BALBOA BLVD 2497 E LAKESHORE DR STE B 16800 LAKESHORE DR # A

LAGUNA HILLS LAGUNA NIGUEL LAGUNA WOODS LAKE ARROWHEAD LAKE ARROWHEAD LAKE BALBOA LAKE ELSINORE LAKE ELSINORE

CA CA CA CA CA CA CA CA

92653-3115 92677-3910 92637-6403 92352 92352-0167 91406-5532 92530-4437 92530-4909

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 60 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LAKE VIEW PHARMACY SAV-ON PHARMACY ADVANCED CARE PHARMACY HV PHARMACY RALPHS PHARMACY RITE PRICE PHARMACY MESA CLINICAL PHARMACY

Provider Name

(951) 245-4488 (909) 245-5492 (949) 347-8881 (949) 457-2246 (949) 380-1009 (949) 586-7780 (760) 379-6106

31571 CANYON EST DR STE 118 30901 RIVERSIDE DR 22642 LAMBERT ST STE 404 22641 LAKE FOREST DR STE B12 23716 EL TORO RD 23653 EL TORO RD STE A 12608 MOUNTAIN MESA RD

LAKE ELSINORE LAKE ELSINORE LAKE FOREST LAKE FOREST LAKE FOREST LAKE FOREST LAKE ISABELLA

CA CA CA CA CA CA CA

92532-0424 92530-4934 92630-1645 92630-1780 92630-4711 92630-4731 93240-9149

LAKE COUNTY TRIBAL HEALTH PHARMACY NORTH LAKE MEDICAL PHCY NORTH LAKE MEDICAL PHCY INC LEOS LAKESIDE PHARMACY FOUNDATION PHARMACY HOWARD DRUGS PAVILIONS PHARMACY R. NANDAN MD. INC A BETTER WAY PHARMACY BURNS PRESCRIPTION PHARMACY ILAB PHARMACY ILAB PHARMACY LANCASTER PHARMACY PMD PHARMACY QUARTZ HILL PHARMACY REGIONAL CARE PHARMACY, INC SAV-ON DRUGS VALLEY PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY THU PHARMACY BRANSCOMB PHARMACY CORP BROADWAY PHARMACY SAVE MART PHARMACY LINCOLN PHARMACY RALEY'S DRUG CENTER LINDEN PHARMACY LIVE OAK PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY GKN RX INC YOUNGS PAYLESS PHARMACY FAIRMONT PHARMACY LODI PHARMACY

(707) 533-2752 (707) 263-1328 (707) 263-6192 (619) 443-1013 (562) 633-1150 (562) 866-5795 (562) 866-7083 (562) 272-7630 (661) 945-0822 (661) 942-1461 (661) 230-9002 (661) 945-8066 (661) 948-1818 (661) 579-2099 (661) 943-4118 (661) 945-4600 (661) 940-4752 (661) 942-8777 (415) 924-6738 (209) 858-5787 (310) 676-3489 (707) 984-8371 (619) 717-8990 (559) 924-9593 (916) 209-3618 (916) 408-3633 (209) 887-3397 (530) 695-5100 (925) 447-7762 (925) 456-7697 (209) 398-2035 (209) 727-3762 (209) 625-8633 (209) 365-7788

925 BEVINS CT 347 LAKEPORT BLVD 5136 HILL RD 9943 MAINE AVE 3650 SOUTH ST STE 100 5818 N BELLFLOWER BLVD 5500 WOODRUFF AVE 3650 EAST SOUTH ST STE 212 204 W AVENUE J 866 W LANCASTER BLVD 1649 W AVENUE J STE 101 44503 16TH ST W STE 101 1841 W AVENUE I STE 107 44469 10TH ST W STE B 42357 50TH ST W 326 E AVENUE I 43543 20TH ST W 1324 W AVENUE J STE 1 570 MAGNOLIA AVE 15240 S HARLAN RD 15735 HAWTHORNE BLVD STE 110 51 BRANSCOMB RD STE 100 7581 BROADWAY 105 W HANFORD ARMONA RD 831 STERLING PKWY # 120 765 S HIGHWAY 65 19047 MAIN ST 9970 LIVE OAK BLVD 1951 HOLMES ST 2000 PORTOLA AVE 1471 B ST SUITE:R 18980 N HIGHWAY 88 1121 W VINE ST STE 13 929 S. CHEROKEE LANE

LAKEPORT LAKEPORT LAKEPORT LAKESIDE LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LARKSPUR LATHROP LAWNDALE LAYTONVILLE LEMON GROVE LEMOORE LINCOLN LINCOLN LINDEN LIVE OAK LIVERMORE LIVERMORE LIVINGSTON LOCKEFORD LODI LODI

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95453-9754 95453-5412 95453-6168 92040-3107 90712-1502 90713-1058 90713-1535 90712 93534-3684 93534-2342 93534-2865 93534-2886 93534-1475 93534-3324 93536-3529 93535-1914 93534-5961 93534-2948 94939-1343 95330-9754 90260 95454 91945-1605 93245-2321 95648-8691 95648 95236-9492 95953-2334 94550-6015 94551-1762 95334-1432 95237-9787 95240-5113 95240

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 61 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RALEY'S DRUG CENTER SAVE MART PHARMACY COMMUNITY HEALTHCARE SVCS INC INLAND COMPOUNDING PHARMACY LLUMC OUTPATIENT PHCY LOMA LINDA HEALTH PHARMACY LOMA LINDA PHARMACY

Provider Name

(209) 369-7403 (209) 334-6867 (909) 796-2140 (909) 478-3842 (909) 558-4500 (909) 796-3780 (909) 796-8308

33 N LOWER SACRAMENTO RD 610 W KETTLEMAN LN 24747 REDLANDS BLVD STE D 24747 REDLANDS BLVD SUITE F 11234 ANDERSON ST 11382 MOUNTAIN VIEW AVE STE A 25620 BARTON RD

LODI LODI LOMA LINDA LOMA LINDA LOMA LINDA LOMA LINDA LOMA LINDA

CA CA CA CA CA CA CA

95242-2842 95240-6050 92354 92354 92354-2804 92354-3878 92354-3110

LOMA LINDA UNIV MED CTR MERIDIAN

(909) 558-3766

25875 BARTON RD STE B108

LOMA LINDA

CA

92354-3891

LOMA LINDA UNIVERSITY FACULTY PHARM QUALITY SPECIALTY PHARMACY SAV-ON PHARMACY LONE PINE DRUG AHF PHARMACY - LONG BEACH ALLIED REXALL DRUG ATLANTIC DRUGS ATLANTIC PROFESSIONAL PHARMACY BENZER PHARMACY BIXBY PHARMACY COAST HEM & ONC ASSOCIATES DELL'S LOS ALTOS UNITED DRUG # DOUGLAS PARK PHARMACY FAMILY PHARMACY GAGE PHARMACY GALAXY PHARMACY GOLDEN PHARMACY HOMECARE PHARMACY JOHNS SHOP RITE PHARMACY LAKEWOOD PHARMACY AND COMPOUNDING

(909) 558-2804 (310) 530-2444 (805) 737-0416 (760) 876-5569 (562) 494-4900 (562) 591-2381 (562) 912-7940 (562) 491-9799 (562) 438-7055 (562) 627-1809 (562) 997-4070 (562) 597-2160 (562) 353-4723 (562) 591-4417 (562) 423-8437 (562) 599-1301 (562) 599-5292 (562) 933-2273 (562) 616-0056

11370 ANDERSON ST STE 1000 2233 LOMITA BLVD 1500 N H ST 200 N MAIN STREET 3500 E. PACIFIC COAST HWY 2101 PACIFIC AVE 4233 ATLANTIC AVE 1045 ATLANTIC AVE STE 102 3500 E BROADWAY 3816 WOODRUFF AVE STE 108 701 E 28TH ST STE 418 1777 N BELLFLOWER BLVD 3828 SCHAUFELE AVE STE 260 1400 ATLANTIC AVE 5735 ATLANTIC AVE 1295 E ANAHEIM ST 1750 PACIFIC AVE #A 450 E SPRING ST STE 11 3717 E SOUTH ST

LOMA LINDA LOMITA LOMPOC LONE PINE LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92354-3450 90717 93436-2812 93545-0189 90804 90806-4513 90807 90813-3414 90803-5907 90808-2145 90806 90815-4013 90808-1793 90813-2013 90805 90813-3709 90813 90806-1625 90805-4521

(562) 470-7070

2150 E SOUTH ST STE 114

LONG BEACH

CA

90805-4467

LONG BEACH MEMORIAL MED. CTR. PHCY LOS COYOTES DRUG MEDCOMPOUNDERS PHARMACY INC MEDICAL MALL PHARMACY MISSION PHARMACY MOLINO PHARMACY NEW PHNOM PICH PHARMACY INC NTM PHARMACY PACIFIC PLAZA PHARMACY INC PACIFIC SHORES MEDICAL GROUP

(562) 933-7948 (562) 420-1480 (562) 427-1999 (562) 491-9003 (562) 436-7257 (562) 433-4900 (562) 434-7559 (562) 621-0838 (562) 426-6588 (562) 590-0345

2801 ATLANTIC AVE 3597 N LOS COYOTES DIAGONAL 3711 LONG BEACH BLVD STE 808 1043 ELM AVE STE 305 1050 ATLANTIC AVE 2540 E ANAHEIM ST # B 2100 E ANAHEIM ST STE A 2317 E ANAHEIM ST 2777 PACIFIC AVE 1043 ELM AVE STE 104

LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH

CA CA CA CA CA CA CA CA CA CA

90806-1737 90808-2404 90807-3324 90813-3271 90813-3403 90804-3607 90804-3408 90804-3501 90806-2625 90813-3244

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 62 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PACIFIC VIEW PHARMACY PAVILIONS PHARMACY PCH MEDICAL PHARMACY PHNOM PICH PHARMACY

Provider Name

(562) 595-9333 (562) 496-1851 (562) 591-7655 (562) 438-3324

2491 PACIFIC AVE STE 1 5949 E SPRING ST 306 E PACIFIC COAST HWY STE101 2338 E ANAHEIM ST STE 100

LONG BEACH LONG BEACH LONG BEACH LONG BEACH

CA CA CA CA

90806-2900 90808-3752 90806-0813 90804-5735

PROFESSIONAL PRESCRIPTION PHARMACY RALPHS RALPHS RALPHS SPECTRUM PHARMACY SPRING PARK PHARMACY ST MARY PHARMACY T & C PHARMACY TEN PHARMACY TODAY PHARMACY VERMILLION'S DRUG VILLAGE ROAD PHARMACY WARDS PHARMACY YEES PRESCRIPTION PHARMACY MAIN DRUG STORE RALEY'S DRUG CENTER COMPOUNDING CORNER PHARMACY LOS ALAMITOS PHARMACY ROSS PHARMACY SCRIPT INFUSION PHARMACY, INC SO-LOW DRUGS, INC. UNIPHARMA, INC SAVE MART PHARMACY 10TH AVE PHARMACY 1663 PHARMACY 2010 PHARMACY 6122 PHARMACY A A PHARMACY AALPHA PHARMACY ACCESS MEDICAL PHARMACY AD-RX PHARMACY AHF PHARMACY AHF PHARMACY AHF PHARMACY AHF PHARMACY HOLLYWOOD AHF PHARMACY-DOWNTOWN ALEXANDER PHARMACY

(562) 426-7664 (562) 795-1087 (562) 490-0201 (562) 425-9673 (562) 599-3000 (562) 420-1303 (562) 492-9484 (562) 494-1487 (562) 283-8999 (562) 438-2031 (562) 591-0549 (562) 425-6434 (562) 437-0678 (562) 597-7733 (916) 652-7265 (916) 652-5633 (562) 431-2308 (562) 431-2505 (562) 594-6888 (562) 296-2120 (562) 596-2729 (562) 799-8844 (650) 969-0772 (323) 298-7693 (213) 250-7229 (213) 483-5910 (323) 725-1250 (213) 680-9616 (213) 483-8741 (310) 873-6565 (323) 936-8221 (323) 860-5200 (323) 722-1010 (323) 860-0173 (323) 661-0643 (213) 741-5271 (323) 467-1084

2863 ATLANTIC AVE 6290 E PACIFIC COST HWY 2250 E CARSON ST 3380 N LOS COYOTES DIAGONAL 837 E ANAHEIM ST 6226 E SPRING ST STE 140 505 W WILLOW ST 2340 E PACIFIC COAST HWY STE G 750 LONG BEACH BLVD STE 1 2200 E ANAHEIM ST STE C 1942 E ANAHEIM ST 5412 E VILLAGE RD 653 LONG BEACH BLVD 1703 TERMINO AVE 3685 TAYLOR RD 6119 HORSESHOE BAR RD 4292 KATELLA AVE 3801 KATELLA AVE STE 120 10879 LOS ALAMITOS BLVD 10571 CALLE LEE STE 163 11270 LOS ALAMITOS BLVD 10437 LOS ALAMITOS BLVD 2175 GRANT RD 2706 W MARTIN LUTHER KING BLVD 1663 BEVERLY BLVD 201 S ALVARADO ST STE 611 6122 WHITTIER BLVD 625 W COLLEGE ST STE 101 174 S ALVARADO ST 1271 WESTWOOD BLVD 6240 WILSHIRE BLVD 6255 W SUNSET BLVD 5356 WHITTIER BLVD 6210 W SUNSET BLVD 1300 N VERMONT AVE # 407 1400 S GRAND AVE STE 801 1084 N WESTERN AVE

LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LONG BEACH LOOMIS LOOMIS LOS ALAMITOS LOS ALAMITOS LOS ALAMITOS LOS ALAMITOS LOS ALAMITOS LOS ALAMITOS LOS ALTOS LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90806-1713 90803 90807-3044 90808-3916 90813-3550 90815-1441 90806-2830 90804 90813-4417 90804-3417 90813-3908 90808-1636 90802-1323 90804-2124 95650-9998 95650-8528 90720-3562 90720-3360 90720 90720-2572 90720-3958 90720-2111 94024-6952 90008 90026-5747 90057-2386 90022-4504 90012-1650 90057-2211 90024 90048-5104 90028 90022-4032 90028-8701 90027-6005 90015 90029-2310

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 63 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ALL MEDS SOLUTIONS ALLURE PHARMACY ALVARADO DRUGS AMERICAN HEALTH SOLUTIONS PHCY APOTHECARY PHARMACY ARDMORE PHARMACY ATLANTIC PHARMACY B & G PHARMACY INC BARGAIN OAKHURST PHARMACY BARRINGTON-WILSHIRE PHARMACY BEVERLY GLEN PHARMACY BEVERLY PHARMACY BEVERLY PHARMACY BEYOND THE PHARMACY BIG ONE PHARMACY BIOMED PHARMACY SOLUTIONS BOTICA DEL SOL BOTICA SAN JOSE BOYLE HEIGHTS MEDICAL PHARMACY BRAVO PHARMACY BRENT AIR PHARMACY BRENTWOOD PLAZA PHARMACY BRIOVARX MRP CAL MED PHARMACY CALIFORNIA MEDICAL PHARMACY CAMPUS PHARMACY CANAAN BOKJEE PHARMACEUTICAL CAREMAX PHARMACY CAREMAX PHARMACY CAREMAX PHARMACY CAREMAX PHARMACY CATHAY MEDICAL PHARMACY CENTURY BEVERLY HILLS PHARMACY CENTURY CITY PHARMACY CENTURY MEDICAL PHARMACY CENTURY PICO PHARMACY CHILDREN'S HOSPITAL PHARMACY CHINATOWN PHARMACY COL PHARMACY COLLEGE PHARMACY COLONIAL DRUGS COLORADO MEDICAL PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (213) 788-1199 (310) 826-1111 (213) 388-9518 (310) 838-7422 (310) 737-7277 (213) 385-2135 (323) 264-5060 (323) 668-0523 (310) 289-6590 (310) 473-3323 (310) 475-0568 (213) 413-4448 (323) 651-3249 (323) 660-3667 (213) 617-7888 (310) 299-0808 (323) 260-7531 (323) 668-1766 (323) 222-0736 (323) 586-9828 (310) 476-2211 (310) 820-1496 (323) 227-8883 (213) 746-4677 (213) 413-2343 (310) 208-2340 (323) 932-0202 (323) 234-4343 (213) 382-8899 (213) 385-9926 (213) 381-3200 (213) 613-1158 (310) 360-1015 (310) 553-3434 (323) 264-7311 (310) 657-6999 (323) 361-2406 (213) 687-9999 (323) 673-9543 (213) 624-1028 (323) 666-4044 (323) 254-6736

Provider Street 3470 WILSHIRE BLVD, STE 800 11670 SAN VICENTE BLVD STE A 819 S ALVARADO ST 3463 OVERLAND AVE 11700 NATIONAL BLVD STE L 3545 WILSHIRE BLVD STE 200 5119 E BEVERLY BLVD 5101 HOLLYWOOD BLVD 8700 W PICO BLVD 11701 WILSHIRE BLVD STE 3 2946 N BEVERLY GLEN CIR 2105 BEVERLY BLVD STE 107 7909 BEVERLY BLVD 3730 W SUNSET BLVD 655 N BROADWAY 8640 W 3RD ST STE 100 2331 E CESAR E CHAVEZ AVE 1417 N VERMONT AVE 1611 E CESAR E CHAVEZ AVE 7316 COMPTON AVE. 134 S BARRINGTON AVE 11980 SAN VICENTE BLVD STE 104 1902-1910 MARENGO ST STE 200 1414 S GRAND AVE STE 101 2201 W TEMPLE ST 100 UCLA MEDICAL PLZ STE 150 903 S CRENSHAW BLVD #102B 4301 S FIGUEROA ST STE E 4216 BEVERLY BLVD 2426 W 8TH ST STE 102 814 S ALVARADO ST 711 W COLLEGE ST STE 100 412 S SAN VICENTE BLVD 2080 CENTURY PARK E STE 102 4057 WHITTIER BLVD 8722 W PICO BLVD 4650 SUNSET BLVD 709 N HILL ST #21 305 N SOTO ST SUITE A 626 W COLLEGE ST 1727 N VERMONT AVE #107 1680 COLORADO BLVD

Page 64 of 679

Provider City LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90010 90049-5127 90057-4018 90034-5419 90064-3668 90010-2378 90022-1703 90027-6105 90035 90025-1544 90077-1724 90057 90048-4501 90026-1528 90012-2801 90048-3384 90033-1810 90027-6023 90033-2411 90001 90049-3309 90049-6602 90033 90015-3072 90026-4917 90024-7001 90019 90037 90004-4430 90057-3840 90057-4010 90012-1092 90048-4108 90067-2004 90023-2536 90035-2206 90027 90012 90033-1862 90012-1616 90027 90041

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

COLORADO PHARMACY COLUMBUS PHARMACY

Provider Name

(323) 739-0011 (213) 622-2777

2455 COLORADO BLVD #6 861 N BROADWAY

LOS ANGELES LOS ANGELES

CA CA

90041-1182 90012-2309

COMPASSIONATE ONCOLOGY MEDICAL GR CORONA DRUG CRENSHAW PHARMACY CURERX DABNEY PHARMACY DISCOUNT MEDICAL PHARMACY DNM PHARMACY DRUG STOP 22 INC EAST L.A. PHARMACY, CORP. ECHMED PHARMACY EDDIE'S PHARMACY EDEN PHARMACY EISNER PEDIATRIC & FAMILY CTR ELITE CARE PHARMACY ETHICAL DRUGS EXPRESS RX INC FAIRFAX DISCOUNT PHARMACY FARMACIA FAMILIA FARMACIA SUPERIOR FLORENCE PHCY & MEDICAL SUPPLY FUSION RX COMPOUNDING GALLERIA PHARMACY GARFIELD PRESCRIPTION PHARMACY GATEWAY CIRCLE PHARMACY GOLDEN CARE PHARMACY GOOD PRICE PHARMACY GRAND AVE PHARMACY GRAND PHARMACY INC GRAND SPECIALTY PHARMACY HAH INC HARVARD PHARMACY HK PHARMACY HOPE SPECIALTY PHARMACY HYE PHARMACY, INC. HYUNDAI PHARMACY IMPERIAL OF WESTWOOD PHARMACY JANA HEALTHCARE PHARMACY JAY'S DRUG KEY DRUG

(310) 229-3555 (213) 749-4174 (323) 732-5555 (323) 667-1111 (323) 757-2263 (323) 661-8366 (323) 634-8930 (323) 957-2840 (323) 685-5039 (323) 666-8932 (310) 358-2400 (213) 381-7705 (213) 747-5542 (323) 426-9990 (323) 467-2101 (213) 353-0552 (323) 937-1111 (323) 222-8882 (424) 335-0737 (323) 277-9500 (310) 204-6676 (323) 733-7200 (323) 295-5585 (323) 223-3228 (323) 234-9956 (323) 255-5161 (213) 746-4114 (213) 380-5100 (213) 747-3200 (213) 483-4330 (323) 732-1911 (323) 464-3925 (800) 557-5555 (323) 661-7152 (213) 480-3322 (310) 475-6000 (323) 836-0007 (323) 731-4696 (213) 383-2211

2080 CENTURY PARK E STE 1005 2105 S SAN PEDRO ST 3631 CRENSHAW BLVD STE 111 5060 W SUNSET BLVD STE C 11115 S MAIN ST 2716 GRIFFITH PARK BLVD 6221 WILSHIRE BLVD STE 100 6753 SANTA MONICA BLVD 4968 WHITTIER BLVD 3060 GLENDALE BLVD 8408 BEVERLY BLVD 2681 W OLYMPIC BLVD STE 102 1500 S OLIVE ST 5101 SANTA MONICA BLVD #6 254 N WESTERN AVE 1711 W TEMPLE ST STE 100 7771 BEVERLY BLVD 1833-B E CESAR E CHAVEZ AVE 1175 S ROBERTSON BLVD 1422 E FLORENCE AVE 2001 WESTWOOD BLVD STE A 3250 W OLYMPIC BLVD STE 101 3756 SANTA ROSALIA DR 3133 N BROADWAY 4128 S BROADWAY 6000 N FIGUEROA ST # 102 1400 S GRAND AVE STE 100 505 S VIRGIL AVE STE 107 1513 S GRAND AVE # 100 2035 W 7TH ST 3130 W OLYMPIC BLVD STE 150 124 N WESTERN AVE 1480 COLORADO BLVD STE 100 5236 SANTA MONICA BLVD 461 S WESTERN AVE 1820 WESTWOOD BLVD 5233 MELROSE AVE 3170 W OLYMPIC BLVD STE D 770 S VERMONT AVE

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90067-2013 90011-1125 90016-4869 90027-5840 90061-1997 90027-3343 90048-5209 90038-1218 90022-3130 90039 90048-3402 90006-2883 90015-3023 90029 90004-4108 90026-5421 90036 90033 90035-1403 90001-1937 90025 90006-2368 90008-3606 90031-2703 90037-2221 90042-4232 90015-3048 90020-1407 90015 90057-4023 90006-2492 90004-4106 90041-2368 90029-1210 90020-4102 90025-4612 90038-3144 90006-2400 90005-1520

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 65 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KING PHARMACY KINGSLEY PHARMACY KORYO PHARMACY KT PLAZA PHARMACY KYOTO PHARMACY LA CHRISTIAN HEALTH CENTERS

Provider Name

(323) 262-8845 (213) 383-8877 (213) 738-6970 (213) 382-0212 (213) 253-5999 (323) 268-8391

2707 WHITTIER BLVD 3663 W 6TH ST STE 102 2727 W OLYMPIC BLVD STE 103 928 S WESTERN AVE #110 420 E 3RD ST STE 106 1625 E 4TH ST

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA

90023-1441 90020-3047 90006-2641 90006 90013-1645 90033-4201

LA HEMATOLOGY ONCOLOGY MED GROUP LEE'S DISCOUNT DRUG LG PHARMACY INC LINCOLN HEIGHTS PHARMACY LITTLE TOKYO PHARMACY LORENA PHARMACY LOS ANGELES DRUGS M & S PHARMACY M J KELLY PHARMACY

(213) 977-1214 (213) 382-6391 (323) 664-6664 (323) 222-3332 (213) 680-4011 (323) 268-3384 (213) 387-3030 (310) 822-6354 (213) 622-5696

1245 WILSHIRE BLVD #303 2732 W OLYMPIC BLVD 4846 HOLLYWOOD BLVD 2417 N BROADWAY 402 E 2ND ST 3400 WHITTIER BLVD 3030 W OLYMPIC BLVD STE 118 4561 S CENTINELA AVE 312 W 5TH ST STE 103

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA

90017 90006-2633 90027-5302 90031-2218 90012-4209 90023-1708 90006-6508 90066-6248 90013

MANCHESTER PROFESSIONAL PHARMACY MARCOS FARMACIA MARIPOSA PHARMACY MARTIN PHARMACY MEDICAL SQUARE PHARMACY MEDICO PHARMACY MEKAGREEN PHARMACY MEN'S HEALTH FOUNDATION MICKEY FINE PHCY & SNACK SHOP MINI PHARMACY MISSION ROAD PHARMACY MOLINAS PHARMACY

(323) 750-3523 (323) 269-7958 (213) 365-5067 (213) 382-9718 (213) 483-1744 (310) 444-9011 (323) 643-4240 (310) 205-0724 (310) 277-6123 (888) 545-6464 (323) 227-4646 (323) 261-3504

600 W MANCHESTER AVE 4762 WHITTIER BLVD 2970 W OLYMPIC BLVD # 104 801 S VERMONT AVE STE 104 2100 W 3RD ST STE 190 11779 SANTA MONICA BLVD 1373 W 29TH ST STE A 9201 W SUNSET BLVD STE 812 2000 AVENUE OF THE STARS # QSR 2425 PORTER ST 1155 N MISSION RD 3746 WHITTIER BLVD

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA

90044-5719 90022-3026 90006-2518 90005-1567 90057-1922 90025-2843 90007-7800 90069-3709 90067-4700 90021-2510 90033-1040 90023-1704

MORNINGSIDE MEDICAL PHARMACY INC MOTHER'S CARE MY PHARMACIST ON CALL NEXTGEN PHARMACY NOFEL PHARMACY NORMANDY PHARMACY NORMANDY PHARMACY NORTHEAST CLINIC PHARMACY NOUBARS EL ADOBE PHARMACY NOUBARS EL ADOBE PHARMACY OLIVE BRANCH PHARMACY OLIVE BRANCH PHARMACY

(323) 753-1333 (213) 739-3030 (310) 497-3109 (323) 776-1508 (213) 623-9171 (213) 386-3001 (323) 913-3337 (323) 222-0181 (323) 461-9451 (213) 413-3999 (213) 536-4888 (323) 432-2131

1704 W MANCHESTER AVE 3500 W 6TH ST STE 120 3426 WHITTIER BLVD 1039 W FLORENCE AVE #102 215 E 7TH ST #A 3003 W OLYMPIC BLVD STE 101 5112 HOLLYWOOD BLVD STE 104 3309 N EASTERN AVE 5207 HOLLYWOOD BLVD 2010 WILSHIRE BLVD STE 2010F 2070 S CENTRAL AVE 2811 S SAN PEDRO ST

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA

90047-3063 90020-5801 90023-1708 90044 90014 90006-6511 90027-6124 90032-1991 90027-4908 90057-3507 90011-1235 90011-2023

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 66 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

OLIVE HILL PHARMACY OLYMPIA PLAZA PHARMACY OWL REXALL DRUG PACIFIC DRUGS PAVILIONS PHARMACY PHARMACA INTEGRATIVE PHARMACY 2000 PHARMASAVE DRUG PICO PHARMACY PICO SQUARE PHARMACY PICO UNION PHARMACY PING ON MEDICAL PHARMACY PING ON PHARMACY PLATINUM PHARMACY INC PLAZA WEST PHARMACY PMQ PHARMACY 1 PORTOLA PHARMACY QUALICARE PHARMACY SERVICES

Provider Name

(213) 680-2000 (323) 937-2590 (323) 254-2851 (323) 226-0237 (323) 466-7158 (310) 476-1237 (310) 234-9991 (323) 655-7979 (213) 380-8808 (213) 385-0076 (213) 380-3124 (213) 617-3322 (213) 617-3333 (310) 444-7979 (310) 645-6422 (213) 486-4071 (323) 222-2362 (323) 731-4004

255 S HILL ST # 217 5901 W OLYMPIC BLVD STE 103 5634 N FIGUEROA ST 1047 N STATE ST 727 VINE ST 12025 SAN VICENTE BLVD 1646 WESTWOOD BLVD 8474 W 3RD ST STE 112 2521 W PICO BLVD 2334 W PICO BLVD 1273 S UNION AVE 650 N BROADWAY STE B 640 N BROADWAY STE 3 1377 WESTWOOD BLVD 8540 S SEPULVEDA BLVD STE 102 522 S. SAN PEDRO STREET 3408 N EASTERN AVE 3801 S WESTERN AVE

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90012-3500 90036-4659 90042-4102 90033-1332 90038-3713 90049-4922 90024-5604 90048-4142 90006-4003 90006-4002 90015 90012-2802 90012-2815 90024 90045-3810 90013-2102 90032 90062

QUEENSCARE HEALTH CENTER PHARMACY QUEENSCARE HTH CTR PHCY-E 3RD ST RALPHS RALPHS RALPHS RALPHS RALPHS RALPH'S RALPHS PHARMACY RALPHS PHARMACY RALPHS PHARMACY RAMIREZ PHARMACY RANCHO PARK PHARMACY REXFORD PHARMACY REXMED PHARMACY ROBERTSON SPECIALTY PHARMACY RONALD REAGAN UCLA OP PHARMACY ROSS MEDICAL PHARMACY, INC. ROYAL CARE PHARMACY S AND S PHARMACY SAL PHARMACY SAMARITAN MEDICAL TOWER PHCY SAV-ON PHARMACY

(323) 635-1152 (323) 354-3919 (213) 480-3112 (323) 957-6830 (323) 937-9383 (323) 936-0050 (310) 444-0603 (310) 824-5013 (213) 383-6207 (213) 452-0830 (323) 512-0268 (323) 269-7329 (310) 475-3541 (888) 998-3191 (323) 268-7163 (424) 258-6721 (310) 267-8524 (323) 731-8304 (323) 850-0722 (323) 222-7982 (310) 860-9809 (213) 482-0644 (323) 295-3330

4618 FOUNTAIN AVE 4816 E 3RD ST 3410 W 3RD ST 5429 HOLLYWOOD BLVD 260 S LA BREA AVE 5601 WILSHIRE BLVD 11727 W OLYMPIC BLVD 10861 WEYBURN AVE 670 S WESTERN AVE 645 W 9TH ST 7257 W SUNSET BLVD 2403 E CESAR E CHAVEZ AVE 10587A W PICO BLVD 8610 S SEPULVEDA BLVD STE 106 4481 WHITTIER BLVD 1700 SOUTH ROBERTSON 662 GAYLEY AVE ROOM B140B 1818 S WESTERN AVE STE 100 7300 W SUNSET BLVD STE L 2922 DIVISION ST 8614 W. THIRD STREET 1127 WILSHIRE BLVD STE 201 3901 CRENSHAW BLVD

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90029 90022 90020-1622 90027-3405 90036-3023 90036-3701 90064-1202 90024-2909 90005-3024 90015-1415 90046-3409 90033-3001 90064-2333 90045 90022-1535 90035-4316 90024 90006-5807 90046-3429 90065 90048-3324 90017-3903 90008-2522

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 67 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SAV-ON PHARMACY SERRANO MEDICAL PHARMACY SERV U PHARMACY SHILOH FAMILY PHARMACY INC SHYN'S PHARMACY SILOAM PHARMACY SIMON'S DISCOUNT PHARMACY SMITH PHARMACY SMITH PHARMACY INC SOTO DRUG COMPANY SOUTH FIGUEROA DRUGS SOUTH WESTERN PHARMACY

Provider Name

(323) 662-5105 (213) 384-3405 (213) 385-5225 (323) 536-9575 (213) 487-7535 (213) 382-0700 (323) 874-2507 (323) 733-9390 (323) 461-8331 (213) 480-6588 (323) 298-7543 (323) 752-1692

2035 HILLHURST AVE 4220 W 3RD ST STE 100 2034 W PICO BLVD 5551 HOLLYWOOD BLVD 520 S VIRGIL AVE STE 102 2528 W OLYMPIC BLVD STE 102 7256 W SUNSET BLVD 1732 S WESTERN AVE 1107 N WESTERN AVE 2911 BEVERLY BLVD STE 102 1503 WEST MARTIN LUTHER KING 7301 S WESTERN AVE

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA

90027-2702 90020-3450 90006 90028-6814 90020-1425 90006-2922 90046-3410 90006-5804 90029-1016 90057-1025 90062 90047-2254

ST JOHNS WELL CHLD & FMLY CNTR PHCY ST. LOUIS DRUG COMPANY STOCKER RX PHARMACY STUDIORX SUN DRUG COMPANY SUNSHINE PHARMACY SUPERMARKET PHARMACY SYD'S PHARMACY SYNERGY HEMATOLOGY ONCOLOGY T & T PHARMACY TAI ON PHARMACY TFC PHARMACY

(213) 226-7396 (323) 268-6819 (323) 295-3194 (323) 934-8000 (323) 663-8017 (323) 653-8692 (213) 385-3321 (323) 933-8571 (323) 525-1111 (323) 920-4584 (213) 625-3333 (323) 348-4205

808 W 58TH ST STE 123 2100 E 1ST ST 3750 SANTA ROSALIA DR UNIT #1 937 CRENSHAW 1803 HILLHURST AVE 357 N FAIRFAX AVE 325 1/2 S WESTERN AVE 7111 BEVERLY BLVD 5901 W OLYMPIC BLVD STE 420 447-A E EL SEGUNDO BLVD 818 N HILL ST STE A 4914 1/2 W SLAUSON AVE

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA CA CA

90037-3632 90033-3918 90008-5108 90019 90027-4407 90036-2108 90020-3804 90036 90036-4669 90061-2741 90012-2395 90056

THE ANGELES CLINIC AND RESEARCH INS THE JEFFREY GOODMAN SPECIAL CA THE MEDICINE SHOPPE THE PHARMACY THE PHARMACY DEPOT

(310) 582-7900 (323) 993-7513 (310) 837-1030 (323) 564-6051 (323) 965-9885

11818 WILSHIRE BLVD STE 200 1625 SCHRADER BLVD 11126 PALMS BLVD 11905 S CENTRAL AVE 4948 W PICO BL, STE B

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA

90025-6647 90028-6213 90034-6503 90059-2836 90019

TOTAL REMEDY & PRESCRIPTION CENTER TOTALCARE PHARMACY INC UCLA MED CTR MDICL PLZ LVL IV PHCY UCLA PHARMACY MED PLZ 1ST FLR UCLA PHARMACY-MOP UMC PHARMACY INC UNITED PHARMACY UNIVERSAL DRUGS UNIVERSITY CARE PHARMACY UPTOWN DRUG COMPANY

(213) 481-1130 (323) 290-2057 (310) 794-7458 (310) 794-1176 (310) 206-4242 (323) 661-2223 (310) 247-0247 (323) 666-7778 (323) 462-2182 (213) 612-4300

1234 WILSHIRE BLVD STE 106 3971 S WESTERN AVE 200 MEDICAL PLZ STE 426 200 MEDICAL PLAZA, SUITE 135 10833 LE CONTE AVE RM A7-224 1201 1/2 N VERMONT AVE 1129 S ROBERTSON BLVD 5181 W SUNSET BLVD 5848 SANTA MONICA BLVD 444 S FLOWER ST

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA CA CA CA

90017-4810 90062-1114 90095-6949 90095 90095-3075 90029-1703 90035-1403 90027-5715 90038-2002 90071-2901

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 68 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

USC MEDICAL PLAZA PHARMACY USC PHARMACY VENICE PHARMACY INC. VERMONT GALLERIA PHARMACY,INC. VERMONT VO PHARMACY VERNBRO PHARMACY VERNON CENTRAL BOTICA PHCY

Provider Name

(323) 442-5770 (213) 740-2738 (213) 381-6087 (213) 388-4100 (213) 480-1503 (323) 232-1111 (323) 231-8992

1510 SAN PABLO ST STE 144 3601 TROUSDALE PKWY 1514 S VERMONT AVE STE I-2 440 S VERMONT AVE # 109 2655 W OLYMPIC BLVD 231 W VERNON AVE 4375 S CENTRAL AVE

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES

CA CA CA CA CA CA CA

90033-5394 90089-0096 90006-4540 90020-1910 90006-2800 90037-2700 90011-3526

VINE DISCOUNT PHCY & MED SUPPLY INC VIRGIL PHARMACY VITAMIN QUOTA PHARMACY WATTS PROFESSIONAL PHARMACY WESTCHESTER PHARMACY WESTERN MEDICAL PHARMACY WESTLAKE PHARMACY WESTSIDE MEDICAL WESTSIDE PHARMACY WESTWOOD CENTER PHARMACY WHITE MEMORIAL MED PLZ PHCY WILSHIRE GRAND PHARMACY WILSHIRE LA JOLLA PHARMACY INC WILSHIRE WESTGATE PHARMACY WILTON CARE PHARMACY WILTON PHARMACY WOORI PHARMACY INC YEH'S PHARMACY II YORK DISCOUNT PHARMACY INC ZENITH PHARMACY ZION DRUG LOS BANOS DRUG COMPANY SAVE MART PHARMACY PHARMACA INTEGRATIVE PHARMACY SILICON VALLEY PHARMACY SORCI HEALTHCARE PHARMACY WELLNESS PHARMACY LOS OSOS REXALL DRUG RALPHS THE MEDICINE SHOPPE LUCERNE PHARMACY INTRA RX DRUGS LYNWOOD LYNWOOD COMMUNITY PHARMACY

(323) 957-9446 (213) 384-1200 (323) 936-7221 (323) 564-3218 (310) 670-3463 (323) 465-3112 (213) 383-4262 (310) 441-1200 (310) 479-0200 (310) 208-6666 (323) 221-6000 (213) 480-1300 (323) 658-6611 (310) 477-8527 (323) 463-0800 (323) 731-0600 (213) 384-6323 (323) 733-7788 (323) 302-8090 (323) 665-8959 (213) 382-6485 (209) 826-5834 (209) 829-7915 (408) 395-1867 (408) 378-5381 (408) 356-4747 (408) 356-4848 (805) 528-1017 (805) 528-0244 (805) 528-1447 (707) 274-6643 (310) 637-2006 (310) 438-2616

1253 VINE ST STE 11 2999 W 6TH ST STE 103 2768 W 8TH ST 9909 COMPTON AVE 8930 S SEPULVEDA BLVD 1075 N WESTERN AVE 2500 WILSHIRE BLVD STE 101 1360 WESTWOOD BLVD STE C 11504 SANTA MONICA BLVD 10921 WILSHIRE BLVD 1701 CESAR CHAVEZ AVE STE 109 2974 WILSHIRE BLVD 6360 WILSHIRE BLVD 11860 WILSHIRE BLVD 5660 HOLLYWOOD BLVD 3511 W OLYMPIC BLVD STE 102 266 S HARVARD BLVD STE 120 966 S WESTERN AVE STE 103 5821 YORK BLVD 3919 BEVERLY BLVD STE 101 3900 W 3RD ST 601 J ST 1400 MERCEY SPRINGS RD 54 N SANTA CRUZ AVE 14107 WINCHESTER BLVD STE M 15714 LOS GATOS BLVD STE A 14777 LOS GATOS BLVD STE 101 989 LOS OSOS VALLEY RD 1320 LOS OSOS VALLEY RD 1199 LOS OSOS VALLEY RD 6244 E HIGHWAY 20 3628 E IMPERIAL HWY STE 102 3737 MARTIN LUTHER KING JR BLV

LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS ANGELES LOS BANOS LOS BANOS LOS GATOS LOS GATOS LOS GATOS LOS GATOS LOS OSOS LOS OSOS LOS OSOS LUCERNE LYNWOOD LYNWOOD

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90038-1662 90020 90005-1225 90002-2850 90045-3606 90029-2307 90057-4306 90024-4919 90025-3008 90024-3906 90033-2464 90010 90048 90025-6613 90028-6810 90019-3563 90004-4374 90006-1014 90042-2634 90004-3432 90020-2675 93635-4224 93635 95030-5932 95032-1836 95032 95032-2059 93402-3205 93402-3309 93402-3203 95458-7800 90262-2600 90262-3525

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 69 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

MATS PHARMACY AND MEDICAL SUPPLIES SANTA ELENA PHARMACY B K PHARMACY CORP CAMARENA PHARMACY MADERA MEDICAL PHARMACY NEW LIFE PHARMACY SAVE MART PHARMACY LISA FAMILY PHARMACY DUME PLAZA PHARMACY SUPER CARE DRUGS BOB'S UNITED DRUGS RALEY'S DRUG CENTER STRIPLINS PHARMACY MARINA DEL REY PHARMACY MARINA PHARMACY RALPHS RALPHS PHARMACY PIONEER MARKET PHARMACY PEACH TREE PHARMACY THE MEDICINE SHOPPE THE MEDICINE CABINET CLONEYS MCKINLEYVILLE PHARMACY MEADOW VISTA PHARMACY MECCA COMMUNITY PHARMACY MENDOCINO VILLAGE PHARMACY UNITED HEALTH CNTRS PHCY MENDO GREAT RX PHARMACY LOTUS PHARMACY NIMBLE PHARMACY PHARMACA INTEGRATIVE PHARMACY EL PORTAL PHARMACY GVHC PMQ MERCED PHARMACY MERCED DRUG RALEY'S DRUG CENTER SAVE MART PHARMACY SAVE MART PHARMACY

(310) 637-6285 (323) 249-8497 (559) 675-1688 (559) 479-4580 (559) 674-8553 (559) 674-4511 (559) 661-0871 (530) 873-0460 (310) 457-9707 (310) 456-1177 (209) 823-2174 (209) 825-0494 (209) 923-4418 (310) 823-5311 (310) 577-5536 (310) 821-4993 (310) 827-4843 (209) 742-5550 (530) 741-9800 (530) 743-4629 (323) 771-4965 (707) 840-9923 (530) 878-7440 (760) 396-3000 (707) 937-4800 (559) 655-5000 (951) 679-7988 (951) 301-8868 (866) 966-4625 (650) 618-6310 (209) 384-8880 (209) 383-5987 (209) 388-1080 (209) 722-3853 (209) 723-2111 (209) 723-1912

3625 MARTIN LUTHER KING JR BLV 9910 LONG BEACH BLVD STE F 1129 W 4TH ST STE A 344 E 6TH ST STE 101 402 S MADERA AVE STE A 483 E ALMOND AVE STE 102 1504 HOWARD RD 14137 LAKERIDGE CT 29211 HEATHERCLIFF RD STE 25 23661 PACIFIC COAST HWY 629 E YOSEMITE AVE 1282 W LATHROP RD 1144 NORMAN DR STE 103 4558 ADMIRALTY WAY 4644 LINCOLN BLVD STE 103-110 4311 LINCOLN BLVD 4700 ADMIRALTY WAY 5034 COAKLEY CIR STE 200 5730 PACKARD AVE STE 620 812 5TH ST 6046 ATLANTIC BLVD 1567 CITY CENTER RD 16893 PLACER HILLS RD 91275 AVENUE 66 STE 200 10481 LANSING STREET 121 BARBOZA ST BUILDING 3 26930 CHERRY HILLS BLVD 27994 BRADLEY RD STE H 900 WILLOW RD 871 SANTA CRUZ AVE 3377 G ST STE B 857 W CHILDS AVE STE 101 35 E 16TH ST 3548 G ST 1300 W OLIVE AVE 150 W OLIVE AVE

LYNWOOD LYNWOOD MADERA MADERA MADERA MADERA MADERA MAGALIA MALIBU MALIBU MANTECA MANTECA MANTECA MARINA DEL REY MARINA DEL REY MARINA DEL REY MARINA DEL REY MARIPOSA MARYSVILLE MARYSVILLE MAYWOOD MCKINLEYVILLE MEADOW VISTA MECCA MENDOCINO MENDOTA MENIFEE MENIFEE MENLO PARK MENLO PARK MERCED MERCED MERCED MERCED MERCED MERCED

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90262-3509 90262-1561 93637-4477 93638-3631 93637-3203 93637-5748 93637-5127 95954-9470 90265-4145 90265 95336-5801 95336-9671 95336-5959 90292-5417 90292-6313 90292-8814 90292-6905 95338-8519 95901 95901-5615 90270-3119 95519 95722-9531 92254 95460-0000 93640-1901 92586-2574 92586 94025 94025 95340 95341 95340-5020 95340-0691 95348-1663 95348-3135

VALLEY PRESCRIPTION COMPOUNDING PHY PHARMACA INTERGRATIVE PHARMACY CALAVERAS PHARMACY COUNTRY VILLAGE PHARMACY

(209) 722-5765 (415) 388-6354 (408) 262-2056 (951) 681-8889

330 E 13TH ST 230 E BLITHEDALE AVE 114 S PARK VICTORIA DR 10251 COUNTRY CLUB DR UNIT B

MERCED MILL VALLEY MILPITAS MIRA LOMA

CA CA CA CA

95341-6212 94941-2032 95035-5724 91752-1329

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

HOLY CROSS PHARMACY UNITED DRUGS MISSION HILLS PHARMACY RELIANCE PHARMACY AMENA WELLNESS PHARMACY CAL MED PHARMACY MISSION MEDICAL PHARMACY MISSION PLAZA PHARMACY OSO MEDICAL PHARMACY PAVILIONS PHARMACY RAZI PHARMACY SAV-ON PHARMACY TOWER PHARMACY CARRANZA PHARMACY INC.- MODESTO FLORIDA AVENUE PRESCRIPTIONS INC

(818) 898-1628 (818) 639-0108 (818) 837-5999 (949) 276-8777 (949) 586-1700 (949) 364-0122 (949) 364-9009 (949) 582-3633 (949) 582-3294 (949) 583-7294 (949) 583-9779 (949) 364-1200 (209) 538-2971 (209) 576-7277

11550 INDIAN HILLS RD STE 130 10630 SEPULVEDA BLVD STE #101 11333 SEPULVEDA BLVD 28251 MARGUERITE PKWY STE D 24031 MARGUERITE PKY STE A 27800 MEDICAL CENTER RD STE 99 26800 CROWN VALLEY PKWY #185 26902 OSO PKWY STE 160 26022 MARGUERITE PKWY 23162 LOS ALISOS BLVD STE 102A 23072 ALICIA PKWY 26732 CROWN VLY PKWY STE 101 1620 CROWS LANDING RD STE K 1541 FLORIDA AVE STE P

MISSION HILLS MISSION HILLS MISSION HILLS MISSION VIEJO MISSION VIEJO MISSION VIEJO MISSION VIEJO MISSION VIEJO MISSION VIEJO MISSION VIEJO MISSION VIEJO MISSION VIEJO MODESTO MODESTO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91345-1201 91345 91345-1116 92692-3721 92692-1929 92691-6415 92691-7304 92691-5801 92692-3262 92691-7869 92692-1636 92691-6306 95358-5602 95350-4438

GVHC PMQ WEST MODESTO PHARMACY PARADISE DRUGS RALEY'S DRUG CENTER RALEY'S PHARMACY ROGERS DRUGS STORE SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY MOJAVE PHARMACY CANARY PHARMACY PAVILIONS PHARMACY MONTE VISTA UNITED DRUGS BEVERLY PLAZA PHARMACY BEVERLY PROF UNITED DRUGS CEDRA PHARMACY GRACE CARE PHARMACY MONTEBELLO PHARMACY

(209) 576-1972 (209) 524-7726 (209) 527-4600 (209) 551-6030 (209) 522-5229 (209) 545-1385 (209) 577-1350 (209) 569-0236 (661) 824-1800 (909) 445-0805 (626) 358-7542 (909) 624-9633 (323) 725-7155 (323) 728-0248 (323) 206-4466 (323) 597-1188 (323) 722-3200

1114 6TH ST STE A 400 PARADISE RD 3430 TULLY RD 3020 FLOYD AVE STE 139 402 H ST 3601 PELANDALE AVE 2100 STANDIFORD AVE 801 OAKDALE RD STE C 16912 STATE HIGHWAY 14 4950 SAN BERNARDINO ST #101A 130 W FOOTHILL BLVD 9635 MONTE VISTA AVE 101 E BEVERLY BLVD STE 101 433 N 4TH ST STE 100 1417 W BEVERLY BLVD #103 3414 W BEVERLY BLVD 817 W WHITTIER BLVD

MODESTO MODESTO MODESTO MODESTO MODESTO MODESTO MODESTO MODESTO MOJAVE MONCLAIR MONROVIA MONTCLAIR MONTEBELLO MONTEBELLO MONTEBELLO MONTEBELLO MONTEBELLO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95354-2203 95351-3105 95350-0840 95355-9604 95351-3308 95356 95350-6522 95355-4589 93501-1226 91763 91016-2171 91763-2235 90640-4319 90640-4311 90640-4123 90640-1539 90640-4735

MONTEBELLO PROFESSIONAL PHARMACY THE PRESCRIPTION SHOP VISTA PHARMACY MONTEREY BAY ONC AND GENE CTR PHARMACA INTEGRATIVE PHARMACY 986 PHARMACY ALPHA MEDICAL PHARMACY III

(323) 722-1999 (323) 728-8127 (323) 278-0016 (831) 375-4105 (831) 333-0751 (626) 782-7800 (626) 872-0505

265 E BEVERLY BLVD STE B 1215 W WHITTIER BLVD 825 WASHINGTON BLVD STE C 5 HARRIS CT 570 MUNRAS AVE STE 10 701 S ATLANTIC BLVD STE 168 401 N GARFIELD AVE #101

MONTEBELLO MONTEBELLO MONTEBELLO MONTEREY MONTEREY MONTEREY PARK MONTEREY PARK

CA CA CA CA CA CA CA

90640-3776 90640-4642 90640-6179 93940-5750 93940-3014 91754-3866 91754

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

GARFIELD MEDICAL SQUARE PHARMACY GLOBAL ONCOLOGY, INC HEALTH CARE MEDICAL PHARMACY HEALTH CARE PHARMACY HENRYS PHARMACY HYGEIA LTC PHARMACY KANG KANG PHARMACY MONTEREY PARK PROFESSIONAL RX RAMONA PROFESSIONAL PHARMACY SUN SUN PHARMACY SUN YUAN PHARMACY TAMMYS PHARMACY YAN-YAN PHARMACY UNI-MED PHARMACY MOORPARK COMPREHENSIVE PHCY RHEEM SPECIALTY PHARMACY CDA CLINICAL PHARMACY DAY STREET PHARMACY LIFETIME VALUE PHARMACY MEDICAL PLAZA PHARMACY MORENO VALLEY PHARMACY ORANGE EXPRESS PHARMACY RIVERSIDE CTY REG DEPT PHCY SERV SUPER CARE PHARMACY SUPER RX PHARMACY MORRO BAY DRUG AND GIFT OWENS PHARMACY CAMINO PHARMACY NOWRX DATE PHARMACY

(626) 288-6120 (626) 312-9500 (626) 573-4513 (626) 571-0154 (626) 307-5408 (323) 263-4903 (626) 280-8833 (626) 308-9227 (626) 288-8515 (626) 288-6560 (626) 572-0800 (626) 572-3400 (626) 572-7261 (818) 330-7031 (805) 523-8300 (877) 404-7112 (951) 242-2540 (951) 485-8100 (951) 656-7171 (951) 247-3501 (951) 485-6500 (951) 924-4990 (951) 486-4529 (951) 243-2530 (951) 242-7471 (805) 771-9988 (530) 926-2069 (650) 934-7699 (650) 386-5761 (951) 696-5400

500 N GARFIELD AVE 600 N GARFIELD AVE STE 210 420 N GARFIELD AVE STE 101 223 N GARFIELD AVE STE 101 127 N GARFIELD AVE STE E 786 MONTEREY PASS RD 301 N GARFIELD AVE STE J 850 S ATLANTIC BLVD STE 100 616 N GARFIELD AVENUE STE 101 600 N GARFIELD AVE STE 107A 201 W GARVEY AVE STE 107 210 N GARFIELD AVE STE 101 228 N GARFIELD AVE 2490 HONOLULU AVE STE 110 865 PATRIOT DR STE 103 346 RHEEM BLVD STE 109 11441 HEACOCK ST STE D 23900 IRONWOOD AVE STE C 23080 ALESSANDRO BLVD STE 212 12818 HEACOCK ST STE C5 12980 FREDERICK ST STE B 12730 HEACOCK ST STE 1 26520 CACTUS AVE 24825 ALESSANDRO BLVD STE 2 14425 MORENO BEACH DR 600 MORRO BAY BLVD STE B 216 N MOUNT SHASTA BLVD 701 E EL CAMINO REAL 2224 OLD MIDDLEFIELD WAY STE J 39765 DATE ST STE 101

MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTEREY PARK MONTROSE MOORPARK MORAGA MORENO VALLEY MORENO VALLEY MORENO VALLEY MORENO VALLEY MORENO VALLEY MORENO VALLEY MORENO VALLEY MORENO VALLEY MORENO VALLEY MORRO BAY MOUNT SHASTA MOUNTAIN VIEW MOUNTAIN VIEW MURRIETA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91754-1242 91754-1170 91754-1206 91754 91754-1756 91754 91754-1721 91754-4727 91754-1141 91754-1167 91754-7420 91754-1746 91754-1709 91020-1800 93021-3509 94556-1511 92557-7907 92557-7151 92553-9675 92553-3173 92553-5263 92553-3040 92555-3927 92553-5851 92555-5704 93442-1916 96067-2239 94040-2833 94043-2421 92563-2005

HEMATOLOGY ONCOLOGY CONSULTANTS LLUMC-MURRIETA POB PHARMACY PROCARE PHARMACY RALPHS RANCHO SPRINGS OUTPATIENT PHCY SAV-ON DRUGS SAV-ON PHARMACY SAV-ON PHARMACY CLINIC OLE PHARMACY FAMILY DRUG

(951) 252-9600 (951) 290-4810 (951) 304-2038 (951) 600-8639 (951) 698-4505 (909) 600-4479 (951) 696-4147 (909) 600-1127 (707) 603-1333 (707) 224-7807

28078 BAXTER RD STE 140 28078 BAXTER ROAD STE 326 25405 HANCOCK AVE STE 100 23801 WASHINGTON AVE 25485 MEDICAL CENTER DR # 110 39140 WINCHESTER RD 28047 SCOTT RD 41000 CALIFORNIA OAKS RD 1141 PEAR TREE LANE STE 250 1805 OLD SONOMA RD

MURRIETA MURRIETA MURRIETA MURRIETA MURRIETA MURRIETA MURRIETA MURRIETA NAPA NAPA

CA CA CA CA CA CA CA CA CA CA

92563 92563 92562-5983 92562-2264 92562-6927 92563-3500 92563 92562-5749 94558 94559-3714

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PHARMACA INTEGRATIVE PHARMACY RALEY'S DRUG CENTER SAVE MART PHARMACY SAVE MART PHARMACY NIMBLE PHARMACY PARADISE PHARMACY PLAZA PHARMACY NEEDLES POINT PHARMACY DOKIMOS NEVADA CITY PHARMACY NEWARK HALLER'S PHARMACY TIB PHARMACY LLC BURT'S PHARMACY RALPHS REGENCY MEDICAL PHARMACY SAV-ON PHARMACY THE MEDICINE SHOPPE LYONS PHCY & COMPOUNDING LAB NEWHALL PHARMACY VALENCIA PHARMACY VALENCIA PHARMACY PIONEER UNITED DRUGS BALBOA PHARMACY BEST CHOICE PHARMACY CA PHCY & COMPOUNDING CTR INC COAST HILLS PHARMACY GYNECOLOGIC ONC ASSOCIATES HILL PHARMACY KING'S PHCY AND COMPNDING CTR MARINERS PHARMACY NEWPORT CARE CENTER PHARMACY NEWPORT CENTER PHARMACY NEWPORT COAST PHARMACY NEWPORT LIDO PHARMACY VIA LIDO DRUGS

Provider Name

(707) 253-0975 (707) 224-1269 (707) 255-7400 (707) 253-1643 (866) 966-4625 (619) 399-7581 (619) 267-0768 (760) 326-2312 (530) 470-8854 (510) 797-4333 (510) 573-0064 (805) 498-6675 (805) 376-1380 (805) 375-4050 (805) 499-7549 (805) 375-6650 (661) 777-7770 (661) 799-7017 (661) 255-7910 (661) 255-7910 (209) 862-2955 (949) 673-5370 (949) 724-4000 (949) 642-8057 (949) 720-7044 (949) 642-1361 (949) 640-6564 (949) 631-4624 (949) 645-7200 (949) 515-0600 (949) 640-1320 (949) 719-3707 (949) 764-6580 (949) 723-8921

4020 BEL AIRE PLZ 217 SOSCOL AVE 1312 TRANCAS ST 2355 CALIFORNIA BLVD 801 NATIONAL CITY BLVD STE B 502 EUCLID AVE STE 100 2220 E PLAZA BLVD 1101 W BROADWAY ST 737 ZION ST 6170 THORNTON AVE 5886 MOWRY SCHOOL ROAD 2333 BORCHARD RD 583 N VENTU PARK RD 1000 NEWBURY ROAD 541 S REINO RD 2241 MICHAEL DR 23206 LYONS AVE STE 112 24239 MAIN ST 25050 PEACHLAND AVE STE 100 23550 LYONS AVE STE 111 1261 MAIN ST 716 E BALBOA BLVD 4229 BIRCH ST STE 100 4000 BIRCH ST STE 120 2610 SAN MIGUEL DR 351 HOSPITAL RD STE 507 1441 AVOCADO AVE 510 SUPERIOR AVE STE 120 320 SUPERIOR AVE STE 120 1441 SUPERIOR AVE STE G 1401 AVOCADO AVE 400 NEWPORT CENTER DR STE 106 351 HOSPITAL RD STE 107 3445 VIA LIDO

NAPA NAPA NAPA NAPA NATIONAL CITY NATIONAL CITY NATIONAL CITY NEEDLES NEVADA CITY NEWARK NEWARK NEWBURY PARK NEWBURY PARK NEWBURY PARK NEWBURY PARK NEWBURY PARK NEWHALL NEWHALL NEWHALL NEWHALL NEWMAN NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH NEWPORT BEACH

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94558-2835 94559-4007 94558-2912 94559-1062 91950-3200 91950-2948 91950-5161 92363-2704 95959-2920 94560-3700 94560 91320-3206 91320-2710 91320 91320-4268 91320-3340 91321-2671 91321-2907 91321-2523 91321-5729 95360-1324 92661-1306 92660-1959 92660 92660-5437 92663-3500 92660-7721 92663-3665 92663-2740 92663-2704 92660-7720 92660-8600 92663-3503 92663-3908

WESTCLIFF COMPOUNDING PHARMACY PAVILIONS PHARMACY NIPOMO REXALL DRUGS PHARMCO DRUGS HIGHLAND FAIRE PHARMACY PLAZA WEST PHARMACY RX UNLIMITED PHARMACY

(949) 272-0775 (949) 718-4986 (805) 929-1929 (951) 734-1668 (916) 571-5545 (818) 894-3333 (818) 781-2400

1901 WESTCLIFF #3A 21181 NEWPORT COAST DR 330 W TEFFT ST # E 2844 HAMNER AVE 5731 WATT AVE 8704 SEPULVEDA BLVD 16673 ROSCOE BLVD

NEWPORT BEACH NEWPORT COAST NIPOMO NORCO NORTH HIGHLANDS NORTH HILLS NORTH HILLS

CA CA CA CA CA CA CA

92660 92657-1123 93444 92860-1929 95660-4751 91343-5112 91343-6109

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 73 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name A TO Z UNITED DRUGS BELLAIRE PHARMACY CAHUENGA BLVD PHARMACY DUOMO PHARMACY INC EL CAMINO PHARMACY GREYWELL PHARMACY HYE PHARMACY N HOLLYWOOD MED ARTS NORMANDY PHARMACY PRIORITY CARE PHARMACY QUALITY SCRIPTS PHARMACY RIVERSIDE PARK PHARMACY SCIENCE PHARMACEUTICAL PHCY SUPERIOR PHARMACY SUPERIOR PHARMACY II SUPREME CARE PHARMACY VCH PMQ PHARMACY 1 CLINICARE PHARMACY DEVONSHIRE MEDICAL PHARMACY ER PHARMACY RX, INC. HOPE PHARMACY MARKET PHARMACY MED ZONE PHARMACY MEDICAL CENTER PHARMACY NORTHRIDGE CENTER PHARMACY NORTHRIDGE PLAZA PHARMACY RELIABLE REXALL PHARMACY S & J DISCOUNT PHARMACY ALONDRA PHARMACY LA FAMILIA PHARMACY NORWALK PHARMACY PIONEER PHARMACY SAN ANTONIO PHARMACY MCC PHARMACY NOVATO PHARMACA INTEGRATIVE PHCY DR. PHARMACY OAKDALE PHARMACY RIVER OAK PHARMACY RALEY'S DRUG CENTER AHF PHARMACY BRADFORD PHARMACY INC CHILDRENS CLINIC PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (818) 985-8151 (818) 765-1025 (818) 980-1445 (818) 980-4999 (818) 763-4334 (818) 306-5500 (818) 508-7154 (818) 766-3996 (818) 358-4300 (818) 508-8665 (818) 821-6830 (818) 985-7230 (818) 759-7223 (818) 980-9888 (818) 691-3351 (818) 763-7007 (818) 301-6378 (818) 727-7234 (818) 832-7076 (818) 366-1150 (818) 832-2757 (818) 701-7777 (818) 709-5200 (818) 993-7333 (818) 885-8191 (818) 998-8700 (818) 885-7722 (818) 700-2956 (562) 921-9470 (562) 868-2277 (562) 864-7435 (562) 402-6972 (562) 807-0001 (512) 596-2930 (415) 892-3722 (818) 991-1901 (209) 322-3745 (209) 847-2226 (559) 683-8360 (510) 628-0954 (510) 451-1388 (510) 428-3166

Provider Street 12626 RIVERSIDE DR 12650 SHERMAN WAY STE 9 5503 CAHUENGA BLVD STE 100 12157 VICTORY BLVD # A 10940 VICTORY BLVD 10672 RIVERSIDE DR 12509 VICTORY BLVD 4420 VINELAND AVE 12914B SHERMAN WAY 5652 VINELAND AVE STE 102 11507 OXNARD ST UNIT 2 11655 RIVERSIDE DR 7225 FULTON AVE # H 11755 VICTORY BLVD STE 100A 11755 N VICTORY BLVD # 102 6007 LANKERSHIM BLVD STE 7 6801 COLDWATER CANYON AVE 9245 RESEDA BLVD 17075 DEVONSHIRE ST 19500 PLUMMER ST UNIT D3 10222 RESEDA BLVD 9250 RESEDA BLVD, UNIT 2C 18251 ROSCOE BLVD STE 103 18433 ROSCOE BLVD STE 101 18250 ROSCOE BLVD STE 104 18546 ROSCOE BLVD STE 102 18350 ROSCOE BLVD 8415 RESEDA BLVD 12519 ALONDRA BLVD 14359 PIONEER BLVD STE B 13330 BLOOMFIELD AVE STE 102 15917 PIONEER BLVD 13931 SAN ANTONIO DR 6100 REDWOOD BLVD STE A 7514 REDWOOD BLVD 706 LINDERO CANYON RD STE 776 1390 W H ST STE F 1080 W F ST 40041 HIGHWAY 41 400 30TH ST 445 8TH ST 747 52ND ST

Page 74 of 679

Provider City NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTH HOLLYWOOD NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORTHRIDGE NORWALK NORWALK NORWALK NORWALK NORWALK NOVATO NOVATO OAK PARK OAKDALE OAKDALE OAKHURST OAKLAND OAKLAND OAKLAND

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91607-3420 91605-5248 91601-2920 91606-3204 91606-3725 91602-2319 91606-3135 91602-2116 91605-4953 91601-2062 91606-4186 91602-1021 91605-4111 91606-3423 91606 91606 91605-5162 91324-3137 91325-1600 91324-2153 91324-1459 91324 91325-4200 91325-4122 91325 91324-4667 91325-4109 91324-4642 90650-7351 90650-4870 90650-3251 90650-7117 90650-4036 94945-4501 94945-2460 91377-5477 95361-3529 95361-3677 93644-8803 94609-3306 94607-3901 94609-1809

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DOLPHIN HEALTH PHARMACY EBAC OUTPATIENT PHARMACY FRUITVALE AVENUE PHARMACY HIGH STREET PHARMACY

Provider Name

(510) 638-1321 (510) 869-8451 (510) 261-1412 (510) 530-1335

7400 MACARTHUR BLVD # A 3100 SUMMIT ST FL 2 2693 FRUITVALE AVE 4248 MACARTHUR BLVD

OAKLAND OAKLAND OAKLAND OAKLAND

CA CA CA CA

94605-2939 94609-3412 94601-2034 94619-1908

INTERGRATED MEDICAL ASSOC PHCY INC LIFESCRIPT PHARMACY MY LAN PHARMACY NEW OAKLAND PHARMACY NEW OAKLAND PHARMACY NEW OAKLAND PHARMACY NEW OAKLAND PHCY-LAKE MERRITT NICHOLS HILL PHARMACY OAKLAND CLINIC PHARMACY PACIFIC PHARMACY PERALTA OUTPATIENT PHARMACY PHARMACA INTEGRATIVE PHARMACY ROCKFORTH PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY VIBRANT PHARMACY VITACARE WELLSPRING PHARMACY RALEY'S DRUG CENTER SAVE MART PHARMACY MISSION PARK PHARMACY

(510) 382-1671 (510) 878-7562 (510) 451-1916 (510) 628-0368 (510) 268-0288 (510) 763-3282 (510) 628-0878 (510) 893-8841 (510) 428-4088 (510) 451-3234 (510) 869-8835 (510) 740-1468 (510) 969-4577 (510) 532-0100 (510) 272-9042 (510) 638-9851 (510) 832-7500 (510) 428-1559 (925) 625-4500 (925) 625-7557 (760) 757-1212

10500 MACARTHUR BLVD # 103 7700 EDGEWATER DR STE 220 401 E 18TH ST STE B 333 9TH ST 822 WEBSTER ST 388 9TH ST STE 108 250 E 18TH ST 3RD FLR 2844 SUMMIT ST 5220 CLAREMONT AVE 650 INTERNATIONAL BLVD 3300 WEBSTER ST STE 101 5729 COLLEGE AVE 10500 INTERNATIONAL BLVD 3100 E 9TH ST 247 E 18TH ST 7400 MACARTHUR BLVD STE B 2447 TELEGRAPH AVE 4184 PIEDMONT AVE STE C 2077 MAIN ST 2545 MAIN ST 2201 MISSION AVE

OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLAND OAKLEY OAKLEY OCEANSIDE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94605 94621-3018 94606-1850 94607-4211 94607-4220 94607-4288 94606-1729 94609-3637 94618-1033 94606-2986 94609-3106 94618-1628 94603-3804 94601-2913 94606-1728 94605-2939 94612-2404 94611-5174 94561-3302 94561-1853 92058-2328

NORTH COUNTY ONCOLOGY MED CLINIC OCEANSIDE PHARMACY RALPHS RALPHS SAV-ON DRUGS SAV-ON PHARMACY MEDICAL ARTS PHARMACY OJAI REXALL DRUGS OJAI VILLAGE PHARMACY THE MEDICINE SHOPPE OLIVEHURST DRUG STORE INC ABC PHARMACY DIPLOMAT SPECIALTY PHARMACY GEMMELS COMPOUNDING PHARMACY MEDICINE SHOPPE

(760) 758-5770 (760) 231-5800 (760) 806-3225 (760) 754-1906 (760) 729-4127 (760) 433-9634 (805) 646-7211 (805) 646-4361 (805) 646-7272 (805) 646-0106 (530) 743-5451 (909) 291-3800 (909) 881-1728 (909) 986-1129 (909) 391-3542

3617 VISTA WAY 3601 VISTA WAY STE 103 4251 OCEANSIDE BLVD 101 OLD GROVE RD 3450 MARRON RD 3925 MISSION AVE 1320 MARICOPA HWY 1125 MARICOPA HWY 202 E OJAI AVE 960 E OJAI AVE 4897 OLIVEHURST AVE 2920 INLAND EMPIRE BLVD #112 1809 EXCISE AVE #207-208 143 N EUCLID AVE 1520 N MOUNTAIN AVE

OCEANSIDE OCEANSIDE OCEANSIDE OCEANSIDE OCEANSIDE OCEANSIDE OJAI OJAI OJAI OJAI OLIVEHURST ONTARIO ONTARIO ONTARIO ONTARIO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92056-4522 92056-4559 92056-3471 92057-1216 92056-4672 92058 93023-3154 93023-3126 93023-2737 93023-2901 95961-4225 91764-6581 91761-8559 91762-3510 91762-1128

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 75 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ONTARIO PHARMACY PRXP OF CA LLC VIDA DRUG STORE AND PHARMACY CHAPMAN MED OUTPATIENT PHCY CHILDRENS HOSP CLINIC PHARMACY ED'S HEALTHY LIVING PHCY & COMP HEMATOLOGY ONC MED GROUP OF OC K & T PHARMACY ORANGE EXPRESS PHARMACY ORANGE PLAZA PHARMACY RX SOLUTION PHARMACY SAV-ON DRUGS SAV-ON PHARMACY SAV-ON PHARMACY SPECIALTY CARE RX ST JOSEPH PAVILLION PHARMACY TNT PHARMACY 2 YORBA PARK PHARMACY UNITED HEALTH CNTR PHCY ORANGE SAV-ON PHARMACY THE MEDICINE SHOPPE ORLANDCARE PHCY AND MEDICAL CRYSTAL MEDICAL CENTER PHARMACY DOVES LANDING PHARMACY FEATHER RIVER TRB HLTH PHCY RALEY'S DRUG CENTER FARMACIA ESTRELLA HERBAY PHARMACY NORTH MEDICAL PLAZA PHARMACY OMAC PHARMACY OXNARD DRUG COMPANY STANS DRUGS INC THE MEDICINE SHOPPE

Provider Name

(909) 986-8161 (760) 326-2312 (909) 983-0999 (714) 628-0100 (714) 509-8856 (714) 485-0908 (714) 835-1800 (714) 633-3366 (714) 288-1720 (714) 550-9798 (714) 288-8744 (714) 771-3014 (714) 633-1681 (714) 771-7933 (714) 941-6177 (714) 744-8724 (714) 538-6868 (714) 633-1326 (559) 626-4031 (805) 934-4002 (925) 254-1211 (530) 865-4688 (530) 533-1545 (530) 533-1234 (530) 534-5394 (530) 533-6876 (805) 240-9962 (805) 981-2500 (805) 981-3366 (805) 486-2688 (805) 483-2115 (805) 486-2678 (805) 487-6303

666 E E ST 4345 E LOWELL ST SUITES C & D 437 N EUCLID AVE STE B 2617 E CHAPMAN AVE STE 111 1201 W LA VETA AVE 879 S TUSTIN ST 1010 W LA VETA STE 200 3116 E CHAPMAN AVE 1233 N TUSTIN AVE 1010 WEST LA VETA AVE STE 130 7626 E CHAPMAN AVE STE C 4550 E CHAPMAN AVE 940 N TUSTIN ST 8440 E CHAPMAN AVE 2140 W CHAPMAN AVE STE 110 1140 W LA VETA AVE 705 W LA VETA AVE #110A 2501 E CHAPMAN AVE # 106 445 11TH ST 1120 E CLARK AVE 282 VILLAGE SQ 61 E WALKER ST 2809 OLIVE HIGHWAY 2450 ORO DAM BLVD STE B 2145 5TH AVE 2325 MYERS ST STE B 5020 S C ST 1451 N RICE AVE STE F 1700 N ROSE AVE STE 140 901 W 7TH ST 105 W 5TH ST 3001 SAVIERS RD 2196 SAVIERS RD

ONTARIO ONTARIO ONTARIO ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE ORANGE COVE ORCUTT ORINDA ORLAND OROVILLE OROVILLE OROVILLE OROVILLE OXNARD OXNARD OXNARD OXNARD OXNARD OXNARD OXNARD

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91764-4228 91761-2222 91762-3456 92869-3231 92868-4203 92866 92868-4301 92869 92867-5147 92868-4301 92869-8532 92869-4109 92867-5956 92869-2459 92868 92868-4225 92868 92869-3204 93646-2211 93455-5123 94563-2504 95963-1581 95966-6131 95966-6052 95965-5870 95966-5334 93033-7502 93030-7992 93030-7633 93030-6755 93030-7105 93033-5312 93033-3825

VENTURA CNTY HEMATOLOGY ONCOLOGY ZOLI RX PHARMACY CENTRAL AVE PHARMACY KNOLLS PHARMACY PALI-RX PALISADES COMPOUNDING PHARMACY PHARMACA INTEGRATIVE PHARMACY DORADO PHARMACY

(805) 485-8709 (805) 222-0819 (831) 373-1225 (310) 454-6000 (310) 454-0377 (310) 454-4848 (310) 454-1345 (818) 485-5554

1700 N ROSE AVE STE 320 1700 LOMBARD ST STE 100 133 15TH ST 16630 MARQUEZ AVE 900 VIA DE LA PAZ 540 PALISADES DR 15150 W SUNSET BLVD 13003 VAN NUYS BLVD STE E

OXNARD OXNARD PACIFIC GROVE PACIFIC PALISADES PACIFIC PALISADES PACIFIC PALISADES PACIFIC PALISADES PACOIMA

CA CA CA CA CA CA CA CA

93030-7648 93030-8288 93950-2746 90272-3233 90272-3549 90272-2844 90272-3720 91331-8324

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 76 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LAUREL CARE PHARMACY COACHELLA VALLEY PHARMACY CORNERSTONE PHARMACY DESERTRX PHARMACY FIRESIDE PHARMACY LA QUINTA PHARMACY PALM DESERT DRUGS RIVERS EDGE PHARMACY SAV-ON PHARMACY SUPER RX PHARMACY TOWN CENTER DRUGS DESERT HOSPITAL OP PHARMACY HERITAGE PHARMACY LAS PALMAS PHARMACY RALPHS SAV-ON DRUGS SUPER RX PHARMACY THE MEDICINE SHOPPE WHITE CROSS PHARMACY 1 AV PHARMACY ILAB PHARMACY PALMDALE MEDICAL PHARMACY SAV-ON PHARMACY MAXIMART PHARMACY MEDICAL PLAZA PHARMACY OWENS PHARMACY #21 PV DRUG STORE CCRX CHASE PHARMACY LIRAS PHARMACY MEDICAL GROUP PHARMACY NEW CENTURY PHARMACY VAN NUYS MEDICAL PHARMACY

Provider Name

(747) 225-3925 (760) 223-7188 (760) 200-0220 (760) 836-3738 (760) 346-1113 (760) 777-9902 (760) 636-5587 (760) 340-3248 (760) 346-2573 (760) 772-2764 (760) 341-3984 (760) 323-1001 (760) 416-7999 (760) 416-0830 (760) 327-4381 (760) 322-1131 (760) 318-7440 (760) 778-8870 (760) 322-6700 (661) 272-6970 (661) 230-9003 (661) 267-2638 (661) 274-9557 (650) 327-3922 (650) 326-2300 (530) 547-0936 (424) 327-2990 (818) 810-5603 (818) 810-5608 (818) 894-1171 (818) 787-4490 (818) 989-2333 (818) 810-6918

13678 VAN NUYS BLVD 77-932 COUNTRY CLUB DR #2-2 39575 WASHINGTON ST STE 103 73091 COUNTRY CLUB DR STE A4 73847 HIGHWAY 111 43875 WASHINGTON ST STE A 73261 HIGHWAY 111 STE 101 36919 COOK ST STE 102 74590 HIGHWAY 111 78210 VARNER RD 72624 EL PASEO STE A1 1180 N INDIAN CYN DR STE E140 275 N EL CIELO RD D405 555 E TACHEVAH DR STE 1W101 425 S SUNRISE WAY 1751 N SUNRISE WAY 1717 E VISTA CHINO 174 S SUNRISE WAY 1445 N SUNRISE WAY STE 100 38750 TRADE CENTER DR STE G 250 GRAND CYPRESS AVE STE 604 540 W PALMDALE BLVD # A 38727 TIERRA SUBIDA AVE 240 CAMBRIDGE AVE 211 QUARRY RD #108 9387 DESCHUTES RD STE 1 2325 PALOS VERDES DR W STE 220 8727 VAN NUYS BLVD STE 105 14427 CHASE ST, STE A 14400 ROSCOE BLVD 14860 ROSCOE BLVD STE 102 8227 WOODMAN AVE 8737 VAN NUYS BLVD UNIT B

PACOIMA PALM DESERT PALM DESERT PALM DESERT PALM DESERT PALM DESERT PALM DESERT PALM DESERT PALM DESERT PALM DESERT PALM DESERT PALM SPRINGS PALM SPRINGS PALM SPRINGS PALM SPRINGS PALM SPRINGS PALM SPRINGS PALM SPRINGS PALM SPRINGS PALMDALE PALMDALE PALMDALE PALMDALE PALO ALTO PALO ALTO PALO CEDRO PALOS VERDES ESTATES PANORAMA CITY PANORAMA CITY PANORAMA CITY PANORAMA CITY PANORAMA CITY PANORAMA CITY

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91331 92211-3407 92211 92260-2338 92260-4005 92211 92260 92211-6069 92260-3804 92211-4134 92260-3309 92262-4883 92262 92262-5772 92262-7663 92262-3408 92262-3569 92262-6737 92262-3700 93551-3787 93551-3675 93551-4232 93551-4248 94306-1504 94304 96073-9711 90274-2777 91402-2451 91402 91402-3001 91402-7904 91402-5426 91402-2401

FEATHER RIVER HOSPITAL OUTPATIENT PARADISE DRUG FOBI COMPREHENSIVE PHARMACY PARAMOUNT FAMILY PHARMACY SANTA MARIA PHARMACY SANTA MARIA PHARMACY ST. LUKE PHARMACY, INC ST. LUKE PHARMACY, INC

(530) 876-2525 (530) 877-4981 (562) 630-5700 (562) 531-1313 (562) 630-1620 (562) 790-8618 (562) 220-2793 (562) 220-2610

5125 SKYWAY 6240 CLARK RD STE B 7922 ROSECRANS AVE STE P2 8010 2ND ST 16249 PARAMOUNT BLVD STE A 16444 PARAMOUNT BLVD STE 105 16402 PARAMOUNT BLVD 16660 PARAMOUNT BLVD STE 106

PARADISE PARADISE PARAMOUNT PARAMOUNT PARAMOUNT PARAMOUNT PARAMOUNT PARAMOUNT

CA CA CA CA CA CA CA CA

95969-5624 95969-4167 90723-6009 90723-3404 90723 90723-5453 90723-5428 90723-5457

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 77 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FOX DRUG STORE UNITED HEALTH NTRS PHCY PARLIE

Provider Name

(559) 646-8888 (559) 646-3561

13699 E MANNING AVE STE 105 650 S ZEDIKER AVE BLDG 1

PARLIER PARLIER

CA CA

93648-9637 93648-2639

AHCS MENTAL HEALTH & WELLNESS INC AKHTAMAR PHARMACY ARARAT PHARMACY ARCADE LANE COMPOUNDING PHCY BROWN WELIN UNITED DRUGS CAL OAKS II HM PHARMACY CAL OAKS PHARMACY

(626) 794-1124 (626) 817-9828 (626) 798-6789 (626) 577-7979 (626) 795-5918 (626) 696-1583 (626) 795-5956

1377 N FAIR OAKS AVE 1729 E WASHINGTON BLVD 2611 E WASHINGTON BLVD 700 E COLORADO BLVD 937 E GREEN ST 625 S FAIR OAKS AVE STE 125 55 E CALIFORNIA BLVD # 103

PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA

CA CA CA CA CA CA CA

91103-2101 91104 91107-1412 91101-2102 91106-2906 91105-2615 91105-3954

COMMUNITY HEALTH ALLIANCE OF PASADE COMPREHENSIVE DERMATOLOGY CTR EXCLUSIVE MEDICAL PHARMACY FAIRMONT PHARMACY MICHAELS PHARMACY NOVA PHARMACY OLD PASADENA PHARMACY PASADENA CITY PHARMACY PHOENIX PHARMACY PHOENIX PLAZA PHARMACY RALPHS RALPHS

(626) 993-1222 (626) 793-7790 (626) 578-9991 (626) 793-1188 (626) 204-7420 (626) 583-8786 (626) 844-5000 (626) 797-6661 (626) 791-7600 (626) 229-8918 (626) 793-0531 (626) 351-6572

1855 N FAIR OAKS AVE 625 S FAIR OAKS AVE STE 200 65 N MADISON AVE 50 BELLEFONTAINE ST STE 103 960 E GREEN ST STE 152 290 N HILL AVE STE 4 155 S DE LACEY AVE APT 1000 1684 E WASHINGTON BLVD 2523 E WASHINGTON BLVD 800 FAIRMOUNT AVE STE #105 160 N LAKE AVE 3601 E FOOTHILL BLVD

PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA

CA CA CA CA CA CA CA CA CA CA CA CA

91103-1620 91105 91101 91105-3132 91106-2411 91106-1563 91105-4521 91104 91104-2044 91105-3151 91101-1836 91107-3121

RIGOR DERMATOLOGY & LASER CENTER ST LUKE'S PROFESSIONAL PHCY UNICARE PHARMACY & SUPPLY WASHINGTON PHARMACY BROOKLIN OAKS PHARMACY INC CHC PHARMACY PASO ROBLES SAV-ON DRUGS PATTERSON FAMILY PHARMACY SAVE MART PHARMACY MY TOWN PHARMACY NUEVO PHARMACY PERRIS HILLS PHARMACY VIP PHARMACY PHC PHARMACY RALEY'S PHARMACY SAVE MART PHARMACY PHELAN FAMILY PHARMACY THE MEDICINE SHOPPE

(626) 844-3884 (626) 791-7595 (626) 793-7771 (626) 791-5000 (805) 296-3370 (512) 596-2930 (805) 237-1803 (209) 892-8444 (209) 892-4545 (951) 943-1575 (951) 322-4700 (951) 657-9511 (951) 846-0022 (707) 559-7612 (707) 765-9100 (707) 762-1036 (760) 706-0130 (760) 868-2800

675 S ARROYO PKWY STE 100B 2554 E WASHINGTON BLVD STE B 301 S FAIR OAKS AVE 2487 E WASHINGTON BL STE F 597 12TH ST 416 SPRING ST 189 NIBLICK RD 47 S DEL PUERTO AVE 1035 SPERRY AVE 404 E 4TH ST 75 W NUEVO RD STE H 540 W 4TH ST STE 1 126 AVOCADO AVE STE 101 1179 N MCDOWELL BLVD 157 N MCDOWELL BLVD 939 LAKEVILLE ST 3936 PHELAN RD STE A1 4050 PHELAN RD STE 8

PASADENA PASADENA PASADENA PASADENA PASO ROBLES PASO ROBLES PASO ROBLES PATTERSON PATTERSON PERRIS PERRIS PERRIS PERRIS PETALUMA PETALUMA PETALUMA PHELAN PHELAN

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91105-3263 91107 91105-2561 91104 93446-2202 93446-3161 93446-4845 95363-2517 95363-9266 92570-2201 92571-0801 92570-2077 92571-2605 94954-6559 94954-2304 94952-3329 92371-4142 92371-4454

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 78 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

AP 6 PHARMACY COSLO PHARMACY PICO CARE PHARMACY RIVERA PHARMACY ST PAULS PHARMACY W & P PHARMACY INC PINE CONE DRUG SAVE MART PHARMACY WHITE CROSS PROFESSIONAL PHCY MODEL DRUG CITY CENTER PHARMACY INC ADVANCED THERAPEUTICS LLC MERUS HEALTH PLACENTIA LINDA PHARMACY RALPHS RALEY'S DRUG CENTER ROBINSONS PHARMACY

Provider Name

(562) 949-0748 (562) 287-8678 (562) 364-7922 (562) 949-4238 (562) 699-9690 (562) 566-3160 (209) 296-8777 (510) 758-6581 (510) 724-2333 (805) 481-5111 (925) 432-9770 (888) 603-8181 (714) 982-1708 (714) 993-3345 (714) 524-6200 (530) 622-6630 (530) 622-3186

6336 PASSONS BLVD 9301 TELEGRAPH RD 6650-6652 ROSEMEAD BLVD 9253 TELEGRAPH RD 8809 WHITTIER BLVD 9205 WHITTIER BLVD 19660 STATE HIGHWAY 88 1530 FITZGERALD DR 2160 APPIAN WAY STE 102 911 OAK PARK BLVD SUITE 101 1270 E LELAND RD STE 102 319 E PALM DR STE A&B 1150 E YORBA LINDA BLVD 1233 E YORBA LINDA BLVD 700 N ROSE DR 160 PLACERVILLE DR 359 MAIN ST

PICO RIVERA PICO RIVERA PICO RIVERA PICO RIVERA PICO RIVERA PICO RIVERA PINE GROVE PINOLE PINOLE PISMO BEACH PITTSBURG PLACENTIA PLACENTIA PLACENTIA PLACENTIA PLACERVILLE PLACERVILLE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90660-3355 90660-5424 90660-3533 90660-5423 90660-2657 90660-2450 95665-9458 94564-2229 94564-2524 93449-3405 94565 92870-3238 92870-3828 92870-3830 92870-7520 95667-3919 95667-5605

SHINGLE SPGS HLTH AND WELLNESS CTR SAN JOAQUIN DRUG INC PLAYA PHARMACY DIABLO VLY ONC AND HEM MED GRP THE MEDICINE SHOPPE PLEASANTON CUSTOM CARE PHCY RALEY'S DRUG CENTER SAVE MART PHARMACY STONERIDGE PROFESSIONAL PHCY

(530) 387-8005 (209) 382-1291 (310) 823-4500 (925) 677-5041 (925) 685-0147 (925) 846-4455 (925) 846-7944 (925) 462-3530 (925) 463-2248

5168 HONPIE RD 9215 E HWY 140 STE A 8131 W MANCHESTER AVE 400 TAYLOR BLVD STE 202 2100 MONUMENT BLVD 4271 1ST ST 5420 SUNOL BLVD 6155 W LAS POSITAS BLVD 5720 STONERIDGE MALL RD # 150

PLACERVILLE PLANADA PLAYA DEL REY PLEASANT HILL PLEASANT HILL PLEASANTON PLEASANTON PLEASANTON PLEASANTON

CA CA CA CA CA CA CA CA CA

95667 95365 90293-8211 94523-2147 94523-3489 94566-7123 94566-7701 94588-4939 94588-2876

VALLEY MEDICAL ONCOLOGY CONSULTANTS ARENA PHARMACY POINT RX ARTESIA MEDICAL PHARMACY BONITA FAMILY PHARMACY CBC MISSION PHARMACY EAST VALLEY PMQ PHARMACY 1 EXPRESS UNITED DRUGS EZRX PHARMACY HOLT PHARMACY ORANGE GROVE PHARMACY OWL DRUG PHILLIPS RANCH PHARMACY PHILLIPS RANCH PHARMACY

(925) 734-8130 (707) 882-3025 (844) 300-3244 (909) 623-0551 (909) 593-3400 (909) 865-1149 (626) 869-2472 (909) 398-1289 (909) 764-3060 (909) 620-1011 (909) 623-6429 (909) 623-0563 (909) 868-7363 (909) 766-8330

5725 W LAS POSITAS BLVD # 100 235 MAIN ST 139 W. RICHMOND AVE STE B 160 E ARTESIA ST STE 135 250 W BONITA AVE STE 110 716 E MISSION BLVD # A 1555 S GAREY AVE 752 E ARROW HWY 649 INDIAN HILL BLVD 1101 E HOLT AVE STE F 1770 N ORANGE GROVE AVE # 100 728 FAIRPLEX DR 3038 W TEMPLE AVE 3040 W TEMPLE AVE

PLEASANTON POINT ARENA POINT RICHMOND POMONA POMONA POMONA POMONA POMONA POMONA POMONA POMONA POMONA POMONA POMONA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94588-4007 95468 94801 91767-2924 91767-1863 91766-2040 91766-5222 91767-2247 91767 91767-5800 91767-3027 91768-1100 91766-6816 91766-6816

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 79 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROYALTY PHARMACY SAN ANTONIO PHCY AT CASA COLINA SANTA MARIA PHARMACY WESTERN UNIVERSITY PHARMACY PORTER RANCH PHARMACY RALPHS FAMILY PHARMACY PORTERVILLE PHARMACY SAVE MART PHARMACY PORTOLA VILLAGE PHARMACY 1ST CHOICE PHARMACY SAN DIEGO OPTIMUM QUINCY PHARMACY SAV-ON PHARMACY TRI STAR PHARMACY ABC PHARMACY CUCAMONGA COMMUNITY PHARMACY CUCAMONGA PHARMACY DK PHARMACY HAVEN PHARMACY HOMES PHARMACY PARKVIEW PHARMACY QUICK CARE PHARMACY INC RALPHS RALPHS SAV-ON PHARMACY SIERRA PHARMACY UNITED PHARMACY YOUR DRUG STORE

Provider Name

(909) 620-8008 (909) 962-6430 (909) 993-0240 (909) 706-3730 (818) 360-1915 (818) 832-3156 (559) 791-1400 (559) 793-4410 (559) 781-1590 (530) 832-4218 (858) 218-3180 (858) 433-1011 (530) 283-4545 (760) 789-0094 (916) 476-4260 (909) 285-1118 (909) 948-8377 (909) 987-2518 (909) 493-1500 (909) 989-2899 (909) 989-8688 (909) 981-0956 (866) 393-8116 (909) 484-2647 (909) 646-9366 (208) 395-3906 (909) 989-9800 (909) 941-6942 (909) 941-7472

1902 ROYALTY DR STE 110 255 E BONITA AVE BLDG 1 #102 2288 S GAREY AVE 795 E 2ND ST STE 1 11167 TAMPA AVE 19761 RINALDI ST 301A E OLIVE AVE 406 W PUTNAM AVE 900 W HENDERSON AVE 157 COMMERCIAL ST 13025 POMERADO ROAD #A 12265 SCRIPPS POWAY PKWY STE 1 411 MAIN ST 1459 MAIN ST 1995 ZINFANDEL DR STE 101 7974 HAVEN AVE 7777 MILLIKEN AVE # B 9349 FOOTHILL BLVD STE A 10431 LEMON AVE STE G 9170 HAVEN AVE STE 122 9713 BASELINE RD 8283 GROVE AVE STE 105 9397 HAVEN AVE 7368 MILLIKEN AVE 12201 HIGHLAND AVE 8850 FOOTHILL BLVD 8661 BASELINE RD 10841 WHITE OAK AVE STE 101 8237 ROCHESTER AVE STE 120

POMONA POMONA POMONA POMONA PORTER RANCH PORTER RANCH PORTERVILLE PORTERVILLE PORTERVILLE PORTOLA POWAY POWAY QUINCY RAMONA RANCHO CORDOVA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA RANCHO CUCAMONGA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91767-3036 91767 91766-5645 91766-2007 91326-2254 91326-4143 93257-4871 93257-3321 93257-1704 96122-9606 92064 92064-6150 95971-9120 92065-2128 95670-2862 91730-3052 91730-6780 91730-3567 91737-3763 91730-5416 91730-1408 91730-3139 91730-5336 91730-6793 91739-2573 91730-3334 91730 91730-3811 91730-0717

DESERT HEMATOLOGY ONCOLOGY MED GRP GELSON'S PHARMACY RIVER'S EDGE COMMUNITY PHARMACY SAV-ON DRUGS VIVARX GOLDEN COVE PHCY & HOME HLTHCR RALPHS RANCHO SANTA FE PHARMACY MEDSRX INC PAVILIONS PHARMACY ELMORE PHARMACY OWENS HEALTHCARE

(760) 568-3613 (760) 321-1006 (760) 832-6287 (760) 674-4738 (760) 610-6512 (310) 750-6082 (310) 377-6829 (858) 756-3096 (949) 303-1053 (949) 858-0670 (530) 527-4636 (530) 527-4275

39800 BOB HOPE DR # C 36-101 BOB HOPE DR 35400 BOB HOPE DR STE 207 40101 MONTEREY AVE 72780 COUNTRY CLUB DR STE 403 31238 PALOS VERDES DR W 30019 HAWTHORNE BLVD 6056 EL TORDO 29851 AVENTURA STE J1 22451 ANTONIO PKWY 401 WALNUT ST 434 WALNUT ST # 5

RANCHO MIRAGE RANCHO MIRAGE RANCHO MIRAGE RANCHO MIRAGE RANCHO MIRAGE RANCHO PALOS VERDES RANCHO PALOS VERDES RANCHO SANTA FE RANCHO SANTA MARGARITA RANCHO SANTA MARGARITA RED BLUFF RED BLUFF

CA CA CA CA CA CA CA CA CA CA CA CA

92270-3920 92270-2001 92270-1774 92270-3261 92270-4149 90275 90275-5467 92067 92688-2014 92688-2813 96080-3319 96080-3348

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 80 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name OWENS HEALTHCARE RALEY'S DRUG CENTER OWENS PHARMACY LIM'S FAMILY PHARMACY INC OWENS HEALTHCARE OWENS HEALTHCARE OWENS HEALTHCARE OWENS HEALTHCARE OWENS HEALTHCARE OWENS HEALTHCARE #8 RALEY'S DRUG CENTER REDDING RANCHERIA I.H.S. PHCY ABC PHARMACY BEEMAN'S REDLANDS PHARMACY BRAND NEW PHARMACY INC CAJON PHARMACY CITRUS PHARMACY REDLANDS PHARMACY SAV-ON PHARMACY KOVACS- FREY PHARMACY PILL BOX DRUG RALPHS SOUTH BAY PHARMACY SUNNY BAY PHARMACY BERKSHIRE PHARMACY NOB HILL PHARMACY THE PILL CLUB REEDLEY PRO-SCRIPT PHARMACY CAREQUEST PHARMACY DR IKE'S PHARMACY #1 RESEDA PHARMACY INC SAV-ON PHARMACY VALLEY MARKET PHARMACY VICTORY TAMPA MEDICAL PHARMACY VINA PHARMACY ABC PHARMACY NORTH RIALTO DRUG YOUR DRUG STORE CAREZONE PHARMACY CENTRAL PHARMACY CENTER PROFESSIONAL PHARMACY SAV-ON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (530) 528-7690 (530) 527-2137 (530) 241-3550 (530) 241-8700 (530) 244-8600 (530) 243-4336 (530) 241-6633 (530) 226-5530 (530) 351-7050 (530) 244-8669 (530) 246-3511 (530) 224-2700 (909) 726-3080 (909) 792-2300 (909) 335-5400 (909) 792-4922 (909) 793-8259 (909) 792-8118 (909) 793-2218 (310) 371-7541 (310) 378-9487 (310) 370-8784 (310) 379-9885 (310) 944-9466 (650) 216-9800 (650) 631-1685 (650) 562-7271 (559) 637-7000 (818) 435-4444 (818) 578-7400 (818) 708-3030 (818) 885-1525 (818) 774-9300 (818) 345-6111 (818) 345-6534 (909) 546-1000 (909) 875-2131 (909) 546-1300 (844) 792-2739 (510) 234-4381 (760) 446-4141 (760) 384-4020

Provider Street 1050 S MAIN ST 727 S MAIN ST 2025 COURT ST STE E 1035 PLACER ST STE 110 1002 PLACER ST 2025 COURT ST STE A 2510 AIRPARK DR STE 204 2880 CHURN CREEK RD STE A 317 LAKE BLVD STE B 2025 COURT ST STE B 201 LAKE BLVD UNIT B 1441 LIBERTY ST 1600 E CITRUS AVE STE K 255 TERRACINA BLVD 1819 W REDLANDS BLVD STE 101 232 CAJON ST STE A 511 AMIGOS DR STE B 245 TERRACINA BLVD STE 201 450 E CYPRESS AVE 2860 ARTESIA BLVD 165 PALOS VERDES BLVD 1413 HAWTHORNE BLVD 520 N PROSPECT AVE STE 101 500 TORRANCE BLVD 11 BERKSHIRE AVE 270 REDWOOD SHORES PKWY 133 ARCH ST STE 7 1045 G STREET 6901 CANBY AVE STE 108 7640 TAMPA AVE STE E 6900 RESEDA BLVD STE E 19307 SATICOY ST 18353 VANOWEN ST SUITE J 19300 VANOWEN ST 18541 SHERMAN WAY STE 103 826 E FOOTHILL BLVD 531 E FOOTHILL BLVD 1850 N RIVERSIDE AVE STE 170 860 HARBOUR WAY S STE E 2300 MACDONALD AVE 1109 N CHINA LAKE BLVD 927 S CHINA LAKE BLVD

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Provider City RED BLUFF RED BLUFF REDDDING REDDING REDDING REDDING REDDING REDDING REDDING REDDING REDDING REDDING REDLANDS REDLANDS REDLANDS REDLANDS REDLANDS REDLANDS REDLANDS REDONDO BEACH REDONDO BEACH REDONDO BEACH REDONDO BEACH REDONDO BEACH REDWOOD CITY REDWOOD CITY REDWOOD CITY REEDLEY RESEDA RESEDA RESEDA RESEDA RESEDA RESEDA RESEDA RIALTO RIALTO RIALTO RICHMOND RICHMOND RIDGECREST RIDGECREST

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

96080-4363 96080-4338 96001-1805 96001-1125 96001-1124 96001-1805 96001-2461 96002-1168 96003-2504 96001-1821 96003-2506 96001-0848 92374-4218 92373-4870 92373-3121 92373-5216 92373-6283 92373-4867 92373-6115 90278-3421 90277-5808 90278-3923 90277-3033 90277-3413 94063-3632 94065-1173 94062-1326 93654-2935 91335-4391 91335-1735 91335-4270 91335-2330 91335 91335 91335-4166 92376-5230 92376-5223 92376-8056 94804-3648 94804-1821 93555-3131 93555-6315

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SAVE MART PHARMACY RIVERBANK PHARMACY SAVE MART PHARMACY RIVERDALE DRUG ABC PHARMACY AQUA PHARMACY ARLINGTON MEDICA PHARMACY ARLINGTON PRESCRIPTION PHCY CARE PLUS PHARMACY CENTRAL BEST PHARMACY COMMUNITY CARE PHARMACY COMMUNITY PROFESSIONAL PHCY CRESCENT HEALTHCARE INC EMPIRE PHARMACY GOLDEN HEALTH PHARMACY ICAREMORE PHARMACY INC JC NEIGHBORHOOD PHARMACY JURUPA VALLEY PHARMACY PARKE VISTA PHARMACY PARKVIEW MEDICAL PLAZA PHARMACY PARKVIEW MEDICAL PLZ PHCY LTC PHARMACY EXPRESS RAINCROSS PHARMACY RALPHS

Provider Name

(209) 599-3363 (209) 863-9988 (209) 863-1483 (559) 867-3013 (951) 299-9922 (951) 683-2600 (951) 240-5555 (951) 688-5232 (951) 324-1610 (951) 823-0273 (951) 682-1063 (951) 683-1200 (800) 735-4872 (951) 530-8800 (951) 289-9916 (951) 299-7100 (951) 977-9643 (951) 332-2235 (951) 687-4203 (951) 637-0180 (951) 637-7054 (951) 683-2172 (951) 788-4646 (951) 637-9819

1453 GOODWIN DR 2603 PATTERSON RD STE 9 2237 CLARIBEL RD 3462 W MOUNT WHITNEY 777 W BLAINE ST 4336 MARKET ST 8207 ARLINGTON AVE STE A 8990 GARFIELD ST #12 4990 ARLINGTON AVE STE A 4100 CENTRAL AVE STE 100 4440 BROCKTON AVE 4510 BROCKTON AVE STE 107 2010 IOWA AVE STE 110 1340 MASSACHUSETTS AVE 2392 UNIVERSITY AVE 9493 GARFIELD ST 8151 ARLINGTON AVE STE T 7990 LIMONITE AVE STE F 3838 SHERMAN DR STE 1 3975 JACKSON ST STE 109 3975 JACKSON ST STE 111 5575 MISSION BLVD 4646 BROCKTON AVE 3350 LA SIERRA AVE

RIPON RIVERBANK RIVERBANK RIVERDALE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95366 95367-3407 95367-9473 93656-9767 92507-3940 92501-3518 92503-0429 92503-3922 92504-2757 92506-2933 92501-4068 92501-4051 92507-7433 92507-2834 92507-4266 92503-3765 92503-0437 92509-0108 92503-4001 92503-3946 92503-3946 92509-4503 92506 92503-5228

RIVERSIDE CNTY REG MED CTR MENTAL

(951) 358-4958

9990 COUNTY FARM RD. SUITE 2-P

RIVERSIDE

CA

92503

RIVERSIDE NEIGHBORHOOD HTH CTR PHCY RIVERSIDE PHARMACY & CMPDING RIVERWALK PHARMACY RX EXPRESS PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SPENCERS PRESCRIPTION PHARMACY TAP PHARMACY THE MEDICINE SHOPPE BEL AIR PHARMACY H&H INTEGRATIVE PHARMACY SAVE MART PHARMACY RALEY'S DRUG CENTER PAVILIONS PHARMACY SKINNER'S RX PHARMACY

(951) 358-4958 (951) 343-1633 (951) 352-3030 (951) 785-5386 (951) 689-2370 (909) 656-3394 (951) 686-7373 (951) 406-1521 (951) 509-9277 (916) 632-0184 (916) 259-2558 (916) 435-2882 (707) 585-3444 (310) 541-1915 (310) 377-4871

7140 INDIANA AVE 9448 MAGNOLIA AVE STE B 4234 RIVERWALK PARKWAY STE 130 6160 ARLINGTON AVE STE C14 2975 VAN BUREN BLVD 8939 TRAUTWEIN RD 6942 BROCKTON AVE 4270 RIVERWALK PKWY STE 102 10237 MAGNOLIA AVE 2341 SUNSET BLVD 1240 SUNSET BLVD STE 500 3021 STANFORD RANCH RD 125 RALEYS TOWNE CTR 7 PENINSULA CTR 905 DEEP VALLEY DR

RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE RIVERSIDE ROCKLIN ROCKLIN ROCKLIN ROHNERT PARK ROLLING HILLS ESTATES ROLLING HILLS ESTATES

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92504 92503-3746 92505 92504-1922 92503-5672 92508-9473 92506-3802 92505-3374 92503-3440 95765-4337 95765 95765-5537 94928-2440 90274-3506 90274-3808

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Provider Phone Number

Provider Street

Page 82 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROSAMOND PHARMACY 986 PHARMACY DEL MAR PHARMACY DONG TAM PHARMACY GARVEY UNITED DRUGS HAPPY PHARMACY LA PHARMACY OMNI HEALTHCARE SOLUTIONS PAYLESS PHARMACY ROBERT PHARMACY ROSA II PHARMACY ROSA PHARMACY V N PHARMACY WATSONS PHCY AND HOME HEALTH BEL AIR PHARMACY BEL AIR PHARMACY RALEY'S DRUG CENTER RALEY'S PHARMACY REMEDY RX SAVE MART PHARMACY CALIFORNIA PHARMACY DDE PHARMACY EASTLAND PHARMACY MANNING UNITED DRUGS NEW LIFE PHARMACY NOGALES PHARMACY ACARIAHEALTH PHARMACY #14, INC.

Provider Name

(661) 256-1118 (626) 988-0106 (626) 927-9773 (626) 572-2929 (626) 571-1359 (626) 872-0103 (626) 572-8255 (626) 288-2878 (626) 287-2889 (626) 307-5501 (626) 286-8931 (626) 573-9477 (626) 307-2711 (626) 280-2223 (916) 786-6104 (916) 783-1174 (916) 781-7840 (916) 771-3344 (916) 740-1600 (916) 782-2720 (909) 598-9885 (626) 581-3133 (626) 810-1056 (626) 810-8211 (626) 839-3000 (626) 810-2240 (916) 927-0336

1415 W ROSAMOND BLVD STE 22 8054 GARVEY AVE STE 101 9008 GARVEY AVE STE A 3163 SAN GABRIEL BLVD STE 103 7837 GARVEY AVE STE 100A 9143 VALLEY BLVD STE 101B 2630 SAN GABRIEL BLVD STE 106 3109 DEL MAR AVE 8841 VALLEY BLVD 9126 VALLEY BLVD #A 8729 VALLEY BLVD 9200 VALLEY BLVD 8244 GARVEY AVE # B 8622 GARVEY STE 102 1039 SUNRISE AVE 4008 FOOTHILLS BLVD 1915 DOUGLAS BLVD STE 200 4051 WOODCREEK OAKS BLVD 1420 E ROSEVILLE PKWY #130 5060 FOOTHILLS BLVD 19766 COLIMA RD 18491 COLIMA RD 18339 E COLIMA RD STE A 1724 NOGALES ST 1722 DESIRE AVE STE 103 1015 NOGALES ST STE 124 4225 NORTHGATE BLVD STE 2

ROSAMOND ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEMEAD ROSEVILLE ROSEVILLE ROSEVILLE ROSEVILLE ROSEVILLE ROSEVILLE ROWLAND HEIGHTS ROWLAND HEIGHTS ROWLAND HEIGHTS ROWLAND HEIGHTS ROWLAND HEIGHTS ROWLAND HEIGHTS SACRAMENTO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

93560-7429 91770-2449 91770 91770-2586 91770-3059 91770-1993 91770-5204 91770 91770-1713 91770-1920 91770-1743 91770-1900 91770-2566 91770 95661-7004 95747-7233 95661-3833 95747-6812 95661-3081 95747-6500 91748-3265 91748-2805 91748-2792 91748-2943 91748-2969 91748-1311 95834-1233

ALLWELL PHARMACY AND MED SUP. LLC ANDERSON BROS FLORIN SQ PHCY ANDERSON BROTHERS PHARMACY AVELLA OF SACRAMENTO INC BEL AIR PHARMACY BEL AIR PHARMACY BEL AIR PHARMACY BEL AIR PHARMACY C & M PHARMACY FOLSOM PHARMACY GREENHAVEN PHARMACY HEART CENTER PHARMACY HEART CENTER PHARMACY KIM PHARMACY

(916) 457-2905 (916) 428-3794 (916) 489-3638 (916) 564-9888 (916) 419-4442 (916) 399-9060 (916) 920-3558 (916) 972-7028 (916) 928-6183 (916) 364-9900 (916) 378-5757 (916) 238-3118 (916) 900-2114 (916) 469-9813

5611 STOCKTON BLVD 2374 FLORIN RD 2900 FULTON AVE 2288 AUBURN BLVD #102 3250 ARENA BLVD 7465 RUSH RIVER DR 1540 W EL CAMINO AVE 4320 ARDEN WAY 4195 NORWOOD AVE 9545 FOLSOM BLVD STE 7 7248 S LAND PARK DR STE 116 1740 FRUITRIDGE RD # 104 500 UNIVERSITY AVE STE 110 5026 FRUITRIDGE RD #3

SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95824-1611 95822-4403 95821-4910 95821-1619 95834 95831-5255 95833-1946 95864-3103 95838-2623 95827-1209 95831-3661 95822-3067 95825-6504 95820-5302

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Provider Phone Number

Provider Street

Page 83 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name KIM PHARMACY KNOTTS PHARMACY LOTUS PHARMACY INC MASON PHARMACY MED-AID PHARMACY MEDCARE PHARMACY MERCY PHARMACY METHODIST HOSPITAL OF SAC MIDTOWN PHARMACY NATOMAS PHARMACY OPTION CARE PARKSIDE PHARMACY PAYLESS PHARMACY PROFESSIONAL VILLAGE PHARMACY PUCCI'S PHARMACY RALEY'S RALEY'S DRUG CENTER RALEY'S DRUG CENTER RALEY'S DRUG CENTER RALEY'S DRUG CENTER SACRAMENTO PHARMACY INC. SACRAMENTO ST STU HLT SRV PHCY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SPINE & NERVE DIAGNOSTIC CTR THANH THUY PHARMACY THE PHARMACY AT CARES THU PHARMACY TIMBERLAKE PHARMACY VALLEY PHARMACY OF SACRAMENTO VANGS PHARMACY INC WELL-CARE PHARMACY DEER PARK PHARMACY SMITHS PHARMACY VASCONIS PHARMACY A & O CLINIC PHARMACY A AND O COMPOUNDING PHARMACY ALISAL PHARMACY ALLCARE PHARMACY LOS PALOS GSTRLGY ANCILLARY SVC NOB HILL PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (916) 392-3488 (916) 455-3068 (916) 422-5675 (916) 428-7500 (916) 736-3188 (916) 706-2400 (916) 733-6970 (916) 423-6052 (916) 452-3454 (916) 575-7827 (916) 452-3253 (916) 452-2200 (916) 624-9900 (916) 483-3455 (916) 442-5891 (916) 413-6644 (916) 421-3267 (916) 972-7198 (916) 452-3811 (916) 383-4541 (916) 993-9980 (916) 278-6040 (916) 484-7016 (916) 689-8300 (916) 646-1407 (916) 419-9900 (916) 391-7210 (916) 914-6256 (916) 395-0352 (916) 760-2470 (916) 423-2098 (916) 393-5961 (916) 649-1615 (707) 963-5209 (707) 963-2794 (707) 963-1444 (831) 758-0976 (831) 769-0458 (831) 424-7321 (831) 424-8053 (831) 771-1458 (831) 759-2163

Provider Street 6665 STOCKTON BLVD # 6 706 56TH ST # 170 6540 STOCKTON BLVD 4600 47TH AVE STE 110 3100 STOCKTON BLVD 4241 FLORIN RD STE 50A 3941 J ST 7500 HOSPITAL DR 3701 J ST 2087 ARENA BLVD STE 160 5491 CARLSON DR 4404 DEL RIO RD 2303 NORTHGATE BLVD 1701 PROFESSIONAL DR 2821 J ST 4650 NATOMAS BLVD 4551 MACK RD 3518 MARCONI AVE 4850 FREEPORT BLVD 8391 FOLSOM BLVD 2925 FULTON AVE 6000 J STREET 2501 FAIR OAKS BLVD 7960 GERBER RD 3291 TRUXEL RD 4420 DUCKHORN DR STE 200 6830 STOCKTON BLVD STE 160 2000 O ST 6590 STOCKTON BLVD B 8100 TIMBERLAKE WAY STE A 7600 HOSPITAL DR STE A 7260 E SOUTHGATE DR STE E 3645 NORTHGATE BLVD STE F 6 WOODLAND RD STE 100 1390 RAILROAD AVE 1381 MAIN ST 610 E ROMIE LN STE 1 680 E ROMIE LN STE E 323 N SANBORN RD 331 MAIN ST 1081 LOS PALOS DR 1320 S MAIN ST

Page 84 of 679

Provider City SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SACRAMENTO SAINT HELENA SAINT HELENA SAINT HELENA SALINAS SALINAS SALINAS SALINAS SALINAS SALINAS

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95823-1634 95819-3337 95823-1635 95824-3923 95820-1417 95823-2535 95819-3624 95823-5403 95816-5542 95834 95819-2435 95822-1126 95833-2504 95825-2104 95816-4315 95835-1217 95823 95821-5302 95822-2102 95826-3538 95821-4909 95819 95825-7685 95828-4352 95833-1013 95834-2590 95823-2392 95811-5224 95823 95823-5409 95823-5406 95823-2609 95834-1641 94574-9501 94574-1124 94574-1904 93901-4209 93901-4206 93905-2247 93901-2705 93901-3916 93901-2109

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROMIE LANE HEALTH MART PHARMA SHERMAN'S APOTHECARY PHARMACY STAR PHARMACY KELLYS DRUG STORE JACKS DRUG STORE AMERICAN SURGICAL PHARMACY BEEMANS HIGHLAND PHARMACY BEEMANS RX PHARMACY CBC COMMUNITY PHARMACY DELTA DRUGS DONS DRUG FAMILY PHARMACY GUARDIAN PHARMACY

Provider Name

(831) 424-0395 (831) 422-5988 (831) 621-5558 (209) 754-3595 (415) 454-1451 (909) 882-3353 (909) 886-6851 (909) 882-3719 (909) 887-6359 (909) 887-7989 (909) 884-0128 (909) 884-2739 (909) 570-2339

505 E ROMIE LN STE H 1212 S MAIN ST STE 101 1273 SO. MAIN STREET 64 E SAINT CHARLES ST 121 TUNSTEAD AVE 103 E HIGHLAND AVE 399 E HIGHLAND AVE 355 E 21ST ST 1800 WESTERN AVE 1666 MEDICAL CENTER DR STE 1 1222 W 5TH ST 1033 N WATERMAN AVE STE C 1823 COMMERCENTER W

SALINAS SALINAS SALINAS SAN ANDREAS SAN ANSELMO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO

CA CA CA CA CA CA CA CA CA CA CA CA CA

93901-4031 93901-2286 93901 95249 94960-2616 92404 92404-3808 92404-4851 92411-1356 92411-1257 92411-2759 92410-3808 92408-3303

LOMA LINDA UNIVERSITY HOME DELIVERY LOMA LINDA UNIVERSITY PHARMACY OB PHARMACY PEARSONS MEDICAL GROUP PHCY RESOURCE PHARMACY SIERRA PHARMACY WATERMAN PHARMACY CARE4U HEALTH MART PHARMACY DAVITA RX LLC SAVE MART PHARMACY ALPHASCRIPT SAVE MART PHARMACY RALPHS PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SEA VIEW PHARMACY AHF PHARMACY ALLEN UNITED DRUGS ALVARADO COMMUNITY PHARMACY BALBOA PHARMACY CARE PHARMACY CARMEL VALLEY PHARMACY CHILDRENS MEDICAL CENTER PHCY COMMUNITY MEDICAL CENTER PHCY CRESCENT HEALTHCARE INC DAWN PHARMACY FROST MEDICAL PHARMACY GALLOWAYS MEDICAL CENTER PHY

(909) 651-4705 (909) 771-2999 (909) 888-9411 (909) 883-3088 (909) 884-5555 (909) 475-4250 (909) 882-5800 (650) 226-8002 (650) 238-1240 (650) 742-9737 (800) 780-3584 (650) 637-1788 (949) 940-0167 (949) 369-5596 (949) 492-9448 (949) 496-0123 (619) 574-9700 (619) 232-8101 (619) 287-7697 (858) 278-0111 (619) 501-8046 (858) 481-4990 (858) 966-4060 (619) 262-4373 (800) 736-4872 (619) 287-1206 (858) 560-1911 (619) 525-1551

125 E. CLUB CENTER DR STE 1500 250 S G ST 618 S MOUNT VERNON AVE STE 136 1700 N WATERMAN AVE 1535 S D ST STE 230 4108 N SIERRA WAY 2150 N WATERMAN AVE STE 104 474 SAN MATEO AVE 1178 CHERRY AVE 1322 EL CAMINO REAL 1160 INDUSTRIAL RD STE 17 1133 OLD COUNTY RD 811 AVENIDA TALEGA 989 AVENIDA PICO 804 E AVENIDA PICO 665 CAMINO DE LOS MARES #101 3940 FOURTH AVE # 150 1141 6TH AVE 6367 ALVARADO CT 6465 BALBOA AVE STE 101 5065 EL CAJON BLVD 12750 CARMEL COUNTRY RD # A101 3030 CHILDRENS WAY STE 108 610 GATEWAY CTR WAY STE A-E 10070 CARROLL CANYON RD STE 10 4776 EL CAJON BLVD STE 105 7910 FROST ST STE 130 2995 NATIONAL AVE

SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BERNARDINO SAN BRUNO SAN BRUNO SAN BRUNO SAN CARLOS SAN CARLOS SAN CLEMENTE SAN CLEMENTE SAN CLEMENTE SAN CLEMENTE SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92408 92410-3320 92410 92404-5115 92408-3253 92407-3825 92404-4811 94066 94066-2302 94066-1304 94070-4128 94070-4009 92673 92673-3908 92673-5624 92673-2840 92103 92101-5203 92120-4904 92111 92115-3348 92130-2159 92123-4226 92102 92131-1134 92115-4521 92123 92113-2419

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 85 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GOOD MORNING PHARMACY GOOD PHARMA COMPOUNDING PHCY HILLCREST PHARMACY JP PHARMACY LA VITA COMPOUNDING PHARMACY LINDA VISTA PHARMACY MEDICAL CENTER PHARMACY

Provider Name

(858) 268-1660 (858) 488-9000 (619) 260-1010 (858) 271-0014 (858) 453-2500 (858) 277-6147 (619) 819-2200

7655 CLAIREMONT MESA BL STE 30 951 TURQUOISE ST 120 UNIVERSITY AVE 9188 MIRA MESA BLVD 3978 SORRENTO VALLEY BLVD #300 2361 ULRIC ST 286 EUCLID AVENUE STE 206

SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO

CA CA CA CA CA CA CA

92111 92109-1192 92103-3007 92126-4804 92121-1436 92111-6402 92114

MEDICAL ONCOLOGY ASSOC OF SAN DIEGO MKT PHARMACY NGUYEN HIEN PHARMACY PARADISE HILLS PHARMACY PARK BOULEVARD PHARMACY PHILLIP PHARMACY POINT LOMA CABRILLO DRUG PRIDE PHARMACY PT LOMA SHELTER ISL UNTD DRUG RALPHS RALPHS RALPHS RALPHS RALPHS RANCHO PHARMACY RIVERS EDGE COMMUNITY RONS PHARMACY SERVICES ROYAL PHARMACY GROUP SAN DIEGO COMPOUNDING PHCY SAV ON PHARMACY SAV-ON PHARMACY

(858) 637-7888 (619) 693-5860 (619) 521-0013 (619) 470-3710 (619) 295-3109 (619) 458-3660 (619) 630-2710 (619) 501-5888 (619) 223-7171 (619) 225-1631 (858) 675-7028 (619) 237-7660 (619) 298-5181 (619) 237-2108 (858) 240-7378 (858) 485-9333 (858) 652-6900 (619) 282-1338 (858) 277-8884 (619) 237-9127 (858) 385-9229

3075 HEALTH CENTER DR STE 102 4153-B UNIVERSITY AVE 4242 EL CAJON BLVD 5865 CUMBERLAND ST 3904 PARK BLVD 5507 EL CAJON BLVD STE E 955 CATALINA BLVD STE 102A 1270 UNIVERSITY AVE 1105 ROSECRANS ST 3515 SPORTS ARENA BLVD 10525 4S COMMONS DR 101 G ST 1020 UNIVERSITY AVE 4315 MISSION BLVD 9912 CARMEL MOUNTAIN RD STE E 15721 BERNARDO HTS PKY STE L 10140 BARNES CANYON RD 4419 47TH ST 5395 RUFFIN RD STE 104 655 14TH ST 12475 RANCHO BERNARDO RD

SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92123-2773 92105 92105-1230 92139-3043 92103-3502 92115-3624 92106-2881 92103-3312 92106-2629 92110 92127 92101-6833 92103-7325 92109-3917 92129-2808 92128-3176 92121 92115 92123-1338 92101 92128-2143

SCRIPPS HEALTH MERCY AMBULATORY PHY SHARP REES STEALY PHARMACY SHARP REES STEALY PHARMACY SHARP REES STEALY PHARMACY SHARP REES STEALY PHARMACY THE MEDICINE SHOPPE UCSD HOME INFUSION PHARMACY UCSD MEDICAL CENTER PHARMACY

(858) 678-7111 (619) 446-1512 (858) 526-6080 (858) 939-6540 (619) 446-1515 (619) 470-4550 (619) 543-5231 (619) 543-3279

4060 4TH AVE, SUITE 110 300 FIR ST 10243 GENETIC CENTER DR 2929 HEALTH CENTER DR 16899 WEST BERNARDO DR 2939 ALTA VIEW DR 9610 RIDGEHAVEN CT STE A 200 W ARBOR DR DEPT 8765

SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO SAN DIEGO

CA CA CA CA CA CA CA CA

92103 92101 92121 92123-2762 92127-1603 92139-3394 92123-5603 92103-8765

UCSD MEDICAL OFFICES SOUTH PHARMACY

(619) 543-5934

4168 FRONT ST # 1-127

SAN DIEGO

CA

92103-2030

UNIVERSITY COMPOUNDING PHARMACY

(619) 683-2005

1875 3RD AVE

SAN DIEGO

CA

92101-2604

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 86 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

VIET PHCY & MEDICAL SUPPLIES WELLNESSRX PHARMACY WHITE CROSS PHARMACY SAN DIMAS PHARMACY SAV-ON PHARMACY VIA VERDE PRESCRIPTION SHOPPE ABSOLUTE CARE CASA BLANCA PHARMACY MINTWOOD PHARMACY NORTH VALLEY PHCY AND MED SUPP YM DRUGS INC AHF PHARMACY B & B PHARMACY CENTRAL DRUG STORE CHARLIE'S DRUG STORE CLAY MEDICAL PHARMACY COMMUNITY PHARMACY DANIEL'S PHARMACY FRANKLIN PHARMACY GEARY PHARMACY GOLDEN GATE PHARMACY GOOD LIFE RX PHARMACY GREEN HOUSE PHARMACY JOE'S PHARMACY KOSHLAND PHARM MISSION WELLNESS PHARMACY NEMS - CLEMENT PHARMACY

Provider Name

(619) 563-8212 (619) 582-1933 (619) 284-1141 (909) 599-8369 (909) 599-8874 (909) 599-3444 (818) 365-0422 (818) 698-4390 (818) 363-8108 (818) 365-5300 (818) 256-1999 (415) 255-2720 (415) 674-8116 (415) 585-0111 (415) 567-0771 (415) 956-5456 (415) 648-0815 (415) 584-2210 (415) 775-3917 (415) 752-1469 (415) 661-0790 (415) 922-0777 (415) 665-7775 (415) 751-2326 (415) 344-0600 (415) 826-3484 (415) 391-9686

4616 EL CAJON BLVD STE 6 5971 UNIVERSITY AVE STE 304 4074 FAIRMOUNT AVE 1330 W COVINA BLVD 220 E BONITA AVE 1152 VIA VERDE 541 N MACLAY AVE STE 104 2012 GLENOAKS BLVD 774 N MACLAY AVE # B 11541 LAUREL CANYON BLVD STE C 1015 TRUMAN ST 4071 18TH ST 1727 FILLMORE ST # A 4494 MISSION ST 1101 FILLMORE ST 929 CLAY ST 2462 MISSION ST 943 GENEVA AVE 1508 FRANKLIN ST 5427 GEARY BLVD 1844 NORIEGA ST 731 LARKIN ST 1516 NORIEGA ST 5199 GEARY BLVD 301 FOLSOM ST STE B 2424 MISSION STREET 1019 CLEMENT ST

SAN DIEGO SAN DIEGO SAN DIEGO SAN DIMAS SAN DIMAS SAN DIMAS SAN FERNANDO SAN FERNANDO SAN FERNANDO SAN FERNANDO SAN FERNANDO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92115-4426 92115-6348 92105-1608 91773-3200 91773-3186 91773-4401 91340-2478 91340 91340-2143 91340-4602 91340-3317 94114-2535 94115-3167 94112-1950 94115-4711 94108-1556 94110-2415 94112-3402 94109-4523 94121-2306 94122-4324 94109-7149 94122-4434 94118-2815 94105-2309 94110 94118-2112

PACIFIC HEMATALOGY ONCOLOGY ASSOC PARNASSUS HEIGHTS PHARMACY PHARMACA INTERGRATIVE PHARMACY POST & DIVISADERO MEDICAL PHCY SAVE MART PHARMACY SAVE MART PHARMACY SCRIPTDASH SCRIPTSITE PHARMACY SF ONCOLOGY ASSC MED GRP

(415) 923-6562 (415) 564-9191 (415) 661-3003 (415) 346-2664 (415) 923-6789 (415) 681-4136 (800) 874-5881 (415) 800-8060 (415) 885-8600

2100 WEBSTER ST STE 220 350 PARNASSUS AVE STE 100 925 COLE ST 2299 POST ST 1750 FULTON ST 1515 SLOAT BLVD 1400 TENNESSEE ST UNIT 2 12540 MCCANN DR 2100 WEBSTER STREET SUITE 326

SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO

CA CA CA CA CA CA CA CA CA

94115-2376 94117-3608 94117-4315 94115-3441 94117-1204 94132-1222 94107-3421 94102-2914 94115

SF STATE UNIV STUDENT HLTH SRV PHY ST MARYS MEDICAL CTR CLINIC PHCY SUNSET WELLNESS PHARMACY SUTTER PROFESSIONAL PHARMACY

(415) 338-1710 (415) 750-4878 (415) 664-8800 (415) 567-3223

1600 HOLLOWAY AVE 2235 HAYES ST 801 IRVING ST 2300 SUTTER ST #101

SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO

CA CA CA CA

94132 94117-1012 94122-2310 94115-3029

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 87 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name THOUSAND CRANES PHARMACY TORGSYN DISCOUNT PHARMACY VISITACION VALLEY PHARMACY WELLMAN'S PHARMACY WELLMAN'S UNITED DRUGS ALEX PHARMACY ALPHA MEDICAL PHARMACY B & A PHARMACY EZ PHARMACY GOOD PHARMACY KIEU AN PHARMACY LOTUS PHARMACY LUCKY PHARMACY MED QUICK PRESCRIPTION SHOPPE NEW-1 PHARMACY PACIFIC PHARMACY PAYLESS PHARMACY V TOP UNITED PHARMACY SERVICES WELLCOME PHARMACY SAN JACINTO PHARMACY SUPER RX PHARMACY THE MEDICINE SHOPPE ABORN PHARMACY ALUM ROCK PHARMACY INC BASCOM PHARMACY LLC BAY PHARMACY BAY PHARMACY PC CAPITOL PHARMACY CREEKSIDE PHARMACY DOWNTOWN PHARMACY EVERGREEN PHARMACY EVERGREEN PHARMACY FRIENDLY #1 PHARMACY FRIENDLY PHARMACY GARCIA PHARMACY ICARE PHARMACY JACKSON MEDICAL PHARMACY KING PHARMACY LEXANN PHARMACY INC LINDA RX PHARMACY LION PHARMACY LOS ALAMITOS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (415) 409-4357 (415) 752-3737 (415) 239-5811 (415) 788-8882 (415) 362-3622 (626) 571-1188 (626) 280-3131 (626) 927-9970 (626) 872-0750 (626) 280-3060 (626) 280-0466 (626) 872-0181 (626) 282-2277 (626) 281-2015 (626) 307-5517 (626) 991-6888 (626) 286-1588 (626) 573-4698 (626) 766-1799 (951) 654-9393 (951) 654-4221 (951) 654-2791 (408) 531-1899 (408) 254-1551 (408) 995-6020 (408) 223-0180 (408) 254-8884 (408) 298-1385 (408) 929-6029 (408) 298-2255 (408) 531-9961 (408) 270-0670 (408) 226-0200 (408) 279-8188 (408) 294-3219 (408) 926-7691 (408) 251-8122 (408) 347-0193 (408) 528-9079 (408) 270-2828 (408) 784-3921 (408) 259-1000

Provider Street 1832 BUCHANAN ST STE 203 5614 GEARY BLVD 100 LELAND AVE 728 PACIFIC AVE STE 110 1053 STOCKTON ST 140 W VALLEY BLVD STE 105 1418 S SAN GABRIEL BLVD 230 E VALLEY BLVD STE 103 625 E VALLEY BLVD STE J 1428 S SAN GABRIEL BLVD 600 E VALLEY BLVD # G 1135 S SAN GABRIEL BLVD # 2 416 W LAS TUNAS DR STE 100 546 W LAS TUNAS DR 808 E VALLEY BLVD 207 S SANTA ANITA AVE STE G-10 927 E LAS TUNAS DR STE H 1730 S SAN GABRIEL BLVD 828 E VALLEY BLVD STE B 100 E MAIN ST 1271 NORTH STATE ST 1477 S SAN JACINTO AVE 2060 ABORN RD STE 150B 1855 ALUM ROCK AVE STE A 105 N BASCOM AVE STE 101 1661 BURDETTE DR STE AB 200 JOSE FIGUERES AVE STE 235 2114 SENTER RD STE 26 1863 ALUM ROCK AVE STE A 60 N 13TH ST STE A 2365 QUIMBY RD 2690 S WHITE RD STE 200A 485 LEWIS RD STE D 639 TULLY RD STE A 25 N 14TH ST, SUITE 110 1727B BERRYESSA RD 266 N JACKSON AVE STE 8 2323 MONTPELIER DR STE D 1569 LEXANN AVE STE 104 1569 LEXANN AVE #130 2857 SENTER RD SUITE A 115 N JACKSON AVE STE 103

Page 88 of 679

Provider City SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN FRANCISCO SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN GABRIEL SAN JACINTO SAN JACINTO SAN JACINTO SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94115-3252 94121-2215 94134-2806 94133-4449 94108-1109 91776-3784 91776-3656 91776-3597 91776-3591 91776-3656 91776-3673 91776-3114 91776-1236 91776-1111 91776-3607 91776-1138 91776-1661 91776-3928 91776 92583-4228 92583 92583-5105 95121-1587 95116-1398 95128-1811 95121-1665 95116-1588 95112-2608 95116-2004 95112-3525 95122-1337 95148-2076 95111-2108 95111-1000 95112-6204 95133-1172 95116-1606 95116-1611 95121-1793 95121-1793 95111 95116-1924

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MCKEE MEDICAL PHARMACY INC MED- PLACE PHARMACY MEDEX DRUGS MEGA DRUGS LLC NOB HILL PHARMACY PRESCRIPTION HEADQUARTERS INC SAMARITAN APOTHECARY PHARMACY SAN JOSE COMPOUNDING PHARMACY SAVCO PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SENTER PHARMACY SUN PHARMACY INC TROPICANA DRUGS TROPICANA DRUGS LONG TERM CARE TULLY MEDICAL CLINIC PHARMACY MARBELLA PHARMACY OC PHARMACY ALAMEDA PHARMACY LLC MEDICAL ARTS PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY CONVERSIO HEALTH KOHANA PHCY & CTR REGENERATIVE PHARMA101 QUALITY-CARE PHARMACY RALPHS PHARMACY SAN MARCOS PHARMACY SAV-ON PHARMACY WELCARE PHARMACY BUY WELL DRUGS CAL OAKS III PHARMACY MARINER ADVANCED PHARMACY CORP

Provider Name

(408) 923-8871 (408) 564-6785 (408) 292-8244 (408) 283-9518 (408) 224-6200 (408) 277-0160 (408) 884-8828 (408) 296-5015 (408) 298-6190 (408) 578-2295 (408) 972-2862 (408) 559-9491 (408) 937-6032 (408) 370-1205 (408) 267-6828 (408) 287-4899 (408) 440-2077 (408) 251-6441 (408) 251-0205 (408) 274-6698 (949) 388-2364 (949) 429-5326 (510) 362-7254 (510) 357-1881 (510) 276-8106 (510) 276-9395 (805) 473-5178 (805) 542-0864 (805) 540-2780 (760) 744-5959 (760) 891-0618 (760) 798-0898 (760) 798-2824 (760) 727-3333 (626) 441-1159 (626) 382-2580 (650) 312-1342

2350 MCKEE RD STE A3 2101 FOREST AVE STE 122 401 E SANTA CLARA ST 696 E SANTA CLARA ST STE 111 6061 SNELL AVE 1340 TULLY RD STE 312 2505 SAMARITAN DR STE 300 2453 FOREST AVE 455 OCONNOR DR STE 190 129 BERNAL RD 844 BLOSSOM HILL RD 2027 CAMDEN AVE 3457 MCKEE RD 200 EL PASEO DE SARATOGA 565 W CAPITOL EXPY 2643 SENTER RD STE A 2559 S KING RD STE B10 1167 S KING RD 1169 S KING RD 1693 FLANIGAN DR STE 104 31103 RANCHO VIEJO RD STE D1 31654 RANCHO VIEJO RD UNIT N 1555 DOOLITTLE DR STE 160 13847 E 14TH ST 1300 FAIRMONT DR 15840 HESPERIAN BLVD 720 AEROVISTA PL STE D 181 TANK FARM RD STE 120 243 GRANADA DR STE A 727 W SAN MARCOS BLVD STE 113 306 S TWIN OAKS VALLEY RD 631A S RANCHO SANTA FE RD 1571 SAN ELIJO RD S 1921 W SAN MARCOS BLVD STE 140 375 HUNTINGTON DR 2010 HUNTINGTON DR 43 EAST 3RD AVE

SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JOSE SAN JUAN CAPISTRANO SAN JUAN CAPISTRANO SAN LEANDRO SAN LEANDRO SAN LEANDRO SAN LORENZO SAN LUIS OBISPO SAN LUIS OBISPO SAN LUIS OBISPO SAN MARCOS SAN MARCOS SAN MARCOS SAN MARCOS SAN MARCOS SAN MARINO SAN MARINO SAN MATEO

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95116-1617 95128-1424 95113-1914 95112-1911 95123-4127 95122 95124-4010 95128-1505 95128 95119-1303 95123-2725 95124-2024 95127-2233 95130-1616 95136-3914 95111-1184 95122-1894 95122-2144 95122-2144 95121-1683 92675-1759 92675 94577-2272 94578-2632 94578-3507 94580-1538 93401-8726 93401-7082 93401-7336 92078-1244 92078-4333 92078-3973 92078 92078-3994 91108-2357 91108 94401

SAN MATEO NEIGHBORHOOD PHARMACY TED'S VILLAGE PHARMACY BROOKVALE MEDICAL CENTER PHCY VALE ROAD PHARMACY

(650) 827-5277 (650) 349-1373 (510) 235-4443 (510) 232-2377

9 37TH AVE 29 W 25TH AVE 2101 VALE RD STE 100 2023 VALE RD STE 101

SAN MATEO SAN MATEO SAN PABLO SAN PABLO

CA CA CA CA

94403-4404 94403-2236 94806-3844 94806-3891

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 89 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

COOVER PHARMACY LITTLE CO OF MARY HOSP PHARMACY PENINSULA PHARMACY RALPHS PHARMACY SAN PEDRO PHARMACY & ORTHO CTR MARIN MEDICAL PHARMACY MCC PHARMACY DIABLO PHARMACY SAN RAMON CUSTOM CARE PHCY SAVE MART PHARMACY BARR PHARMACY EL PORTAL PHARMACY ALLCARE PHARMACY AP8 PHARMACY BOLSA GRANDE PHARMACY BRISTOL MEDICAL PHARMACY CATINAT PHARMACY DIACARE PHARMACY DRUG DEPOT EXCELCARE PHARMACY E-Z CARE PHARMACY FARMACIA BRISTOL FARMACIA FAMILIAR

Provider Name

(310) 833-2575 (310) 514-5265 (310) 833-3535 (310) 833-3225 (310) 831-0155 (415) 479-1930 (415) 755-2514 (925) 237-9939 (925) 830-0555 (925) 828-8670 (559) 875-2517 (559) 399-8644 (714) 550-9303 (714) 426-5468 (714) 884-4271 (714) 549-3385 (714) 557-5140 (714) 541-8150 (877) 378-4911 (714) 554-1111 (714) 968-2000 (714) 241-1888 (714) 486-2277

891 W 9TH ST 1300 W 7TH ST 1294 W 6TH ST STE 100 1050 N WESTERN AVE 1360 W 6TH ST STE 115 750 LAS GALLINAS AVE STE 104 3110 KERNER BLVD 2301 CAMINO RAMON STE 190 124 MARKET PL 21001 SAN RAMON VALLEY BLVD 1825 ACADEMY AVE 2407 JENSEN AVE STE 101 1106 E 17TH ST STE B 2720 S BRISTOL ST STE 102 5015 W EDINGER AVE STE B 2740 S BRISTOL ST STE 102 2619 W EDINGER AVE #D2 2212 E 4TH ST STE 102 999 N TUSTIN STE 12 12526 WESTMINSTER AVENUE 202 N EUCLID ST, #102 1155 W CENTRAL AVE STE 112 1126 S BRISTOL ST

SAN PEDRO SAN PEDRO SAN PEDRO SAN PEDRO SAN PEDRO SAN RAFAEL SAN RAFAEL SAN RAMON SAN RAMON SAN RAMON SANGER SANGER SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90731 90732-3505 90731-2997 90732-2428 90732-3595 94903-3431 94901 94583-2060 94583-4740 94583-3469 93657-3705 93657-2248 92701-2603 92704-6299 92704-1968 92704 92704 92705 92705 92706 92703 92707 92704-3420

FIRST STREET MEDICAL PLAZA PHARMACY HARBOR HEALTHY LIVING PHARMACY KATRINA PHARMACY LAURA PHARMACY LVRX III MEDCARE FAMILY PHARMACY II MEDCARE FAMILY PHCY MEDICINE SHOPPE MED-ZONE MERCY MEDICAL CENTER PHARMACY MINH PHARMACY MTM PHARMACY MTM PHARMACY FAIRVIEW PARAGON COMPOUNDING PHCY INC PHARMACY 9 POPULAR MEDICAL PHARMACY QUALITY CARE PHARMACY ROSE PHARMACY

(714) 954-1902 (714) 531-8080 (657) 231-6850 (714) 884-4493 (714) 862-2470 (714) 557-2982 (714) 953-7538 (714) 999-0075 (714) 558-1900 (714) 754-1331 (714) 530-0144 (714) 278-4800 (714) 881-0012 (714) 707-5099 (714) 554-6238 (714) 547-4473 (714) 754-4567 (714) 662-0548

2010 E 1ST ST STE 120 646 S HARBOR BLVD 4718 W 1ST ST # 101 2525 WESTMINSTER AVE 301 E 17TH ST 3501 S HARBOR BLVD STE 167 1710 S MAIN ST 1125 E 17TH ST # S102 800 N TUSTIN AVE STE K 2621 S BRISTOL ST STE 100 5110 WESTMINSTER AVE STE B 2339 W 1ST ST 1002 N FAIRVIEW ST 1701 E EDINGER AVE STE B8 122 N EUCLID STE A 420 S BRISTOL ST 2413 S FAIRVIEW ST STE E 1220 HEMLOCK WAY STE 110

SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92705-4079 92704-1384 92703-3106 92706-2143 92706-2804 92704-6940 92707-1836 92701-2201 92705-3605 92704-5718 92703-1165 92703 92703-1811 92705-5010 92703 92703-4527 92704-5339 92707-3600

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Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SAFETY FIRST PHARMACY SANTA ANA PHARMACY HEALTH CTR SANTA ANA TUSTIN CLINIC PHCY SAV-ON DRUGS SOUTH COAST PHARMACY SOUTH GATE ROSE PHARMACY SOUTH MAIN ALOHA PHARMACY WAGNER PHARMACY FEDERAL DRUG CO PRESCRIPTION PHARMACY PRESCRIPTION PHARMACY RALPHS SAN YSIDRO PHARMACY SBCH DISCHARGE PHARMACY THE MEDICINE SHOPPE HAN'S PHARMACY SAVE MART PHARMACY SAV-ON PHARMACY ZOEY PHARMACY DOMINICAN PLAZA PHARMACY HORSNYDER PHARMACY MEDICAL PHARMACY UNITED WESTSIDE PHARMACY CRESCENT HEALTHCARE INC CRESCENT HEALTHCARE INC GRIFFITH DRUGS, INC. ROSE PHARMACY HOMETOWN MEDICAL PHARMACY HOMETOWN PHARMACY JDX PHARMACY LA JOYA PHARMACY MARIAN INFUSION SERVICES MARIAN MEDICAL CENTER PHARMACY SAV-ON DRUGS BRENTWOOD PHARMACY CENTRAL PHARMACY DRUGTOWN PHARMACY GOLDEN WELLNESS RX MCCARTHY DRUGS OCEAN PARK PHARMACY PARKSIDE PHARMACY PATTONS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (714) 486-3708 (714) 884-4686 (714) 547-3949 (714) 543-8300 (714) 755-7002 (714) 953-6861 (714) 676-2078 (714) 547-3590 (805) 687-7551 (805) 682-6507 (805) 964-4831 (805) 564-7670 (805) 969-2284 (805) 569-8380 (805) 687-1376 (408) 247-7450 (408) 249-6700 (661) 775-3944 (661) 298-5858 (831) 462-7726 (831) 423-2315 (831) 426-0200 (831) 423-7175 (877) 872-4844 (800) 879-4844 (562) 949-1003 (714) 664-0518 (805) 322-3411 (805) 922-6515 (805) 922-1747 (805) 922-3996 (805) 739-3810 (805) 739-3459 (805) 928-7623 (310) 393-0201 (310) 395-3294 (310) 393-9821 (310) 451-2828 (310) 452-1105 (310) 452-5705 (310) 453-7843 (310) 451-1414

Provider Street 1605 W 1ST ST STE A 1103 S HARBOR BLVD STE E 801 N TUSTIN AVE STE 100 2000 E 17TH ST 3378 S BRISTOL ST 517 N MAIN ST STE 101 618 S MAIN ST 1224 E MCFADDEN AVE 3327 STATE ST 317 W PUEBLO ST 215 PESETAS LN 100 W CARRILLO ST 1498 E VALLEY RD 400 W PUEBLO ST 3605 STATE ST 3423 EL CAMINO REAL 3705 EL CAMINO REAL 23850 W COPPER HILL RD 18500 VIA PRINCESSA STE 4 1595 SOQUEL DR 1226 SOQUEL AVE 2025 SOQUEL AVE 1401 MISSION ST 11980 TELEGRAPH RD STE 102 11980 TELEGRAPH RD STE 100 11721 TELEGRAPH RD 12540 MCCANN DR 1482 S BROADWAY STE A 1414 S MILLER ST STE E 1504 S BROADWAY 1115 W MAIN ST STE E1 506 PLAZA DR STE 6 1400 E CHURCH ST 2320 S BROADWAY 214 26TH ST 900 WILSHIRE BLVD STE 104 802 7TH ST 1202 MONTANA AVE STE C 2601 LINCOLN BLVD 2731 OCEAN PARK BLVD 2428 SANTA MONICA BLVD 734 MONTANA AVE

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Provider City SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA ANA SANTA BARBARA SANTA BARBARA SANTA BARBARA SANTA BARBARA SANTA BARBARA SANTA BARBARA SANTA BARBARA SANTA CLARA SANTA CLARA SANTA CLARITA SANTA CLARITA SANTA CRUZ SANTA CRUZ SANTA CRUZ SANTA CRUZ SANTA FE SPRINGS SANTA FE SPRINGS SANTA FE SPRINGS SANTA FE SPRINGS SANTA MARIA SANTA MARIA SANTA MARIA SANTA MARIA SANTA MARIA SANTA MARIA SANTA MARIA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92703-3626 92704-2347 92705-3607 92705-8647 92704-8203 92701-4619 92701-5716 92705-4106 93105-2623 93105-4310 93110-1416 93101-3215 93108-1241 93105 93105-2521 95051-2806 95051-2614 91354 91387 95065-1719 95062-2108 95062-1323 95060-4738 90670-6087 90670-6089 90670-3674 90670-3337 93454-6914 93454-6915 93454-7214 93458-4270 93454-6952 93454-5906 93454-7816 90402-2524 90401-1873 90403-1408 90403-5955 90405-4619 90405-5205 90404-2045 90403-1404

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RALPHS SANTA MONICA MEDICAL PL PHCY SMC PHARMACY ST JOHNS MED PLAZA PHCY THE ANGELES CLINIC AND RSRCH INS TRI-TECH PHARMACEUTICALS TWENTY-TWO TWENTY-TWO RX PHCY UCLA 16TH STREET PHARMACY UCLA HEMATOLOGY & ONCOLOGY PALM PHARMACY SEEBER'S PHARMACY CREEKSIDE PHARMACY DOLLAR DRUG LOMBARDI ROSA RALEY'S DRUG CENTER RP HEALTHCARE SAVE MART PHARMACY TUTTLE'S DOYLE PARK PHCY TUTTLE'S HOEN PHARMACY VISTA ROSA PHARMACY STAR DRUG CO ALL CARE PHARMACY

Provider Name

(310) 582-3915 (310) 393-6767 (310) 315-9999 (310) 453-6553 (310) 582-7900 (424) 268-1780 (310) 453-5557 (424) 259-8520 (310) 829-5471 (805) 525-8700 (805) 525-3313 (707) 525-1130 (707) 575-1313 (707) 583-8770 (707) 546-4313 (707) 571-5955 (707) 542-6519 (707) 546-9090 (707) 528-4511 (707) 236-6880 (805) 688-6898 (619) 449-0908

1644 CLOVERFIELD BLVD 1260 15TH ST STE 100 1908 SANTA MONICA BLVD STE 4 1301 20TH ST STE 120 2001 SANTA MONICA BLVD 910 BROADWAY AVE STE 105 2222 SANTA MONICA BLVD STE 103 1223 16TH ST RM 1202 2336 SANTA MONICA BLVD STE 301 254 E. HARVARD BLVD 110 W HARVARD BLVD STE H 95 MONTGOMERY DR STE 108 1055 W COLLEGE AVE STE C 751B LOMBARDI CT 1407B FULTON RD 2456 W 3RD ST 915 VILLAGE CT 1220 SONOMA AVE 4731 HOEN AVE 3569A ROUND BARN CIRCLE 3576 MADERA ST 8790 CUYAMACA ST STE B

SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA MONICA SANTA PAULA SANTA PAULA SANTA ROSA SANTA ROSA SANTA ROSA SANTA ROSA SANTA ROSA SANTA ROSA SANTA ROSA SANTA ROSA SANTA ROSA SANTA YNEZ SANTEE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90404-4006 90404-1136 90404-1991 90404-2094 90404-2102 90401-2797 90404-2305 90404-1217 90404-2067 93060 93060-3874 95404-6617 95401-5036 95407-5454 95403-1809 95401-6425 95405-6759 95405-6621 95405-7862 95403-1757 93460-9367 92071-4295

EDGEMOOR GERIATRIC HOSPITAL PHCY SAUGUS DRUGS PALCO PHARMACY LEISURE WORLD PHARMACY RALPH'S PHARMACY SAVE MART PHARMACY FOX DRUG STORE SHAFTER MEDICAL PHARMACY AIDS HEATLHCARE FOUNDATION CAPITOL DRUGS SHERMAN OAKS MAXSONS DRUGS MICHAELS PHARMACY MULTICARE PHARMACY OAKS COMMUNITY PHARMACY OLYMPUS PHARMACY INC OMEGA CARE PHARMACY PHANTASTIC PHARMACY RALPHS RALPHS PHARMACY

(619) 596-6340 (661) 296-3980 (707) 764-3591 (562) 795-6202 (562) 598-2734 (831) 393-1400 (559) 896-1645 (661) 746-5600 (818) 986-2643 (818) 905-8338 (818) 789-0301 (818) 905-0669 (818) 461-9600 (818) 309-2233 (888) 670-9080 (818) 849-6466 (818) 849-5992 (818) 784-3005 (818) 989-5422

655 PARK CENTER DRIVE 27641 BOUQUET CANYON RD 113 MAIN ST STE D 1661D GOLDEN RAIN RD 12470 SEAL BEACH BLVD 2000 CALIFORNIA AVE 1939 HIGH ST 825 CENTRAL VALLEY HWY STE A 4900 VAN NUYS BLVD STE 200 4454 VAN NUYS BLVD #5 14070 VENTURA BLVD 4955 VAN NUYS BLVD 4849 VAN NUYS BLVD STE 101A 13322 RIVERSIDE DR 14437 VENTURA BLVD 4611 VAN NUYS BLVD 4347 VAN NUYS BLVD 14049 VENTURA BLVD 14440 BURBANK BLVD

SANTEE SAUGUS SCOTIA SEAL BEACH SEAL BEACH SEASIDE SELMA SHAFTER SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS SHERMAN OAKS

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92071-6957 91350 95565-9901 90740-4907 90740-2711 93955-3150 93662-3510 93263-2003 91403-1741 91403-2911 91423 91403-1801 91403-2110 91423 91423-2606 91403 91403-3727 91423-5234 91401-4823

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 92 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RIGHT CHOICE PHARMACY BEST BUY DRUGS APEX INFUSION PHARMACY ALAMO PHARMACY GOLDEN LIFE PHARMACY II HOME CARE PHARMACY MID VALLEY PHARMACY PAVILIONS PHARMACY RX POINT PHARMACY INC SAV-ON PHARMACY SIMI PHARMACY TAPO PHARMACY THE MEDICINE SHOPPE WOOD RANCH PHCY & COMPDNG CTR SOLEDAD RX PHARMACY PHARMACA INTERGRATIVE PHARMACY

Provider Name

(818) 849-5864 (626) 355-3456 (562) 597-6800 (805) 306-1636 (805) 416-8900 (805) 527-9600 (805) 527-4013 (805) 426-6040 (805) 864-2310 (805) 520-6297 (805) 582-7474 (805) 583-1223 (805) 581-3784 (805) 426-9500 (831) 678-2678 (707) 938-1144

14054 VENTURA BLVD 29 N BALDWIN AVE 3299 E HILL ST STE 301 3695 ALAMO ST STE 100 1960 SEQUOIA AVE STE 3 1687 ERRINGER RD STE 101 2519 ROYAL AVE 2938 TAPO CANYON RD 2718 E LOS ANGELES AVE 1268 MADERA RD 1720 E LOS ANGELES AVE STE F 2950 SYCAMORE DR STE 101 2925 SYCAMORE DR 1464 MADERA RD STE # I-2 547 FRONT ST 303 W NAPA ST

SHERMAN OAKS SIERRA MADRE SIGNAL HILL SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SIMI VALLEY SOLEDAD SONOMA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91423-3532 91024-1903 90755 93063-2188 93063-3176 93065-6509 93065-4700 93063-2171 93065-3936 93065-4002 93065-5823 93065-1210 93065-1207 93065 93960-3014 95476-6516

SONOMA VALLEY COMMUNITY PHARMACY BOB'S GREENLEY PHARMACY COMMUNITY PHARMACY COMMUNITY PHARMACY - FOREST RD SAVE MART PHARMACY DURFEE MEDICAL PHARMACY MERCY SOUTH GATE PHARMACY SAV-ON PHARMACY SOUTH GATE PHARMACY THE MEDICINE CABINET TMC RALEY'S DRUG CENTER RALEY'S DRUG CENTER TAHOE VALLEY PHARMACY FAIR OAKS PHARMACY PAVILIONS PHARMACY RALPHS ANCHOR DRUGS III SUNSHINE CENTER PHARMACY SAV-ON DRUGS SAV-ON PHARMACY TNT PHARMACY RALPH'S ANGKOR PHARMACY BJRX PHARMACY INC.

(707) 939-2278 (209) 532-3139 (209) 536-3700 (209) 536-3800 (209) 536-1118 (626) 448-8200 (323) 206-4177 (323) 569-0744 (323) 537-2837 (323) 564-2056 (323) 249-0360 (530) 541-5230 (530) 544-4111 (530) 541-0870 (626) 799-1414 (626) 799-4156 (626) 799-2926 (650) 360-5300 (650) 589-4133 (619) 461-2100 (619) 461-9170 (714) 899-1898 (661) 253-0320 (209) 473-4706 (209) 474-2888

19270 SONOMA HWY 800 DELNERO DR 900 GREENLEY RD STE 912 193 FAIRVIEW LN STE A 1045 MONO WAY 12331 RUSH ST 8116 CALIFORNIA AVE STE A 4155 TWEEDY BLVD 8200 LONG BEACH BLVD UNIT D-2 3270 TWEEDY BLVD STE C 4476 TWEEDY BLVD 1040 EMERALD BAY RD 4018 LAKE TAHOE BLVD 2074 LAKE TAHOE BLVD STE I 1526 MISSION ST 1213 FAIR OAKS AVE 1745 GARFIELD AVE 161 SOUTH SPRUCE AVE 1166 MISSION RD 543 SWEETWATER RD 9831 CAMPO RD 12505 BEACH BLVD STE A2 24975 PICO CANYON RD 4555 N PERSHING AVE STE 7 1801 E MARCH LN STE B280

SONOMA SONORA SONORA SONORA SONORA SOUTH EL MONTE SOUTH GATE SOUTH GATE SOUTH GATE SOUTH GATE SOUTH GATE SOUTH LAKE TAHOE SOUTH LAKE TAHOE SOUTH LAKE TAHOE SOUTH PASADENA SOUTH PASADENA SOUTH PASADENA SOUTH SAN FRANCISCO SOUTH SAN FRANCISCO SPRING VALLEY SPRING VALLEY STANTON STEVENSON RANCH STOCKTON STOCKTON

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95476 95370-5221 95370-5287 95370-4828 95370-5282 91733-4143 90280-2400 90280-6158 90280 90280-4372 90280 96150-6200 96150-6903 96150-6407 91030-3216 91030-3805 91030-4923 94080 94080-1303 91977-5627 91977-1418 90680-4020 91381-1708 95207 95210-6653

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 93 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BJRX PHARMACY LTC BRUCE PHARMACY CALMONT PHARMACY FORTY NINE DRUG COMPANY FREMONT CENTER PHARMACY HILLTOP PHARMACY MARCH LANE MEDICAL PHARMACY PARK WOODS PHARMACY RALEY'S SAVE MART PHARMACY SAVE MART PHARMACY STOCKTON HEMATOLOGY ONCOLOGY WATERFRONT PHARMACY ELEMENTS PHARMACY ORGLIFE PHARMACY RALPHS STUDIO PHARMACY TOLUCA PHARMACY RALEY'S DRUG CENTER SERRA MEDICAL PHARMACY STANFRED DRUGS SUN VALLEY MEDICAL PHARMACY SUNLAND PHARMACY VERDUGO CARE PHARMACY BETTER HEALTH PHARMACY MEDEX PHARMACIES SAVE MART PHARMACY OWENS HEALTHCARE OLIVE TREE PHARMACY EXPRESS PHARMACY #9 4 LIFE RX INC ALLEGIANCE PHARMACY CARE PLUS PHARMACY FIRSTCARE PHARMACY GARDEN PLAZA PHARMACY NORMS PHARMACY RONCO DRUG TAMPA PLAZA PHARMACY TARZANA CARE PHARMACY TARZANA PLAZA PHARMACY THE MEDICINE SHOPPE AGIA PHARMACY & CAFE

NR_0009_10823 10/2017

Provider Phone Number (209) 474-3888 (209) 957-2295 (209) 943-7676 (209) 465-2671 (209) 948-0546 (209) 851-2162 (209) 870-2760 (669) 999-6870 (209) 956-9444 (209) 951-1051 (209) 952-3599 (209) 466-2626 (209) 463-7777 (818) 762-2055 (818) 508-0800 (818) 761-7211 (818) 506-0776 (818) 761-1400 (707) 426-1274 (818) 768-3322 (818) 767-3737 (818) 394-9645 (818) 962-3851 (818) 662-0111 (818) 353-6666 (818) 925-1321 (408) 749-8200 (530) 252-4315 (818) 364-5100 (661) 745-4800 (818) 342-2636 (818) 600-2636 (818) 343-5100 (818) 213-1000 (818) 345-7982 (818) 881-5300 (818) 654-0150 (818) 345-9292 (818) 996-3600 (818) 996-9906 (818) 996-2878 (661) 823-4111

Provider Street 1801 E MARCH LN STE B270 73 W MARCH LANE STE D 2800 N CALIFORNIA ST STE 9 937 N YOSEMITE ST 2525 E FREMONT ST 4545 GEORGETOWN PL STE B10 89 W MARCH LN STE 2 1782 W HAMMER LN 4255 MORADA LN 7506 PACIFIC AVE 4725 QUAIL LAKES DR 2626 N CALIFORNIA ST STE B 123 S COMMERCE ST STE A 12602-12604 VENTURA BLVD. 12038 VENTURA BLVD 12842 VENTURA BLVD 11309 VENTURA BLVD 11914 VENTURA BLVD 268 SUNSET AVE 9375 SAN FERNANDO RD 8031 VINELAND AVE 8747 GLENOAKS BLVD 8422 SUNLAND BLVD 8908 GLENOAKS BLVD 7802 FOOTHILL BLVD UNIT G 8441 FOOTHILL BLVD 484 NORTH MATHILDA 2920 MAIN ST STE A 14124 FOOTHILL BLVD STE 102 900 KERN ST STE C 19554 VENTURA BLVD 18455 BURBANK BLVD # 311 19015 VENTURA BLVD 18555 VENTURA BLVD SUITE A 18411 CLARK ST STE 106 18368 CLARK ST 18607 VENTURA BLVD STE 109 19100 VENTURA BLVD STE L 18370 BURBANK BLVD STE 104 5525 ETIWANDA AVE STE 100 19225 VENTURA BLVD 276 S MILL ST STE A

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Provider City STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STOCKTON STUDIO CITY STUDIO CITY STUDIO CITY STUDIO CITY STUDIO CITY SUISUN CITY SUN VALLEY SUN VALLEY SUN VALLEY SUN VALLEY SUN VALLEY SUNLAND SUNLAND SUNNYVALE SUSANVILLE SYLMAR TAFT TARZANA TARZANA TARZANA TARZANA TARZANA TARZANA TARZANA TARZANA TARZANA TARZANA TARZANA TEHACHAPI

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

95210-5668 95207-5726 95204-3757 95203-2216 95205-3906 95207-6230 95207-5723 95209-2922 95212 95207-1929 95207-5243 95204-5500 95202-2837 91604-2414 91604 91604-2369 91604-3188 91604-2606 94585-1766 91352-1418 91352-3951 91352-2802 91352-3436 91352-2037 91040 91040 94085 96130-4714 91342-8053 93268-2766 91356-2917 91356 91356-3213 91356 91356-3529 91356-3502 91356-4165 91356-3238 91356-2804 91356-3639 91356 93561-1628

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SAV-ON PHARMACY AGHAPY PHARMACY ARCHANGEL MICHAEL PHARMACY CHINO PROFESSIONAL PHARMACY EVERGREEN RX PHARMACY NUFACTOR INC RALPHS RANCHO PUEBLO PHARMACY SAV-ON DRUGS SAV-ON PHARMACY VAIL RANCH PHARMACY 986 PHARMACY VALLEY PRESCRIPTION PHARMACY TEMPLETON HILLS PHARMACY ALL MED DRUGS GELSON'S PHARMACY LOVING HANDS PHARMACY

Provider Name

(661) 823-7094 (951) 302-3111 (951) 302-7733 (951) 296-2252 (951) 296-9074 (800) 323-6832 (909) 303-8764 (951) 972-8822 (951) 303-1144 (909) 694-0055 (951) 303-8300 (626) 309-5052 (626) 285-6838 (805) 434-1801 (805) 495-2110 (805) 493-8001 (805) 379-9907

775 TUCKER RD 4318 MAINE AVE STE C 31754 TEMECULA PKWY STE D 41715 WINCHESTER RD STE 108 41750 WINCHESTER RD STE N 44900 WINCHESTER RD 33293 HIGHWAY 79 31515 RANCHO PUEBLO RD STE 105 31960 US HIGHWAY 79 S 30530 RANCHO CALIFORNIA RD 32675 TEMECULA PKWY STE B 9612 LAS TUNAS DR 5546 ROSEMEAD BLVD STE 101 1050 LAS TABLAS RD 442 N MOORPARK RD 1736 E AVENIDA DE LOS ARBOLES 2220 N MOORPARK RD STE 107

TEHACHAPI TEMECULA TEMECULA TEMECULA TEMECULA TEMECULA TEMECULA TEMECULA TEMECULA TEMECULA TEMECULA TEMPLE CITY TEMPLE CITY TEMPLETON THOUSAND OAKS THOUSAND OAKS THOUSAND OAKS

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

93561-2502 92592-2921 92592-6805 92590-4853 92590-4898 92590-2579 92592 92592-4837 92592-9347 92591-3277 92592-6836 91780-2108 91780-1855 93465-9729 91360-3702 91362-1301 91360-3174

LYNN OAKS COMPOUNDING PHARMACY NORTH OAKS PHARMACY PLAZA PHARMACY ROLLING OAKS PHARMACY THE MEDICINE SHOPPE TRIVALLEY ONC HEMATOLOGY ASSOC THREE RIVERS DRUG BELLA VIDA PHARMACY BIOFUSION CARSON PHARMACY CHOICE COMPOUNDING PHARMACY FOX DRUG OF TORRANCE GREEN PHARMACY LITTLE CO MARY HOSPITAL PHARMACY LOMITA CARE PHARMACY MEDICAL ARTS PHARMACY PACIFICA PHARMACY PLAZA PHARMACY PREMIER FAMILY PHARMACY RALPHS RALPH'S RALPHS PHARMACY RALPHS PHARMACY SERVAC PHARMACY

(805) 495-1015 (805) 241-0935 (805) 492-2451 (805) 557-1006 (805) 497-6113 (805) 496-0592 (559) 561-4217 (310) 320-3333 (310) 320-6444 (310) 328-0982 (310) 543-1111 (310) 328-7244 (310) 504-0600 (310) 303-5777 (310) 378-4999 (310) 214-8282 (310) 530-0831 (310) 530-3010 (310) 606-2121 (310) 787-8862 (310) 378-5214 (310) 327-0675 (310) 370-0535 (310) 370-1040

2220 LYNN RD STE 100 1014 E AVENIDA DE LOS ARBOLES 430 E AVE DE LOS ARBOLES #103 325 ROLLING OAKS DR # 140A 227 W JANSS RD STE 120 555 MARIN ST STE 200 40893 SIERRA DR 1039 W CARSON ST 19110 VAN NESS AVE 21720 S VERMONT AVE STE 101 4201 TORRANCE BLVD STE 120 1327 EL PRADO AVE 4305 TORRANCE BLVD SUITE 105 4101 TORRANCE BLVD 3655 LOMITA BLVD STE 102 20911 EARL ST STE 120 23560 MADISON ST STE 112 3400 LOMITA BLVD STE 102 21150 HAWTHORNE BLVD STE 106 1770 W CARSON ST 5035 PACIFIC COAST HWY 17500 CRENSHAW BLVD 3455 SEPULVEDA BLVD 3586 REDONDO BEACH BLVD

THOUSAND OAKS THOUSAND OAKS THOUSAND OAKS THOUSAND OAKS THOUSAND OAKS THOUSAND OAKS THREE RIVERS TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91360-1904 91360 91360-3003 91361-1201 91360-1855 91360-4105 93271-0415 90502 90501-1101 90502-2127 90503-4579 90501-2716 90503-4400 90503-4607 90505-1900 90503-4353 90505-4709 90505-4911 90503 90501-2821 90505-5441 90504-3404 90505-2606 90504-1404

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 95 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUNNY BAY PHARMACY THE REMEDY PHARM TORMED PHARMACY I TORRANCE MEM HOSPITAL PHARMACY TORRANCE PHCY & CMPDING CTR V M PHARMACY ABALA PHARMACY GRANT LINE PHARMACY INC HAROLD K REICH'S PHARMACY RALEY'S PHARMACY SAVE MART PHARMACY TAHOE FOREST PHARMACY BEST CHOICE PHCY & MED SUPPLY INC FOOTHILL REMEDY DRUGS GRACE PHARMACY MIRACLE PHARMACY SAV-ON PHARMACY TUJUNGA PHARMACY ALPHA PHARMACY CHERRY STREET PHARMACY

Provider Name

(310) 370-0911 (310) 375-0655 (310) 326-7706 (310) 517-4799 (424) 250-1701 (310) 378-0005 (209) 832-7080 (209) 832-2999 (209) 835-1832 (209) 830-6800 (209) 830-1977 (530) 587-7607 (818) 353-5384 (818) 236-2500 (818) 957-5555 (818) 273-4602 (818) 249-2056 (818) 352-9200 (559) 556-6014 (844) 892-1050

3565 DEL AMO BLVD 23811 HAWTHORNE BLVD 3440 LOMITA BLVD 3330 LOMITA BLVD 23600 TELO AVE #155 23451 MADISON ST STE 100 550B W EATON AVE 2160 W GRANT LINE RD STE 205 39 W 10TH ST 2550 S TRACY BLVD 875 S TRACY BLVD 10956 DONNER PASS RD STE 100 7148 FOOTHILL BLVD 6253 FOOTHILL BLVD 7057 FOOTHILL BLVD 7418-7420 FOOTHILL BLVD 6240 FOOTHILL BLVD 6501 FOOTHILL BLVD STE 102 873 E MERRITT AVE 1028 N CHERRY ST

TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TORRANCE TRACY TRACY TRACY TRACY TRACY TRUCKEE TUJUNGA TUJUNGA TUJUNGA TUJUNGA TUJUNGA TUJUNGA TULARE TULARE

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90503-1637 90505-5907 90505-4801 90505-5002 90505-4035 90505-4736 95376-3422 95377-7333 95376-3901 95376 95376-4744 96161-4860 91042-2717 91042-2723 91042-2714 91042 91042-2724 91042-2766 93274-2246 93274-2212

TUOLUMNE ME WUK IND HLTH CTR PHCY BOIES MEDICAL CENTER PHARMACY RALEY'S DRUG CENTER TOWER PHARMACY TURLOCK'S NEW VISION PHARMACY CREATIVE COMPOUNDING PHARMACY CURA PHARMACY HEALTHCARE UNITED DRUGS SAV-ON DRUGS TUSTIN PHARMACY NEW PHARMACY 2 MYERS MEDICAL PHARMACY RALEY'S DRUG CENTER

(209) 928-5407 (209) 634-8511 (209) 667-4919 (209) 250-1786 (209) 250-2582 (714) 627-5600 (714) 505-2872 (714) 669-4000 (714) 544-9262 (714) 731-1344 (760) 367-2000 (707) 468-1866 (707) 468-5156

18880 CHERRY VALLEY BLVD 828 DELBON AVE 2900 GEER RD STE 2 501 E OLIVE AVE 2016 W MONTE VISTA AVE 13771 NEWPORT AVE STE 7 17400 IRVINE BLVD STE P 14642 NEWPORT AVE 13270 NEWPORT AVE 13400 NEWPORT AVE 72724 29 PALMS HWY STE 104 260 HOSPITAL DR STE 111 1325 N STATE ST

TUOLUMNE TURLOCK TURLOCK TURLOCK TURLOCK TUSTIN TUSTIN TUSTIN TUSTIN TUSTIN TWENTYNINE PALMS UKIAH UKIAH

CA CA CA CA CA CA CA CA CA CA CA CA CA

95379-9506 95382 95382-1142 95380-4012 95382-9664 92780-4682 92780 92780-6057 92780-3410 92780-3717 92277-2459 95482 95482-3419

NEW TIBURCIO VASQUEZ HLTH CTR PHCY SAVE MART PHARMACY ABC PHARMACY ACE PHARMACY ALTA CARE PHARMACY DOCTOR'S CHOICE PHARMACY KEN PHARMACY

(510) 489-8088 (510) 441-9393 (909) 946-5512 (909) 946-9400 (909) 360-8352 (909) 532-5588 (909) 579-0719

33255 9TH ST 32300 DYER ST 954 W FOOTHILL BLVD # 6D 886 W FOOTHILL BLVD STE D 1113 ALTA AVE STE 100 639 N 13TH AVE 583 E FOOTHILL BLVD

UNION CITY UNION CITY UPLAND UPLAND UPLAND UPLAND UPLAND

CA CA CA CA CA CA CA

94587-2137 94587-1761 91786-3782 91786-3780 91786 91786-4906 91786-3995

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 96 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name KING'S PHARMACY MOUNTAIN PLAZA PHARMACY SAV-ON PHARMACY T.H.E. PHARMACY UPLAND PHARMACY RALEY'S DRUG CENTER SAVE MART PHARMACY SAVE MART PHARMACY ADV DERMATOLOGY & COSMETIC RALPHS SANTA CLARITA VLY HLTH CARE PHCY THE DRUGGIST VALENCIA PHARMACY @ HENRY MAYO VALENCIA PHCY LTC @ HENRY MAYO VALENCIA TOWN CENTER PHARMACY CAPITAL CITY PHARMACY MERCURY PHARMACY MT DIABLO SOLANO ONC GRP MED RALEY'S DRUG CENTER SOLANO DERMATOLOGY ASSOCIATES SOLANO HEMATOLOGY ONCOLOGY INC COMMUNITY PHCY OF VALLEY CNTR FOOTHILLS DRUG STORE KEY PHARMACY 986 PHARMACY ALLIED HEALTH PHARMACY COWDREYS PHARMACY FIVE STAR PHARMACY INC H K VALLEY PHARMACY HEALTHY WAY PHARMACY HOSPICARE PHARMACY HYE PHARMACY INC KOVAC'S CARE PHARMACY MED CENTER PHARMACY INC MED-CARE RX PHARMACY MEDICINE LAND PHARMACY MEDICORX SPECIALTY MESA PHARMACY IV PHARMACY FOR LESS, INC. PREMIER CARE PHARMACY STATE PHARMACY SUPER DISCOUNT PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (909) 982-1778 (909) 985-0914 (208) 395-3906 (909) 946-6411 (909) 608-1832 (707) 447-2526 (707) 452-0145 (707) 448-8420 (661) 254-3686 (661) 263-6480 (661) 254-3600 (661) 294-4040 (661) 705-1330 (661) 705-1335 (661) 291-1800 (707) 644-2272 (707) 200-4411 (707) 551-3333 (707) 642-2284 (707) 643-5785 (707) 551-3300 (760) 749-1156 (209) 920-3299 (818) 509-3630 (818) 933-2010 (818) 290-8465 (818) 781-0111 (818) 786-0227 (818) 708-0728 (818) 997-9420 (818) 786-3110 (818) 782-7152 (818) 786-2669 (818) 785-4944 (818) 650-6799 (818) 997-7000 (818) 390-9696 (818) 785-6049 (818) 343-5000 (818) 376-0333 (818) 386-8555 (818) 376-8316

Provider Street 1060 E FOOTHILL BLVD STE 101 1607 N MOUNTAIN AVE 1910 N CAMPUS AVE 360 E 7TH ST STE F 1183 E FOOTHILL BLVD # 130 3063 ALAMO DR # C 1979 PEABODY RD 777 E MONTE VISTA AVE 28212 KELLY JOHNSON PKWY #245 27760 MCBEAN PKWY 23823 VALENCIA BLVD STE 110 27867 SMYTH DR STE 101 23929 MCBEAN PKWY STE 100A 23929 MCBEAN PKWY STE 100B 26357 MCBEAN PKWY STE 140 339 GEORGIA ST 480 REDWOOD ST STE 33 100 HOSPITAL DR STE 110B 4300 SONOMA BLVD STE 550 2290 SACRAMENTO ST 100 HOSPITAL DR STE 110 29115 VALLEY CENTER RD 1906 VISTA DEL LAGO DR STE G 12660 RIVERSIDE DR STE 100 6521 VAN NUYS BLVD 14659 VICTORY BLVD 15243 VANOWEN ST 16438 VANOWEN ST UNIT 101 17643 SHERMAN WAY 7223 BALBOA BLVD 16525 SHERMAN WAY STE C 1 13745 VICTORY BLVD 14423 GILMORE ST 14624 SHERMAN WAY STE 104 14550 HAYNES ST STE 200A 7400 VAN NUYS BLVD # 101 7039 VALJEAN AVE 7218 VAN NUYS BLVD #B 16600 SHERMAN WAY STE 290 13703 BURBANK BLVD 15714 1/2 VANOWEN ST 14618 VICTORY BLVD STE B

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Provider City UPLAND UPLAND UPLAND UPLAND UPLAND VACAVILLE VACAVILLE VACAVILLE VALENCIA VALENCIA VALENCIA VALENCIA VALENCIA VALENCIA VALENCIA VALLEJO VALLEJO VALLEJO VALLEJO VALLEJO VALLEJO VALLEY CENTER VALLEY SPRINGS VALLEY VILLAGE VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91786-4070 91784-1732 91784-1667 91786 91786-4049 95687-6394 95687-6288 95688-2920 91355 91354-1430 91355-2103 91355-6060 91355-4467 91355-4467 91355 94590-5906 94590-2958 94589-2577 94589-2200 94590 94589 92082-6553 95252 91607-3430 91401-1425 91411-1622 91405-3605 91406-4733 91406-3510 91406-2702 91406 91401-2348 91401-1430 91405-2287 91411-1613 91405 91406-3915 91405-6803 91406-3875 91401-5040 91406-5029 91411-1621

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUPER RITE DRUGS TNH PHARMACY VETERAN'S PHARMACY YM DRUGS YOUNG'S PHARMACY VENICE FAMILY CABRILLO PHARMACY CLINICAS DEL CAMINO REAL, INC. - VE COLLEGE PHARMACY OPTION CARE RALPHS ROGERS UNITED DRUGS THE MEDICINE SHOPPE THE MEDICINE SHOPPE VENTURA COUNTY PHARMACY ALLCARE PHARMACY BEST PHARMACY CURT'S PHARMACY OASIS PHARMACY PRESCRIPTION SHOP PRESCRIPTION STATION, INC QUEENS PHARMACY VISTA CARE PHARMACY YOUR DRUG STORE VILLA PARK PHARMACY INTERGATED CARE SYSTEMS KAWEAH DELTA PHARMACY PILL BOX PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SEQUOIA ONCOLOGY MEDICAL ASSOC SOUTH COURT PHARMACY THE MEDICINE SHOPPE TOWN CENTER PHARMACY CEDAR PARK PHARMACY GREENFIELD PHARMACY HILLCREST PHARMACY NORTH MED CARE PHARMACY

Provider Name

(818) 787-2552 (818) 988-1288 (818) 849-6460 (818) 901-7080 (818) 787-9339 (310) 664-7756 (805) 643-9939 (805) 659-0119 (805) 642-4135 (888) 579-0917 (805) 650-0466 (805) 648-1856 (805) 648-2724 (805) 647-1133 (805) 765-6046 (760) 241-0508 (760) 962-9220 (760) 245-3518 (760) 241-4080 (760) 245-7761 (760) 241-3390 (760) 962-1200 (760) 843-7000 (760) 843-7200 (714) 998-3030 (559) 734-2896 (559) 624-4880 (559) 734-6747 (559) 622-0849 (559) 625-9888 (559) 738-9487 (559) 624-3036 (559) 738-8800 (559) 625-5015 (559) 734-5893 (760) 630-8806 (760) 842-1700 (760) 295-2625 (760) 758-7650

14425 BURBANK BLVD 15211 VANOWEN ST STE 301 14105 BURBANK BLVD 6578 VAN NUYS BLVD 7134 VAN NUYS BLVD 604 ROSE AVE 146 N BRENT ST 200 S. WELLS RD RM 1 90 N ASHWOOD AVE 5574 EVERGLADES ST STE D 1776 S VICTORIA AVE 2909 LOMA VISTA RD 2611 E THOMPSON BLVD 9308 TELEPHONE RD STE B 3350 LOMA VISTA RD 12998 HESPERIA RD STE 102 16850 BEAR VALLEY RD 14829 7TH STREET SUITE E 15433 W SAND ST STE 102 15247 11TH ST NUMBER 1100 15048 7TH ST STE A 12677 HESPERIA RD STE 180 12351 MARIPOSA RD #11 12370 HESPERIA RD STE 7 17821 SANTIAGO BLVD 7140 W PERSHING CT 202 W WILLOW AVE STE 102 317 W NOBLE AVE 3615 W NOBLE AVE 5203 W WALNUT AVE 5201 W GOSHEN AVE 4945 W CYPRESS AVE STE C 1620 S COURT ST 3507 W WALNUT AVE 535 W ACEQUIA 130 CEDAR RD 2067 W VISTA WAY 1988 HACIENDA DR 161 THUNDER DR STE 100

VAN NUYS VAN NUYS VAN NUYS VAN NUYS VAN NUYS VENICE VENTURA VENTURA VENTURA VENTURA VENTURA VENTURA VENTURA VENTURA VENTURA VICTORVILLE VICTORVILLE VICTORVILLE VICTORVILLE VICTORVILLE VICTORVILLE VICTORVILLE VICTORVILLE VICTORVILLE VILLA PARK VISALIA VISALIA VISALIA VISALIA VISALIA VISALIA VISALIA VISALIA VISALIA VISALIA VISTA VISTA VISTA VISTA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

91401-4895 91405-3681 91401 91401-1426 91405-3005 90291 93003-2810 93004 93003-1810 93003-6542 93003-6592 93003-2915 93003-2743 93004-2680 93003-3024 92395-8317 92395 92395 92392 92395-3727 92395-3839 92395-7754 92395 92395-4787 92861 93291-7941 93291 93277-2668 93277-1859 93277-3466 93291-8619 93277-1592 93277-4962 93277-4170 93291 92083-5102 92083-6031 92081 92083-6051

MED-RX PHARMACY AND COMPOUNDING ADVANCE MEDICAL PHARMACY

(760) 724-7125 (925) 939-6311

1031 E VISTA WAY 112 LA CASA VIA STE 100

VISTA WALNUT CREEK

CA CA

92084 94598-3004

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 98 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name CONTRA COSTA ONCOLOGY RIDGECREST PHARMACY SCRIPTWORKS-A PROFESSIONAL PHCY EXPRESS PHARMACY#4 ANSR PHARMACY 102 SAVE MART PHARMACY WATSONVILLE PHARMACY OWENS HEALTHCARE OWENS PHARMACY AP 7 PHARMACY BETTER VALUE PHARMACY BTN ORANGE PHARMACY DIABETES CARE PHARMACY EAST VALLEY PMQ PHARMACY EZCARE PHARMACY MAXSON MEDICAL PHARMACY INC MERCED MEDICAL PHARMACY SAN GABRIEL MEDICAL PHCY SAV-ON PHARMACY TLC MEDICAL ARTS PHARMACY WEST COVINA MEDICAL CTR PHCY CAREFIRSTRX PHARMACY EASYCARE PHARMACY FAMILY CARE PHARMACY MEDALLION PHARMACY MEDCENTA PHARMACY MICHAEL BENJAMIN MD OAK HILLS MEDICAL PHARMACY OMID S SHAYE MD A MEDICAL CORP ROYAL HILLS PHARMACY AHF PHARMACY WEST HOLLYWOOD BEVERLY SINAI MEDICAL PHARMACY CAPITOL DRUGS WEST HOLLYWOOD CIENEGA PHARMACY CURSON PHARMACY FAIRFAX PHARMACY GENESEE PHARMACY GREAT EARTH COMPOUNDS MID-WEST MEDICAL PHARMACY PAVILIONS PHARMACY RALPHS SPAULDING PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (925) 939-9610 (925) 937-6800 (925) 934-4400 (661) 240-5900 (831) 630-3100 (831) 768-7180 (831) 728-1818 (530) 623-1632 (530) 938-4135 (626) 214-7420 (626) 960-4723 (626) 593-1358 (626) 814-0111 (626) 869-2470 (626) 587-0400 (626) 338-1143 (626) 962-3685 (626) 960-8696 (626) 915-5555 (626) 338-7233 (626) 502-1991 (818) 887-8844 (818) 927-1000 (818) 300-1352 (818) 340-0212 (818) 914-5049 (818) 570-2134 (818) 715-0070 (818) 346-1773 (818) 887-7380 (323) 654-0907 (310) 657-2881 (310) 289-5277 (310) 360-9969 (323) 878-2555 (323) 656-9622 (323) 822-9500 (310) 550-1822 (310) 657-1635 (310) 273-5126 (323) 876-5651 (323) 656-3663

Provider Street 500 LENNON LN 1844 SAN MIGUEL DR STE 105 480 N WIGET LN 650 F ST 558 MAIN ST 1465 MAIN ST 1433 FREEDOM BLVD 50 NUGGET LANE 582 MAIN ST 1300 S SUNSET AVE 1135 S SUNSET AVE STE 101 140 N ORANGE AVE STE 103 1339 W GARVEY AVE N 420 S GLENDORA AVE 1535 W MERCED AVE #100 933 S SUNSET AVE 1515 W MERCED AVE 1250 S SUNSET AVE STE 207 2630 E WORKMAN AVE 1500 W WEST COVINA PKWY STE 10 725 S ORANGE AVE 7325 MEDICAL CENTER DR STE 102 7320 WOODLAKE AVE STE 100 7325 MEDICAL CENTER DR # 303 23101 SHERMAN PL 6401 PLATT AVE SUITE #4 7325 MEDICAL CENTER DR STE 201 7345 MEDICAL CENTER DR STE 100 7320 WOODLAKE AVE STE 330 7301 MEDICAL CENTER DR STE 106 8212 SANTA MONICA BLVD 8737 BEVERLY BLVD 8578 SANTA MONICA BLVD 7360 SANTA MONICA BLVD #101 7559 SANTA MONICA BLVD 1111 N FAIRFAX AVE STE 110 7764 SANTA MONICA BLVD 8941 SANTA MONICA BLVD 8733 BEVERLY BLVD 8969 SANTA MONICA BLVD 1233 N LA BREA AVE 7722 SANTA MONICA BLVD

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Provider City WALNUT CREEK WALNUT CREEK WALNUT CREEK WASCO WATSONVILLE WATSONVILLE WATSONVILLE WEAVERVILLE WEED WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST COVINA WEST HILLS WEST HILLS WEST HILLS WEST HILLS WEST HILLS WEST HILLS WEST HILLS WEST HILLS WEST HILLS WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD WEST HOLLYWOOD

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

94598-2415 94596 94598-2408 93280-2018 95076-4318 95076-3759 95076-2742 96093 96094-2339 91790-3342 91790-3938 91790-2016 91790-2242 91790-3001 91790-3404 91790-3410 91790-3403 91790-3962 91791-1627 91790-2729 91790-2614 91307-4110 91307-1493 91307 91307-2003 91307 91307-1926 91307-1923 91307 91307-1919 90046-5913 90048-1828 90069 90046-6619 90046-6406 90046-5363 90046-6219 90069-4912 90048-1827 90069-4911 90038-1023 90046-6220

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WEST KNOLL PHARMACY CAPITOL PHARMACY INC JEFFERSON PHARMACY RALEYS CENTRAL FILL RALEY'S DRUG CENTER SALUD CLINIC PHARMACY COMPOUNDIA PHARMACY PASEO OAKS PHARMACY PAVILIONS PHARMACY THE MEDICINE SHOPPE 2010 PHARMACY ALOHA PHARMACY ANH-NHI PHARMACY AUDREY PHARMACY AUDREY PHARMACY BINH-DAN PHARMACY BOLSA EXPRESS PHARMACY BOLSA MEDICAL ARTS PHARMACY BT PHARMACY CALIFORNIA PHARMACY CATINAT PHARMACY DANH'S PHARMACY DONGNAI PHARMACY DRAGON PHARMACY GOLDEN PHARMACY KIM AN PHARMACY KIM UNITED DRUGS LANVY PHARMACY LC SCRIPTS PHCY & COMPOUNDING LINHS PHARMACY LINH'S PHARMACY LST GARDEN PHARMACY INC MAICO PHARMACY MAILAN HERITAGE PHARMACY MAY PHARMACY NGOC MAI PHARMACY PAVILIONS PHARMACY SAV-ON PHARMACY TAM'S RX PHARMACY TAN BINH PHARMACY INC TANA PHARMACY THE PROFESSIONAL PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (310) 657-2027 (916) 617-4321 (916) 371-2022 (916) 403-2828 (916) 372-3111 (916) 403-2988 (855) 371-4443 (805) 379-4110 (818) 597-1370 (805) 497-3974 (714) 379-9800 (714) 839-1267 (714) 894-4518 (714) 531-1983 (714) 531-1244 (714) 531-5502 (714) 891-8810 (714) 897-2541 (714) 622-5992 (714) 775-2000 (714) 531-3560 (714) 892-4407 (714) 379-5072 (714) 927-7871 (714) 839-0256 (714) 839-5888 (714) 775-6677 (714) 531-2828 (714) 892-4445 (714) 892-8773 (714) 775-0550 (714) 890-3174 (714) 531-7000 (714) 899-4960 (714) 893-2697 (714) 890-7112 (714) 847-5696 (714) 898-9669 (714) 892-9808 (714) 531-8275 (714) 554-4121 (714) 893-2464

Provider Street 8547 SANTA MONICA BLVD 2923 W CAPITOL AVE 1029 JEFFERSON BLVD STE A 2928 RAMCO ST STE 100 1601 1/2 W CAPITOL AVE 500B JEFFERSON BLVD 766 LAKEFIELD RD UNIT E 3701 E THOUSAND OAKS BLVD 1135 LINDERO CANYON RD 1250 LA VENTA DR STE 114 7785 WESTMINSTER BLVD 15611 BROOKHURST ST 8900 BOLSA AVE STE A 9741 BOLSA AVE STE 116 9822 BOLSA AVE STE G 14516 BROOKHURST ST 9262 BOLSA AVE STE A 15262 GOLDENWEST ST 14262 BEACH BLVD 14541 BROOKHURST ST STE C5 9549 BOLSA AVE STE A 9182 BOLSA AVE 9081 BOLSA AVE #108 5839 WESTMINSTER BLVD STE A 10301 BOLSA AVE STE 105 15550 BROOKHURST ST 14536 BROOKHURST ST # 101 14971 BROOKHURST ST STE A 15440 BEACH BLVD #120 9191 BOLSA AVE STE 102 9500 BOLSA AVE STE N 14501 MAGNOLIA ST STE 100 10161 BOLSA AVE STE 105B 14441 BEACH BLVD STE 108 14571 MAGNOLIA ST 9014 BOLSA AVE 16450 BEACH BLVD 6755 WESTMINSTER BLVD 14024 MAGNOLIA ST STE 103A 15434 BROOKHURST ST 10512 BOLSA AVE STE 104 7631D WESTMINSTER BLVD

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Provider City WEST HOLLYWOOD WEST SACRAMENTO WEST SACRAMENTO WEST SACRAMENTO WEST SACRAMENTO WEST SACRAMENTO WESTLAKE VILLAGE WESTLAKE VILLAGE WESTLAKE VILLAGE WESTLAKE VILLAGE WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER

State

ZIP code

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90069-4120 95691-2910 95691-3331 95691-5841 95691-3219 95605 91361-2661 91362-3607 91362-5473 91361-3762 92683-4025 92683-7556 92683-5475 92683-6683 92683-6870 92683-5750 92683-8905 92683-6169 92683 92683 92683-5904 92683-5556 92683 92683-9107 92683-6784 92683-7571 92683-5750 92683-6037 92683 92683-5502 92683-5943 92683-5542 92683-6770 92683 92683-5574 92683-5531 92683-7859 92683-3706 92683-4766 92683-7057 92683-6727 92683-3919

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THEO PHARMACY THU VAN PHARMACY TMT INTNL PHARMACEUTICAL CORP TT PHARMACY VALUE SCRIPTS PHARMACY WEST DRUG VILLAGE PHARMACY BRIGHT PLAZA PHARMACY CALIFORNIA SPECIALTY PHARMACY HEART DRUGS PHARMACY PHARMACARE PHARMACY PIH COMMUNITY PHARMACY, LLC PRESCRIPTION SHOP UNITED DRUGS RALPHS

Provider Name

(714) 373-0214 (714) 775-0772 (714) 988-6888 (714) 622-5549 (714) 891-5280 (714) 892-6916 (530) 633-2819 (562) 943-7500 (877) 602-7779 (562) 692-4278 (562) 846-1005 (562) 789-5412 (562) 464-6655 (562) 945-5641

13701 BEACH BLVD # A2 10362 BOLSA AVE STE 108 7921 WESTMINSTER BLVD 9091 EDINGER AVE STE B 9433 BOLSA AVE STE B 8526 WESTMINSTER BLVD 414 MAIN ST 15725 E WHITTIER BLVD STE A 13027 HADLEY ST STE B 11120 WHITTIER BLVD 12826 PHILADELPHIA ST #C 12462 PUTNAM STREET 14350 WHITTIER BLVD 14919 WHITTIER BLVD

WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WHEATLAND WHITTIER WHITTIER WHITTIER WHITTIER WHITTIER WHITTIER WHITTIER

CA CA CA CA CA CA CA CA CA CA CA CA CA CA

92683-3203 92683-6763 92683 92683 92683-5964 92683-4605 95692-9422 90603-2312 90601-4206 90606-1432 90601-4117 90602-1002 90605-2138 90605-1793

THE ONC INST OF HOPE & INNOVATION VO PHARMACY WHITTIER DRUGS

(562) 698-6888 (562) 646-3339 (562) 789-5852

8135 PAINTER AVE STE 103 12464 E WASHINGTON BLVD 9209 COLIMA RD STE 1100

WHITTIER WHITTIER WHITTIER

CA CA CA

90602-3171 90602-1005 90605-1863

WHITTIER INTERCOMMUNITY PHARMACY BEAR CREEK PHARMACY SAV-ON PHARMACY SUPER RX PHARMACY FOUCH & SON PHARMACY HOWARD PHARMACY WILLOWS PHARMACY AVALON PHARMACY THE MEDICINE CABINET SUPER RX PHARMACY RALEY'S DRUG CENTER A & G CARE PHARMACY ANNEX PHCY & MED SUPPLY INC PMQ WINNETKA PHARMACY CORNER DRUG COMPANY, INC. RALEY'S DRUG CENTER ABSOLUTE WELLNESS PHARMACY BASSO PHARMACY TAFT PHARMACY WARNER VICTORY PHARMACY WEST VALLEY PHARMACY WINNETKA PHARMACY B & B VILLAGE CENTER PHARMACY

(562) 945-4166 (951) 677-4880 (951) 600-4620 (951) 678-1755 (530) 473-5350 (707) 456-3005 (530) 934-7744 (310) 549-9393 (310) 513-9214 (951) 325-2523 (707) 838-4319 (818) 576-0070 (818) 882-5010 (714) 364-4008 (530) 662-2813 (530) 666-1445 (818) 912-6800 (818) 347-7337 (818) 348-0860 (818) 346-1901 (818) 222-9877 (818) 854-6600 (714) 777-2737

12291 WASHINGTON BLVD STE 101 36243 INLAND VALLEY DR 23893 CLINTON KEITH RD 36010 HIDDEN SPRINGS RD 692 E STREET 3 MARCELA DRIVE SUITE B 226 N BUTTE ST 1203 N AVALON BLVD STE A 228 E ANAHEIM ST 30712 BENTON RD 8858 LAKEWOOD DR 7233 CORBIN AVE 20177 SATICOY STREET 20800 SHERMAN WAY 602 MAIN ST 367 W MAIN ST 19720 VENTURA BLVD UNIT 100 5952 FALLBROOK AVE # 5954 20056 VENTURA BLVD 6325 TOPANGA CANYON BLVD #102 22554 VENTURA BLVD 19944 VENTURA BLVD 18525 YORBA LINDA BLVD

WHITTIER WILDOMAR WILDOMAR WILDOMAR WILLIAMS WILLITS WILLOWS WILMINGTON WILMINGTON WINCHESTER WINDSOR WINNETKA WINNETKA WINNETKA WOODLAND WOODLAND WOODLAND HILLS WOODLAND HILLS WOODLAND HILLS WOODLAND HILLS WOODLAND HILLS WOODLAND HILLS YORBA LINDA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

90606-2549 92595 92595-7894 92595-7622 95987-0000 95490 95988-2804 90744-2646 90744-4516 92596 95492-9595 91306-3006 91306 91306-2707 95695-3405 95695-3600 91364 91367-3221 91364 91367 91364 91364-2629 92886-4135

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 101 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HEALTHY LIVING PHARMACY LINDA VISTA PHARMACY TELNET-RX PHARMACY LUKE'S YREKA DRUG RALEY'S DRUG CENTER BEL AIR PHARMACY FRANKLIN PHARMACY MISSION PHARMACY SERVICES RALEY'S DRUG CENTER RIVERSIDE PHARMACY SAFESAVE PHARMACY SUTTER PHARMACY GREEN VALLEY PHARMACY SAIL DRUG YUCAIPA CARE PHARMACY NEW PHARMACY ALAMOSA PHARMACY CITY MARKET PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY MEDSTUFF INC WARD ROAD PHARMACY CARL'S PHARMACY CITY MARKET PHARMACY CLARKS PHARMACY ASPEN GENOA-QOL HEALTHCARE GRACE HEALTH PHARMACY HAVANA PHARMACY AND MED SUPPLY

Provider Name

(714) 692-3261 (714) 528-3610 (800) 298-7176 (530) 842-2600 (530) 842-4182 (530) 755-9917 (530) 674-3277 (530) 674-7214 (530) 673-8880 (530) 751-1889 (530) 674-3550 (530) 821-5110 (909) 790-1688 (909) 797-9191 (909) 570-9771 (760) 228-1600 (719) 589-1766 (719) 589-6656 (303) 421-1200 (303) 420-1377 (303) 487-5325 (303) 428-1992 (303) 422-1476 (720) 898-4232 (303) 403-4142 (303) 420-7979 (970) 925-3273 (970) 920-7230 (970) 925-2728 (720) 688-1880 (720) 748-2449 (303) 750-3600

4957 YORBA RANCH RD STE A 4300 ROSE DRIVE STE D 3940 PROSPECT AVE STE R 829 S MAIN ST 1840 FORT JONES RD 1286 STABLER LN 1619 FRANKLIN RD 400 PLUMAS BLVD STE 100 700 W ONSTOTT RD # C 866 PLUMAS ST 737 COLUSA AVE 470 PLUMAS BLVD STE 103 33733 YUCAIPA BLVD STE 1 12350 CALIFORNIA ST 33490 OAK GLEN RD STE E 57725 29 PALMS HWY STE 209 108 BLANCA AVE 131 MARKET ST 9731 W 58TH AVE 8031 WADSWORTH BLVD 8055 SHERIDAN BLVD 6350 SHERIDAN BLVD 12350 W 64TH AVE 15200 W 64TH AVE 10382 RALSTON RD 5656 WARD WAY STE A 306 E MAIN ST 685 E COOPER AVE STE A112 300 PUPPY SMITH ST. 791 CHAMBERS RD RM 152 3191 S VAUGHN WAY # 102 1555 S HAVANA ST UNIT HJ

YORBA LINDA YORBA LINDA YORBA LINDA YREKA YREKA YUBA CITY YUBA CITY YUBA CITY YUBA CITY YUBA CITY YUBA CITY YUBA CITY YUCAIPA YUCAIPA YUCAIPA YUCCA VALLEY ALAMOSA ALAMOSA ARVADA ARVADA ARVADA ARVADA ARVADA ARVADA ARVADA ARVADA ASPEN ASPEN ASPEN AURORA AURORA AURORA

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

92887-2564 92886 92886-1752 96097 96097-9531 95993-2620 95993-4646 95991-5071 95991-3511 95991-4022 95991 95991-5005 92399-2256 92399-4404 92399-2095 92284-3044 81101 81101-2238 80002-2009 80003-1645 80003-1910 80003-6645 80004-4016 80007-7510 80004-5860 80002-1346 81611-1930 81611-2011 81611 80011-7112 80014-3505 80012-5004

IDGP PHARM AT THE UNIV OF CO HOSP KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY

(720) 848-4086 (303) 615-2860 (303) 343-3170 (303) 364-9196 (303) 671-8701 (303) 755-1246 (303) 752-4777 (303) 680-8690 (303) 627-3301

1635 URSULA ST RM 7284 25701 E SMOKY HILL ROAD 15109 E COLFAX AVE 655 PEORIA ST 15250 E MISSISSIPPI AVE 1155 S HAVANA ST 17000 E ILIFF AVE 4271 S BUCKLEY RD 18211 E HAMPDEN AVE

AURORA AURORA AURORA AURORA AURORA AURORA AURORA AURORA AURORA

CO CO CO CO CO CO CO CO CO

80045-7402 80016 80011-5729 80011-8228 80012-3768 80012-4019 80013-1520 80013-2901 80013-3532

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 102 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KING SOOPERS PHARMACY KING SOOPERS PHARMACY SADDLE ROCK PHARMACY

Provider Name

(303) 750-2452 (303) 627-0158 (720) 353-4212

3190 S PARKER RD 6412 S PARKER RD 22962 E SMOKY HILL RD

AURORA AURORA AURORA

CO CO CO

80014-3110 80016-3011 80016-1382

UNIV OF COLORADO HOSP ATRIUM PHCY

(720) 848-4083

12605 E 16TH AVE RM 1054

AURORA

CO

80045-7109

UNIV. COLORADO HOSPITAL PHARMACY UNIVERSITY OF COLORADO HOSP PHCY XENIA CUSTOM PHARMACY CITY MARKET PHARMACY BASALT CLINIC PHARMACY MILL STREET DRUG KING SOOPERS PHARMACY BERTHOUD DRUG GENOA-QOL HEALTHCARE KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY MEDICAL CENTER PHARMACY PHARMACA INTEGRATIVE PHARMACY PHARMACA INTEGRATIVE PHARMACY PHARMACA INTEGRATIVE PHARMACY THE APOTHECARY

(720) 848-1020 (720) 848-8368 (720) 669-4567 (970) 949-5437 (970) 927-3833 (970) 884-9133 (303) 644-5080 (970) 532-2034 (303) 413-6288 (303) 444-0164 (303) 530-0400 (303) 499-4244 (303) 440-3111 (303) 442-5164 (303) 442-0589 (303) 867-3400 (303) 492-8553

1635 AURORA CT STE F702 # 1012 12605 E 16TH AVE RM 1510 #027 14001 E ILIFF AVE #200 260 BEAVER CREEK PLACE 140 BASALT CENTER CIRCLE 15 EAST MILL ST 1045 FIRST STREET 330 MOUNTAIN AVE 1333 IRIS AVE 1650 30TH ST 6550 LOOKOUT RD 3600 TABLE MESA DR 2750 BROADWAY ST 1647 PEARL ST 2700 BROADWAY ST 645 S BROADWAY ST 1900 WARDENBURG DR

AURORA AURORA AURORA AVON BASALT BAYFIELD BENNETT BERTHOUD BOULDER BOULDER BOULDER BOULDER BOULDER BOULDER BOULDER BOULDER BOULDER

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

80045-2553 80045 80014-1425 81620-0000 81621-0000 81122 80102 80513 80304-2226 80301-1014 80301-3303 80305-5800 80304-3573 80302-5410 80304-3543 80305-5926 80310

UNIV OF CO THE APOTHECARY AT UMGP CITY MARKET PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY PLATTE VALLEY PHARMACY SALUD PHARMACY BRIGHTON KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY B & B PHARMACY BUENA VISTA DRUG CITY MARKET PHARMACY WB DRUG BENZER PHARMACY CITY MARKET PHARMACY PALACE DRUG INC CITY MARKET PHARMACY

(303) 499-2879 (970) 547-9343 (303) 655-7773 (303) 637-0350 (303) 483-7455 (303) 655-4998 (303) 439-0169 (303) 439-9040 (303) 424-7346 (303) 920-3050 (970) 842-2416 (719) 395-2481 (719) 395-3149 (719) 346-8851 (303) 822-9371 (719) 275-3319 (719) 275-3375 (970) 963-5727

350 BROADWAY ST STE 50 400 N PARK AVE 500 W BROMLEY LN 100 N 50TH AVE 1610 PRAIRIE CNT PKWY STE 2110 1860 E EGBERT 12167 SHERIDAN BLVD 1150 US HIGHWAY 287 9983 WADSWORTH PKWY 2355 W 136TH AVE 1302 EDISON ST 403 US 24 SOUTH 438 S HWY 24 314 14TH ST 568 US HWY 36 1703 FREMONT DR 601 MAIN ST 1051 HIGHWAY 133

BOULDER BRECKENRIDGE BRIGHTON BRIGHTON BRIGHTON BRIGHTON BROOMFIELD BROOMFIELD BROOMFIELD BROOMFIELD BRUSH BUENA VISTA BUENA VISTA BURLINGTON BYERS CANON CITY CANON CITY CARBONDALE

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

80305-3300 80424-8827 80601-2949 80601-8300 80601 80601-2475 80020-2459 80020-7021 80021-4249 80023-9331 80723-2310 81211 81211 80807-1608 80103 81212-2405 81212-3736 81623-1874

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 103 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CITY MARKET PHARMACY ITC CMPD & NTNL WELLNESS PHCY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY CEDAREDGE PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY US SPECIALTY CARE PHARMACY

Provider Name

(970) 963-3730 (303) 663-4224 (303) 663-0768 (303) 660-2510 (303) 688-9721 (970) 856-3161 (303) 400-5204 (303) 798-2491 (303) 779-4242 (800) 641-8475

250 VALLEY RD 651 TOPEKA WAY # 600 100 FOUNDERS PKWY 750 S RIDGE RD 7284 LAGAE RD 210 SE INDEPENDENCE AVE 19711 E SMOKY HILL RD 7575 S UNIVERSITY BLVD 8200 S HOLLY ST 7472 S TUCSON WAY STE 100B

CARBONDALE CASTLE ROCK CASTLE ROCK CASTLE ROCK CASTLE ROCK CEDAREDGE CENTENNIAL CENTENNIAL CENTENNIAL CENTENNIAL

CO CO CO CO CO CO CO CO CO CO

81623-9755 80109-3116 80104-6604 80104-9763 80108-9451 81413-4215 80015-5194 80122-3180 80122-4012 80112-4452

JEFF'S VALLEY HEALTHMART PHARMACY COLORADO SPRINGS HLTH PART PHCY COMPASS PHARMACY, LLC EASTSIDE EXPRESS PHARMACY GENOA-QOL HEALTHCARE IVYWILD PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY MEDICINE SHOPPE MEMORIAL HOSPITAL STAFF PHCY PENROSE PROFESSIONAL PHCY PREMIER PHARMACY GROUP, LLC PROFESSIONAL PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE VILLAGE PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY SALUD PHCY COMMERCE CITY KING SOOPERS PHARMACY CITY MARKET PHARMACY CITY MARKET PHARMACY

(719) 676-3333 (719) 633-2762 (719) 444-4774 (719) 596-4650 (719) 630-3421 (719) 634-5541 (719) 522-2201 (719) 591-4163 (719) 636-5046 (719) 527-1640 (719) 866-6646 (719) 390-9211 (719) 598-5191 (719) 598-3578 (719) 590-7515 (719) 488-2988 (719) 577-9800 (719) 365-2525 (719) 776-5487 (719) 457-6377 (719) 633-8278 (719) 475-9030 (719) 471-3600 (719) 630-3154 (719) 596-2141 (303) 286-5470 (303) 288-6629 (303) 227-6458 (303) 816-4970 (970) 565-6466 (970) 824-4449

4493 BENT BROTHERS BLVD 1633 MEDICAL CENTER PT 2502 E PIKES PEAK AVE STE 20 3960 MAIZELAND RD 875 W MORENO AVE 1640 S NEVADA AVE 9225 N UNION BLVD 6030 STETSON HILLS BLVD 1750 W UINTAH ST 815 CHEYENNE MEADOWS RD 3250 CENTENNIAL BLVD 3175 S ACADEMY BLVD 6930 N ACADEMY BLVD 3620 AUSTIN BLUFFS PKWY 3570 HARTSEL DR 1070 W BAPTIST RD 1625 MEDICAL CENTER PT STE 140 1400 E BOULDER ST 2222 N NEVADA AVE 101 S UNION BLVD 155 PRINTERS PKWY 3159 W COLORADO AVE 2306 N WAHSATCH AVE 2431 N UNION BLVD 3277 W CAREFREE CIR 15051 E. 104TH AVE 4850 E 62ND AVE 6255 QUEBEC PKWY 25637 CONIFER RD 508 E MAIN ST 505 W VICTORY WAY

COLORADO CITY COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COLORADO SPRINGS COMMERCE CITY COMMERCE CITY COMMERCE CITY CONIFER CORTEZ CRAIG

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

81019 80907-8732 80909-6033 80909-1608 80905-1731 80905 80920 80923 80904-2926 80906-4902 80907-4077 80916-3203 80918-1127 80918-6631 80920-4165 80921-2402 80907-5798 80909-5533 80907-6831 80910 80910-6100 80904-2040 80907-6965 80909-1107 80917-3004 80022 80022-3288 80022-4812 80433-9029 81321-3307 81625-2929

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 104 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RIO GRANDE PHARMACY LLC CITY MARKET PHARMACY ADVANCED RX, INC ALBERTSON'S PHARMACY APOTHECARE PHARMACY AVELLA OF DENVER INC CAPITOL HEIGHTS PHARMACY CARES PHARMACY CCC PHARMACY CHERRY CREEK PHARMACY INC CLEARSPRING PHARMACY, LTD. GOLDIN PHARMACY AND MED SUPPLY HUAN PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY MEDSTUFF MHCD PHARMACY ROCKY MTN CANCER CNTRS MIDTOWN SAV-ON PHARMACY SCALES PHARMACY SCL HEALTH PHCY SVCS-FRANKLIN ST JOSEPH HOSP OUTPATIENT PHCY THE UROLOGY CENTER OF COLORADO TKS PHARMACY TODD'S HARVARD PARK PHCY,INC.

Provider Name

(719) 657-3513 (970) 874-5771 (303) 975-1700 (303) 744-8660 (303) 778-2427 (303) 863-7644 (303) 388-3679 (303) 321-0436 (303) 318-3490 (303) 333-2232 (303) 333-2010 (303) 355-6818 (303) 936-3230 (303) 678-2443 (303) 571-1943 (303) 333-3837 (303) 832-5298 (303) 936-7403 (303) 936-2377 (303) 388-1689 (303) 715-4057 (303) 758-0011 (303) 333-1545 (303) 937-4404 (303) 451-9470 (720) 531-6371 (303) 722-5793 (303) 371-8985 (303) 333-2035 (303) 504-7799 (303) 388-4876 (303) 340-4459 (303) 974-5424 (303) 318-1305 (303) 318-3333 (303) 825-8822 (720) 583-2110 (303) 733-3755

650 GRAND AVE 122 GUNNISON RIVER DR 1035 S FEDERAL BLVD STE B 323 S BROADWAY 2535 S DOWNING ST STE G10 1245 E COLFAX AVE STE 102 1200 MADISON ST 4500 E 9TH AVE STE 180 1825 MARION ST 6336 LEETSDALE DR 201 UNIVERSITY BLVD STE 105 909 S ONEIDA ST STE 11 633 S FEDERAL BLVD #203 1950 CHESTNUT PL 1331 SPEER BLVD 2810 QUEBEC ST 1155 E 9TH AVE 5125 W FLORIDA AVE 2727 W EVANS AVE 1370 KEARNEY ST 2700 S COLORADO BLVD 6470 E HAMPDEN AVE 890 S MONACO PKWY 3125 S SHERIDAN BLVD UNIT 2 3801 E 120TH AVE 10406 MARTIN LUTHER KING BLVD 825 S COLORADO BLVD 18605 E 48TH AVE 970 S ONEIDA ST UNIT 1B 4455 E 12TH AVE 1800 WILLIAMS ST STE 100 200 QUEBEC ST BLDG 400 1999 PENNSYLVANIA ST 1830 FRANKLIN ST SUITE 190 1835 FRANKLIN ST 2777 MILE HIGH STADIUM CIR 4809 ARGONNE ST STE 225 950 E HARVARD AVE

DEL NORTE DELTA DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER DENVER

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

81132-2206 81416-1856 80219-4169 80209-1560 80210-5853 80218 80206-3440 80220-3911 80218-1122 80224 80206-4617 80224 80219 80202 80204-2512 80207-2900 80218-4802 80219-3605 80219-5507 80220-2726 80222-6602 80222-7605 80224-1574 80227-5506 80233-6701 80238-2326 80246-8006 80249-6663 80224-1700 80220 80218 80230-7145 80203-1314 80218 80218 80211-5222 80249-6801 80210-7009

UNIVERSITY COLORADO HOSPITAL PHCY WELLSHIRE PHARMACY ALBERTSON'S PHARMACY

(720) 848-9590 (303) 504-6699 (970) 382-2228

8111 E LOWRY BLVD STE 110 4141 E DICKENSON PL 311 W COLLEGE DR

DENVER DENVER DURANGO

CO CO CO

80230-7255 80222-6012 81301-5911

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 105 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CITY MARKET PHARMACY CITY MARKET PHARMACY RIVERGATE PHARMACY KIOWA DRUG CITY MARKET PHARMACY EAGLE PHARMACY GOOD DAY PHARMACY KING SOOPERS PHARMACY EDWARDS MEDICAL CTR PHARMACY VAIL VALLEY PHARMACY

Provider Name

(970) 247-9435 (970) 247-2921 (970) 375-7711 (719) 438-5832 (970) 328-1311 (970) 328-6875 (970) 454-2110 (303) 237-6140 (970) 569-7676 (970) 569-4150

3130 MAIN AVE 6 TOWN PLZ # C 575 RIVERGATE LN STE 111 1201 MAINE ST 0103 MARKET ST 301 BROADWAY 180 ELM AVE 1725 SHERIDAN BLVD 322 BEARD CREEK RD 105 EDWARDS VILLAGE BLVD

DURANGO DURANGO DURANGO EADS EAGLE EAGLE EATON EDGEWATER EDWARDS EDWARDS

CO CO CO CO CO CO CO CO CO CO

81301-4247 81301-5104 81301-7490 81036 81631 81631 80615-3420 80214-1323 81632 81632

CENTENNIAL PROFESSIONAL PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY OPTION CARE BEATTIES HEALTHMART PHARMACY KING SOOPERS PHARMACY ROCKY MT PHCY OF ESTES PARK MONFORT FAMILY CLINIC PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY CO ST VETERANS NURSING HM PHCY FOX DRUG STORE ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY CITY DRUG GOOD DAY PHARMACY GOOD DAY PHARMACY

(303) 699-3070 (303) 794-6397 (303) 761-7817 (303) 806-2770 (303) 694-1202 (720) 890-5095 (303) 729-4170 (970) 586-5577 (970) 395-9011 (303) 674-8246 (303) 427-9295 (303) 682-4170 (719) 784-5308 (719) 784-3523 (970) 490-1128 (970) 223-1990 (970) 482-1234 (970) 225-1234 (970) 224-1212

14200 E ARAPAHOE RD 5050 S FEDERAL 101 ENGLEWOOD PKWY 3475 S UNIVERSITY BLVD STE E 7303 S ALTON WAY STE A 3140 VILLAGE VISTA DR 1951 STATE HWY 7 453 E WONDER VIEW AVE STE 1 2930 11TH AVE 1173 BERGEN PKWY 1575 W 84TH AVE 6110 FIRESTONE BLVD 903 MOORE DR 1100 E MAIN ST 731 S LEMAY AVE 3660 S MASON ST 209 N COLLEGE AVE 2601 S LEMAY AVE STE 44 2001 S SHIELDS ST

ENGLEWOOD ENGLEWOOD ENGLEWOOD ENGLEWOOD ENGLEWOOD ERIE ERIE ESTES PARK EVANS EVERGREEN FEDERAL HEIGHTS FIRESTONE FLORENCE FLORENCE FORT COLLINS FORT COLLINS FORT COLLINS FORT COLLINS FORT COLLINS

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

80112-4065 80110 80110-2459 80113-3139 80112-2305 80516-2527 80516 80517-9647 80620-1011 80439-9522 80260-4786 80504-6425 81226-9509 81226-1673 80524-3251 80525-3031 80524-2404 80525-2295 80526-1827

HARMONY EMERGENCY DEPARTMENT PHCY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY POUDRE VALLEY HOSPITAL PHARMACY SALUD PHARMACY FORT COLLINS DALE'S PHARMACY THE SALUD PHARMACY CITY MARKET PHARMACY

(970) 237-8140 (970) 221-4940 (970) 494-6950 (970) 484-1410 (970) 267-5110 (970) 223-5769 (970) 495-8030 (970) 494-4041 (303) 857-6266 (303) 286-4560 (970) 858-9508

4630 SNOW MESA DR 1015 S TAFT HILL RD 1842 N COLLEGE AVE 2325 S COLLEGE AVE 2602 S TIMBERLINE RD 4503 JOHN F KENNEDY PKWY 1024 S LEMAY AVE 1635 BLUE SPRUCE DR 237 DENVER AVE 1115 2ND ST 135 S PLUM ST

FORT COLLINS FORT COLLINS FORT COLLINS FORT COLLINS FORT COLLINS FORT COLLINS FORT COLLINS FORT COLLINS FORT LUPTON FORT LUPTON FRUITA

CO CO CO CO CO CO CO CO CO CO CO

80528 80521-4240 80524-1333 80525-1721 80525-2401 80525-3250 80524-3929 80524-5427 80621-1819 80621-1745 81521-2524

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Provider Phone Number

Provider Street

Page 106 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name POUDRE INFUSION THERAPY KING SOOPERS PHARMACY DOWNTOWN DRUG INC. THE PHARMACY AT VALLEY VIEW COAST TO COAST COMPOUNDING LLC KING SOOPERS PHARMACY CITY MARKET PHARMACY ALBERTSON'S PHARMACY CANYON VIEW PHARMACY CITY MARKET PHARMACY CITY MARKET PHARMACY CITY MARKET PHARMACY CITY MARKET PHARMACY GENOA-QOL HEALTHCARE KING SOOPERS PHARMACY ATRIUM APOTHECARY GENOA-QOL HEALTHCARE GOOD DAY PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY SUMMIT VIEW PHARMACY THE PHARMACY AT ST MICHAELS ASSURED PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY PHARMACA INTEGRATIVE PHARMACY CITY MARKET PHARMACY HAXTUN HOSPITAL DISTRICT PHCY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY ABTS EXPRESS MMH HOMETOWN PHARMACY CITY MARKET PHARMACY FRESH RX LLC SOUTHERN UTE HEALTH CENTER GOOD DAY PHARMACY GOOD DAY PHARMACY KREMMLING MERCANTILE OPERA HOUSE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (970) 494-2130 (303) 320-3110 (970) 945-7987 (970) 945-2202 (303) 237-4478 (303) 279-5684 (970) 887-7152 (970) 257-0233 (970) 644-4380 (970) 241-2779 (970) 245-1215 (970) 434-9651 (970) 244-8110 (970) 361-3748 (970) 628-7563 (970) 378-4500 (970) 475-6016 (970) 350-2413 (970) 392-4150 (970) 353-9780 (970) 339-1717 (970) 810-2000 (970) 978-4557 (303) 771-3254 (303) 773-2390 (720) 488-3405 (303) 798-0388 (970) 641-6379 (970) 774-6979 (303) 683-4288 (303) 470-6445 (720) 344-0334 (303) 683-3669 (970) 854-3400 (970) 854-2222 (970) 872-2623 (970) 442-6400 (970) 563-4781 (970) 461-9101 (970) 587-1128 (970) 724-3205 (719) 384-2521

Provider Street 915 CENTRE AVE STE 3 4600 LEETSDALE DR 825 GRAND AVE 1906 BLAKE AVE 780 SIMMS ST #103 17171 S GOLDEN RD 1001 THOMPSON RD 2512 BROADWAY 2373 G RD STE 120 200 ROOD AVE 2770 HIGHWAY 50 569 32 RD 630 24 RD 515 28 3/4 RD 2600 N 12TH ST 1801 16TH ST 1300 N 17TH AVE 1900 16TH ST 6922 10TH STREET 2712 11TH AVE 2100 35TH AVE 2001 70TH AVE STE 104 2914 67TH AVE STE 101 8200 E BELLEVIEW AVE STE 416C 4910 S YOSEMITE ST 6000 S HOLLY ST 5910 S UNIVERSITY BLVD STE E2 880 N MAIN ST 235 W FLETCHER ST 4000 RED CEDAR DR 9551 S UNIVERSITY BLVD 2205 W WILDCAT RESERVE PKWY 8673 S QUEBEC ST 118 S INTEROCEAN AVE 1001 E JOHNSON ST 215 SIXTH ST 565 GODDARD AVE 356 OURAY DR 4775 LARIMER PKWY 201 JOHNSTOWN CENTER DR 101 MARTIN WAY 223 COLORADO AVE

Page 107 of 679

Provider City FT COLLINS GLENDALE GLENWOOD SPRINGS GLENWOOD SPRINGS GOLDEN GOLDEN GRANBY GRAND JUNCTION GRAND JUNCTION GRAND JUNCTION GRAND JUNCTION GRAND JUNCTION GRAND JUNCTION GRAND JUNCTION GRAND JUNCTION GREELEY GREELEY GREELEY GREELEY GREELEY GREELEY GREELEY GREELEY GREENWOOD VILLAGE GREENWOOD VILLAGE GREENWOOD VILLAGE GREENWOOD VILLAGE GUNNISON HAXTUN HIGHLANDS RANCH HIGHLANDS RANCH HIGHLANDS RANCH HIGHLANDS RANCH HOLYOKE HOLYOKE HOTCHKISS IGNACIO IGNACIO JOHNSTOWN JOHNSTOWN KREMMLING LA JUNTA

State

ZIP code

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

80526 80246-1311 81601-3403 81601-4227 80401-4725 80401-7334 80446 81507 81505-9641 81501-7819 81503-2294 81504-7053 81505-1239 81501-5016 81501-8190 80631-5154 80631-9584 80631-5114 80634 80631-8443 80634-3910 80634-4628 80634-7980 80111-2803 80111-1383 80111-4251 80121-2800 81230-2414 80731-2737 80126-8067 80126-8117 80129-5496 80130-5800 80734-1533 80734-1854 81419 81137 81137 80534-9021 80534-9073 80459 81050-1517

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

EXEMPLA GOOD SAMARITAN MED CTR KING SOOPERS PHARMACY BLUE SPRUCE PHARMACY CENTURA HLTH PHCY- ST ANT HOSP KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY PEOPLES PHARMACY

Provider Name

(303) 689-6101 (303) 604-3070 (303) 432-5925 (720) 321-8290 (303) 233-1001 (303) 914-2061 (303) 985-8797 (303) 988-8058 (303) 989-8490 (303) 987-0707

200 EXEMPLA CIR 480 N HWY 287 9485 W COLFAX AVE 11600 W 2ND PL STE 1817 1555 QUAIL ST 7984 W ALAMEDA AVE 1927 S WADSWORTH BLVD 12043 W ALAMEDA PKWY 1545 S KIPLING PKWY 255 UNION BLVD STE 100

LAFAYETTE LAFAYETTE LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD

CO CO CO CO CO CO CO CO CO CO

80026-3370 80026-0000 80215-3918 80228-1573 80215-6251 80226-3032 80227-3271 80228-2701 80232-6236 80228-1833

UNION SQUARE PHARMACY AT BELMAR BEN'S FAMILY PHARMACY SILVER SPRING PHARMACY ALBERTSON'S PHARMACY ALLHEALTH NETWORK PHARMACY CLEARSPRING PHARMACY CLEARSPRING PHARMACY ELITE PHARMACY, INC GEM PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY FLATIRONS FAMILY PHARMACY GOOD DAY PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY SALUD PHARMACY LONGMONT CHINOOK HEALTHCARE INC KING SOOPERS PHARMACY SAV-ON PHARMACY ALBERTSON'S PHARMACY BANNER FAMILY PHARMACY-SKYLINE COLUMBINE DRUG GENOA-QOL HEALTHCARE GOOD DAY PHARMACY KING SOOPERS PHARMACY

(303) 274-7877 (719) 775-0500 (719) 775-0400 (720) 922-0749 (303) 797-2500 (303) 795-4300 (303) 707-1500 (303) 248-7234 (303) 795-3154 (303) 615-2995 (303) 770-3402 (303) 738-5710 (303) 978-9950 (303) 933-5119 (303) 979-2180 (720) 981-4610 (303) 827-3480 (303) 776-0709 (303) 776-7590 (303) 772-7552 (303) 702-0089 (303) 827-2657 (720) 458-4887 (303) 673-1818 (303) 673-0697 (970) 667-5642 (970) 820-4300 (970) 663-4600 (412) 931-3131 (970) 669-7500 (970) 663-2048

8015 W ALAMEDA AVE STE 100 333 M AVE 333 M AVE 8434 S KIPLING PKWY 5500 S SYCAMORE ST STE 100 8031 SOUTHPARK CIR STE A 8031 SOUTHPARK CIR STE B 8100 S LINCOLN ST 191 E ORCHARD RD STE 100 100 LITTLETON BLVD 5050 E ARAPAHOE RD 7901 S BROADWAY 9820 W BELLEVIEW AVE 11747 W KEN CARYL AVE 6760 S PIERCE ST 8126 S WADSWORTH BLVD 603 KEN PRATT BLVD 1925 MOUNTAIN VIEW AVE 1611 PACE ST 2255 MAIN ST 995 S HOVER ST 220 E ROGERS RD 325 W SOUTH BOULDER RD STE 5 1375 E SOUTH BOULDER RD 910 W CHERRY ST 1451 W EISENHOWER BLVD 2555 E 13TH ST STE 125 2295 W EISENHOWER BLVD 1250 N WILSON AVE 2033 BOISE AVE 1275 EAGLE DR

LAKEWOOD LIMON LIMON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LITTLETON LONGMONT LONGMONT LONGMONT LONGMONT LONGMONT LONGMONT LOUISVILLE LOUISVILLE LOUISVILLE LOVELAND LOVELAND LOVELAND LOVELAND LOVELAND LOVELAND

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

80226-3075 80828 80828 80127-6316 80120-8201 80120-5724 80120-5724 80122 80121-8056 80120 80122-2302 80122-2718 80123-2101 80127-3700 80128-4574 80128-9118 80501-6419 80501-3128 80504 80501-1488 80501-7908 80501-6027 80027 80027-2301 80027-3083 80537-3110 80537-5135 80537 80537-4461 80538-4221 80537-8058

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 108 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KING SOOPERS PHARMACY LOVELAND COMMUNITY PHARMACY MED CENTER OF THE ROCKIES PHCY ST VRAIN PHARMACY INC MEEKER DRUGS INC JACKS MARKET PHARMACY

Provider Name

(970) 669-6275 (970) 461-3843 (970) 624-1485 (303) 823-9134 (970) 878-9988 (719) 852-9894

253 E 29TH ST 302 3RD ST SE STE 150 2500 ROCKY MOUNTAIN AVE 440 MAIN ST 530 MAIN STREET 222 SOLAR AVE

LOVELAND LOVELAND LOVELAND LYONS MEEKER MONTE VISTA

CO CO CO CO CO CO

80538-2721 80537-5508 80538 80540 81641 81144-1066

MONTE VISTA MEDICAL CLINIC PHARMACY VISTA CARE PHARMACY CITY MARKET PHARMACY CITY MARKET PHARMACY GENOA-QOL HEALTHCARE HARTMAN BROTHERS PHARMACY CITY MARKET PHARMACY ALBERTSON'S PHARMACY KING SOOPERS PHARMACY UMC PHARMACY THE APOTHECARY SHOPPE CITY MARKET PHARMACY PAGOSA SPECIALTY PHARMACY PALISADE PHARMACY HAYS DRUG STORE CLARKS PHARMACY BATTLEMENT ALLHEALTH NETWORK PHCY AT PARK KING SOOPERS PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BLENDE DRUG, INC BROADWAY PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE J B PHARMACY KING SOOPERS PHARMACY KING SOOPERS PHARMACY MEDICAL ARTS PHARMACY MESA PHARMACY PRESCRIPTION SHOP THE PHARMACY AT PARKVIEW RANGELY PHARMACY RIDGWAY PHARMACY INC

(719) 628-0533 (719) 628-2661 (970) 249-2665 (970) 240-2811 (970) 497-1945 (970) 252-1760 (970) 984-2067 (303) 450-4145 (303) 452-8661 (970) 327-0655 (970) 864-2100 (970) 731-6006 (970) 264-4166 (970) 464-5669 (970) 527-4109 (970) 285-5661 (303) 339-5333 (303) 334-9548 (720) 851-7754 (303) 840-7683 (719) 561-4405 (719) 543-5921 (719) 542-2477 (719) 545-0430 (719) 283-1075 (719) 296-6937 (719) 545-1811 (719) 564-0491 (719) 544-0870 (719) 557-5676 (719) 544-1371 (719) 564-0220 (719) 595-7900 (970) 675-2169 (970) 626-3440

1033 2ND AVE 133 ADAMS ST 128 S TOWNSEND AVE 16400 S TOWNSEND AVE 605 MIAMI RD STE 100 531 MAIN ST 850 CASTLE VALLEY BLVD 500 E 120TH AVE 750 E 104TH AVE 1350 ASPEN STREET SUITE B 480 MAIN ST 63 N PAGOSA BLVD 426 PAGOSA ST 707 37 3/10 RD # B 224 GRAND AVE 71 SIPPRELLE DR 9397 CROWN CREST BLVD STE 101 17761 COTTONWOOD DR 17031 LINCOLN AVE 12959 S PARKER RD 1545 S PRAIRIE AVE 1601 W US HIGHWAY 50 1910 SANTA FE DR 101 COLORADO AVE 41 MONTEBELLO RD STE 122 1304 CHINOOK LN 915 W NORTHERN AVE 3050 W NORTHERN AVE 102 W 29TH ST 1925 E ORMAN AVE STE 102 25140 E US HIGHWAY 50 1728 S PRAIRIE AVE 400 W 16TH ST 225 EAGLE CREST ST 570 PALOMINO TRL

MONTE VISTA MONTE VISTA MONTROSE MONTROSE MONTROSE MONTROSE NEW CASTLE NORTHGLENN NORTHGLENN NORWOOD NUCLA PAGOSA SPRINGS PAGOSA SPRINGS PALISADE PAONIA PARACHUTE PARKER PARKER PARKER PARKER PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO PUEBLO RANGELY RIDGWAY

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

81144-1737 81144 81401-3988 81401-5404 81401-4108 81401 81647-9441 80233-1143 80233-4317 81423 81424-0000 81147-8351 81147-0120 81526-8738 81428-0000 81635-9232 80138-8575 80134 80134-3144 80134-3447 81005-2312 81008-1690 81006-1452 81004-4213 81001-1366 81001-1851 81004-3123 81005-2317 81008-1002 81004-3500 81006-9737 81005-2253 81003-2745 81648-3105 81432-9246

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 109 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CITY MARKET PHARMACY CITY MARKET PHARMACY R & R FAMILY PHARMACY CITY MARKET PHARMACY LYON'S CORNER DRUG YAMPA VALLEY MEDICAL CENTER PHCY BARNES PHARMACY WALKER PHARMACY APOTHECA SUNSHINE PHARMACY ALBERTSON'S PHARMACY APOLLO PHARMACY GENOA-QOL HEALTHCARE KING SOOPERS PHARMACY UTE MOUNTAIN UTE HEALTH CENTER HOMETOWN PHARMACY AND MEDICAL CITY MARKET PHARMACY EAGLE VALLEY PHARMACY AT VAIL STAR DRUG HEALTH MART GOOD DAY PHARMACY

Provider Name

(970) 625-9420 (970) 468-5369 (719) 523-6201 (970) 879-7317 (970) 879-1114 (970) 870-1100 (970) 521-0190 (970) 522-1302 (970) 728-0488 (970) 728-3601 (303) 255-0587 (303) 280-7020 (303) 487-1146 (720) 872-1660 (970) 565-4441 (719) 845-0069 (970) 476-1621 (970) 479-7253 (719) 738-1130 (970) 568-7282

1320 RAILROAD AVE 300 DILLON RIDGE RD 909 MAIN STREET 1825 CENTRAL PARK DRIVE 840 LINCOLN AVE 1024 CENTRAL PARK DR 422 MAIN ST STE A 410 W MAIN STREET 126 W. COLORADO AVE STE 102A 333 W COLORADO AVE 3840 E 104TH AVE 16697 WASHINGTON ST 8989 HURON ST STE 204 13700 COLORADO BLVD 232 RUSTLING WILLOW ST 824 E MAIN ST 2099 N FRONTAGE RD W 181 W MEADOW DR STE 300 628 MAIN ST 7670 5TH ST

RIFLE SILVERTHORN SPRINGFIELD STEAMBOAT SPRINGS STEAMBOAT SPRINGS STEAMBOAT SPRINGS STERLING STERLING TELLURIDE TELLURIDE THORNTON THORNTON THORNTON THORNTON TOWAOC TRINIDAD VAIL VAIL WALSENBURG WELLINGTON

CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO CO

81650-3326 80498 81073-1646 80487 80487-5005 80487-8813 80751-4220 80751-3034 81435 81435 80233 80023-8970 80260-6858 80602-6912 81334 81082 81657-4958 81657-4040 81089-2136 80549

CENTURA HLTH PHCY AT ST ANTHONY NTH KING SOOPERS PHARMACY REMEDI SENIORCARE OF COLORADO BLUE SPRUCE PHARMACY AT INDEP KING SOOPERS PHARMACY KING SOOPERS PHARMACY WHEAT RIDGE PROFESSIONAL PHCY KING SOOPERS PHARMACY WINDSOR COMMUNITY PHARMACY CITY MARKET PHARMACY FOLTMER DRUG INC SHOP-ALL INC HANCOCK PHARMACY VI STOP & SHOP PHARMACY BEACON FALLS PHARMACY LLC BIG Y PHARMACY ENGLISH APOTHECARY TOWNE APOTHECARY STOP & SHOP PHARMACY TOWNE PHARMACY ALBION - HANCOCK PHARMACY LLC

(720) 627-0090 (303) 404-9026 (303) 993-8604 (303) 432-5725 (303) 238-7301 (303) 425-7455 (303) 421-6111 (970) 674-2840 (970) 674-3160 (719) 687-6007 (970) 332-4911 (970) 848-5427 (203) 734-8900 (203) 732-3907 (203) 729-4567 (203) 791-9820 (203) 792-3363 (203) 266-7801 (203) 481-3392 (203) 488-1631 (203) 331-9200

14300 ORCHARD PKWY 10351 FEDERAL BLVD 8971 HARLAN ST UNIT B 4851 INDEPENDENCE ST STE 199 3400 YOUNGFIELD ST 5301 W 38TH AVE 6650 W 38TH AVE 1520 MAIN ST 1300 MAIN ST 779 GOLDHILLS PL S 317 MAIN ST 315 E 8TH AVE 95 WAKELEE AVE 100 DIVISION ST 20 N MAIN ST 81 STONY HILL RD 140 GREENWOOD AVE 95 MAIN ST S 22 LEETES ISLAND RD 1012 MAIN ST 2125 FAIRFIELD AVE

WESTMINSTER WESTMINSTER WESTMINSTER WHEAT RIDGE WHEAT RIDGE WHEAT RIDGE WHEAT RIDGE WINDSOR WINDSOR WOODLAND PARK WRAY YUMA ANSONIA ANSONIA BEACON FALLS BETHEL BETHEL BETHLEHEM BRANFORD BRANFORD BRIDGEPORT

CO CO CO CO CO CO CO CO CO CO CO CO CT CT CT CT CT CT CT CT CT

80023 80260-7431 80031 80033 80033-5245 80212-7058 80033-4906 80550-7909 80550-5989 80863-1101 80758-1726 80759-2823 06401-1151 06401-2147 06403-1131 06801-3038 06801-2530 06751-2004 06405-6514 06405-3730 06605-2246

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 110 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ARROW PRESCRIPTION CTR BRIDGEPORT COMMUNITY PHARMACY BRIDGEPORT PHARMACY HANCOCK PHARMACY HANCOCK PHARMACY HANCOCK PHARMACY III LUPE'S DRUG STORE MAIN STREET PHARMACY RIGHT CARE PHARMACY INC ST VINCENT'S OUTPATIENT PHARMACY STOP & SHOP PHARMACY BEACON MEDICATION SERVICES BEACON PRESCRIPTIONS BEACON PRESCRIPTIONS SOUTH ST PRICE CHOPPER PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY BROOKFIELD PHARMACY GEER PHARMACY QUALITY CARE DRUG/CENTERBROOK STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY MAIN STREET PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY BIG Y PHARMACY GRIEBS PHARMACY GENOA-QOL HEALTHCARE STOP & SHOP PHARMACY GRIFFIN PHARMACY & GIFTS DURHAM PHARMACY OPTION CARE PHARMSCRIPT OF CT LLC STOP & SHOP PHARMACY GENOA-QOL HEALTHCARE RIVERSIDE PHARMACY STOP & SHOP PHARMACY BEACON PRESCRIPTIONS STOP & SHOP PHARMACY STOP & SHOP PHARMACY BIG Y PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (203) 367-7979 (203) 330-9191 (203) 367-9000 (203) 576-9000 (203) 367-3666 (203) 372-9900 (203) 374-0600 (203) 212-3800 (203) 908-4600 (203) 576-6250 (203) 372-6538 (860) 582-4847 (860) 589-5587 (860) 583-1006 (860) 582-3702 (860) 582-4080 (860) 583-9213 (203) 275-9040 (860) 824-3822 (860) 767-0206 (860) 669-6636 (860) 537-2570 (860) 635-6303 (203) 297-6130 (203) 798-0735 (203) 797-8476 (860) 774-7437 (203) 655-1000 (860) 457-4690 (860) 774-5301 (203) 732-1490 (860) 349-3478 (860) 829-8850 (908) 389-1818 (860) 267-2771 (860) 785-6052 (860) 289-0000 (860) 569-7135 (203) 467-2600 (203) 468-1113 (860) 739-5957 (860) 623-1407

Provider Street 4699 MAIN ST STE 103 192 FAIRFIELD AVE 978 E MAIN ST 1020 FAIRFIELD AVE 1557 FAIRFIELD AVE 3768 MAIN ST 3129 MAIN ST 2117 BOSTON AVE 2366 MAIN ST 2800 MAIN STREET 4531 MAIN ST 25 MELLEN ST 25 COLLINS RD 57 SOUTH ST 121 FARMINGTON AVE 657 FARMINGTON AVE 747 PINE ST 60 OLD NEW MILFORD RD 99 S CANAAN RD 33 MAIN ST 215 E MAIN ST 99 LINWOOD AVE 35 SHUNPIKE RD 151 MAIN ST 72 NEWTOWN RD 44 LAKE AVENUE EXT 70 WAUREGAN RD 1021 POST RD 1007 N MAIN ST 1094 KILLINGLY COMMONS DRIVE 130 DIVISION ST 321 MAIN ST 80 CLARK DR UNIT A1 80 CLARK DR UNIT B 11 E HIGH ST 287 MAIN ST STE A2 926 MAIN ST 940 SILVER LN 875 FOXON RD 370 HEMINGWAY AVE 248 FLANDERS RD 67 PROSPECT HILL RD

Page 111 of 679

Provider City BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRISTOL BRISTOL BRISTOL BRISTOL BRISTOL BRISTOL BROOKFIELD CANAAN CENTERBROOK CLINTON COLCHESTER CROMWELL DANBURY DANBURY DANBURY DANIELSON DARIEN DAYVILLE DAYVILLE DERBY DURHAM EAST BERLIN EAST BERLIN EAST HAMPTON EAST HARTFORD EAST HARTFORD EAST HARTFORD EAST HAVEN EAST HAVEN EAST LYME EAST WINDSOR

State

ZIP code

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

06606-5301 6604 06608-1913 06605-1187 06605-1935 06606-3610 06606-4223 06610-3030 06606-5339 6606 06606-1818 06010-6313 06010-3844 06010-6524 06010-4217 06010-3932 06010-6925 06804-2430 06018-2502 06409-1083 06413-2200 06415-1100 06416-2414 06810-7805 06810-6254 06811-5244 06239-3712 06820-4510 06241-2170 06241-2143 06418-1326 06422-1614 06023-1157 06023-1157 06424-1022 06118-1885 06108-2237 06118-1235 06513-1837 06512-2317 6333 06088-3605

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BIG Y PHARMACY ABLE CARE PHCY AND MED SUPPLIES DIPLOMAT SPECIALTY INFUSION GP GENOA-QOL HEALTHCARE STOP & SHOP PHARMACY LUPE'S DRUG STORE STOP & SHOP PHARMACY UNITY PHARMACY

Provider Name

(860) 896-0264 (860) 745-0183 (860) 763-7020 (860) 253-2605 (860) 741-2230 (203) 368-1955 (203) 254-8538 (203) 955-1781

135 WEST RD 15 PALOMBA DR 31 MOODY RD 153 HAZARD AVE STE 100 54 HAZARD AVE 2035 BLACK ROCK TPKE 1160 KINGS HIGHWAY CUTOFF 1326 POST RD

ELLINGTON ENFIELD ENFIELD ENFIELD ENFIELD FAIRFIELD FAIRFIELD FAIRFIELD

CT CT CT CT CT CT CT CT

06029-3719 6082 06082-3101 06082-4592 06082-3845 06825-3550 06824-5271 6824

ARROW PRESCRIPTION CENTER #15 INC STOP & SHOP PHARMACY STOP & SHOP PHARMACY GRANBY PHARMACY STOP & SHOP PHARMACY FINCH PHARMACY GRANNICK PHARMACY GREENVIEW PHARMACY LLC GREENWICH PHARMACY NORTH STREET PHARMACY BIG Y PHARMACY FORT HILL PHARMACY STOP & SHOP PHARMACY BIG Y PHARMACY ANNEX PHARMACY APEX PHARMACY & HOME CARE CTR

(860) 679-5262 (860) 652-9208 (860) 659-5844 (860) 653-2517 (860) 844-8346 (203) 531-8494 (203) 869-3492 (203) 531-3323 (203) 661-2721 (203) 869-2130 (860) 445-7719 (860) 445-6431 (860) 445-8807 (203) 453-7446 (203) 281-6571 (203) 281-6571

263 FARMINGTON AVE 55 OAK ST 215 GLASTONBURY BLVD 9 HARTFORD AVE 120 SALMON BROOK ST 263 GLENVILLE RD 277 GREENWICH AVE 13 N WATER ST 116 GREENWICH AVE 1043 NORTH ST 995 POQUONNOCK RD 116 FORT HILL RD 220 ROUTE 12 STE 1 830 BOSTON POST RD 2380A DIXWELL AVE 2380 DIXWELL AVE

FARMINGTON GLASTONBURY GLASTONBURY GRANBY GRANBY GREENWICH GREENWICH GREENWICH GREENWICH GREENWICH GROTON GROTON GROTON GUILFORD HAMDEN HAMDEN

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

6030 06033-2315 06033-4408 6035 06035-2604 6831 06830-6503 06830-5814 06830-5504 06831-2701 06340-4257 06340-4396 06340-3414 6437 06514-1810 6514

OUTPATIENT PHARMACY SERVICES @ YNHH STOP & SHOP PHARMACY ARROW PRESCRIPTION CENTER ARROW PRESCRIPTION CENTER ARROW PRESCRIPTION CENTER ARROW PRESCRIPTION CTR COMMUNITY CARE PHARMACY HARTFORD HEALTHCARE COMM PHCY HARTFORD PHARMACY HARTFORD PHARMACY II, INC. HARTFORD PHARMACY III, INC HEALTH CARE PHARMACY MAPLE PHARMACY STOP & SHOP PHARMACY HIGGANUM PHARMACY JEWETT CITY PHARMACY

(203) 747-3933 (203) 248-9631 (860) 522-9289 (860) 286-2766 (860) 524-5304 (860) 527-2800 (860) 560-2000 (860) 727-1123 (860) 422-8888 (860) 244-2222 (860) 524-3333 (860) 263-8585 (860) 969-4400 (860) 232-8848 (860) 345-3607 (860) 376-4468

1100 SHERMAN AVE 2335 DIXWELL AVE 500 FARMINGTON AVE 131 COVENTRY ST FL 2 500 ALBANY AVE 100 WOODLAND ST 408 NEW BRITAIN AVE 85 SEYMOUR ST 469 PARK ST 57 PARK ST 33 NEW BRITAIN AVE 740 MAPLE AVE 697 MAPLE AVE 150 NEW PARK AVE 23 KILLINGWORTH RD 78 MAIN ST

HAMDEN HAMDEN HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HARTFORD HIGGANUM JEWETT CITY

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

6514 06514-2100 06105-3106 06112-1548 06120-2508 06105-1217 06106-3832 6106 6106 6106 06106-3306 06114-2314 06114-1856 06106-2159 06441-4242 06351-2226

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 112 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KENT APOTHECARY KILLINGWORTH FAMILY PHCY INC MURPHY'S PHARMACY INC

Provider Name

(860) 927-3725 (860) 452-4275 (860) 567-8325

3 MAPLE ST 183 ROUTE 81 STE 3 59 WEST ST

KENT KILLINGWORTH LITCHFIELD

CT CT CT

06757-1711 6419 06759-3502

CONNECTICUT PHARMACY OF MADISON STOP & SHOP PHARMACY BIG Y PHARMACY GENOA-QOL HEALTHCARE LENOX PHARMACY MANCHESTER PHARMACY STOP & SHOP PHARMACY WESTOWN PHARMACY BIG Y PHARMACY GENOA-QOL HEALTHCARE GRAEBER'S PHARMACY INC HANCOCK LTC HANCOCKS PHARMACY INC MERIDEN COMMUNITY PHARMACY STOP & SHOP PHARMACY CONNECTICUT ONCOLOGY GRP, P.C. GENOA-QOL HEALTHCARE HANCOCK PHARMACY PRICE CHOPPER PHARMACY STOP & SHOP PHARMACY VALUERX PHARMACY SERVICES GENOA-QOL HEALTHCARE HOWES DRUG & MEDICAL STOP & SHOP PHARMACY STOP & SHOP PHARMACY NATHAN HALE PHARMACY INC BIG Y PHARMACY MCQUADE'S MARKETPLACE PHCY MCQUADES SPECIALTY PHARMACY BIG Y PHARMACY

(203) 421-2132 (203) 245-7467 (860) 646-4832 (860) 288-2119 (860) 649-0896 (860) 649-1025 (860) 647-0325 (860) 649-9946 (413) 504-4292 (203) 599-0187 (203) 235-4463 (203) 235-0335 (203) 235-6323 (203) 634-3000 (203) 238-1261 (860) 358-2220 (860) 316-4405 (860) 346-9700 (860) 740-7707 (860) 346-1779 (844) 650-8777 (203) 301-8861 (203) 878-2441 (203) 876-0654 (203) 877-1912 (860) 873-1481 (860) 536-5835 (860) 536-4606 (860) 536-3349 (203) 723-0364

200 BOSTON POST RD 136 SAMSON ROCK DR 234 TOLLAND TPKE 587 MIDDLE TPKE E 299 EAST CENTER ST 348 MAIN STREET 286 BROAD ST 455 HARTFORD RD 141B STORRS RD 883 PADDOCK AVE 172 W MAIN ST 29 GRAVEL ST 840 E MAIN ST 152 COLONY ST UNIT A 485 BROADWAY ST 536 SAYBROOK RD 230 MAIN STREET EXT STE A 644 MAIN ST 855 WASHINGTON ST 416 E MAIN ST 54 TUTTLE PL 949 BRIDGEPORT AVE STE M5 78 BROAD ST 855 BRIDGEPORT AVE 1360 E TOWN RD 26 FALLS RD 179 STONINGTON RD 10 CLARA DR 10 CLARA DR 85 BRIDGE ST

MADISON MADISON MANCHESTER MANCHESTER MANCHESTER MANCHESTER MANCHESTER MANCHESTER MANSFIELD CENTER MERIDEN MERIDEN MERIDEN MERIDEN MERIDEN MERIDEN MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MILFORD MILFORD MILFORD MILFORD MOODUS MYSTIC MYSTIC MYSTIC NAUGATUCK

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

06443-2144 06443-3018 06042-1744 06040-3731 06040-5211 6040 06040-4034 06040-5764 06250-1638 06450-7044 06451-4104 06450-4607 06450-6008 06451-3225 6450 06457-4783 06457-4470 06457-2731 06457-2911 06457-4509 06457-1863 06460-3142 06460-3353 06460-3171 06460-3623 06469-1210 06355-2962 06355-1957 06355-1957 06770-2812

FORD PHARMACY AND MEDICAL SUPPLY NAUGATUCK PHARMACY STOP & SHOP PHARMACY ACCESS CARE PHARMACY ARCH STREET PHARMACY BEACON PRESCRIPTIONS NEW BRITAIN PHARMACY

(203) 729-2680 (203) 632-8380 (203) 723-6939 (860) 229-7000 (860) 225-9000 (860) 225-6487 (860) 223-0522

2 CHURCH ST 153 MAPLE ST 727 RUBBER AVE 248 MAIN ST 333 ARCH ST 543 W MAIN ST 46 BROAD ST

NAUGATUCK NAUGATUCK NAUGATUCK NEW BRITAIN NEW BRITAIN NEW BRITAIN NEW BRITAIN

CT CT CT CT CT CT CT

6770 06770-4256 06770-3642 06051-2222 6051 06053-3915 06053-4305

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 113 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STOP & SHOP PHARMACY GREENWICH PHARMACY NEW CANAAN PHARMACY CANDLEWOOD DRUGS STOP & SHOP PHARMACY APOTHECARY & WELLNESS CTR BELLA VISTA PHARMACY BERNEYS PHARMACY CHAPEL STREET PHARMACY COMMUNITY HEALTH PHARMACY EAST ROCK PHARMACY FAIR HAVEN PHARMACY HANCOCK PHARMACY AT LONG WHARF HANCOCK PHARMACY VII NEW HAVEN PHARMACY STOP & SHOP PHARMACY VISELS PHARMACY WHALLEY DRUG GENOA-QOL HEALTHCARE QUALITY CARE DRUG NEW LONDON THE MEDICINE SHOPPE BIG Y NEW MILFORD PHARMACY STOP & SHOP PHARMACY PRICE CHOPPER PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY MAIN STREET RX STOP & SHOP PHARMACY BIG Y PHARMACY NORTH HAVEN PHARMACY PEOPLES PHARMACY STOP & SHOP PHARMACY CIRCLE CARE CENTER PHARMACY CONNECTICUT PHARMACY CONNECTICUT PHARMCY MED SUPPLY NORWALK PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY SWC PHARMACY

Provider Name

(860) 348-9830 (203) 801-0808 (203) 920-1385 (203) 312-9999 (203) 312-9818 (203) 789-4076 (203) 467-1683 (203) 562-4447 (203) 777-2227 (203) 498-1900 (203) 691-5405 (203) 498-3479 (203) 787-9908 (203) 776-7100 (203) 777-3700 (203) 389-8863 (203) 562-6878 (203) 745-5004 (860) 447-9145 (860) 443-0421 (860) 442-0669 (860) 354-5554 (860) 355-3763 (860) 667-7603 (860) 667-9292 (860) 594-7123 (475) 323-2100 (203) 270-0827 (203) 484-9681 (203) 239-2086 (203) 287-7375 (203) 234-7461 (203) 939-1765 (203) 939-1790 (203) 939-1836 (203) 956-0526 (203) 849-8735 (203) 299-1718 (203) 899-0708

1309 CORBIN AVE 118 MAIN ST 44 EAST AVE 11 STATE ROUTE 37 25 STATE ROUTE 39 1450 CHAPEL ST 321 EASTERN ST BLDG A 615 HOWARD AVE 1245 CHAPEL ST 210 DIXWELL AVE 767 ORANGE ST 72 GRAND AVE 1 LONG WHARF DR 306 GRAND AVE 382 GRAND AVE 112 AMITY RD 714 DIXWELL AVE 399 WHALLEY AVE 165 STATE ST FL 2 467 OCEAN AVE 613 BROAD ST 2 BANK ST 180 DANBURY RD 2985 BERLIN TPKE 44 FENN RD 206 KITTS LN 266 S MAIN ST STE D2 228 S MAIN ST 1289 FOXON RD 278 MAPLE AVE 445 WASHINGTON AVE 79 WASHINGTON AVE 618 WEST AVE 664 MAIN AVE 664 MAIN AVE 250 WESTPORT AVE 380 MAIN AVE 385 CONNECTICUT AVE 120 CONNECTICUT AVE

NEW BRITAIN NEW CANAAN NEW CANAAN NEW FAIRFIELD NEW FAIRFIELD NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW HAVEN NEW LONDON NEW LONDON NEW LONDON NEW MILFORD NEW MILFORD NEWINGTON NEWINGTON NEWINGTON NEWTOWN NEWTOWN NORTH BRANFORD NORTH HAVEN NORTH HAVEN NORTH HAVEN NORWALK NORWALK NORWALK NORWALK NORWALK NORWALK NORWALK

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

06053-3857 06840-4709 06840-5518 06812-4028 06812-4044 06511-4405 06513-2462 06519-2112 06511-4611 06511-3416 06511-2534 06513-3997 06511-5991 6513 06513-3733 06515-1405 06511-1038 06511-3013 06320-6397 06320-4502 06320-2544 06776-2706 06776-4328 06111-4601 06111-2244 06111-4250 06470-6706 06470-2764 06471-1289 06473-3326 6473 06473-1704 06850-4008 6851 06851-1162 06851-4158 06851-1511 06854-1805 06854-1525

SWC PHARMACY AT NORWALK HOSPITAL BIG Y PHARMACY

(203) 852-2690 (860) 886-1301

24 STEVENS ST 224 SALEM TURNPIKE

NORWALK NORWICH

CT CT

06850-3852 06360-6455

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 114 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name GENOA-QOL HEALTHCARE GREENVILLE DRUG STORE STOP & SHOP PHARMACY UNCAS PHARMACY UTLEY & JONES PHARMACY BIG Y PHARMACY STOP & SHOP PHARMACY THE MEDICINE SHOPPE OXFORD PHARMACY GENOA-QOL HEALTHCARE PLANTSVILLE PHARMACY BORDONARO'S PHARMACY PRICE CHOPPER PHARMACY STOP & SHOP PHARMACY REDDING PHARMACY BISSELL PHARMACY STOP & SHOP PHARMACY ROCKY HILL COMMUNITY PHARMACY RX HEALTH LLC SALEM HEALTH MART PHARMACY SALISBURY PHARMACY MARKET 32 SEYBRIDGE PHARMACY INC STOP & SHOP PHARMACY SHARON PHARMACY INC STOP & SHOP PHARMACY THE MEDICINE SHOPPE HOPMEADOW APOTH & MED EQUIP SIMSBURY PHARMACY INC STOP & SHOP PHARMACY HERITAGE VILLAGE PHARMACY RELIANT PHARMACY STOP & SHOP PHARMACY BEACON PRESCRIPTIONS PRICE CHOPPER PHARMACY SERAFINO PHARMACY INC STOP & SHOP PHARMACY SWITZERS PHARMACY BIG Y PHARMACY CORNERSTONE PHARMACY PROFESSIONAL PHARMACY SLAVINS-HANCOCK PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (860) 215-4321 (860) 889-9857 (860) 887-1615 (860) 889-8413 (860) 887-2538 (860) 395-0515 (860) 388-6461 (860) 339-5667 (203) 888-4567 (860) 317-2242 (860) 628-2385 (860) 342-3390 (860) 928-1533 (860) 963-2642 (203) 544-8306 (203) 438-6600 (203) 438-0340 (860) 372-4618 (860) 727-4064 (860) 949-8624 (860) 435-9388 (203) 463-7991 (203) 888-0073 (203) 881-2756 (860) 364-5272 (203) 929-3887 (203) 929-8668 (860) 651-3331 (860) 658-4489 (860) 651-9843 (203) 264-6666 (203) 262-8000 (203) 262-4559 (860) 628-3972 (860) 621-5369 (860) 628-7979 (860) 620-9060 (203) 259-7891 (860) 684-4597 (203) 324-0251 (203) 323-9988 (203) 323-2161

Provider Street 47 TOWN ST STE G 213 CENTRAL AVE 42 TOWN ST 20 TOWN ST 112 LAFAYETTE ST 22 SPENCER PLAIN RD 105 ELM ST 535 BOSTON POST RD 100 OXFORD RD 91 NORTHWEST DR STE L-14 1 W MAIN ST 283 MAIN ST 251 KENNEDY DR STE A 60 PROVIDENCE TURNPIKE 73 REDDING RD 23 GOVERNOR ST 125 DANBURY RD 366 CROMWELL AVE 70 INWOOD RD STE 5 24 HARTFORD RD UNIT 11 20 MAIN ST 140 MAIN ST 37 NEW HAVEN RD 15 FRANKLIN ST 8 GAY ST 898 BRIDGEPORT AVE 202 LEAVENWORTH RD 1300 HOPMEADOW ST 1418 HOPMEADOW ST 498 BUSHY HILL RD 493 HERITAGE RD 200 MAIN ST S 100 MAIN ST N 609 N MAIN ST 410 QUEEN ST 36 N MAIN ST 505 N MAIN ST 322 PEQUOT AVE 87 W STAFFORD SPRINGS PLZ 134 STILLWATER AVE 32 STRAWBERRY HILL CT 1035 WASHINGTON BLVD

Page 115 of 679

Provider City NORWICH NORWICH NORWICH NORWICH NORWICH OLD SAYBROOK OLD SAYBROOK OLD SAYBROOK OXFORD PLAINVILLE PLANTSVILLE PORTLAND PUTNAM PUTNAM REDDING RIDGEFIELD RIDGEFIELD ROCKY HILL ROCKY HILL SALEM SALISBURY SEYMOUR SEYMOUR SEYMOUR SHARON SHELTON SHELTON SIMSBURY SIMSBURY SIMSBURY SOUTHBURY SOUTHBURY SOUTHBURY SOUTHINGTON SOUTHINGTON SOUTHINGTON SOUTHINGTON SOUTHPORT STAFFORD SPRINGS STAMFORD STAMFORD STAMFORD

State

ZIP code

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

06360-2315 06360-3801 06360-2316 06360-2306 06360-2737 06475-4000 06475-4132 06475-1506 06478-1943 06062-1534 06479-1522 06480-1856 06260-1628 06260-0000 06896-3210 06877-4608 06877-4139 06067-1841 06067-3441 6420 06068-1800 06483-3121 06483-3460 06483-2809 06069-2030 06484-4625 06484-1809 06070-1411 06070-1410 06070-2931 06488-3879 06488-2299 06488-3840 06489-2051 06489-1801 06489-2517 06489-2051 06890-1345 6076 06902-4839 06902-2594 06901-2996

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name STAMFORD PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY THE MEDICINE SHOPPE PHARMACY PRICE CHOPPER PHARMACY UNIV OF CT SHS PHARMACY BIG Y PHARMACY OPTION CARE ORONOQUE PHARMACY ROTARY DRUG STOP & SHOP PHARMACY BEACON PRESCRIPTIONS BIG Y PHARMACY BIG Y PHARMACY PRICE CHOPPER PHARMACY STOP & SHOP PHARMACY TORRINGTON PHARMACY MEDICAL ARTS PHARMACY STOP & SHOP PHARMACY TRUMBULL PHARMACY PRICE CHOPPER PHARMACY BEACON PRESCRIPTIONS STOP & SHOP PHARMACY STOP & SHOP PHARMACY THE MEDICINE SHOPPE CONNECTICUT PHARMACY DIRECT MASONICARE HEALTH CENTER STOP & SHOP PHARMACY WASHINGTON HEALTH CTR & PHCY BRASS CITY PHARMACY BRASS MILL PHARMACY LLC BUNKER HILL PHARMACY DELLA PIETRA PHARMACY EAST MAIN PHARMACY HEALTH COMPLEX STOLL'S PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY WATERBURY PHARMACY WH PICKETT DRUG COMPANY SIMPLY PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (203) 883-8484 (203) 358-9626 (203) 356-0126 (203) 327-4479 (860) 553-6556 (860) 486-0736 (203) 386-1489 (203) 383-7787 (203) 378-1111 (203) 378-9394 (203) 375-5717 (860) 585-5158 (860) 872-0369 (860) 489-2970 (860) 496-5058 (860) 489-2433 (860) 489-5511 (203) 590-3737 (203) 261-3691 (203) 590-7555 (860) 872-8961 (860) 875-9263 (860) 870-6255 (860) 871-1053 (860) 875-2507 (203) 295-4629 (203) 679-6266 (203) 265-3942 (860) 619-0251 (203) 759-5000 (203) 721-8022 (203) 574-7825 (203) 754-0181 (203) 755-7200 (203) 753-7778 (203) 575-0199 (203) 597-1498 (203) 755-9538 (203) 755-5814 (203) 757-2000 (203) 753-5158 (860) 865-1303

Provider Street 1055 HIGH RIDGE RD 1937 W MAIN ST 2200 BEDFORD ST 296 BEDFORD ST 1220 STORRS ROAD 234 GLENBROOK RD UNIT 2011 355 HAWLEY LN 60 WATSON BLVD 7365 MAIN ST #17 1030 BARNUM AVE 200 E MAIN ST 241 MAIN ST 33 FIELDSTONE CMNS 504 WINSTED RD 990 TORRINGFORD ST 211 HIGH ST 110 E MAIN ST 15 CORPORATE DR STE 1-1 40 QUALITY ST 10 BROADWAY RD, BLDG B, UNIT B 35 TALCOTTVILLE RD 40 W MAIN ST 50 WINDSORVILLE RD 10 PITKIN RD 79 EAST ST 10 FAIRFIELD BLVD UNIT C 22 MASONIC AVE 930 N COLONY RD 5 BRYAN HALL PLAZA 558 CHASE AVE STE 2B 1405 E MAIN ST UNIT 3 256 BUNKER HILL AVE 792 HIGHLAND AVE 2152 E MAIN ST 84 PROGRESS LN 185 GROVE ST 240 CHASE AVE 920 WOLCOTT ST 410 REIDVILLE DR 197 E MAIN ST 675 N MAIN ST 92 BOSTON POST RD

Page 116 of 679

Provider City STAMFORD STAMFORD STAMFORD STAMFORD STORRS STORRS MANSFIELD STRATFORD STRATFORD STRATFORD STRATFORD STRATFORD TERRYVILLE TOLLAND TORRINGTON TORRINGTON TORRINGTON TORRINGTON TRUMBULL TRUMBULL TRUMBULL VERNON VERNON ROCKVILLE VERNON ROCKVILLE VERNON ROCKVILLE VERNON ROCKVILLE WALLINGFORD WALLINGFORD WALLINGFORD WASHINGTON DEPOT WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERBURY WATERFORD

State

ZIP code

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

06905-1121 06902-4516 06905-3905 06901-1720 6268 06269-2011 06614-1514 06615-7171 6614 6614 06614-5114 06786-5910 06084-3418 06790-2963 06790-3542 06790-6301 06790-5429 06611-1351 06611-3115 6611 06066-5261 6066 06066-2385 06066-4709 06066-3837 06492-5903 06492-3048 06492-2471 6794 06704-1947 06705-1022 06708-1906 06708-4117 06705-2603 06705-3829 06710-2289 06704-2237 06705-1300 06705-2633 06702-2323 06704-3508 06385-2421

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STOP & SHOP PHARMACY HEALTH COMPLEX PHARMACY STOP & SHOP PHARMACY SUBURBAN PHARMACY THE MEDICINE SHOPPE WEST HAVEN PHARMACY LANG'S PHARMACY OF WESTON ACHORN'S PHARMACY COLONIAL DRUGGISTS INC SHORELINE INTEGRATIVE PHARMACY STOP & SHOP PHARMACY CT MULTISPECIALTY GROUP STOP & SHOP PHARMACY STOP & SHOP PHARMACY BEACON PRESCRIPTIONS MEDICAL PHARMACY INC STOP & SHOP PHARMACY

Provider Name

(860) 442-6698 (860) 274-8816 (860) 274-7461 (860) 236-3564 (860) 232-4595 (203) 934-7100 (203) 226-7800 (203) 226-0741 (203) 227-9538 (203) 309-3783 (203) 254-9461 (860) 246-6647 (860) 956-3740 (860) 563-4462 (860) 423-1410 (860) 423-1661 (860) 456-7240

117 BOSTON POST RD 55 DEFOREST ST 763 STRAITS TPKE 344 N MAIN ST 774 FARMINGTON AVE 764 CAMPBELL AVE UNIT A 190 WESTON RD 289 POST RD E 611 POST RD E 1835 POST RD EAST 1790 POST RD E 1260 SILAS DEANE HWY STE 107 1380 BERLIN TPKE 680 SILAS DEANE HWY 972 MAIN ST 1213 MAIN ST 1391 MAIN ST

WATERFORD WATERTOWN WATERTOWN WEST HARTFORD WEST HARTFORD WEST HAVEN WESTON WESTPORT WESTPORT WESTPORT WESTPORT WETHERSFIELD WETHERSFIELD WETHERSFIELD WILLIMANTIC WILLIMANTIC WILLIMANTIC

CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT

06385-2400 06795-2126 06795-3320 06117-2510 06119-1615 06516-3786 06883-2126 06880-3613 06880-4548 06880-5666 06880-5607 06109-4363 06109-1093 06109-3053 06226-2310 06226-1907 06226-1949

LANG'S PHARMACY OF WILTON CENTER STOP & SHOP PHARMACY PRICE CHOPPER PHARMACY STOP & SHOP PHARMACY BEACON PRESCRIPTIONS STOP & SHOP PHARMACY CANFIELD CORNER PHARMACY WOODBURY DRUG AHF PHARMACY ALPHA PEOPLES DRUGS APEX CARE PHARMACY APEX CARE SPECIALTY PHARMACY BELLEVUE PHARMACY CARY RX CATHEDRAL PHARMACY CENTRAL CARE PHARMACY CHEVY CHASE PHARMACY EXCEL PHARMACY FLEXCARE PHARMACY FOERS MEDICAL ARTS PHARMACY FOER'S MEDICAL ARTS PHARMACY FOER'S PHARMACY

(203) 762-6700 (203) 834-2204 (860) 687-1910 (860) 688-1744 (860) 738-2506 (860) 738-2707 (203) 263-2595 (203) 263-2282 (202) 293-8695 (202) 265-7979 (202) 388-1900 (202) 265-2200 (202) 629-4221 (202) 930-4242 (202) 265-1300 (202) 678-6010 (202) 966-8600 (202) 652-1776 (202) 575-0578 (202) 296-7190 (202) 775-4400 (202) 237-1171

28 CENTER ST 5 RIVER RD 675 POQUONOCK AVE 1095 KENNEDY RD 294 MAIN ST 200 NEW HARTFORD RD 2 MAIN ST N 682 MAIN ST S 2141 K ST NW STE 606-RX 1638 R ST NW STE 1 3839 MINNESOTA AVE NE 210 MICHIGAN AVE NE 3939 S CAPITOL STREET SW 1300 7TH ST NW STE 200 3000 CONNECTICUT AVE 2202 MLK JR AVE SE 3812 NORTHAMPTON ST NW 3923 S CAPITOL ST SW UNIT A 3861 ALABAMA AVE SE 2141 K ST NW 818 18TH ST NW 5215 LOUGHBORO RD NW

WILTON WILTON WINDSOR WINDSOR WINSTED WINSTED WOODBURY WOODBURY WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON

CT CT CT CT CT CT CT CT DC DC DC DC DC DC DC DC DC DC DC DC DC DC

06897-3007 06897-4069 06095-2259 06095-1339 06098-1641 06098-3370 06798-2950 6798 20037-1810 20009 20019-2660 20017 20032-2308 20001-3504 20008 20020 20015-2949 20032-2308 20020-1001 20037-1810 20006-3513 20016-2633

FORT LINCOLN PHARMACY & MED EQUIP

(202) 269-0000

3180 BLADENSBURG RD NE

WASHINGTON

DC

20018

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 117 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE

Provider Name

(855) 254-4469

801 PENNSYLVANIA AVE SE STE 12

WASHINGTON

DC

20003-2167

GEORGE WASHINGTON CLINIC PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GOOD HOPE CARE PHARMACY GRUBBS PHARMACY NW GRUBBS PHARMACY GRUBB'S SE PHARM AND MINI-MART

(202) 741-3600 (202) 238-0181 (202) 548-5101 (202) 777-1078 (202) 281-3901 (202) 610-6450 (202) 733-4852 (202) 503-2644 (202) 543-4400 (202) 503-3610

2150 PENNSYLVANIA AVE NW 1400 7TH ST NW 300 H ST NE 1345 PARK RD NW 1050 BRENTWOOD RD NE 1535 ALABAMA AVE SE 1343 GOOD HOPE RD SE 1517 17TH ST NW 326 E CAPITOL ST NE 1800 MARTIN L KING JR AVE SE

WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON

DC DC DC DC DC DC DC DC DC DC

20037-3201 20001 20002 20010-2307 20018-1000 20032-5054 20020 20036-6230 20003-3809 20020

H STREET CARE PHCY AND WELLNESS CTR HERITAGE PHARMACY CORP MEDSTAR PHARMACY @ WHC MEDSTAR PHCY AT GEORGETOWN METRO CARE PHARMACY MIRAMED SPECIALTY PHARMACY MORGAN CARE PHARMACY MORTON 8TH ST PHARMACY LLC MT PLEASANT PHARMACY NATIONS CARE PHARMACY NEW HAMPSHIRE PHARMACY NORTH CAPITOL PHARMACY PALISADES PHARMACY RELIANCE PHARMACY RODMAN'S DRUG STORE SEAT PLEASANT DRUGS SHEPHERD PHARMACY STATE PHARMACY INC STERLING PHARMACY

(202) 621-9665 (202) 543-4300 (202) 877-6309 (202) 444-3772 (202) 722-0171 (202) 248-2998 (202) 337-4100 (202) 547-0378 (202) 387-3100 (202) 621-6325 (202) 726-3100 (202) 241-1491 (202) 362-0004 (202) 398-2800 (202) 363-7233 (202) 396-3400 (202) 722-2426 (202) 610-2100 (202) 399-7877

812 H ST NE 770 M ST SE 106 IRVING ST NW STE 1200 3800 RESERVOIR RD NW 6323 GEORGIA AVE NW #100 1613 RHODE ISLAND AVE NE 3001 P ST NW 724 E CAPITOL ST NE 3169 MOUNT PLEASANT ST NW 3818 12TH ST NE 5001 NEW HAMPSHIRE AVE NW 1516 N CAPITOL ST NW 5185 MACARTHUR BLVD NW # 107 4047 MINNESOTTA AVE 5100 WISCONSIN AVE NW 350 EASTERN AVE NE 7814 EASTERN AVE NW 2041 MARTIN LUTHER KING JR AVE 1647 BENNING RD NE STE 101

WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON

DC DC DC DC DC DC DC DC DC DC DC DC DC DC DC DC DC DC DC

20002-3629 20003 20010-2952 20007-2113 20011-1137 20018-1801 20007-3053 20003-1344 20010-2709 20017-2630 20011-4117 20002-3344 20016-3341 20019 20016-4119 20019-2833 20012-1303 20020-7024 20002-4571

SUPER PHARMACY AND MEDICAL EQUIPMEN TRIPLE ALLIANCE PHARMACY

(202) 388-0050 (202) 450-3655

1019 H ST NE 1219 BRENTWOOD RD NE

WASHINGTON WASHINGTON

DC DC

20002-3743 20018-1019

TSCHIFFELY PHARMACY AT 19TH STREET TSCHIFFELY PHARMACY AT K STREET UNITY HEALTH PHARMACY UNITY HEALTH PHARMACY WELLINGTON APOTHECARY WHITMAN WALKER PHARMACY

(202) 466-8440 (202) 429-4320 (202) 299-1770 (202) 741-5611 (202) 832-2200 (202) 745-6135

1145 19TH ST NW 2021 K ST NW 3020 14TH ST NW 765 KENILWORTH TERRACE NE 1160 VARNUM ST NE 1525 14TH ST NW

WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON WASHINGTON

DC DC DC DC DC DC

20036-3701 20006-1003 20009-6865 20019-1898 20017-2107 20005

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 118 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SUPER G DISCOUNT DRUG DARLEY PHARMACY GRUBBS PHCY & SRGCL SUPPLIES REHOBOTH PHARMACY INC. SHAYONA PHARMACY BAYARD PHARMACY BAYHEALTH AMBULATORY PHARMACY CARE HEALTHMART PHARMACY DOVER COMMUNITY PHARMACY RODNEY VILLAGE PHARMACY LLC GEORGETOWN PHARMACY HOMETOWN DRUGS EXPRESS PHARMACY CAPE PHARMACY WEIS PHARMACY ATLANTIC APOTHECARY MIDDLETOWN LIVING WELL PHARMACY LLC SUPER G PHARMACY KENT PHARMACY THE PILL BOX PHARMACY GIANT PHARMACY MILLSBORO PHARMACY INC PRMC HOME SCRIPTS MILLSBORO SUSSEX PHARMACY GIANT PHARMACY UNITED PHARMACY BIOTEK REMEDYS MANOR PHARMACY INC MEDS YOUR WAY NEWCASTLE DISCOUNT PHARMACY SYNERGY RX EXPRESS CHRISTIANA CARE PHARMACY GLASGOW PHARMACY METRO PHARMACY INC OPTION CARE REGIONAL HEMATOLOGY & ONCOLOGY SUPER G DISCOUNT DRUG NANTICOKE PHARMACY SEAFORD PHARMACY ATLANTIC APOTHECARY AINSLEY'S PHARMACY AMAZING PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (302) 832-0156 (302) 798-0202 (302) 791-9899 (302) 798-8900 (302) 907-0074 (302) 724-4497 (302) 744-6615 (302) 741-2273 (302) 724-9323 (302) 747-7533 (302) 856-2828 (302) 450-1970 (302) 875-5400 (302) 645-0090 (302) 645-7088 (302) 376-9355 (302) 378-8228 (302) 828-9181 (302) 491-6886 (302) 430-0995 (302) 947-4380 (302) 934-9398 (302) 297-2596 (302) 947-0333 (302) 537-8210 (302) 664-1220 (302) 544-5138 (302) 328-3175 (302) 595-4472 (302) 384-6925 (302) 323-1687 (302) 733-2182 (302) 838-8700 (302) 407-5895 (302) 623-0345 (302) 731-7782 (302) 227-5954 (302) 536-7666 (410) 749-5900 (302) 653-9355 (302) 764-5348 (302) 543-5049

Provider Street 300 EDEN CIR 111 DARLEY RD 2714 PHILADELPHIA PIKE 2616 PHILADELPHIA PIKE #B 38660 SUSSEX HWY UNIT 10 202 W LOOCKERMAN ST 640 S STATE ST 1404 FORREST AVE STE 5 1035 S GOVERNORS AVE 1664 S GOVERNORS AVE 432 E MARKET ST 16819 S DUPONT HWY STE 600 30214 SUSSEX HWY UNIT 7 17252 N VLG MAIN BLVD STE 3 17232 N VILLAGE MAIN BLVD 118 SANDHILL DR STE 101 723 N BROAD ST 200 DOVE RUN DR 641 N DUPONT BLVD 115 AERENSON DR 25939 PLAZA DRIVE 317 OLD LANDING RD 30265 COMMERCE DR SUITE 106 A 32362 LONG NECK RD UNIT 5 38069 TOWN CENTER DR 200 BROADKILL RD STE 2 2 PENNS WAY STE 404 1412 N DUPONT HWY 102 JESTAN BLVD 232 NEW CASTLE AVE 18 PENN MART SHOPPING CTR 4755 OGLETOWN STANTON RD 2600 GLASGOW AVE STE 108 620 STANTON CHRISTIANA RD 102 200 HYGEIA DR STE 2400 4701 OGLETOWN STANTON RD #2400 19312 LIGHTHOUSE PLAZA BLVD 1609A MIDDLEFORD RD 613 W STEIN HWY 103 S DUPONT BLVD STE 2 3610 MILLER RD 205 W 4TH ST

Page 119 of 679

Provider City BEAR CLAYMONT CLAYMONT CLAYMONT DELMAR DOVER DOVER DOVER DOVER DOVER GEORGETOWN HARRINGTON LAUREL LEWES LEWES MIDDLETOWN MIDDLETOWN MIDDLETOWN MILFORD MILFORD MILLSBORO MILLSBORO MILLSBORO MILLSBORO MILLVILLE MILTON NEW CASTLE NEW CASTLE NEW CASTLE NEW CASTLE NEW CASTLE NEWARK NEWARK NEWARK NEWARK NEWARK REHOBOTH BEACH SEAFORD SEAFORD SMYRNA WILMINGTON WILMINGTON

State

ZIP code

DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE DE

19701-4303 19703-2723 19703-2568 19703 19940-3529 19904-3248 19901-3530 19904-3478 19904-6901 19904-7004 19947-2266 19952-2488 19956-3880 19958 19958 19709 19709-1166 19709-7971 19963-1098 19963-1241 19966 19966-1207 19966 19966-9062 19967-6968 19968 19720-2407 19720-1844 19720-5299 19720-2701 19720-4207 19718-0001 19702-5703 19713 19713-2049 19713 19971-6158 19973-3617 19973-1203 19977-1549 19802 19801-2204

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CHRISTIANA CARE PHCY CONCORD PHARMACY EXPRESS DISCOUNT PHARMACY FIRST STATE PHARMACY INC GREENHILL PHARMACY GREENHILL PHARMACY MARKET STREET PHARMACY OUTPATIENT PHARMACY PEOPLE'S PHARMACY

Provider Name

(302) 428-6844 (302) 478-1212 (302) 575-9891 (302) 468-4300 (302) 660-8847 (302) 516-7507 (302) 421-9200 (302) 651-4649 (302) 762-6700

501 W 14TH ST 3613 SILVERSIDE RD 4528 KIRKWOOD HWY STE A 1707 FOULK RD 2511 W 4TH ST STE F 824 N MARKET ST STE 103 1914 N MARKET ST 1600 ROCKLAND RD FL 1 2701 N WASHINGTON ST

WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON

DE DE DE DE DE DE DE DE DE

19801-1013 19810-5101 19808 19803-2770 19805 19801-4937 19802-4813 19803-3607 19802

SHOPRITE PHRMCY CHRISTINA CROSSING SUPER G DISCOUNT DRUG UNIONCARE PHARMACY HOMETOWN PHARMACY ALACHUA ALBERTSON'S PHARMACY HIS GRACE PHARMACY ORLANDO FAMILY PHYSICIANS PHARMACY 4 LESS PHARMACY SPECIALISTS TOTAL OPTIMAL HEALTH PHCY CARE AND SAVE PHARMACY BUY RITE DRUGS APOLLO BEACH PHARMACY APOPKA CARE PHARMACY ARBOR PHARMACY, LLC GINGER PHARMACY MEDICINE SHOPPE NORTH APOPKA PHARMACY RX FLORIDA THE PHARMACY STORE THE PHARMACY STORE 202 DESOTO PHARMACY ATLANTIS PHARMACY RX CARE PHARMACY AVON PHARMACY HEALTH-SMART DISCOUNT PHARMACY BARTOW PHARMACY & MED SUPPLY BAY HARBOR DRUGS DOCTORS CHOICE PHARMACY

(302) 225-6888 (302) 475-6572 (302) 384-8948 (386) 418-1444 (407) 831-3454 (407) 790-4863 (407) 274-9777 (321) 207-8438 (407) 260-7002 (407) 865-7977 (407) 901-7777 (229) 435-4571 (813) 606-4577 (407) 814-4843 (407) 814-3977 (407) 814-3868 (407) 774-1957 (407) 703-5454 (407) 703-7862 (407) 703-5951 (407) 703-2676 (863) 491-7415 (561) 232-2893 (863) 875-5700 (863) 453-3884 (850) 537-6267 (863) 537-6694 (305) 397-8319 (727) 697-1090

501 S MARKET ST 4301 CONCORD PIKE 408 N UNION ST 15560 NW US HIGHWAY 441 503 E ALTAMONTE DR 600 E ALTAMONTE DR STE 1400 659 DOUGLAS AVE 805 DOUGLAS AVE SUITE 159 393 MAITLAND AVE 990 N SR 434 STE 1128 696 EAST ALTAMONTE DR STE 1060 117 AVENUE E 264 APOLLO BEACH BLVD 63 W MAIN ST 1112 ROCK SPRINGS RD 739 S ORANGE BLOSSOM TRL 3030 E SEMORAN BLVD STE 164 1087 W. ORANGE BLOSSOM TRAIL 807 E SEMORAN BLVD 101 S PARK AVE 202 N PARK AVE STE 300 301 N BREVARD AVE STE E 100 JOHN F KENNEDY DR 301 HAVENDALE BLVD 1577 US HIGHWAY 27 N 5809 HWY 189N 1478 N WILSON AVE 1015 KANE CONCOURSE 7455 STATE ROAD 52

WILMINGTON WILMINGTON WILMINGTON ALACHUA ALTAMONTE SPRINGS ALTAMONTE SPRINGS ALTAMONTE SPRINGS ALTAMONTE SPRINGS ALTAMONTE SPRINGS ALTAMONTE SPRINGS ALTAMOTE SPRINGS APALACHICOLA APOLLO BEACH APOPKA APOPKA APOPKA APOPKA APOPKA APOPKA APOPKA APOPKA ARCADIA ATLANTIS AUBURNDALE AVON PARK BAKER BARTOW BAY HARBOR BAYONET POINT

DE DE DE FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

19801-5208 19803-1461 19805-3026 32615-4886 32701-4702 32701-4829 32714-2509 32714-2017 32701-5432 32714-7061 32701 32320-2034 33572-2260 32703-5155 32712-2387 32703-3708 32703-5909 32712 32703-5516 32703 32703-4148 34266-4501 33462-1120 33823-4513 33825-2150 32531-0000 33830-3373 33154 34667-6714

AMERICAN CARE OF SOUTH FLORIDA, INC FAST & FRIENDLY PHARMACY

(561) 992-4357 (561) 992-4211

1301 S MAIN ST 5153 14TH ST W

BELLE GLADE BELLE GLADE

FL FL

33430 33430

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 120 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

K&M DRUGS BAY LIFE PHARMACY BELLEVIEW COMMUNITY PHARMACY SUNSHINE DRUGS G & R HEALTHMART PHARMACY BLOUNTSTOWN DRUGS GOLDEN PHARMACY INC AT HOME INFUSION SERVICES

Provider Name

(561) 996-0228 (727) 400-4860 (352) 347-4064 (352) 245-3961 (352) 527-3111 (850) 674-2222 (850) 674-4557 (877) 309-2207

364 S MAIN ST 2864 WEST BAY DR 10762 SE HWY 441 5909 SE ABSHIER BLVD 3791 N LECANTO HWY 20370 CENTRAL AVE W 17324 MAIN ST N 3500 NW BOCA RATON BLVD #704

BELLE GLADE BELLEAIR BLUFFS BELLEVIEW BELLEVIEW BEVERLY HILLS BLOUNTSTOWN BLOUNTSTOWN BOCA RATON

FL FL FL FL FL FL FL FL

33430-3428 33770-2620 34420 34420 34465-3559 32424-1945 32424-1763 33431-4873

BOCA PHARMACY HOME HEALTH CENTER BOCA RATON PHARMACY BOCA TOWN PHARMACY HSUS PHARMACY KPB PHARMACY MEDICINE SHOPPE PHARMACY MEDPOINT PHARMACY INC SPECIALTY CARE PHARMACY

(561) 391-6336 (561) 544-8997 (561) 372-5700 (888) 970-4787 (561) 409-4287 (561) 465-3530 (561) 451-2111 (561) 241-7711

22191 POWERLINE RD STE 22C 625 NE SPANISH RIVER BLVD 7400 N FEDERAL HWY 5800 N FEDERAL HWY STE 2 19585 STATE ROAD 7 UNIT N 4800 NW BOCA RATON BLVD STE 3 23020 SANDALFOOT PLAZA DR 4802 NW BOCA RATON BLVD

BOCA RATON BOCA RATON BOCA RATON BOCA RATON BOCA RATON BOCA RATON BOCA RATON BOCA RATON

FL FL FL FL FL FL FL FL

33433-5019 33431-6100 33487-1692 33487-4008 33498-4744 33431 33428-6654 33431-4818

SUNBELT PHARMACY AND DISCOUNT CORP THE CENTERS PHARMASEA, LLC TRUSTEDMEDRX YAMATO PHARMACY A PLUS PHARMACY FREDS PHARMACY JOHNSONS PHARMACY JOHNS PHARMACY TRUECARE PHARMACY ABERDEEN PHARMACY BENZER PHARMACY

(561) 757-3352 (561) 955-2995 (855) 939-6337 (561) 487-9260 (850) 547-5596 (850) 547-1865 (850) 547-2163 (239) 221-7233 (863) 375-3699 (561) 734-8010 (561) 336-3281

2831 N FEDERAL HWY BAY 2 701 NW 13TH STREET, SUITE 5 6971 N FEDERAL HWY STE 203 9101 LAKERIDGE BLVD STE 10 203 N WAUKESHA ST 1718 S WAUKESHA ST 219 N WAUKESHA ST 9048 BONITA BEACH RD SE 304 W MAIN ST 8276 S JOG RD 2309 W WOOLBRIGHT RD STE 4

BOCA RATON BOCA RATON BOCA RATON BOCA RATON BONIFAY BONIFAY BONIFAY BONITA SPRINGS BOWLING GREEN BOYNTON BEACH BOYNTON BEACH

FL FL FL FL FL FL FL FL FL FL FL

33431-6809 33486 33487-1648 33496-2147 32425-2245 32425-3114 32425-2245 34135-4237 33834-5053 33472-2938 33426-6366

BETHESDA MEM HOSP OUTPATIENT PHCY CHEMISTS N DRUGGISTS PHARMACY GULFSTREAM PHARMACY INC KINGS PHARMACY LIBERTY PHARMACY MEDICATION STATION INC MY COMMUNITY PHARMACY NEIGHBORHOOD PHARMACY PICC LINES PLUS RIGHTCHOICE PHARMACY SEACREST PHARMACY ADVANCE PHARMACY-2

(561) 737-7733 (561) 733-1100 (561) 276-4800 (561) 738-9494 (561) 374-9200 (561) 736-1010 (561) 200-4245 (561) 734-7433 (561) 736-5161 (561) 509-0707 (561) 731-2929 (941) 216-3788

2815 S SEACREST BLVD 3599 W WOOLBRIGHT RD 4998 N OCEAN BLVD 7410 BOYNTON BEACH BLVD STE A4 3469 W BOYNTON BEACH BLVD 141 E WOOLBRIGHT RD 1050 GATEWAY BLVD #101 1780 N CONGRESS AVE STE 700 3800 S CONGRESS AVE STE 11 709 S FEDERAL HWY STE 1 2404 S SEACREST BLVD STE B 5325 26TH ST W

BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BOYNTON BEACH BRADENTON

FL FL FL FL FL FL FL FL FL FL FL FL

33435-7934 33436-7243 33435-7364 33437-6157 33436-4611 33435-6007 33426-8363 33426 33426-8424 33435-5610 33435-6704 34207

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 121 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BAYSHORE PHARMACY BENZER PHARMACY BRADENTON HOMETOWN PHARMACY DISCOUNT RX LLC FAIRWAY PHARMACY FAMILYCARE DISCOUNT PHARMACY GENOA-QOL HEALTHCARE MANATEE DISCOUNT PHARMACY MANATEE FAMILY PHARMACY PELOT'S PHARMACY BENZER PHARMACY BILLS PRESCRIPTION CENTER BRANDON PHARMACY CHOICE PHARMACY KABS PHARMACY MY PHARMACY OF BIG BEND PALM PLAZA PHARMACY REPUBLIC PHARMACY THE MEDICINE SHOPPE

Provider Name

(941) 753-6075 (813) 304-2221 (941) 727-9120 (941) 216-3788 (941) 538-7122 (941) 914-9991 (941) 748-9409 (941) 209-1234 (941) 281-2903 (941) 748-8130 (813) 689-7800 (813) 689-3521 (813) 684-4444 (813) 685-4707 (813) 413-8362 (813) 741-2794 (813) 689-7700 (813) 653-4802 (813) 662-9926

6229 14TH ST W 2104 59TH ST W 1407 57TH AVE W 5325 26TH STREET WEST STE 2 5139 MANATEE AVE W 3633 CORTEZ RD W STE B9 379 6TH AVE W 3549 1ST ST 3705 MANATEE AVE W 831 MANATEE AVE E 105 S MOON AVE 202 E BRANDON BLVD 1035 PROFESSIONAL PARK DRIVE 401 S PARSONS AVE STE C 759 W BRANDON BLVD 947 LITHIA PINECREST RD 162 N PARSONS AVE 106 S PARSONS AVE 216 OAKFIELD DR

BRADENTON BRADENTON BRADENTON BRADENTON BRADENTON BRADENTON BRADENTON BRADENTON BRADENTON BRADENTON BRANDON BRANDON BRANDON BRANDON BRANDON BRANDON BRANDON BRANDON BRANDON

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

34207-4611 34209-7004 34207-3646 34207 34209-3740 34210-3156 34205-8820 34208-4441 34205-1711 34208-1243 33511-5109 33511-5221 33511-4886 33511-5241 33511-4901 33511 33510 33511 33511-5707

TOTAL CARE PHARMACY OF BLOOMINGDALE TOTAL CARE PHARMACY OF BRANDON NORTH FLORIDA PHCY MED SHOPPE PALMS PHARMACY OF BRANFORD BUY RITE DRUGS BRONSON PHARMACY BROOKSVILLE DRUGS CORTEZ DRUGS GOOD SHEPHERD PHARMACY PINE BROOK PHARMACY PINE BROOK PHARMACY #4 SUNSHINE WELLNESS CENTER A PLUS PHARMACY BUNNELL PHARMACY OPTIMUM CARE PHARMACY BUSHNELL PHARMACY DIVINE PHARMACY PEGASUS RX PHARMACY SAFESCRIPT PHARMACY CALLAHAN PHARMACY KIMS FAMILY PHARMACY INC ACOLOGY PHARMACY

(813) 689-2273 (813) 662-4791 (386) 935-6905 (386) 935-0542 (850) 643-5454 (352) 486-9033 (352) 796-4975 (352) 592-1320 (352) 610-4455 (352) 610-4347 (352) 600-7838 (352) 796-7200 (386) 313-6959 (386) 437-3325 (386) 263-2943 (352) 569-5800 (352) 793-2679 (727) 938-6200 (352) 793-8000 (904) 628-0365 (850) 968-5655 (239) 573-2424

519 E BLOOMINGDALE AVE STE C 1218 MILLENNIUM PKWY 305 US HIGHWAY 27 SW 103 US HIGHWAY 27 SW 11049 STATE ROAD 20 NW 150 N HATHAWAY AVE 80 PONCE DE LEON BLVD 12116 CORTEZ BLVD 13033 CORTEZ BLVD 14482 CORTEZ BLVD 11373 CORTEZ BLVD STE 101 90 PONCE DE LEON 4750 E MOODY BLVD STE 107 703 E MOODY BLVD 2405 E MOODY BLVD STE 101 417 N WEST ST 1333 W C 48 STE A 115 W BELT AVE 880 N MAIN ST 450077 STATE ROAD 200 740 N HIGHWAY 29 131 DEL PRADO BLVD S STE 101

BRANDON BRANDON BRANFORD BRANFORD BRISTOL BRONSON BROOKSVILLE BROOKSVILLE BROOKSVILLE BROOKSVILLE BROOKSVILLE BROOKSVILLE BUNNELL BUNNELL BUNNELL BUSHNELL BUSHNELL BUSHNELL BUSHNELL CALLAHAN CANTONMENT CAPE CORAL

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33511-8180 33511-3895 32008-2769 32008-2767 32321 32621-6739 34601 34613-5514 34613-4838 34613-5975 34613-5414 34601 32110-7710 32110-5907 32110-5986 33513-6021 33513-8923 33513-5101 33513-5011 32011-3863 32533-9595 33990-1744

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 122 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

APOLLO PHARMACY CALOOSA PHARMACY CASTILLO'S PHARMACY CENTER PHARMACY II DEL PRADO DISCOUNT PHARMACY

Provider Name

(239) 541-8794 (239) 800-2419 (239) 542-9600 (239) 772-8866 (239) 673-9415

447 CAPE CORAL PKWY E 8 DEL PRADO BLVD S STE F 1303 SE 47TH TERRACE 1501 VISCAYA PKWY 2504 DEL PRADO BLVD S

CAPE CORAL CAPE CORAL CAPE CORAL CAPE CORAL CAPE CORAL

FL FL FL FL FL

33904-8559 33990-1773 33904-9674 33990-6226 33904

FAMILY HEALTH CENTERS OF SW FLORIDA GULF MED PHARMACY INC LEE PHARMACY 4 NEIGHBORHOOD MARKET T-RX PHARMACY BEST CARE PHARMACY CAMBRIDGE OAKS PHARMACY XUBEX COMMUNITY PHARMACY TURNER DRUGS CELEBRATION CENTURY PHARMACY FLORIDA STATE HOSPITAL NORTH FLORIDA PHCY MED SHOPPE KINGS DISCOUNT DRUGS ALPHA-OMEGA PHARMACY BAY LIFE PHARMACY BAY LIFE PHARMACY II BAYCARE PHARMACY CURLEW PHARMACY GENOA-QOL HEALTHCARE HIGHLAND PHARMACY INC J&K CARE PHARMACY LINCOURT PHARMACY MP PHARMACY SCOTTS RX ST LUKE PHARMACY TRINITY PHARMACY CLERMONT COMMUNITY PHARMACY FAVOR PHARMACY KEY HEALTH PHARMACY MCHILLS PHARMACY MEDICAP PHARMACY NV PHARMACY TRISTAR PHARMACY LLC K AND M DRUGS EMPIRE SPECIALTY PHARMACY LLC FIVE POINTS PHCY & WELLNESS

(239) 226-4580 (239) 542-1291 (239) 424-2456 (239) 458-8045 (239) 677-4949 (407) 636-5444 (407) 960-4712 (407) 624-5088 (407) 566-9060 (850) 256-3472 (850) 663-7675 (352) 490-7700 (850) 638-4875 (844) 557-0835 (727) 581-5400 (727) 216-6374 (727) 462-3311 (727) 773-1600 (727) 533-9073 (727) 446-2331 (727) 447-6622 (727) 447-4248 (727) 240-0271 (727) 733-4100 (727) 754-7851 (727) 531-2007 (352) 989-5890 (352) 708-8023 (352) 989-5850 (352) 394-1333 (352) 243-6340 (407) 778-4800 (407) 614-4602 (941) 983-7277 (321) 549-5005 (321) 806-3951

316 DEL PRADO S 4106 DEL PRADO BLVD S 636 DEL PRADO BLVD S 505 SW PINE ISLAND RD 211 HANCOCK BRIDGE PKWY #7 1015 STATE ROAD 436 STE 117 3950 S US HIGHWAY 17-92 #1048 500 STATE ROAD 436 STE 1010 1530 CELEBRATION BLVD # 105 7531 MAYO ST 100 N MAIN ST BLDG 1235 1100 N YOUNG BLVD 1242 MAIN ST 4625 EAST BAY DR STE 313 1235 S MISSOURI AVE 2090 GULF TO BAY BLVD 303 PINELLAS STREET 30226 US HIGHWAY 19 N 1437 S BELCHER RD 1224 S HIGHLAND AVE 756 N BELCHER RD 501 S LINCOLN AVE 28813 US HIGHWAY 19 N 2215 N HERCULES AVE 2019 GULF TO BAY BLVD 1474 S BELCHER RD 290 CITRUS TOWER BLVD #106 1670 E HIGHWAY 50 STE A 1500 OAKLEY SEAVER DR STE 3 1158 5TH ST 12302 ROPER BLVD STE 106-107 16744 CAGAN CROSSINGS BLVD 16201 HWY 50 E STE 301 340 E SUGARLAND HWY 1034 CLEARLAKE RD 1108 LAKE DR

CAPE CORAL CAPE CORAL CAPE CORAL CAPE CORAL CAPE CORAL CASSELBERRY CASSELBERRY CASSELBERRY CELEBRATION CENTURY CHATTAHOOCHEE CHIEFLAND CHIPLEY CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLEARWATER CLERMONT CLERMONT CLERMONT CLERMONT CLERMONT CLERMONT CLERMONT CLEWISTON COCOA COCOA

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33990-1710 33904-7163 33990 33991 33990-4021 32707-5756 32707-3289 32707-5376 34747 32535-2416 32324-1107 32626-1704 32428-2471 33764 33756-9111 33765-3714 33756 33761-1042 33764-2829 33756-4375 33765 33756-5945 33761-2583 33763-2325 33765-3703 33764-2877 34711-2783 34711-5191 34711-1974 34711-3008 34711-4302 34714-4886 34711-6219 33440-3124 32922-6384 32922-8678

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Provider Phone Number

Provider Street

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PORT ST JOHN DISCOUNT PHARMACY PORT ST JOHN DISCOUNT PHARMACY WEST COCOA PHCY & COMPOUNDING COCOA BEACH DISCOUNT PHARMACY CARDENAS PHARMACY CARE PLUS INFUSION, LLC JORGES PHARMACY JRM PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY SALUS PHARMACY LLC TATA PHARMACY DISCOUNT UNIV PHCY OF CORAL GABLES LLC CORAL SPRINGS MEDICAL CENTER CORAL SPRINGS SPECIALTY PHARMACY KINGS PHARMACY NEIGHBORHOOD MARKET SUNSHINE STATE PHARMACY CRAWFORDVILLE PHARMACY COMMUNITY PHARMACY CRESTVIEW PHARMACY

Provider Name

(321) 305-6975 (321) 637-0911 (321) 305-6909 (321) 799-2030 (305) 529-0003 (305) 460-8600 (305) 856-1250 (305) 448-5958 (305) 442-9946 (305) 444-7530 (786) 360-2360 (786) 409-2705 (305) 448-6116 (954) 344-3131 (954) 510-5000 (954) 575-7085 (954) 345-9250 (954) 346-7759 (850) 962-8946 (386) 698-2666 (850) 683-1111

6250-1 N US HIGHWAY 1 6801 N HIGHWAY 1 STE 1 2711 CLEARLAKE RD #C-10 291 W COCOA BEACH CSWY 2741 CORAL WAY 357 ALMERIA AVE SUITE 102 1701 CORAL WAY 5512 SW 8TH ST 5300 W FLAGLER ST 3949 SW 8TH ST 4677 W FLAGLER ST 3810 SW 8TH ST 217 VALENCIA AVE 3000 CORAL HILLS DR 10231 W SAMPLE RD 2814 N UNIVERSITY DR 10635 W ATLANTIC BLVD 10301 W SAMPLE RD 2650 CRAWFORDVILLE HWY STE 1 897 N SUMMIT ST 1116 N FERDON BLVD

COCOA COCOA COCOA COCOA BEACH CORAL GABLES CORAL GABLES CORAL GABLES CORAL GABLES CORAL GABLES CORAL GABLES CORAL GABLES CORAL GABLES CORAL GABLES CORAL SPRINGS CORAL SPRINGS CORAL SPRINGS CORAL SPRINGS CORAL SPRINGS CRAWFORDVILLE CRESCENT CITY CRESTVIEW

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32927 32927-5095 32922-5721 32931-3529 33145-3201 33134 33145-2728 33134-2220 33134-1148 33134-2901 33134-1512 33134-3002 33134-5905 33065-4108 33065-3939 33065-5010 33071-5669 33065 32327-2159 32112-2109 32536-1710

MOULTONS PHARMACY OF CRESTVIEW INC THE PRESCRIPTION SHOPPE CHEEK PHARMACY INC CITRUS DISCOUNT PHARMACY CONTINUCARE CUTLER RIDGE CONTINUCARE PERRINE NIMOH PHCY & COMPOUNDING LLC RX CARE PHARMACY & KWIK MART RX DISCOUNT PHARMACY INTRAMED DANIA REXALL RX CENTER FIRST CHOICE SPECIALTY PHCY MEDOZ PHARMACY OF POLK INC WEBB'S SQUARE PHARMACY

(850) 682-6136 (850) 682-2008 (352) 498-3342 (352) 228-8929 (305) 254-1500 (305) 238-1111 (352) 437-5985 (352) 567-2238 (352) 521-0155 (954) 966-7578 (954) 921-4661 (863) 547-9922 (855) 633-6948 (863) 421-9200

648 N FERDON BLVD 536 E 1ST AVE 16734 SE 19 HWY 659 NE US HIGHWAY 19 UNIT 2 11000 SW 211TH ST 18853 SW 117TH AVE 12878 US HIGHWAY 301 14306 7TH ST 12620 US HIGHWAY 301 11 SW 12TH AVE STE 106 16 S FEDERAL HWY 2306 NORTH BLVD W SUITE A&B 40230 US HIGHWAY 27 #100-110 2200 SOUTH BLVD W

CRESTVIEW CRESTVIEW CROSS CITY CRYSTAL RIVER CUTLER BAY CUTLER RIDGE DADE CITY DADE CITY DADE CITY DANIA DANIA BEACH DAVENPORT DAVENPORT DAVENPORT

FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32536 32536-2505 32628 34429-4240 33189-2804 33177-3250 33525-5801 33523-3434 33525-6058 33004-3527 33004-3605 33837 33837-2636 33837-7002

CHRONIC CARE PHARMACEUTICAL SVC LLC FAMILY PHYSICIANS RX MARTNICKS PHCY & DISCT. INC NEIGHBORHOOD DRUGS OF DAVIE NSU CLINIC PHARMACY AT DAVIE

(954) 321-5312 (954) 321-8029 (954) 530-4698 (954) 424-3784 (954) 262-4550

3901 SW 47TH AVE STE 404 6191 ORANGE DR STE 6177N 6783 STIRLING RD 8844 W STATE ROAD 84 3200 S UNIVERSITY DR

DAVIE DAVIE DAVIE DAVIE DAVIE

FL FL FL FL FL

33314-2815 33314-3457 33314-7118 33324-4455 33328-2018

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Provider Phone Number

Provider Street

Page 124 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PATIENT'S CHOICE PHARMACY

Provider Name

(954) 622-2222

4801 S UNIVERSITY DR SUITE 111

DAVIE

FL

33328

RADIANT CARE PHCY & COMPOUNDING HALIFAX HOSP MED CTR PHCY HOLLY HILL PHARMACY MAIL MEDS CLINICAL PHARMACY STEVES PHARMACY INC

(954) 530-4808 (386) 254-4197 (386) 677-7377 (239) 939-9226 (386) 255-0907

5779 S UNIVERSITY DR 303 N CLYDE MORRIS BLVD 1702 RIDGEWOOD AVE 1435 DUNN AVE STE 101 636 MASON AVE

DAVIE DAYTONA BEACH DAYTONA BEACH DAYTONA BEACH DAYTONA BEACH

FL FL FL FL FL

33328-6114 32114-2709 32117-5416 32114-1434 32117-4835

STEWART MARCHMAN ACT BEHAVIORAL THE MEDICINE SHOPPE GEORGE PHARMACY CAREONE PHARMACY SERVICES NORTH BROWARD MEDICAL CENTER FISHER PHARMACY THE PRESCRIPTION PLACE PIERSON COMMUNITY PHARMACY RITTER'S TOWNE PHARMACY LLC THE MEDICINE SHOPPE ALL HEART PHARMACY APEX PHARMACY INC DELRAY SHORES PHARMACY DR G'S PHARMACY OF DELRAY HUBER REXALL DRUGS IRAS DISCOUNT PHARMACY LINTON SQUARE PHCY & MED SPPLY PHC PHARMACY LLC SAV-A-LOT PHARMACY TOTAL CARE WEST ATLANTIC PHARMACY DELTONA PHARMACY OF FLORIDA LLC IPHARMACY JJ'S PHARMACY VALUE N CARE HEART MED PHARMACY NATURXHEAL FAMILY PHARMACY NAVARRO DISCOUNT PHARMACY PHARMACO MED SHOP SHIELDS PHARMACY THE MEDICINE SHOPPE WIZE PHARMACY DUNNELLON DISCOUNT DRUGS ENGLEWOOD PHARMACY

(386) 236-1658 (386) 310-7900 (386) 322-2180 (855) 822-7366 (954) 786-6802 (850) 892-5612 (850) 892-6898 (386) 738-6268 (386) 734-6666 (386) 734-3383 (561) 501-6915 (561) 499-7500 (561) 272-2124 (561) 330-3146 (561) 276-6034 (561) 455-0090 (561) 272-0015 (561) 921-6176 (561) 637-5911 (561) 921-2030 (561) 496-0338 (386) 574-7600 (386) 259-4074 (386) 968-1066 (386) 960-8962 (305) 594-9899 (305) 629-9891 (305) 471-8184 (727) 754-9497 (727) 648-2680 (727) 733-0404 (727) 953-9880 (352) 489-4960 (941) 475-3784

1220 WILLIS AVE BLDG 2 948 ORANGE AVE 2566 S. ATLANTIC AVE 1003 E NEWPORT CENTER DR 201 E SAMPLE RD 688 BALDWIN AVE 1337 US HIGHWAY 90 W 650 W PLYMOUTH AVE 120 E NEW YORK AVE 319 S WOODLAND BLVD 911 SE 6TH AVE STE 105 6110 W ATLANTIC AVE UNIT C 601 N CONGRESS AVE STE 407 1425 SOUTH CONGRESS AVE 400 E ATLANTIC AVE 4900 LINTON BLVD STE 21/22 1601 S CONGRESS AVE 1177 GEORGE BUSH BLVD STE 100 15111 JOG RD 4900 LINTON BLVD STE 24 7495 W ATLANTIC AVE STE 206 776 DELTONA BLVD 1235 PROVIDENCE BLVD # Q 1240 PROVIDENCE BLVD STE 2 2091 SAXON BLVD STE 100 2351 NW 93RD AVE 3105 NW 107TH AVE STE 102 11402 NW 41ST ST STE 127 2640 BAYSHORE BLVD 2196 MAIN ST STE A 938 PATRICIA AVE 1153 MAIN ST STE 102 11150 N WILLIAMS ST STE 101-B 900 PINE ST STE 211

DAYTONA BEACH DAYTONA BEACH DAYTONA BEACH SHORES DEERFIELD BEACH DEERFIELD BEACH DEFUNIAK SPRINGS DEFUNIAK SPRINGS DELAND DELAND DELAND DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELRAY BEACH DELTONA DELTONA DELTONA DELTONA DORAL DORAL DORAL DUNEDIN DUNEDIN DUNEDIN DUNEDIN DUNNELLON ENGLEWOOD

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32114-2810 32114-4668 32118-0000 33442-7724 33064 32435-2596 32433-1470 32720-3260 32724-5568 32720-5853 33483-5190 33484 33445-4639 33445-6384 33483-4537 33445-6688 33445 33483-7239 33446-1221 33445-6687 33446-1393 32725-7107 32725-7363 32725-7352 32725-3229 33172-4811 33172 33178-4862 34698-1801 34698-5650 34698-6023 34698-5332 34432-8364 34223-4458

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 125 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LEMON BAY DRUGS EAST BAY PHARMACY LAKE PHARMACY

Provider Name

(941) 475-5636 (352) 357-4341 (352) 357-5485

3542 N ACCESS RD 2 E MAGNOLIA AVE 710 N BAY ST

ENGLEWOOD EUSTIS EUSTIS

FL FL FL

34224-9474 32726-3417 32726-2940

ST MARY PHCY COMPOUND & MED SUPPLY WAAS DRUG STORE INC FLEMING ISLAND PHARMACY LLC 7TH AVENUE FAMILY HEALTH CTR AHF PHARMACY AHF PHARMACY- NORTH POINT AHF PHARMACY-SUNRISE BENZER PHARMACY BEST HEALTH PHARMACY INC BGMC OUTPATIENT PHARMACY CAREMART PHARMACY DIPLOMAT SPECIALTY PHARMACY GARDEN DRUGS GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE IMPERIAL PNT MD CTR OUTPT PHCY IMPERIAL POINT PHCY CENTER INC LAS OLAS CHEMIST MEDIC PHARMACY P & S DRUGS POLARIS PHARMACY SERVICES PRESCRIPTRX PHARMACY RON'S PHARMACY SPECIALTY CARE CENTER PHARMACY SPEEDY SCRIPTS 2 PHARMACY GRANDMA'S COUNTRY PHARMACY FAST AND FRIENDLY PHARMACY CARRELL DISCOUNT PHARMACY CYPRESS PHARMACY INC EXPERT CARE PHARMACY FAM HLTH CTR OF SW FLORIDA FAM HLTH CTR OF SW FLORIDA FAMILY PHARMACY & MEDICAL SUPPLY FORT MYERS PRESCRIPTION SHOP GENOA-QOL HEALTHCARE K&M DRUGS LEE PHARMACY LEE PHARMACY 2

(352) 357-6699 (904) 261-3171 (904) 644-8233 (954) 759-6624 (954) 761-4531 (954) 727-2174 (954) 462-9223 (954) 485-4949 (754) 200-6414 (954) 468-8082 (954) 229-0582 (610) 546-4089 (954) 776-1521 (754) 216-4844 (754) 216-5002 (954) 776-8626 (954) 210-7350 (954) 462-4166 (954) 484-4200 (954) 764-6257 (954) 919-1818 (754) 200-5913 (954) 580-3006 (954) 463-8119 (954) 535-0318 (352) 236-0407 (863) 622-2087 (239) 243-8490 (239) 481-7322 (239) 693-2050 (239) 344-2310 (239) 314-1683 (239) 288-6997 (239) 939-0249 (239) 939-7935 (239) 689-5788 (239) 343-2800 (239) 343-5100

1314 S BAY ST 1551 S 14TH ST 2349 VILLAGE SQ PKWY STE 106 200 NW 7TH AVE 700 SE 3RD AVE 6405 N FEDERAL HWY STE 205 1785 E SUNRISE BLVD 5431 N STATE ROAD 7 331 NW 27TH AVE 1600 S ANDREWS AVE 960 NE 62ND ST 500 SE 15TH ST STE 102 4400 N ANDREWS AVE 2900 W PROSPECT RD STE A 330 SW 27TH AVE # A 6401 N FEDERAL HWY 6310 N FEDERAL HWY 1201 E LAS OLAS BLVD 5150 N FEDERAL HWY 1234C NE 4TH AVE 2900 NW 60TH ST 1523 E COMMERCIAL BLVD 2977 W COMMERCIAL BLVD 1111 W BROWARD BLVD 2323 NW 19TH ST STE 6 11386 E HIGHWAY 316 13 W BROADWAY ST 3432 CLEVELAND AVE 9371 CYPRESS LAKE DR 4901 PALM BEACH BLVD STE 350 2232 GRAND AVE 19701 S TAMIAMI TRL 9861 BERNWOOD PLACE DR #145 3594 BROADWAY 2789 ORTIZ AVE BLDG H 14651 PALM BEACH BLVD STE #102 2776 CLEVELAND AVE 9981 S HEALTHPARK DR

EUSTIS FERNANDINA BEACH FLEMING ISLAND FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT LAUDERDALE FORT MC COY FORT MEADE FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32726 32034-1930 32003-4319 33311-9026 33316-1139 33308-1414 33304 33319-2921 33311-8632 33316-2510 33334-4110 33316-1952 33309-3918 33309-2519 33312-2051 33308-1427 33308-1906 33301-2331 33308-3814 33304-1925 33309-1735 33334-5717 33309-3502 33312-1638 33311-3400 32134-8114 33841 33901-7108 33919-4939 33905-3251 33901 33908-4818 33966-6545 33901-8016 33905-7806 33905-2331 33901-5864 33908-3618

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 126 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LEE PHARMACY 3 LEE PHARMACY 5 LIVEWELL PHARMACY MAIL MEDS CLINICAL PHARMACY MYERLEE PHARMACY OPTION CARE REVIVE PHARMACY RX TO GO LLC SAN CARLOS PHARMACY SUNRISE RX PHARMACY INC AMERICAN CARE CENTRAL FL FT PIERCE BUTTERFIELD DRUGS BUTTERFIELD DRUGS-IPS FORT PIERCE DISCOUNT PHCY INC JACKSON DRUGS LLC OCEAN SIDE PHARMACY SYNERGY SPECIALTY PHARMACY EMERALD COAST CANCER CENTER GENOA-QOL HEALTHCARE NORTH FLORIDA PHCY MED SHOPPE WEEKS PHARMACY WATSONS PHARMACY IV STAT ABLE PHARMACY AYERS PHARMACY BARNES HEALTHCARE SERVICES CRESCENT HEALTHCARE INC GENOA-QOL HEALTHCARE

Provider Name

(239) 343-1600 (239) 343-9836 (239) 208-8847 (239) 939-9226 (941) 482-3022 (239) 561-3456 (239) 204-4223 (239) 275-5357 (239) 590-8820 (239) 288-7450 (772) 293-0770 (772) 489-3700 (772) 489-3796 (772) 577-6469 (772) 464-3784 (561) 465-1118 (850) 312-3570 (850) 863-3148 (727) 322-4008 (386) 497-2580 (850) 835-2028 (863) 635-4568 (850) 226-8162 (352) 519-5795 (352) 733-0090 (352) 333-2525 (352) 373-8389 (352) 264-9995

13681 DOCTORS WAY 4751 S CLEVELAND AVE 4857 PALM BEACH BLVD UNIT 1 2692 OAK RIDGE CT 7050 WINKLER RD 11341 LINDBERGH BLVD 16205 S TAMIAMI TRL STE 6 4371 VERONICA S SHOEMAKER BLVD 18911 S TAMIAMI TRL STE 13 2336 CLEVELAND AVE 1404 S 28TH ST 5009 TURNPIKE FEEDER RD 5011 TURNPIKE FEEDER RD 1727 OKEECHOBEE RD 2301 OKEECHOBEE RD 1118 COLONNADES DR 917 MAR WALT DR STE C 1024 MAR WALT DR 137 HOSPITAL DR NE STE Q 7729 SW US HIGHWAY 27 132 STATE HWY 20 EAST 16 W WALL ST 533 EGLIN PARKWAY NE 5001 NW 34TH BLVD STE B 720 SW 2ND AVE STE 180 1700 NW 80TH BLVD 3300 SW ARCHER RD STE C 4300 SW 13TH ST

FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT MYERS FORT PIERCE FORT PIERCE FORT PIERCE FORT PIERCE FORT PIERCE FORT PIERCE FORT WALTON FORT WALTON BEACH FORT WALTON BEACH FORT WHITE FREEPORT FROSTPROOF FT WALTON BEACH GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33912-4300 33907-1317 33905-3206 33901 33919-7048 33913-8852 33908-5304 33916-2216 33908 33901-3540 34947-6999 34951-2217 34951-2246 34950-3945 34950-6554 34949-3063 32547-6651 32547-6645 32548-5063 32038-3508 32439-0432 33843-2042 32547 32605-1190 32601-1209 32606-9177 32608-1739 32608-4006

SOUTHEASTERN COMMUNITY PHARMACY VINEYARD PHARMACY WESTLAB PHARMACY INC WISES PARKWOOD PHARMACY WISES PHARMACY VERACITY PHARMACY COOK DISCOUNT DRUGS SERVICE DRUG STORE AZALEA HEALTH BIOWORX CLARKE'S PHARMACY FAMILY CARE RX, LLC LIBERTY FOR ALL PHARMACY

(352) 224-2450 (352) 505-3387 (352) 373-8111 (352) 373-3547 (352) 376-8286 (813) 677-8811 (850) 263-4110 (850) 263-3257 (904) 284-5677 (904) 531-3030 (561) 660-6268 (561) 432-2273 (561) 283-4582

4343 W NEWBERRY RD STE 9 6500 SW ARCHER RD STE H 4410 W NEWBERRY RD STE A5 3601 SW 2ND AVE STE A 708 SW 4TH AVE 13135 KINGS LAKE DR #102 5324 BROWN ST 5341 BROWN ST 1305 N ORANGE AVE STE 120 3516 ENTERPRISE WAY STE 7 3989 S JOG RD 4752 S JOG RD 3034 SOUTH JOG RD

GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE GIBSONTON GRACEVILLE GRACEVILLE GREEN COVE SPRINGS GREEN COVE SPRINGS GREENACRES GREENACRES GREENACRES

FL FL FL FL FL FL FL FL FL FL FL FL FL

32607-2825 32608-4786 32607-2290 32607-2865 32601-6427 33534-3960 32440-2238 32440-2239 32043-2547 32043-9305 33467-1514 33467-5119 33467-2004

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 127 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GROVELAND PHARMACY GULF BREEZE APOTHECARY GULFPORT PHARMACY AMERICAN CARE TAMPA HAINES CITY CENTRAL PHARMACY FIRST CHOICE PHARMACY

Provider Name

(352) 429-1353 (850) 677-9340 (727) 223-1075 (863) 438-7911 (863) 419-7777 (863) 438-2799

145 E BROAD ST 1177 GULF BREEZE PKWY 5004 GULFPORT BLVD S 502 E HINSON AVE 1671 E HINSON AVE 401 E HINSON AVE

GROVELAND GULF BREEZE GULFPORT HAINES CITY HAINES CITY HAINES CITY

FL FL FL FL FL FL

34736-2501 32561 33707-4942 33844-5240 33844 33844-5237

FIRST CHOICE PHARMACY, ZOCALO PLAZA HC PHARMACY HEALTHY MEDS PHARMACY BUDGET DRUGS DIRECT MEDS OF FL HALLANDALE PHARMACY LOCATEL HEALTH BUY RITE DRUGS G & R HEALTHMART PHARMACY #3 41 PHARMACY DISCOUNT INC ANGELITO FARMACIA DISCOUNT INC AZALIA'S PHCY & DISCOUNT INC BELEN PHARMACY CARE MED PHARMACY GROUP CITRUS HEALTH NETWORK CONTINUCARE HIALEAH COTOS PHARMACY DRUG CENTER INC EL JARDIN PHARMACY EL JARDIN PHARMACY LLC ELSA PHARMACY INC FARMACIA 22-24 HIALEAH FARMACIA CALI INC. FARMACIA CARDENAS FARMACIA MARQUEZ H E FARMACIA INC IDEAL PHARMACY SOLUTIONS INTERAMERICAN MED CTR GROUP ISABEL PHARMACY JULIOS PHARMACY LARKIN COMM HOSP PALM SPRING LAS VILLAS PHARMACY LOS PALACIOS MEDICAL SUPPLIES PHCY LOVE PHARMACY MADAHIMA PHARMACY

(863) 422-4222 (863) 547-6921 (954) 404-6556 (954) 457-8011 (954) 454-8118 (954) 455-3822 (954) 416-1202 (850) 539-8080 (352) 419-8949 (305) 836-2200 (305) 820-4010 (305) 685-9556 (305) 887-0284 (305) 200-3944 (305) 424-3177 (305) 826-0660 (305) 821-1430 (305) 887-7900 (305) 818-9511 (305) 818-2214 (305) 691-1968 (305) 888-2224 (305) 558-5055 (305) 887-6189 (305) 558-8002 (305) 885-0949 (305) 558-3522 (305) 820-4101 (305) 556-6672 (305) 884-0703 (305) 824-4771 (305) 883-7476 (305) 688-0644 (305) 885-3352 (305) 556-6060

460 US HWY 17-92 N 33048 US HWY 27 730 W HALLANDALE BCH BLVD #105 2500 E HALLANDALE BEACH BLVD 800 E HALLANDALE BEACH BLVD 1109 E HALLANDALE BEACH BLVD 1715 E HALLANDALE BEACH BLVD 704 S US HIGHWAY 27 946 E NORVELL BRYANT HWY 820 E 41ST ST 3890 E 4TH AVE 428 E 49TH ST 1020 W 29TH ST 4201 PALM AVE # AA 4175 W 20TH AVE 3233 PALM AVE 4982 W 12TH AVE 1625 PALM AVE 4375 W 16TH AVE 3112 W 76TH ST 1980 E 4TH AVE 2961 W 12TH AVE 1924 W 60TH ST # 26 2030 PALM AVE 5901 W 16TH AVE 692 W 29TH ST 344 W 65 ST STE 101 5378 W 16 AVENUE 2360 W 68TH ST STE 113-114 2875 W 2ND AVE 1475 W 49TH ST 716 W 29TH ST 4213 E 4TH AVE 1000 E 4TH AVE 8129 W 8TH AVE

HAINES CITY HAINES CITY HALLANDALE HALLANDALE BEACH HALLANDALE BEACH HALLANDALE BEACH HALLANDALE BEACH HAVANA HERNANDO HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33844 33844 33009-5328 33009-4834 33009-4477 33009-4431 33009-4621 32333-2018 34442-2826 33013-2464 33013-2704 33013-1868 33012-5000 33012-4424 33012 33012-5427 33012-3115 33010-3000 33012 33018-3803 33010-2714 33012-4833 33012-7598 33010 33012-6813 33012-5620 33012 33012 33016-5514 33010-1507 33012 33012-5606 33013-2305 33010-4104 33014-3529

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 128 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MAGGIE'S PHARMACY MAGGY PHARMACY DISCOUNT MALECON PHARMACY INC MARTHA FARMACIA MARTINEZ DRUGS STORE INC MED-CARE INFUSION SVCS INC N&D PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY PHARMACY CARE CENTER PILLS PLUS INC RUBIO PHARMACY AND DISCOUNT STAR PHARMACY SYLVESTRE PHARMACY UNIVERSAL ARTS PHARMACY VIDA PHARMACY JLH PHARMACY CARING PHARMACY HILLIARD PHARMACY INC 1ST CHOICE LTC PHARMACY 1ST CHOICE PHARMACY RAYS PHARMACY AMERICANA DISCOUNT PHARMACY BRADYS PHCY BRAVO DRUGS EMERALD HILLS PHARMACY EPIC CARE PHARMACY EZ CARE PHARMACY HOLLYWOOD DISCOUNT PHARMACY INFUPHARMA INFUSION SVCS MAX DRUG INC MEMORIAL REGIONAL HOSP PHCY POST HASTE PHARMACY SKY PHARMACY AND DISCOUNT CORP.

NR_0009_10823 10/2017

Provider Phone Number (305) 818-0863 (305) 557-2262 (305) 558-8551 (305) 823-7887 (305) 693-0441 (305) 863-4277 (305) 888-2889 (305) 854-8544 (305) 883-2277 (305) 823-0823 (305) 556-3117 (305) 822-2210 (305) 556-8585 (305) 822-9522 (305) 825-3386 (305) 424-9144 (305) 231-8200 (305) 821-4337 (305) 698-0021 (305) 405-3333 (305) 821-3131 (305) 885-8888 (305) 557-3151 (305) 822-8234 (305) 825-0015 (386) 454-1586 (904) 845-3371 (727) 940-3521 (727) 934-1300 (727) 945-7297 (954) 981-6661 (954) 989-0085 (954) 505-7672 (954) 983-3336 (954) 963-2113 (954) 981-0614 (954) 989-6300 (954) 923-3839 (954) 987-4125 (954) 265-5907 (954) 989-6524 (954) 929-6500

Provider Street 7590 NW 186TH ST STE 109 1255 W 46TH ST STE 5-6 5966 W 16TH AVE 6871 W 4TH AVE 874 E 41ST ST 3085 WEST 80TH STREET 650 PALM AVE STE 1 1243 SW 8TH ST 366 E 4TH AVE 775 W 49TH ST STE 1 3960 W 12TH AVE 3915 PALM AVE 4410 W 16TH AVE 16801 NW 67TH AVE 6410 NW 186TH ST 2399 W 52ND ST 3141 W 76TH ST UNIT 5 7413 MIAMI LAKES DR 7801 NW 146TH ST 18600 NW 87TH AVE UNIT 109 37 E 44TH ST 1268 PALM AVE 6500 W 4TH AVE 70 W 49TH ST 8204 NW 103RD ST 232 NE 1ST AVE 551770 US HIGHWAY 1 2232 US HWY 19 2208 US HIGHWAY 19 1936 US HIGHWAY 19 N 370B S STATE ROAD 7 6810 STIRLING RD 3009 JOHNSON ST 3000 STIRLING RD STE 120 3948 PEMBROKE RD 3353 SHERIDAN ST STE D 1150 N 35TH AVE STE 105 2013 HARDING ST 4519 HOLLYWOOD BLVD 3501 JOHNSON ST 4401 SHERIDAN ST 2414 SHERIDAN ST

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Provider City HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH HIALEAH GARDENS HIGH SPRINGS HILLIARD HOLIDAY HOLIDAY HOLIDAY HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD HOLLYWOOD

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33015-2952 33012-3283 33012-6814 33014-5337 33013-2455 33018 33010-4392 33010 33010-4998 33012-3645 33012-4105 33012-4447 33012-7100 33015-4203 33015-6006 33016-7213 33018-3885 33014-6818 33016-1504 33015-3528 33013-1815 33010-3921 33012-6606 33012-3710 33016-2202 32643-9443 32046-8820 34691-4351 34691-4351 34691-5539 33023-6718 33024-1842 33021-5536 33021-2066 33021-8114 33021-3632 33021-5424 33020-2714 33021-6611 33021-5421 33021-3513 33020-2064

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CARE PHARMACY CONTINUCARE HOMESTEAD HOMESTEAD COMMUNITY PHCY LLC IMC- HOMESTEAD KACHEEZ PHARMACY LLC LEAL PHARMACY LLC MEDICAL ARTS PHARMACY NAVARRO DISCOUNT PHARMACY ROYAL PALM DRUG G & R HEALTH MART PHARMACY #2 DRUG STORE HEALTHMART HUDSON PHARMACY LILY CARE PHARMACY MEDSOURCE PHARMACY SAVE N CARE PHARMACY BENZER PHARMACY TOWN PHARMACY EAU GALLIE DISCOUNT PHARMACY AZALEA HEALTH INTERLACHEN COMMUNITY PHARMACY B & W REXALL DRUG OF INVERNESS BRASHEAR'S VITAL CARE PHARMACY ISLAND PHARMACY ADVANCED RX & COMPOUNDING PHARMACY

Provider Name

(305) 248-5363 (305) 245-0200 (305) 245-1800 (305) 246-3864 (305) 247-6006 (305) 246-1626 (305) 247-4488 (305) 242-0377 (305) 247-6949 (352) 628-0096 (727) 869-3784 (727) 378-5882 (727) 233-9908 (727) 857-4837 (727) 863-5200 (239) 658-6123 (239) 658-1048 (321) 777-2220 (386) 684-2407 (386) 684-0924 (352) 726-1021 (352) 637-2079 (305) 747-7061

1631 NE 8TH ST 442 WASHINGTON AVE 925 NE 30TH TERRACE STE 200 1443 NE 8TH ST 122 W MOWRY DR 1690 NE 8TH ST 944 N KROME AVE 2598 NE 10TH CT 806 N KROME AVE 5691 S SUNCOAST BLVD 7535 MEDICAL DR UNIT 1 8117 STATE ROAD 52 8811 STATE ROAD 52 STE 11 13910 FIVAY RD STE 3 13850 LITTLE RD 110 E MAIN ST STE A 107 W MAIN ST 991 E EAU GALLIE BLVD UNIT B 1213 STATE ROAD 20 126-1 S COUNTY ROAD 315 214 US HIGHWAY 41 S 206 W DAMPIER ST 82787 OVERSEAS HWY

HOMESTEAD HOMESTEAD HOMESTEAD HOMESTEAD HOMESTEAD HOMESTEAD HOMESTEAD HOMESTEAD HOMESTEAD HOMOSASSA HUDSON HUDSON HUDSON HUDSON HUDSON IMMOKALEE IMMOKALEE INDIAN HARBOUR BEACH INTERLACHEN INTERLACHEN INVERNESS INVERNESS ISLAMORADA

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33033-4603 33030-6036 33033 33033-4506 33030-5904 33033-4604 33030-4409 33033-4717 33030-4407 34446-2605 34667-6502 34667-6728 34667-6751 34667-7130 34667-8025 34142-3754 34142-3926 32937-4933 32148-2737 32148-5418 34450-4997 34450-4212 33036-3609

(904) 448-8181

6951 SAINT AUGUSTINE RD

JACKSONVILLE

FL

32217-2819

AGAPE COMMUNITY HEALTH CENTER INC

(904) 760-4925

120 KING ST

JACKSONVILLE

FL

32204

AHF HEALTHCARE CENTER JACKSONVILLE ALL PEOPLES PHARMACY ALL WELL PHARMACY AMERICAN CARE N FL JACKSONVILLE ARLINGTON PHARMACY BENZER PHARMACY CAREMAX PHARMACY CAREMAX PHARMACY CARTERS ORTEGA PHARMACY INC. CITIZEN PHARMACY COASTAL PHARMACY LLC CURE PHARMACY DENNIS' PHARMACY DUVAL PHARMACY

(904) 389-9744 (904) 766-3145 (904) 779-6990 (904) 389-6954 (904) 724-4337 (813) 304-2221 (844) 725-3939 (904) 728-2656 (904) 389-5558 (844) 224-8493 (904) 621-8175 (904) 253-3405 (904) 772-8998 (904) 696-8882

2 SHIRCLIFF WAY STE 900 4750 SOUTEL DR STE 10 5452 BLANDING BLVD 1918 BLANDING BLVD 936 ARLINGTON RD N 6132 MERRILL RD STE 12 5547 NORMANDY BLVD 2789 PARK ST 2923 CORINTHIAN AVE 1545 UNIVERSITY BLVD N 9191 R G SKINNER PKWY 7001 MERRILL ROAD STE 13 7900 103RD ST STE 14 2386 DUNN AVE STE 117

JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE

FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32204-4753 32208-1829 32244-1957 32210-3202 32211-5956 32277-3489 32205-6246 32205-7607 32210-4401 32211-5229 32256-9655 32277 32210-6660 32218-4602

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Provider Phone Number

Provider Street

Page 130 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DUVAL PHARMACY 201 E- LYNK PHARMACY EDGEWOOD PHARMACY FIRST COAST FOOT AND ANKLE CLINIC FLORIDA SPECIALTY PHARMACY HALLIDAY'S & KOIVISTO'S PHCY JACKSON PHARMACY JAX PHARMACY JAXX PHARMACY LAKE PHARMACY LANE AVENUE PHARMACY MARIETTA PHARMACY MED MATCH MEDSMART PHARMACY MEDTOWN PHARMACY MONUMENT PHARMACY NEW HORIZON PHARMACY NORTH BEACHES PHARMACY INC OSSI'S APOTHECARY OSTEENS PHARMACY OWENS PHARMACY PANAMA PHARMACY PATHSTONE HEALTH SERVICES PHARMACY PLUS, INC. PREMIER PHARMACY PRESTON PHARMACY PRIME PHARMACY LLC QAL SPCL PHCY OF JACKSONVILLE INC RICKER PHARMACY RITE-MART PHARMACY ROBERTS SOUTH BANK PHARMACY RXPERT LLC SETON PHARMACY SETON PHARMACY-DILLON SP2 THE APOTHECARY AT MEMORIAL TOWN AND COUNTRY PHARMACY TROX PHARMACY WELLHEALTH RX CHEEK AND SCOTT PHARMACY DURA-MED PHARMACY AARAV PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (904) 900-7700 (904) 374-9334 (904) 379-3195 (727) 350-1086 (904) 519-2720 (904) 737-2216 (904) 329-2251 (904) 222-8490 (904) 739-8101 (904) 786-3005 (904) 693-6633 (904) 999-4884 (904) 301-0710 (904) 800-1888 (904) 551-5870 (904) 727-3434 (904) 737-9466 (904) 241-5171 (904) 641-5555 (904) 388-0514 (904) 353-7468 (904) 765-3531 (904) 370-8749 (904) 442-8822 (904) 355-5646 (904) 724-0424 (904) 813-7634 (904) 365-5500 (904) 900-3500 (904) 353-7223 (904) 398-9660 (904) 448-1713 (904) 450-6330 (904) 308-7515 (904) 503-5030 (904) 399-6171 (904) 744-0104 (904) 500-8769 (904) 880-1660 (386) 638-0101 (850) 675-6850 (561) 427-0947

Provider Street 7077 NORMANDY BLVD STE 5 5800 BEACH BLVD STE 105 5966 MONCRIEF RD UNIT 1 8075 GATE PKWY W 7015 AC SKINNER PKWY STE 2 4133 UNIVERSITY BLVD S # 1 4347 UNIVERSITY BLVD S STE 3 9323 LEM TURNER RD 6055 SAINT AUGUSTINE RD 5875 SAN JUAN AVE STE C 1233 LANE AVE S STE 9 8299 W BEAVER ST STE 5 6789 SOUTHPOINT PKWY #300 7855 ARGYLE FOREST BLVD # 801 13770 BEACH BLVD STE 3 1301-22 MONUMENT RD 8535 BAYMEADOWS RD STE 6A 1510 PENMAN RD 9852 OLD BAYMEADOWS RD 757 EDGEWOOD AVE N 834 LOMAX ST 7307 N MAIN ST 5244 EDGEWOOD CT SUITE 2 7645 MERRILL RD STE 210 150 E 8TH ST 6022 ATLANTIC BLVD 3604 UNIVERSITY BLVD S #102 1514 NIRA ST 7628 103RD ST UNIT #5 5312 N PEARL ST 1625 ATLANTIC BLVD 4239 SUNBEAM RD STE 1 4205 BELFORT RD STE 1003 3 SHIRCLIFF WAY STE 137 3740 ST JOHNS BLUFF RD #19 3627 UNIVERSITY BLVD S STE 120 939 UNIVERSITY BLVD N 14965 OLD SAINT AUGUSTINE RD 12276 SAN JOSE BLVD STE 707 1150 US HIGHWAY 41 NW STE 13 3877 HIGHWAY 4 6650 W. INDIANTOWN RD # 100

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Provider City JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JASPER JAY JUPITER

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32205-6294 32207-5180 32209-2538 32216-3684 32256 32216-4316 32216-4966 32208-2274 32217-2104 32210-3049 32205-6254 32220-2315 32216-8205 32244-7706 32224-7227 32225-6462 32256-7494 32250-3744 32256-8101 32254-3013 32204-3902 32208-4123 32254 32277 32206-3704 32211-7503 32216 32207-8652 32210-8719 32208-5119 32207-3318 32257-8822 32216-1471 32204-4785 32224-2650 32216-4228 32211-5529 32258-9481 32223-8674 32052-5889 32565-1754 33458

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name JUPITER DRUGS MANHATTANS PHARMACY PRESCRIPTION SHOP OF STUART TEQUESTA DRUGS ST.JESUS PHARMACY MCARE PHARMACY KEY PHARMACY NORTH FL PHCY MED SHOPPE BVL PHARMACY CENTRAL AVENUE PHARMACY COLONIAL DRUGS OF KISSIMMEE LLC FLORIDA HOSPITAL PHARMACARE CT GENOA-QOL HEALTHCARE IBCK PHARMACY JOSEYKAY PHARMACY KISSIMMEE PHARMACY SEDANOS MEDINA-MEDS PHARMACY MODEL PHARMACY OAKS PHARMACY ORLANDO FAMILY PHYSICIANS ORLANDO FAMILY PHYSICIANS PHAMILY PHARMACY PHARMACY 4U RITEMED PHARMACY RITEMED PHARMACY SUNRISE PHARMACY THE HUNTER'S CREEK PHARMACY WEST LAKE PHARMACY J & J PHARMACY MEDICINE CHEST SPANISH SPRINGS RX CARE PHARMACY RXCARE PHARMACY VINTAGE PHARMACY LLC KIRBY AND COMPANY PHCY LLC BAYA PHARMACY BAYA PHARMACY CHEEK AND SCOTT PHARMACY GENOA-QOL HEALTHCARE NORTH FLORIDA PCY MED SHOPPE NORTH FLORIDA PHCY MED SHOPPE AVELLA OF ORLANDO, INC AXIUM HEALTHCARE PHARMACY, INC

NR_0009_10823 10/2017

Provider Phone Number (561) 746-7499 (561) 277-9124 (772) 287-3443 (561) 741-8222 (305) 279-2465 (727) 202-6684 (305) 361-5445 (352) 478-2057 (407) 350-5700 (321) 284-8886 (407) 344-5588 (407) 303-4005 (407) 344-9700 (407) 449-4048 (407) 201-8417 (407) 201-8600 (407) 394-1111 (407) 572-8779 (407) 350-5925 (407) 658-9687 (407) 520-3588 (407) 201-4348 (407) 279-5160 (407) 287-6735 (407) 287-6727 (407) 343-4434 (407) 483-8901 (407) 344-4555 (863) 675-0004 (352) 775-3325 (352) 633-2105 (352) 391-5533 (352) 751-6895 (386) 496-8099 (386) 755-6677 (386) 755-2233 (386) 754-5377 (386) 319-4050 (386) 755-9300 (386) 758-6770 (407) 942-0080 (407) 865-7895

Provider Street 1025 MILITARY TRAIL STE 100 4601 MILITARY TRL STE 101 18222 LAKE BEND DR 1 MAIN ST STE 107 7556A SW 117TH AVE 5853 54TH AVE N 614 CRANDON BLVD 405 S LAWRENCE BLVD 1952 E OSCEOLA PKWY 347 W OAK ST 728 N JOHN YOUNG PKWY 400 CELEBRATION PL 200 PARK PLACE BLVD STE 100 1420 SIMPSON ROAD 406 E VINE ST 1100 N JOHN YOUNG PKWY 4675 OLD PLEASANT HILL RD 1714 N MAIN ST 805 E OAK ST STE 2 790 BUENAVENTURA BLVD 1502 VILLAGE OAK LN 407 W OAK ST 1026 MANN ST 2130 MICHIGAN AVE 1014 CYPRESS PKWY 4543 PLEASANT HILL RD, SUITE D 1196 CYPRESS GLEN CIR. 2544 SIMPSON RD 149 W HICKPOOCHEE AVE 835 S US HIGHWAY 27 725 US HWY 466 13733 N US HIGHWAY 441 104 S OLD DIXIE HWY 395 W MAIN ST STE C 780 SE BAYA DR 1465 W US HIGHWAY 90 STE 110 161 SW STONEGATE TER STE 105 439 SW MICHIGAN ST RM 12 3718 W US HIGHWAY 90 347 SW MAIN BLVD STE 102 100 TECHNOLOGY PARK, STE 155 550 TECHNOLOGY PARK

Page 132 of 679

Provider City JUPITER JUPITER JUPITER JUPITER KENDALL KENNETH CITY KEY BISCAYNE KEYSTONE HEIGHTS KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE KISSIMMEE LABELLE LADY LAKE LADY LAKE LADY LAKE LADY LAKE LAKE BUTLER LAKE CITY LAKE CITY LAKE CITY LAKE CITY LAKE CITY LAKE CITY LAKE MARY LAKE MARY

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33458 33458-4835 33458-3810 33469-4710 33183 33709-1901 33149-2008 32656-9222 34743-8626 34741-4421 34741-4985 34747-4970 34741-2344 34744-4404 34744-4274 34741-4201 34759-3423 34744-3307 34744-4576 34743-8128 34746-6592 34741 34741-4121 34744-2927 34759-3328 34759 34741 34744 33935-4753 32159 32159-6340 32159-8981 32159-4349 32054-1642 32025-5403 32055-6123 32024-3454 32025-0440 32055-4897 32025-5262 32746 32746-6230

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GREENWOOD PHARMACY JUST RX PHARMACY MEDPLEX PHARMACY NH PHARMA BENZER PHARMACY HEARTLAND PHCY LAKE PLACID K & M DRUGS SHAMROCK PHARMACY GOOD HEALTH PHARMACY LAKE WALES PHARMACY THE APOTHECARY SHOP AMERICAN CARE OF S FL LK WORTH AMERICAN DRUGS PHARMACY INC IRAS PHARMACY P&M PHARMACY

Provider Name

(407) 915-6505 (321) 283-0149 (407) 878-7615 (407) 322-2440 (352) 444-2055 (863) 659-1780 (863) 260-0100 (863) 659-4744 (863) 300-1984 (863) 676-0400 (863) 676-1974 (561) 296-4400 (561) 557-3320 (561) 353-1292 (561) 660-8650

3801 W LAKE MARY BLVD UNIT 127 765 PRIMERA BLVD STE 1021 4106 W LAKE MARY BLVD STE 130 405 WAYMONT CT STE 101 2044 CR 470 342 E ROYAL PALM ST 133 TOWER ST 5 N MAIN AVE 1110 DRUID CIRCLE STE E 1322 STATE ROAD 60 E 437 S 11TH ST 818 S DIXIE HWY 2111 10TH AVE 6338 LANTANA RD 7753 LAKE WORTH RD

LAKE MARY LAKE MARY LAKE MARY LAKE MARY LAKE PANASOFFKEE LAKE PLACID LAKE PLACID LAKE PLACID LAKE WALES LAKE WALES LAKE WALES LAKE WORTH LAKE WORTH LAKE WORTH LAKE WORTH

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32746-6168 32746 32746-3383 32746-3586 33538 33852-5019 33852-6836 33852-2603 33853-4307 33853-4322 33853-4250 33460-5042 33461-3345 33463 33467-2536

AMERICAN CARE OF TAMPA INC LAKELAND CAREPLUS PHARMACY CLEVELAND HEIGHTS PHARMACY CLINIC PRESCRIPTION SHOP EAGLE LAKE PHARMACY GENOA-QOL HEALTHCARE LAKELAND FAMILY PHARMACY LAKELAND PHARMACY LAKELAND RED MED CTR PUBLIX PH PEOPLES PHARMACY PROVIDENCE PHARMACY QUICK'N SAVE PHARMACY SUPREME RX LAKEWOOD RANCH PHARMACY CARE RX PHARMACY AUM PHARMACY LAND O' LAKES PHARMACY HEALTH FIRST PHARMACY LANTANA PHARMACY INC ALBERTSON'S PHARMACY BAY LIFE PHARMACY III EDWARDS PHARMACY EMPATH HEALTH PHARMACY MICHAELS PHARMACY ST MARY PHARMACY THE MEDICINE SHOPPE

(863) 666-6100 (863) 668-8490 (863) 646-5041 (863) 680-7235 (863) 937-7992 (836) 614-0066 (863) 698-7260 (863) 688-3444 (863) 284-1834 (863) 858-4444 (863) 937-8092 (863) 583-4999 (863) 940-4733 (941) 907-1500 (561) 328-7430 (813) 388-6875 (813) 803-7303 (561) 967-8800 (561) 964-7614 (727) 581-0440 (727) 614-9933 (727) 724-4171 (727) 523-2572 (727) 585-2000 (727) 585-1333 (727) 501-0188

2600 INDUSTRIAL PARK DRIVE 3020 S COMBEE RD 3405 CLEVELAND HEIGHTS BLVD 1600 LAKELAND HILLS BLVD 5245 A US HWY 98 N 1831 GILMORE AVE STE 1 605 W MEMORIAL BLVD 950-952 SOUTH FLORIDA AVE 1324 LAKELAND HILLS BLVD #203 4977 US HIGHWAY 98 N 5515 US HIGHWAY 98 N STE 1 722 E MEMORIAL BLVD 1611 N FLORIDA AVE 6310 HEALTH PARK WAY STE 130 3707 LAKE WORTH ROAD 2646 NARNIA WAY UNIT 101 7040 LAND O LAKES BLVD UNIT 10 6266 S CONGRESS AVE STE L12 3206 LANTANA RD 10500 ULMERTON RD 3350 EAST BAY DR 12071 INDIAN ROCKS RD 11701 BELCHER RD S STE 128 11987 SEMINOLE BLVD 1290 W BAY DR 1555 E BAY DR STE H

LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKELAND LAKEWOOD RANCH LAKEWORTH LAND O LAKES LAND O LAKES LANTANA LANTANA LARGO LARGO LARGO LARGO LARGO LARGO LARGO

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33801-7135 33803-7306 33803-4807 33805-3019 33809 33805-3017 33815-1466 33803-1153 33805-4543 33809-3657 33809-3133 33801-1848 33805-3107 34202-5177 33461 34638-7269 34638-3201 33462 33462 33771-3544 33771-1925 33774-3216 33773-5117 33778 33770-2204 33771-1002

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 133 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DR. G'S PHARMACY BY THE SEA CADUCEUS PHARMACY HEALTH & CARE PHARMACY LAUDERDALE PHARMACY MEDIX PHARMACY MERIT PHARMACY INC RAMIL RX, INC BETTER HEALTH PHARMACY IMC- LAUDERHILL BRASHEARS PHARMACY ADONAI PHARMACY BURRY'S PHARMACY EXPRESS PHARMACY GENOA-QOL HEALTHCARE LEESBURG COMMUNITY PHARM STARX PHARMACY THE PHARMACIST ACRES PHARMACY LEELAND PHARMACY LEHIGH PHARMACY THE MEDICINE SHOPPE CHEEK & SCOTT DRUGS, INC. THE VILLAGE PHARMACY LONGWOOD PHARMACY MEDICURE LONGWOOD PHARMACY CHOICE BENZER PHARMACY LUTZ PHARMACY MAXXYCOM RX PHARMACY RX EXPRESS PHARMACY SCRUPLES PHARMACY ADAMS PHARMACY MULLINS PHARMACY INC MACCLENNY PHARMACY NORTHEAST FLORIDA STATE HOSPITAL NORTH FLORIDA PHCY MED SHOPPE YATES PHARMACY & GIFTS BENZER PHARMACY MARCO ISLAND PHARMACY RELIABLE PHARMACY PHYSICIAN PREFERRED PHCY INC PRIMENET MEDICAL GROUP, INC

NR_0009_10823 10/2017

Provider Phone Number (954) 938-0005 (954) 797-8077 (954) 626-0446 (954) 530-7171 (954) 530-4793 (954) 739-4666 (954) 533-9792 (954) 530-9318 (954) 615-0900 (352) 746-3420 (352) 460-4030 (352) 787-3787 (352) 460-0542 (352) 702-0079 (352) 347-4064 (352) 323-9555 (352) 742-8080 (239) 674-9737 (239) 230-7966 (239) 491-2909 (239) 369-0141 (386) 362-2591 (386) 658-5860 (407) 332-9753 (407) 434-0433 (561) 793-3300 (813) 968-9100 (813) 948-4500 (813) 406-4929 (813) 948-4321 (813) 948-8111 (850) 265-2442 (850) 265-3344 (904) 259-1116 (904) 259-6211 (850) 973-8120 (850) 569-5100 (813) 661-2263 (239) 970-2490 (239) 970-0415 (954) 960-7360 (954) 984-8000

Provider Street 234 COMMERCIAL BLVD 4361 N STATE ROAD 7 3738 W OAKLAND PARK BLVD 4000 N STATE RD 7 STE 103 4850 W OAKLAND PARK BLVD #106 2464 N STATE ROAD 7 2331 N STATE ROAD 7 STE 121 1478 N STATE ROAD 7 1225 NW 40TH AVE UNIT 2 471 N DACIE PT 620 S LAKE ST STE 4 500 WEBSTER ST 1450 E NORTH BLVD 215 N 3RD ST 2500 CITRUS BLVD 511 MEDICAL PLAZA DR. 33124 COUNTY ROAD 473 1446 LEE BLVD 700 W LEELAND HTS BLVD #100 2814 LEE BLVD UNIT 1 57 HOMESTEAD RD N 1520 OHIO AVE S 10820 MARVIN JONES BLVD 252 W STATE ROAD 434 420 W STATE ROAD 434 14583 SOUTHERN BLVD 6056 VAN DYKE RD 1930 LAND O LAKES BLVD STE 15 1825 COLLIER PKWY 24718 STATE ROAD 54 1408 N DALEMABRY HWY #115 922 OHIO AVE 830 OHIO AVE 1254 S 6TH ST # D-1 7487 S SR 121 139 SW MACON ST 5404 10TH ST 11509 E MLK JR BLVD 905 N COLLIER BLVD 1757 SAN MARCO RD UNIT B 2700 N STATE ROAD 7 1100 S STATE ROAD 7 STE 104

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Provider City LAUDERDALE BY THE SEA LAUDERDALE LAKES LAUDERDALE LAKES LAUDERDALE LAKES LAUDERDALE LAKES LAUDERDALE LAKES LAUDERDALE LAKES LAUDERHILL LAUDERHILL LECANTO LEESBURG LEESBURG LEESBURG LEESBURG LEESBURG LEESBURG LEESBURG LEHIGH ACRES LEHIGH ACRES LEHIGH ACRES LEHIGH ACRES LIVE OAK LIVE OAK LONGWOOD LONGWOOD LOXAHATCHEE LUTZ LUTZ LUTZ LUTZ LUTZ LYNN HAVEN LYNN HAVEN MACCLENNY MACCLENNY MADISON MALONE MANGO MARCO ISLAND MARCO ISLAND MARGATE MARGATE

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33308-4438 33319-4856 33311-1157 33319-4816 33313-7260 33313-3724 33313-3771 33313-5806 33313-5801 34461-6306 34748-6059 34748-5019 34748 34748-5105 34748-3063 34748 34788-4258 33936-4850 33936 33971-1561 33936-6607 32064-4514 32064 32750-5114 32750-5159 33470 33558-8000 33549-2924 33549-8718 33559-6226 33548 32444-2354 32444-2352 32063-4619 32063 32340-2319 32445-3128 33550 34145-2742 34145-5151 33063 33068-4033

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RXPRESS PHARMACY LLC SAV-A-LOT DRUGS CARE RITE PHARMACY KELSON DISCOUNT DRUG PARAMORES PHARMACY N FLORIDA PHCY MED SHOPPE BENZER PHARMACY BROWNING'S PHCY & HLTHCR INC CIRCLES OF CARE INC CITY DISCOUNT PHARMACY DOCCS DISPENSARY HEALTH FIRST FAMILY PHARMACY HEALTH FIRST FAMILY PHARMACY HEALTH FIRST FAMILY PHARMACY LORDONI DISCOUNT PHARMACY MELBOURNE RX PHARMACY PRIME CARE PHARMACY SUNTREE PHARMACY THE MEDICINE SHOPPE THRIFTY DISCOUNT PHARMACY WICKHAM PHARMACY SAVERS DRUG MART HOBBS PHARMACY

Provider Name

(954) 227-3042 (954) 971-6900 (850) 381-2150 (850) 526-2839 (850) 482-3924 (386) 294-3777 (321) 421-7620 (321) 723-6520 (321) 952-6020 (321) 425-4377 (321) 752-6007 (321) 434-7355 (321) 434-7355 (321) 434-7488 (321) 610-3114 (321) 428-4505 (321) 586-5500 (321) 253-3535 (321) 242-2440 (321) 676-5999 (321) 241-6433 (321) 725-5492 (321) 452-0010

7970 W SAMPLE RD 7604 MARGATE BLVD 4721 HIGHWAY 90 3008 JEFFERSON ST STE B 4314 5TH AVE 229 W MAIN ST 401 N WICKHAM RD STE W 141 E HIBISCUS BLVD 2020 COMMERCE DR 2330 N WICKHAM RD SUITE 7 2100 N WICKMAN RD 1223 GATEWAY DR 1350 HICKORY ST 8725 N WICKHAM RD STE 102 6300 N WICKHAM RD 2290 W EAU GALLIE BLVD STE 112 1509 S BABCOCK ST 7640 N WICKHAM RD STE 117 2176 SARNO RD 32 W NEW HAVEN AVE 1060 N WICKHAM RD 200 OCEAN AVE 133 N BANANA RIVER DR

MARGATE MARGATE MARIANNA MARIANNA MARIANNA MAYO MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE MELBOURNE BEACH MERRITT ISLAND

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33065-4712 33063-3352 32446 32446-2318 32446-2182 32066-0000 32935-8659 32901 32904-2335 32935 32935 32901-2607 32901-3224 32940-2240 32940-2028 32935-3133 32901-3033 32940 32935-3086 32901-4406 32935-8937 32951-2369 32952-2546

MERRITT ISLAND DISCOUNT PHARMACY THE PHARMACY 40TH STREET PHARMACY DISCOUNT AHF PHARMACY AIDS HEALTHCARE FOUNDATION AMERICAN CARE OF S FL INC LH

(321) 454-0911 (321) 208-8999 (305) 554-0438 (305) 764-3780 (305) 860-5509 (786) 517-4888

35 N COURTENAY PKWY 110 S COURTENAY PKWY 9258 SW 40TH ST 2900 N BISCAYNE BLVD 3661 S MIAMI AE STE 806 2315 W FLAGLER ST

MERRITT ISLAND MERRITT ISLAND MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL

32953-3476 32952-4891 33165-4151 33137 33133-4214 33135-1524

AMERICAN CARE OF S FL INC NW MIAMI AMERICAN CARE OF S. FL INC CUTLER AMERICAN UNITED PHARMACY CORP ANDRES PHARMACY ANNS PHARMACY AND DISCOUNT ARIGUANABO PHARMACY ASPCARES BAPTIST MEDICAL ARTS PHARMACY BAYVIEW PHARMACY BELLAMAR PHARMACY INC BENZER PHARMACY

(786) 594-0000 (305) 254-7576 (786) 534-5594 (305) 261-2822 (305) 445-1200 (305) 264-3122 (305) 856-0070 (305) 273-8221 (786) 406-1525 (305) 221-6060 (786) 615-8627

1521 NW 54TH ST 11255 SW 211TH STREET 3477 W FLAGLER ST 7167 SW 8TH ST 3498 NW 7TH ST 5755 W FLAGLER ST STE 110 2657 NW 20TH ST 8950 N KENDALL DR STE 102 6301 BISCAYNE BLVD STE 101 10332 W FLAGLER ST 1250 NW 7TH ST UNIT 101-102

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL FL FL FL FL FL

33142-3807 33189-2240 33135-1025 33144-4659 33125 33144-3456 33142-7105 33176-2131 33138-6279 33174-1746 33125-3744

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Provider Phone Number

Provider Street

Page 135 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BLACK & WHITE PHARMACY BTV PHARMACY CAC CARE 54TH ST CASTILLA 87 PHARMACY COCONUT GROVE PHARMACY COMFORT PHARMACY CORP COMPREHENSIVE HEALTH CENTER CONTINENTAL RX CONTINUCARE FLAGLER CONTINUCARE WESTCHESTER DD&G PHCY & RENTAL EQUIPMENT E P MEDICAL EQUIPMENT PHARMACY EASYSCRIPTS

Provider Name

(305) 545-2108 (305) 751-7882 (305) 756-9977 (305) 551-7778 (305) 442-0211 (305) 456-3670 (305) 688-0811 (305) 856-2211 (305) 631-0660 (305) 551-3200 (305) 444-3025 (305) 630-9307 (305) 663-5400

1003 W FLAGLER ST 1495 NW 54TH ST 5385 NE 2ND AVE 890 SW 87TH AVE STE 17 3001 SW 27TH AVE STE 102 8300 W FLAGLER ST STE 165 671 NW 119TH ST 505 SW 8TH ST 2600 W FLAGLER ST 8608 BIRD RD 5870 SW 8TH ST STE 3 6440 SW 117TH AVE 7432 SW 48TH ST

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL FL FL FL FL FL FL FL

33130 33142 33137-2707 33174-3245 33133-4717 33144-2096 33168 33130-3413 33135-1425 33155-3216 33144 33183-2822 33155-4496

EIGHTY EIGHT PHARMACY AND DISCOUNT ELYS PHARMACY AND DISCOUNT CORP FARMACIA 22-24 FARMACIA 22-24 CENTRO FARMACIA JULIA DISCOUNT FARMACIA JULIA DISCOUNT LLC FARMACIA LUIS FLORIDA MEDICINE STORE GASTRO HEALTH SPECIALTY PHCY GR21 PHARMACY DISCOUNT GREAT CARE PHARMACY #2 HAPPY PHARMACY ICARE RX LLC IMC GROUP- BIRD ROAD IMC GROUP-FLAGLER IMC- LA ALIANZA SW 8ST IMC- LITTLE HAVANA IMC- NW 27 AVENUE IMC- QUAIL ROOST JACKSON MEM HOSP ACC PHARMACY JACKSON MEM HOSP CENTRAL FILL

(305) 264-8404 (305) 385-7770 (305) 223-2324 (305) 649-2222 (305) 642-6211 (305) 448-6523 (305) 445-5393 (305) 264-5259 (305) 468-4199 (786) 409-6908 (305) 636-2994 (305) 223-4949 (305) 251-7414 (305) 455-3500 (786) 388-9696 (305) 455-6804 (305) 858-1828 (305) 403-4003 (305) 253-1660 (305) 585-5890 (305) 355-8022

7471 SW 8TH ST 15126 SW 56TH ST 10404 W FLAGLER ST STE 20-21 1266 W FLAGLER ST 3000 NW 7TH ST 3197 SW 18TH ST 3601 SW 8TH ST 8336 SW 8TH ST 7500 SW 87TH AVE STE 202 5929 SW 8TH ST 2505 NW 54 STR 13379 SW 42ND ST 14447 COUNTRY WALK DR 4155 SW 130TH AVE STE 201 7101 W FLAGLER ST 8530 SW 8TH ST 291 SW 27TH AVE 7900 NW 27TH AVE STE D10 11348 QUAIL ROOST DRIVE 1611 NW 12TH AVE 1660 NW 7TH CT

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33144-4547 33185-4072 33174-1615 33135-2420 33125-4204 33145-1803 33135-4111 33144-4180 33173-5426 33144 33142-2947 33175-3204 33186-8104 33175-3417 33144-2601 33144-4053 33135-1401 33147 33157 33136-1005 33136-1420

JACKSON MEMORIAL HOSP-HIGHLAND PARK JACKSON PHARMACY SOLUTIONS JCR MED EQUIPMENT & PHARMACY JDS PHARMACY JENNY'S PHARMACY & DISCOUNT JERRY'S WEST KENDALL PHARMACY

(305) 355-7203 (305) 585-3996 (305) 262-7004 (786) 641-5109 (786) 275-4116 (305) 752-0080

1695 NW 9TH AVE 901 NW 17TH ST UNIT D 9542 SW 40TH ST 10788 SW 24TH ST 9709 NW 27TH AVE 15955 SW 96TH ST STE 105

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL

33136-1409 33136 33165-4036 33165 33147-2153 33196-1272

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 136 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LA GANGA DISCOUNT PHARMACY

Provider Name

(305) 635-5007

2975 NW 17TH AVE

MIAMI

FL

33142-6631

LA MILAGROSA PHARMACY AND DISCOUNT LATINA PHARMACY AND DISCOUNT LIBERTY DRUGS LIBERTY NEIGHBORHOOD PHARMACY LIFESAVER PHARMACY INC LIVE & LET LIVE PHARMACY LOCATEL HEALTH AND WELLNESS MAGNO PHARMACY INC MARCO DRUGS AND COMPOUNDING MED CITI PHARMACY MERCY PROFESSIONAL APOTHECARY MIAMI EXECUTIVE PHARMACY, INC. MIDTOWN DISCOUNT PHARMACY MILAGRO'S PHARMACY MY FAMILY PHARMACY & DISCOUNT NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NAVARRO DISCOUNT PHARMACY NOVA PHARMACY CORP NU-MART DISCOUNT PHARMACY OMEGA PHARMACY ONCOLOGY SPECIALTY PHARMACY ORIENTE PHARMACY P & P PHARMACY PACIFIC PHARMACY, INC PDL PHARMACY PHARMACIE PHARMACY INC PHARMACYONEPRO-MIAMI, INC PHARMAG PHARMACY

(305) 545-1127 (305) 551-4177 (305) 759-3339 (786) 360-4322 (305) 385-0059 (305) 635-5203 (786) 422-8302 (786) 502-4399 (305) 665-4411 (305) 254-5622 (305) 285-2762 (800) 797-3127 (786) 916-5835 (305) 541-0094 (305) 200-5973 (786) 220-8865 (305) 229-1044 (305) 424-9056 (305) 444-9891 (305) 643-9762 (305) 552-1498 (305) 225-9307 (305) 271-9909 (305) 223-3555 (305) 227-0023 (305) 256-9800 (305) 752-0600 (305) 424-9046 (305) 387-1300 (305) 262-6682 (305) 226-6357 (305) 279-9999 (305) 728-1816 (305) 649-0064 (305) 551-0760 (305) 226-5464 (305) 266-3705 (786) 592-1994 (305) 633-0808 (305) 382-3000

444 SW 8TH AVE 300 SW 107TH AVE STE 114 659 NW 62ND ST 6807 NW 7TH AVE 11735 SW 147TH AVE UNIT #5 3520 NW 17TH AVE 8508 BIRD RD 1609 SW 67TH AVE 6627 S DIXIE HWY 11373 SW 211TH ST STE 9 3661 S MIAMI AVE STE 110 8950 SW 74TH CT STE 102 18166 NW 2ND AVE 302 SW 12TH AVE 8410 W FLAGLER ST STE 105B 7205 CORPORATE CENTER DR #104 14491 SW 42ND ST 3105 NW 7TH ST 93 MIRACLE MILE 1601 W FLAGLER ST 8740 BIRD ROAD 9886 SW 24TH ST 10720 SW 72ND ST 10044 W FLAGLER ST 11865A SW 26TH ST 13796 SW 152ND ST 14665 SW 104TH ST 14055 SW 88TH ST 15000 SUNSET DR 7295 SW 24 STREET 10690 FONTAINEBLEAU BLVD 9537 SW 72ND ST 8900 N KENDALL DR 285 NW 27TH AVE 8381 BIRD RD 8876 SW 24TH ST 7167 W FLAGLER ST 13255 SW 137TH AVE STE 110 2060 NW 22ND AVE STE 12 9724 SW 24TH ST

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33130-2507 33174-3601 33150-4329 33150-4115 33196-3321 33142-5540 33155-3214 33155-1827 33143-7919 33189-2246 33133-4206 33156-3172 33169-5009 33130-2001 33144-2041 33126 33175 33125-4201 33134-5403 33135-2119 33165-5470 33165-7514 33173-2702 33174-1863 33175-2464 33177-1163 33186-2976 33186-4002 33193-2301 33155-1401 33172-3117 33173-3247 33176-2118 33125-5131 33155-3353 33165 33144-2601 33186-5327 33142-7338 33165

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 137 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PHARMCARE PHARMACY PRESIDENT PHARMACY PRESIDENTE PHARMACY & DISCOUNT PRICE CHOICE PHARMACY #1 LLC PRIMENET MED GRP OF KENDALL PRO PHARMACY & DISCOUNT

Provider Name

(786) 842-3840 (305) 235-8244 (305) 485-8888 (305) 374-7072 (305) 387-1981 (305) 971-3388

12382 QUAIL ROOST DR 11340 QUAIL ROOST DR 10845 SW 40TH ST 1851 NE 2ND AVE 9000 SW 137TH AVE #115 11476 QUAIL ROOST DR # 78

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL

33177-4974 33157-6567 33165-4410 33132-1002 33186-1435 33157-6575

PROFESSIONAL PHCY SVS & MED EQUIP PTG PHARMACY & DISCOUNT READY PHARMACY INC REGIONS PHARMACY RX INTERNATIONAL PHARMACY LLC

(305) 253-6634 (305) 253-9528 (305) 266-3838 (305) 603-9924 (305) 221-1421

10993 SW 186TH ST 15916 SW 137TH AVE 5782 W FLAGLER ST 1065 SW 27TH AVE 8342 SW 40 ST

MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL

33157-6812 33177-1204 33144-3444 33135-4614 33155-3337

SAN LAZARO PHARMACY AND DISCOUNT SOUTH MIAMI MEDICAL ARTS SOUTH POINT PHARMACY STEVEN'S RX,LLC SUNSET DRUGS SWEETWATER PHARMACY TOTAL RX PHARMACY & DISCOUNT

(305) 635-2358 (305) 666-1605 (305) 541-8699 (305) 961-1160 (786) 452-1276 (305) 552-0166 (305) 637-8444

2295 NW 28TH ST 6200 SUNSET DR STE 102 1864 W FLAGLER ST 1465 SW 8TH ST STE 102 7035 SW 87TH AVE 528 SW 109TH AVE 2341 NW 27TH AVE

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI

FL FL FL FL FL FL FL

33142-5987 33143-4832 33135 33135-3983 33173-2505 33174-1336 33142-7231

UNION PHARMACY AND MEDICAL SUPPLY UNLIMITED PHARMACY VH PHARMACIES VILLAGE PHARMACY WELLNESS RX LLC WR PHARMACY SERVICES WYNWOOD FAMILY PHARMACY CORP XCELLENT PHARMACY YRMA PHARMACY DISCOUNT LLC AHF PHARMACY ALBERT CANAS MD & ASSOCIATES ASF PHARMACY INC DOUGLAS GRDS COMM MTL HLTH CTR MIDTOWN PHARMACY MODERN PHARMACY LLC MT SINAI PHARMACY EXPRESS NAVARRO DISCOUNT PHARMACY PURE PHARMACY SIR CHARLES PHARMACY, INC ST JUDE PHCY & DISCOUNT INC AMBERT MEDICAL CARE CENTER

(305) 262-4646 (305) 229-4051 (305) 324-8777 (305) 274-8599 (305) 384-7600 (786) 717-5095 (786) 360-4155 (305) 229-1496 (305) 266-9999 (305) 538-5914 (305) 534-0503 (305) 861-0837 (305) 531-5341 (305) 531-5816 (305) 531-3784 (305) 674-2518 (305) 865-0075 (305) 532-1300 (305) 705-3415 (305) 621-3448 (305) 556-0071

6456 W FLAGLER ST 10920 W FLAGLER ST STE 207-208 1000 SW 1ST ST 8008 SW 81ST DR 7640 NW 25 ST #105 14244 SW 8TH ST 3032 NW 7TH AVE 11880 SW 40 ST RD STE 119 7958 SW 8TH ST 4308 ALTON RD 1680 MICHIGAN AVE STE 912 1203 71ST ST 1680 MERIDIAN AVE FL 4 753 ARTHUR GODFREY RD 123 ALTON RD 4302 ALTON RD SUITE 110 631 71ST ST 959 WEST AVE STE 16 17560 NW 27TH AVE STE 119 4822 NW 167TH ST 15495 EAGLE NEST LN STE 100

MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI MIAMI BEACH MIAMI BEACH MIAMI BEACH MIAMI BEACH MIAMI BEACH MIAMI BEACH MIAMI BEACH MIAMI BEACH MIAMI BEACH MIAMI GARDENS MIAMI GARDENS MIAMI LAKES

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33144-3009 33174-1278 33130-1009 33143 33122 33184-3104 33127 33175 33144-4209 33140-4556 33139-2550 33141-3647 33139-2703 33140 33139-6708 33140 33141-3019 33139-5214 33056-4075 33014 33014-2242

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 138 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name CAREMED PHARMACY IMC MIAMI LAKES MYCARE PHARMACY AMERICAN DOLLAR PHARMACY CORP. MIAMI SPRINGS PHARMACY MEDPLUS PHARMACY STAY WELL PHARMACY TOPCARE PHARMACY LLC RX EXPRESS PHARMACY SERVICE PRO PHARMACY MIMS PHARMACY AM CARE OF SOUTH FL S BROWARD OPTION CARE SANDESTIN APOTHECARY SERVICES SCOTTS PHARMACY LLC FAST AND FRIENDLY PHARMACY BENZER PHARMACY MOUNTDORA PHARMACY MULBERRY PHARMACY INC NOBLE CARE PHARMACY ADVANCED RX LLC PHARMCO BENZER PHARMACY BENZER PHARMACY CLINICAL COMPOUND PHARMACY FAMILY HEALTH MART PHARMACY GENOA-QOL HEALTHCARE GULF SHORE APOTHECARY GULF SHORE APOTHECARY LAKEVIEW PHARMACY LEE PHARMACY MISIR PHARMACY MOTHERS PHARMACY NAPLES PHARMACY LLC PEBBLEBROOK PHARMACY SW PHARMACY INC US RX PHARMACY WINN DIXIE PHARMACY NARANJA DISCOUNT PHARMACY, LLC RX EXPRESS PHARMACY AB SPECIALTY PHARMACY INC BENZER PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (305) 455-1250 (305) 455-3200 (305) 823-3461 (305) 870-0118 (305) 885-7790 (904) 214-3105 (904) 214-3747 (754) 802-1990 (850) 623-6337 (850) 564-0880 (321) 567-4919 (954) 961-7100 (954) 885-6100 (850) 267-6700 (850) 587-2511 (863) 946-0006 (813) 304-2221 (352) 357-1406 (863) 425-1101 (863) 583-4535 (305) 949-7464 (305) 919-7399 (239) 330-7792 (239) 774-2200 (239) 331-3441 (239) 231-4852 (239) 234-1446 (239) 262-2222 (239) 304-9084 (239) 263-4490 (239) 254-5900 (239) 403-0060 (239) 732-7993 (239) 231-3026 (239) 353-0800 (239) 288-2929 (855) 663-8779 (239) 352-6159 (305) 245-2277 (850) 936-6446 (727) 375-9520 (727) 848-8400

Provider Street 15450 NEW BARN RD STE 105 15529 BULL RUN RD 15518 NW 77TH CT 5399 NW 36TH ST 69 CURTISS PKWY 1545 BRANAN FIELD RD STE 12 2747 BLANDING BLVD STE 104 430 COLLEGE DR UNIT 116 5987 BERRYHILL RD 6472 HIGHWAY 90 2448 US HIGHWAY 1 6200 PEMBROKE ROAD 2814 CORPORATE WAY 400 AUDUBON DRIVE 6505 HIGHWAY 29 N 805 US HWY 27, STE 6 2722 W OLD US HIGHWAY 441 17435 US HIGHWAY 441 STE 102 1009 N CHURCH AVE 7066 N CHURCH AVE 1942 NE 163RD ST 901 N MIAMI BEACH BLVD #1-2 13020 LIVINGSTON RD STE 8 3795 TAMIAMI TRAIL E 2612 TAMIAMI TRL N 5482 RATTLESNAKE HAMMOCK RD 6075 BATHEY LN STE D-5 1400 GULF SHORE BLVD N STE 100 11669 COLLIER BLVD 700 2ND AVE N 3361 PINE RIDGE RD #103 8795 TAMIAMI TRL E UNIT 201 6350 DAVIS BLVD # 1002 848 1ST AVE N STE 120 15215 COLLIER BLVD 306 9TH ST N 11121 HEALTH PARK BLVD STE 700 4849 GOLDEN GATE PKWY 27140 S. DIXIE HWY 8986 ORTEGA PARK DR 2311 SEVEN SPRINGS BLVD 3535 US HIGHWAY 19

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Provider City MIAMI LAKES MIAMI LAKES MIAMI LAKES MIAMI SPRINGS MIAMI SPRINGS MIDDLEBURG MIDDLEBURG MIDDLEBURG MILTON MILTON MIMS MIRAMAR MIRAMAR MIRAMAR BEACH MOLINO MOORE HAVEN MOUNT DORA MOUNT DORA MULBERRY MULBERRY N MIAMI BEACH N MIAMI BEACH NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NAPLES NARANJA NAVARRE NEW PORT RICHEY NEW PORT RICHEY

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33014-2169 33014-7004 33016-3375 33166 33166-5218 32068-8428 32068-5653 32068-8532 32570-4043 32570-4560 32754-3854 33023-2216 33025-6546 32550 32577-5276 33471 32757-3503 32757-6750 33860-2039 33860 33162 33162-3720 34105-5022 34112-6257 34103-4409 34113-7454 34116-7536 34102-4971 34116-6581 34102-5756 34109-3882 34113 34104-5323 34102-6093 34119-6834 34102 34110-5740 34116-6951 33032 32566-4141 34655-3913 34652-6256

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BLAKE PHARMACY ELFERS PHARMACY HEALTHMART FLORIDA PHARMACY JACK'S PHARMACY LITTLE ROAD PHARMACY MAXCARE PHARMACY MEDICINE SHOPPE PHARMACY MEDILINK PHARMACY ROWAN DISCOUNT PHARMACY ROYAL PHARMACY THE MEDICINE SHOPPE Z ORANGE PHARMACY LITTLE DRUG COMPANY THE MEDICINE SHOPPE HOMETOWN PHARMACY NEWBERRY THE PRESCRIPTION PLACE VILLAGE PHARMACY TREASURE ISLAND PHARMACY N FORT MYERS PRESCRIPTION SHOP MEDZDIRECT INC, NAVARRO DISCOUNT PHARMACY PHARMA SOURCE DME RELIABLE SUPER DRUGS AHF PHARMACY ALOE DRUG MART CONTINUCARE NORTH DADE PRESCRIPTION DRUG FOUNDATION RENAL PHARMACY SERVICES A&R PHARMACY

Provider Name

(727) 846-7600 (727) 849-6000 (727) 848-8300 (727) 375-9999 (727) 372-5222 (727) 807-7050 (727) 375-2502 (727) 846-1300 (727) 372-1070 (727) 845-8000 (727) 845-5550 (727) 312-3155 (386) 428-9041 (386) 427-3459 (352) 472-9001 (850) 389-8182 (941) 488-8800 (305) 865-6144 (239) 599-4120 (786) 347-0365 (305) 974-1186 (305) 899-0943 (305) 893-5252 (305) 758-1984 (305) 655-1544 (305) 651-3543 (305) 947-0433 (305) 614-2067 (561) 500-3770

5628 TROUBLE CREEK RD 6113 STATE ROAD 54 5445 JAMES ST 7813 MITCHELL BLVD STE 113 4211 LITTLE RD UNIT 4 6624 US HIGHWAY 19 10720 STATE ROAD 54 STE 103 5812 STATE ROAD 54 4140 ROWAN RD 5335 MAIN ST 4539 GRAND BLVD 7268 SR 54 412 CANAL ST 1141 N DIXIE FWY 24220 W NEWBERRY RD 1140 E JOHN SIMS PKWY STE 6 1095 TAMIAMI TRL N 1630 NE 79TH CAUSEWAY 16251 N CLEVELAND AVE STE 13 1065 NE 125TH ST STE 207 13250 BISCAYNE BLVD 14025 W DIXIE HWY 2168 NE 123RD ST 100 NW 170TH ST STE 208 65 NW 167TH STREET 16800 NW 2ND AVE STE 103 1777 NE 163RD ST 19559 NE 10TH AVE STE A 1201 US HIGHWAY 1 STE 43

NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW PORT RICHEY NEW SMYRNA BEACH NEW SMYRNA BEACH NEWBERRY NICEVILLE NOKOMIS NORTH BAY VILLAGE NORTH FORT MYERS NORTH MIAMI NORTH MIAMI NORTH MIAMI NORTH MIAMI NORTH MIAMI BEACH NORTH MIAMI BEACH NORTH MIAMI BEACH NORTH MIAMI BEACH NORTH MIAMI BEACH NORTH PALM BEACH

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

34652-5158 34653-6004 34652-3927 34655-4723 34655-1606 34652-1739 34655-2264 34652-6050 34653-6116 34652 34652-5121 34653 32168-7010 32168-6069 32669-2211 32578-2204 34275-2114 33141-4132 33903-2176 33161-5832 33181-2040 33161-3442 33181-2902 33169-5510 33169 33169-5549 33162-4732 33179-3501 33408-3546

PREMIER COMPOUNDING PHARMACY INC WINSHIPS PRESCRIPTION CENTER LEMON BAY DRUGS NORTH NORTH PORT PHARMACY TOWN PHARMACY AHF PHARMACY ALBERTSON'S PHARMACY ALLZ WELL PHARMACY AMERICAN CARE OF S FL BROWARD PRIDE PHARMACY INC 17TH STREET DISCOUNT PHARMACY

(561) 691-4991 (561) 842-2444 (941) 426-1123 (941) 426-2800 (941) 429-7766 (954) 566-2745 (954) 491-0661 (954) 769-1098 (754) 200-8248 (954) 390-0916 (352) 351-3330

2000 PGA BLVD STE 5507 721 NORTHLAKE BLVD 13221 TAMIAMI TRL 14255 TAMIAMI TRL 14826 TAMIAMI TRL 1164 E OAKLAND PARK BLVD # F 950 E COMMERCIAL BLVD 821 E OAKLAND PARK BLVD 1600 W OAKLAND PARK BLVD 1421 E OAKLAND PARK BLVD #100 2506 SE 17TH ST # B

NORTH PALM BEACH NORTH PALM BEACH NORTH PORT NORTH PORT NORTH PORT OAKLAND PARK OAKLAND PARK OAKLAND PARK OAKLAND PARK OAKLAND PARK OCALA

FL FL FL FL FL FL FL FL FL FL FL

33408-2726 33408-5281 34287-2163 34287-2215 34287-2701 33334-2707 33334-3210 33334-2752 33311-1520 33334 34471-5523

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 140 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

AMBIENT HLTHCARE OF CENTRAL FL INC AVENUE PHARMACY BENZER PHARMACY

(352) 622-4148 (352) 624-2779 (352) 622-3454

202C SW 17TH ST 2119 SW 1ST AVE 1426 S PINE AVE

OCALA OCALA OCALA

FL FL FL

34471-8138 34471-8181 34471-6544

BITTINGS APOTHECARY & MED EQUI SUP CORNERSTONE PHARMACY EASTERN PHARMACY INC FLORIDA CANCER AFFILIATES GENOA-QOL HEALTHCARE GOLDEN HILLS PHARMACY OCALA PHARMACY LLC RITE CARE PHARMACY SUNSHINE DRUGS SUNSHINE DRUGS OF OCALA WELLS PHARMACY NETWORK WINN DIXIE PHARMACY 1ST COMMUNITY PHARMACY ATRIUM PHARMACY GOOD HOMES PHARMACY OCOEE DISCOUNT PHARMACY 5TH STREET PHARMACY HEARTLAND DISCOUNT PHARMACY OKEECHOBEE DISCOUNT DRUGS HOMETOWN PHARMACY - OLD TOWN TAMPA ROAD PHARMACY NORTH DADE HEALTH CENTER PHCY PRICECHOICE PHARMACY ACCARDI CLINICAL PHARMACY H&R PHARMACY LEGACY PHARMACY OC MID-FLORIDA H&O CENTERS, PA OAK PARK LTC PHARMACY OAK PARK LTC PHARMACY ATKINSON HOSPITAL PHARMACY CARE 1ST PHARMACY ORANGE PARK PHARMACY POINTE MED PHARMACY RITE-MART PHARMACY OF OP RXPERT #1 LLC A & M PHARMACY ACARIAHEALTH PHARMACY INC

(352) 732-3666 (352) 690-7770 (352) 622-9909 (352) 732-4032 (352) 502-4999 (352) 351-3784 (352) 509-7890 (352) 291-0177 (352) 680-9500 (352) 732-4655 (352) 622-2913 (352) 347-3115 (407) 656-0641 (407) 296-1912 (407) 253-2933 (407) 674-7953 (863) 763-3222 (863) 763-7633 (863) 763-5100 (352) 542-9301 (813) 925-9666 (786) 466-1735 (305) 685-3110 (386) 774-5800 (386) 218-0926 (386) 218-4993 (386) 774-1223 (386) 456-1500 (386) 456-1500 (904) 298-0873 (904) 644-8038 (904) 579-3027 (904) 272-1919 (904) 541-1511 (904) 272-1690 (407) 250-4822 (800) 511-5144

619 SE 17TH ST 2509 NE 14TH ST 2046 W SILVER SPRINGS BLVD 433 SW 10TH ST 5664 SW 60TH AVE STE 2A 6998 N US HWY 27 STE 104 8602 SW HIGHWAY 200 11115 SW 93RD COURT RD 9309 SE MARICAMP RD 3450 NE JACKSONVILLE RD 1210 SW 33RD AVE 184 MARION OAKS BLVD 2775 OLD WINTER GARDEN RD 10000 W COLONIAL DR STE 181 8873 W COLONIAL DR 10173 W COLONIAL DR 105 NW 5TH ST 407 S PARROTT AVE 203 SW PARK ST 26064 SE HWY 19 3705 TAMPA RD STE 19 16555 NW 25TH AVE 13931 NW 27TH AVE 2583 S VOLUSIA AVE STE 100 870 SAXON BLVD #45 2413 ENTERPRISE RD 2776 ENTERPRISE RD, STE 100 701 MONASTERY RD 701 MONASTERY RD STE B 1994-A KINGSLEY AVENUE 1101 BLANDING BLVD STE 122 1992 KINGSLEY AVE 1996 KINGSLEY AVE 2300 PARK AVE 2177 KINGSLEY AVE STE 1 6564 OLD WINTER GARDEN RD 6923 LEE VISTA BLVD STE 200

OCALA OCALA OCALA OCALA OCALA OCALA OCALA OCALA OCALA OCALA OCALA OCALA OCOEE OCOEE OCOEE OCOEE OKEECHOBEE OKEECHOBEE OKEECHOBEE OLD TOWN OLDSMAR OPA LOCKA OPA LOCKA ORANGE CITY ORANGE CITY ORANGE CITY ORANGE CITY ORANGE CITY ORANGE CITY ORANGE PARK ORANGE PARK ORANGE PARK ORANGE PARK ORANGE PARK ORANGE PARK ORLANDO ORLANDO

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

34471-4428 34470-4801 34475-6366 34471-0209 34474-5677 34482-3998 34481-9620 34481-3103 34472 34479-2850 34474-2853 34473-2205 34761-2995 34761-3434 34761-6951 34761-4209 34972-2560 34974-4342 34972-4160 32680 34677-6346 33054-6583 33054 32763-9129 32763-8209 32763-7964 32763 32763 32763-6222 32073-4403 32065 32073-4442 32073-4442 32073-5571 32073-5132 32835-1217 32822

NR_0009_10823 10/2017

Page 141 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ACS PHARMACY AHF PHARMACY ORLANDO ALM BUDGET PHARMACY ANGEL'S PHARMACY APOLLO CARE PHARMACY ASPCARES BAILEY'S PHARMACY BAILEY'S PHARMACY BLISS RX C & C COMMUNITY PHARMACY CARE AMERICA AT MAITLAND LLC CENTRAL CARE PHARMACY CENTRAL FL PHARMACY CITY VIEW PHARMACY CYSTIC FIBROSIS PHCY INC DAVITA RX LLC DIRECT COMPOUND PHARMACY DPHSCRIPTS DR PHILLIPS SPECIALTY PHARMACY DR PHILLIPS SPECIALTY PHARMACY DR PHILLIPS SPECIALTY PHARMACY FAMILY PHYSICIANS RX

Provider Name

(877) 985-6337 (407) 770-0507 (407) 378-6679 (551) 358-4242 (407) 985-5305 (407) 730-5998 (407) 930-3102 (407) 930-3102 (239) 939-9226 (407) 295-6201 (407) 678-6733 (407) 270-6722 (407) 898-0055 (321) 206-9426 (407) 898-4427 (407) 587-4800 (407) 203-0005 (321) 842-7230 (407) 745-5066 (407) 903-1544 (407) 730-6909 (407) 381-3085

6251 CHANCELLOR DR 1021 N MILLS AVE 419 E MICHIGAN ST STE 4 259 E MICHIGAN ST 4061 W OAK RIDGE RD 13651 HUNTERS OAK DR STE101 4401 S ORANGE AVE STE 121 4401 S ORANGE AVE SUITE 121 2901 CURRY FORD RD STE 106A 927 S GOLDWYN AVE STE 111 7960 FOREST CITY RD STE 101 2815 DIRECTORS ROW STE 700 1219 E COLONIAL DR 595 W CHURCH ST STE H 3901 E COLONIAL DR 2252 COMMERCE PARK DR STE 350 5060 S CONWAY RD 9400 TURKEY LAKE RD 1430 N MILLS AVE STE 120 7649 TURKEY LAKE RD 10727 NARCOOSSEE RD 2285 S SEMORAN BLVD

ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32809-5501 32803-3231 32806-4511 32806-4537 32809-3604 32837-7679 32806-6935 32806-6935 32806-3353 32805-4389 32810-2907 32809-5526 32803-4701 32805-2285 32803-5245 32819 32812-1258 32819-8001 32803-1877 32819-7383 32832-6943 32822-2703

FIRST CHOICE PHCY & COMPOUNDING CTR FLORIDA HOSPITAL COMMUNTY PHCY

(407) 347-2462 (407) 303-2559

754 S GOLDENROD RD 2501 N ORANGE AVE STE 122

ORLANDO ORLANDO

FL FL

32822-8108 32804-4640

FLORIDA HOSPITAL RXPRESS PHARMACY

(407) 303-1962

601 E ROLLINS ST FL 1

ORLANDO

FL

32803-1248

FLORIDA HOSPITAL RXPRESS PHARMACY FREEDOM PHARMACY GOLDENROD PHARMACY HARRISON'S PHARMACY HUMAN & ANIMAL PHARMACY IMC ORLANDO LEGACY PHARMACY LEGACY RX LLC LINDEN CARE ORLANDO MAGELLAN RX PHARMACY MEDPLUS RX PHARMACY METRO RX METROMEDS NPR FAMILY PHARMACY

(407) 303-8676 (888) 307-4427 (407) 730-3866 (407) 894-2373 (407) 601-7140 (407) 434-8080 (407) 730-7989 (855) 274-1694 (407) 472-6580 (866) 554-2673 (407) 930-8908 (407) 730-6800 (321) 888-2222 (407) 704-5937

7975 LAKE UNDERHILL RD STE 125 3901 E COLONIAL DR 2223 S GOLDENROD RD 3333 CURRY FORD RD 12701 S JOHN YOUNG PKWY #120 8010 W COLONIAL DR # 146-162 10967 LAKE UNDERHILL RD #118 6435 HAZELTINE NATIONAL DR#140 1800 W OAK RIDGE RD 6870 SHADOWRIDGE DR STE 111 2136 WHISPER LAKES BLVD 320 W COLONIAL DR 409 E MICHIGAN ST 7238 W COLONIAL DR

ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO

FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32822-8202 32803-5245 32822-4676 32806-3472 32837-3422 32818-6101 32825-4454 32822-5156 32809-3962 32812-9002 32837-6761 32801-1109 32806-4541 32818-6749

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 142 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

OAKRIDGE PHARMACY ORLANDO FAMILY PHYSICIANS ORLANDO FAMILY PHYSICIANS ORLANDO HEALTH SCRIPTS ORLANDO PHARMACY ORLANDO PROCARE PHARMACY PATIENTS FIRST PHARMACY PHARMACY EXPRESS & MED SUPPLY PHARMACYMAX PHD PHARMACY PRINCETON PLAZA PHARMACY PRIORITY HEALTH RX PROCARE PHARMACY RITECARE PHARMACY ROSEMONT SPECIALTY PHARMACY RX CARE PHARMACY RX MEDS PHARMACY INC RX PLUS PHARMACY RXTREE PHARMACY SANDLAKE PHARMACY SCRIPTS SCRIPTS PHARMACY SCRIPTS PLUS PHARMACY SOUTH ORANGE PHARMACY TRISTAR DISCOUNT PHARMACY LLC US HEALTHLINK PHARMACY BENZER PHARMACY CAREPOINT PHARMACY

Provider Name

(407) 203-6750 (407) 658-9687 (407) 290-9556 (321) 841-2818 (407) 898-1331 (407) 730-3557 (407) 204-4090 (407) 273-0021 (407) 354-4555 (407) 291-1236 (407) 822-5015 (855) 652-2163 (407) 730-2770 (407) 203-6895 (407) 822-1121 (407) 249-0246 (407) 770-6077 (407) 855-4770 (407) 636-8733 (407) 351-8002 (407) 237-6337 (321) 843-4690 (407) 286-2996 (407) 246-5588 (407) 440-3436 (407) 440-4945 (386) 672-0600 (386) 671-9476

1745 W OAK RIDGE RD 1130 S SEMORAN BLVD 810 N NOWELL ST 1400 S ORANGE AVE 2909 N ORANGE AVE STE112 2021 S ORANGE AVE 12981 S ORANGE BLOSSOM TRAIL 10209 E COLONIAL DR STE 180 8751 COMMODITY CIR STE 16 5600 W COLONIAL DR STE 316A 1800 MERCY DR STE 100 1215 E LIVINGSTON ST STE A 1084 LEE RD STE 4 12014 E COLONIAL DR STE 140 5860 N ORANGE BLOSSOM TRL 5660 CURRY FORD RD 2751 N HIAWASSEE RD 717 W LANCASTER ROAD 2537 MAITLAND CROSSING WAY 7300 SAND LAKE COMMONS BL #225 92 W MILLER ST 1222 S ORANGE AVE 6210 W COLONIAL DR STE 116 3520 S ORANGE AVE 1502 N SEMORAN BLVD STE 154 1516 HILLCREST ST STE 301 500 W GRANADA BLVD 1400 HAND AVE STE O

ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORLANDO ORMOND BEACH ORMOND BEACH

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32809-3909 32807-1457 32808-7539 32806 32804-4639 32806-3035 32837 32817 32819 32808-7646 32808-5648 32803-5401 32810-5821 32826-4751 32810-1025 32822-1445 32818-3009 32809 32810 32819 32806-2032 32806-1215 32808-7504 32806-2936 32807-3545 32803-4716 32174-2304 32174-8196

COMMUNITY PHCY OF ORMOND BEACH EXTRA CARE CITY PHARMACY SERVICE PRO PHARMACY THRIF-T DRUGS-PACE CIRCLE S PHARMACY INC A-1 PHARMACY ANGEL'S PHARMACY AZALEA HEALTH FIRST CHOICE PHARMACY ACQUAVIVAS PHARMACY BABCOCK PHARMACY & SURGICALS MALABAR DISCOUNT PHARMACY RX CARE PHARMACY

(386) 917-1881 (407) 890-9241 (850) 995-9999 (850) 994-7005 (561) 924-5238 (386) 385-3987 (386) 325-9300 (386) 328-0558 (386) 219-1988 (321) 725-7188 (321) 499-3999 (321) 775-0911 (321) 952-0656

305 CLYDE MORRIS BLVD #200 1000 EXECUTIVE DR STE 2 4880 WOODBINE RD 3818 HWY 90 323 BACOM POINT RD STE 100 815-3 SOUTH MOODY RD 610 ZEAGLER DR 1302 RIVER ST 3208 CRILL AVE UNIT 2 1555 PORT MALABAR BLVD STE 101 1515 PALM BAY RD NE STE 108 930-1 MALABAR RD SE 1270 MALABAR RD SE

ORMOND BEACH OVIEDO PACE PACE PAHOKEE PALATKA PALATKA PALATKA PALATKA PALM BAY PALM BAY PALM BAY PALM BAY

FL FL FL FL FL FL FL FL FL FL FL FL FL

32174 32765-8140 32571 32571 33476 32177-8417 32177-3811 32177-5042 32177-4159 32905-5407 32905 32907-3252 32907-3407

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 143 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TOTAL HEALTH PHARMACY FEDCO DRUGS GREEN'S PHARMACY LEWIS PHARMACY OF PALM BEACH LLC PALM BEACH PHARMA CORP GARDENS DRUGS NORTHLAKE PHARMACY UNITED LTC PHARMACY AZALEA HEALTH HOME CARE PHARMACY ONE PHARMACY PALM COAST PHARMACY PINNACLE PHARMACY CARE PLUS PHARMACY GOOD SAMARITAN PHARMACY KING PHCY & COMPOUNDING LLC MEDROCK PHARMACY PROMISE PHARMACY ST MARKS PHARMACY ST. MARY PHARMACY II SUNLIFE PHARMACY TRUST PHARMACY VCARE PHARMACY SKYEMED_PALM BEACH, INC PALMS PHARMACY TOUCHPOINT RX PALMETTO DRUG MART BAY RX PHARMACY CALLAWAY GULF COAST PHARMACY COOPERS DRUGS CRESCENT HEALTHCARE INC GENOA-QOL HEALTHCARE GULF COAST PHARMACY PANAMA CITY DRUGS RX EXPRESS PHARMACY SMITHS PHARMACY COASTAL CARE PHARMACY

Provider Name

(321) 308-0303 (561) 833-3348 (561) 832-4443 (561) 655-7867 (561) 650-0236 (561) 622-2141 (561) 619-9900 (561) 899-4429 (386) 246-3958 (386) 445-1212 (386) 447-8944 (386) 597-7400 (386) 313-5995 (727) 784-6200 (727) 785-2640 (727) 772-6868 (727) 240-1341 (727) 772-0500 (727) 772-7070 (727) 773-9000 (727) 491-8300 (727) 781-7400 (727) 787-2273 (561) 253-9851 (561) 513-9161 (561) 651-9393 (941) 404-4121 (850) 640-3062 (850) 615-2000 (229) 435-4571 (800) 284-7411 (850) 522-0143 (850) 615-1000 (850) 615-5000 (850) 215-7455 (850) 785-0286 (850) 249-9500

1850 ELDRON BLVD SE STE 7 255 SUNRISE AVE 151 N COUNTY RD 235 S COUNTY RD 235 PERUVIAN AVE STE 3 10800 N MILITARY TR #119 9091 N MILITARY TRL STE 17 2000 PGA BLVD STE 5508 460 PALM COAST PKWY SW 6 FLORIDA PARK DR N 28 OLD KINGS RD N UNIT B 9 PINE CONE DR STE 109 80 PINNACLE DR STE 900 33915 US HIGHWAY 19 N 33130 US HIGHWAY 19 N 31201 US HWY 19 N STE 1 3209 TAMPA RD 31818 US 19 4954 RIDGEMOOR BLVD 30606 US HIGHWAY 19 N 3420 TAMPA ROAD 36515 US HIGHWAY 19 N 2595 TAMPA RD STE E 2330 S CONGRESS AVE # 236-237 3491 S CONGRESS AVE 3208 2ND AVE N STE 4 907 10TH ST E 610 E BALDWIN RD 420 N TYNDALL PARKWAY 700 E BUSINESS HWY 98 2911 MARTIN LUTHER KING JR BLV 525 E 15TH ST 340 W 23RD ST STE D2 3127 E HIGHWAY 98 540B E 6TH ST 1108 HARRISON AVE 11939 PANAMA CITY BEACH PKWY

PALM BAY PALM BEACH PALM BEACH PALM BEACH PALM BEACH PALM BEACH GARDENS PALM BEACH GARDENS PALM BEACH GARDENS PALM COAST PALM COAST PALM COAST PALM COAST PALM COAST PALM HARBOR PALM HARBOR PALM HARBOR PALM HARBOR PALM HARBOR PALM HARBOR PALM HARBOR PALM HARBOR PALM HARBOR PALM HARBOR PALM SPRING PALM SPRINGS PALM SPRINGS PALMETTO PANAMA CITY PANAMA CITY PANAMA CITY PANAMA CITY PANAMA CITY PANAMA CITY PANAMA CITY PANAMA CITY PANAMA CITY PANAMA CITY BEACH

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32909 33480-3876 33480-3954 33480-4294 33480-4695 33410 33418 33408-2726 32137-4786 32137-3890 32137-8226 32137-8683 32164-2323 34684 34684-3127 34684 34684 34684 34685-1744 34684-4414 34684 34684-1340 34684-3130 33406-7608 33461-3021 33461-3682 34221 32405-4208 32404 32401-3614 32405-5013 32405-5412 32405-4541 32401-5415 32401-3025 32401-2431 32407-2605

EDGAR H PRICE JR CHILD & FAM HEALTH ELLENTON DISCOUNT PHARMACY A&A FAMILY PHARMACY ALPHA TOUCH PHARMACY INC

(941) 776-4050 (941) 444-2233 (954) 987-5230 (954) 435-5200

12271 US HIGHWAY 301 N 8324 US HIGHWAY 301 N 7938 PINES BLVD 12141 PEMBROKE RD

PARRISH PARRISH PEMBROKE PINES PEMBROKE PINES

FL FL FL FL

34219-8410 34219-8653 33024 33025-1727

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 144 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name CHANS PHARMACY PLUS CONSUMER SAVINGS CENTER CORE HEALTH PHARMACY GOODPILL PHARMACY INC IFB PHARMACY, LLC MEMORIAL PILL BOX II PILL BOX PHARMACY PILL BOX PINES WEST PINES DISCOUNT PHARMACY INC PINES HEALTH MART PHARMACY PRIMENET MEDICAL GROUP INC RISE N SHINE PHARMACY INC SIMFAROSE PHARMACY SUNSCRIPT PHARMACY TRUST PHARMACY U TRUST PHARMACY A & E PHARMACY INC AHF PHARMACY BAPTIST MEDICAL PARK PHARMACY EVERWELL SPECIALTY PHARMACY JACKSON-PACE PHARMACY LAKEVIEW CENTER PHARMACY PHYSICIAN SPECIALTY PHARMACY THE MEDICINE SHOPPE THE TOWERS PHARMACY THRIF T DRUGS@ MARKETPLACE THRIF-T DRUGS WOODLANDS MEDICAL SPECIALISTS JAY'S PHARMACY O'QUINN PHARMACY INC PIERSON COMMUNITY PHARMACY ALEXANDER PHARMACY BENZER PHARMACY G AND H PHARMACY HEALTHNOW PHARMACY HP PHARMACY HP PHARMACY FAMILY CARE PHARMACY FAST AND FRIENDLY PHARMACY PLANT CITY DISCOUNT PHARMACY SUPER DISCOUNT PHARMACY MEDICAL III PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (954) 367-3296 (954) 442-4429 (954) 450-8873 (754) 201-3663 (954) 842-2827 (954) 437-7455 (954) 432-7455 (954) 443-7455 (954) 437-4900 (954) 404-6610 (954) 983-1220 (954) 447-7784 (954) 435-7200 (954) 362-7645 (954) 436-2359 (954) 589-0585 (850) 455-0381 (850) 472-0962 (850) 208-6100 (850) 473-9190 (850) 478-4450 (850) 469-3719 (850) 462-9555 (850) 438-7568 (850) 434-4549 (850) 484-4338 (850) 433-2165 (850) 696-4000 (850) 584-7800 (850) 584-7692 (386) 749-9557 (727) 623-0962 (727) 544-4203 (727) 209-9999 (727) 999-2076 (727) 827-2947 (727) 954-8857 (813) 659-9777 (813) 719-3278 (813) 703-1500 (813) 752-1133 (954) 583-4100

Provider Street 2092 N UNIVERSITY DR 1461 N PALM AVE 1661 N HIATUS RD 17177 PINES BLVD 2488 N UNIVERSITY DR 601 N FLAMINGO RD STE 110 1700 NW 122ND TER 17529 PINES BLVD 631 NW 100TH PL 2301 N UNIVERSITY DR STE 112 7189 PEMBROKE RD 17913 NW 7TH ST STE 104 10016 PINES BLVD 7869 PINES BLVD 9833 PINES BLVD 6974 PEMBROKE RD 923 N NEW WARRINGTON RD 4300 BAYOU BLVD STE 170 9400 UNIVERSITY PKWY 6506 N DAVIS HWY 2256 W NINE MILE RD 1201 W HERNANDEZ ST BLDG E 6258 NORTH W STREET 2899 N 12TH AVE 1717 N E ST 4350 BAYOU BLVD 14 W JORDAN ST 4724 N DAVIS HWY 828 S JEFFERSON ST 200 N JEFFERSON ST 112 E 1ST AVE 6530 PARK BLVD 6280 66TH ST N 8091 66TH ST N 7599 PARK BLVD N STE 100 4616 PARK BLVD N 8730 49TH ST N STE 1 1505 W REYNOLDS ST 404 N ALEXANDER ST 607 E ALEXANDER ST 1423 S COLLINS ST 4100 S HOSPITAL DR

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Provider City PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PEMBROKE PINES PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PENSACOLA PERRY PERRY PIERSON PINELLAS PARK PINELLAS PARK PINELLAS PARK PINELLAS PARK PINELLAS PARK PINELLAS PARK PLANT CITY PLANT CITY PLANT CITY PLANT CITY PLANTATION

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33024 33026-3228 33026-2129 33027-1091 33024-3624 33028-1007 33026-1967 33029-1519 33024-6163 33024-3617 33023-2679 33029-2811 33024-6137 33024-6916 33024-6100 33023-2676 32506-4250 32503-1949 32514-5752 32504-6957 32534-9415 32501-1815 32505-1903 32503-4001 32501-6339 32503-1948 32501 32503-2339 32347-4119 32347-2652 32180-3039 33781-3142 33781-5026 33781-5024 33781-3711 33781-3529 33782-5354 33563-4733 33563-4306 33563 33563-6577 33317-2813

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PHARMACY MEDICAL SERVICES INC PHYSICIANS PHARMACY PRESCRIPTION PAD PHARMACY K & M DRUGS SUNSHINE PHARMACY BENZER PHARMACY BENZER PHARMACY DAVID'S PHARMACY & SURGICAL DRUGS4LESS PHARMACY INFINITI PHCY & INF SVC INC INTEGRA RX PALM MEDICINE INC. SOLERA SPECIALTY PHARMACY A1A PHARMACY SAVERITE BEST RX PHARMACY CHARLOTTE PHARMACY HARBOR VIEW PHARMACY MIDWAY PHARMACY MILLENNIUM PHARMACY SERVICES THE MEDICINE SHOPPE THE MEDICINE SHOPPE EMBASSY PHARMACY J'S PHARMACY SUNTRUST PHARMACY BUY RITE DRUGS FAMILY DRUG MART ASTER DISCOUNT PHARMACY BUTTERFIELD PHARMACY EASTPORT PHARMACY

Provider Name

(954) 641-1448 (888) 480-7577 (954) 791-2000 (863) 496-7927 (321) 947-5847 (954) 943-3111 (954) 946-7904 (954) 942-0920 (954) 972-1822 (954) 414-9900 (954) 917-6813 (954) 532-7940 (954) 615-1840 (904) 373-0835 (904) 543-8678 (941) 979-5301 (941) 889-7239 (941) 625-7800 (941) 979-9085 (855) 674-7600 (941) 627-9855 (386) 304-8222 (727) 842-3400 (727) 847-2211 (727) 914-5900 (850) 227-7099 (321) 631-0300 (772) 777-2141 (772) 323-2090 (772) 800-7267

201 NW 70TH AVE # D-E 6299 W SUNRISE BLVD STE 107 333 NW 70TH AVE STE 102 395 VILLAGE DR STE C 120 CARTER BLVD STE 6 60 NE 1ST ST 1960 N FEDERAL HWY 1637 E SAMPLE RD 1247 S POWERLINE RD 1338 N FEDERAL HWY 2661 W ATLANTIC BLVD 2711 E ATLANTIC BLVD 2100 PARK CENTRAL BLVD N STE 3 200C SOLANA RD 190 SOLANA RD 1825 TAMIAMI TRL UNIT B7 3231 TAMIAMI TRL STE G 21340 GERTRUDE AVE 2525 TAMIAMI TRAIL STE G 19531 COCHRAN BLVD 3524B TAMIAMI TRL 4036 S NOVA RD STE D 9320 US HWY 19 N 6416 RIDGE RD 6237 RIDGE RD 302 CECIL G COSTIN SR BLVD 7135 N COCOA BLVD 718 SW PORT ST LUCIE BLVD #2 122 SW CHAMBER CT 8972 S US HIGHWAY 1

PLANTATION PLANTATION PLANTATION POINCIANA POLK CITY POMPANO BEACH POMPANO BEACH POMPANO BEACH POMPANO BEACH POMPANO BEACH POMPANO BEACH POMPANO BEACH POMPANO BEACH PONTE VEDRA BEACH PONTE VEDRA BEACH PORT CHARLOTTE PORT CHARLOTTE PORT CHARLOTTE PORT CHARLOTTE PORT CHARLOTTE PORT CHARLOTTE PORT ORANGE PORT RICHEY PORT RICHEY PORT RICHEY PORT SAINT JOE PORT SAINT JOHN PORT SAINT LUCIE PORT SAINT LUCIE PORT SAINT LUCIE

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33317-2369 33313-6153 33317-2358 34759-4012 33868-8912 33060 33062-1003 33064-6279 33069-4311 33062 33069-2507 33062-4941 33064-2219 32082-2232 32082-2230 33948-1056 33952-8031 33952 33952 33948-2081 33952-8100 32127-9203 34668-4772 34668 34668-6743 32456-1905 32927-5094 34953 34986-3496 34952-3403

HEMATLGY & ONC ASSOC OF TREAS COAST REMED PHARMACY ST. LUCIE PHARMACY WATER'S EDGE DERMATOLOGY LLC FLORESTA PHARMACY PORT ST LUCIE DISCOUNT PHCY BAYSHORE PHARMACY PATIENT CARE PHARMACY SERVICES THE MEDICINE SHOPPE MASSEY DRUGS REDDICK DISCOUNT PHARMACY

(772) 924-2283 (772) 333-2740 (772) 337-1200 (561) 694-9493 (772) 340-4142 (772) 446-9284 (772) 344-0410 (941) 255-1987 (941) 505-1095 (850) 627-7584 (352) 591-1116

1871 SE TIFFANY AVE STE 100 10163 S US HIGHWAY 1 1701 SE TIFFANY AVE STE # 103 1400 SE GOLDTREE DR 1550 SE FLORESTA DR 1936 SE PORT ST LUCIE BLVD 1026 BAYSHORE BLVD 24451 SANDHILL BLVD STE A C 615 CROSS ST UNIT 1112 105 W JEFFERSON ST 15320 NW GAINESVILLE RD

PORT SAINT LUCIE PORT SAINT LUCIE PORT SAINT LUCIE PORT SAINT LUCIE PORT ST LUCIE PORT ST LUCIE PORT ST. LUCIE PUNTA GORDA PUNTA GORDA QUINCY REDDICK

FL FL FL FL FL FL FL FL FL FL FL

34952-7585 34952-5610 34952-7576 34952-7582 34983-4070 34952-5509 34983 33983-5214 33950-5551 32351-2321 32686

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Provider Phone Number

Provider Street

Page 146 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BENZER PHARMACY HEALTH PRO PHARMACY RIVERVIEW PHARMACY RX OASIS SUMMERFIELD PHARMACY INC XTRA CARE PHARMACY AMERICAN CARE OF S FL RB CANCER CARE CENTERS OF BREVARD CIRCLES OF CARE INC CITY DISCOUNT PHARMACY ROCKLEDGE DISCOUNT PHARMACY SPACE COAST COMMUNITY PHARMACY ROYAL PALM PHARMACY AHF PHARMACY - SAFETY HARBOR BAYCARE PHARMACY MAIN STREET PHARMACY FLAGLER COMMUNITY PHARMACY ISLAND FAMILY PHARMACY INC MOULTRIE PHARMACY RX-MART PHARMACY ST JOHNS PHARMACY WELLNESS PHCY OF ST AUGUSTINE PRESCRIPTIONS UNLIMITED ST CLOUD PHCY & WELLNESS CTR 1ST CHOICE PHARMACY 4TH STREET PHARMACY 54TH AVE PHARMACY ALL CHILDRENS OUTPATIENT PHCY AMEN PHARMACY BAYCARE PHARMACY BAYDOUN PHARMACY BAYVIEW PHARMACY COMMUNITY SPECIALTY PHARMACY DANANG PHARMACY FLORIDA COAST FOOT AND ANKLE FMC PHARMACY SERVICES GENOA-QOL HEALTHCARE HEALTHMED PHARMACY OPTION CARE PRIME RX PHARMACY SCRIPTS PHARMACY SOUTHCARE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (813) 304-2221 (813) 672-8889 (813) 677-3800 (813) 677-6000 (813) 234-9409 (813) 280-0927 (561) 578-6958 (321) 636-2111 (321) 890-1590 (321) 806-3972 (321) 917-1204 (321) 636-2275 (561) 557-1230 (727) 259-2000 (727) 499-0085 (727) 330-7530 (904) 824-4556 (904) 461-1081 (904) 794-1399 (904) 342-2162 (904) 797-2770 (904) 429-7333 (407) 892-7166 (407) 593-2959 (727) 954-8877 (727) 329-8798 (727) 350-1500 (727) 767-8933 (727) 209-0619 (727) 502-4144 (727) 329-8868 (727) 317-5825 (727) 896-0001 (727) 623-9854 (727) 384-3338 (727) 568-9404 (727) 327-7262 (727) 894-3001 (727) 592-0045 (727) 522-3222 (727) 867-4900 (727) 344-3902

Provider Street 34490 CORTEZ BLVD 11349 BIG BEND ROAD 9858 US HIGHWAY 301 S 9304 BALM RIVERVIEW RD 13057 SUMMERFIELD SQUARE DR 6520 US HWY S 301 3342 BROADWAY 107 LONGWOOD AVE 1770 CEDAR ST 1260 US HIGHWAY 1 3650 MURRELL RD STE 120 2370 S FISKE BLVD 11328 OKEECHOBEE BLVD STE 5 3135 STATE ROAD 580 STE 1 1840 MEASE DR STE 100 531 MAIN ST STE K 300 HEALTH PARK BLVD STE 1002 600 PLANTATION ISLAND DR #3 3690 US HIGHWAY 1 S 665 STATE ROAD 207 STE 101 2720 US 1 SOUTH STE A 4405 SARTILLO RD STE C 2521 13TH ST STE A 4073 13TH STREET 8808 4TH ST N 5415 4TH ST N 2705 54TH AVE N STE 6 501 6TH AVE S 521 DR MARTIN LUTHER KING JR S 620 10TH ST N 4749 34TH ST S 11270 4TH ST N STE 206 2215 DR MARTIN LUTHER KING JR 5944 34TH ST N STE 1 1001 37TH ST N STE F 11001 DANKA WAY N STE 2 4024 CENTRAL AVE 1839 CENTRAL AVE FL 1 2880 SCHERER DR N STE 850 5985 49TH ST N STE B 4910 34TH ST S 6499 38TH AVE N STE A1

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Provider City RIDGE MANOR RIVERVIEW RIVERVIEW RIVERVIEW RIVERVIEW RIVERVIEW RIVIERA BEACH ROCKLEDGE ROCKLEDGE ROCKLEDGE ROCKLEDGE ROCKLEDGE ROYAL PALM BEACH SAFETY HARBOR SAFETY HARBOR SAFETY HARBOR SAINT AUGUSTINE SAINT AUGUSTINE SAINT AUGUSTINE SAINT AUGUSTINE SAINT AUGUSTINE SAINT AUGUSTINE SAINT CLOUD SAINT CLOUD SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33523 33579 33578-5829 33569 33578-7402 33578-4324 33404-2328 32955-2827 32955-3133 32955-2728 32955 32955-3424 33411-8733 34695-4917 34695-6603 34695-3558 32086-3702 32080 32086-6498 32084-5939 32086-6301 32095-5240 34769-4103 34769 33702-3124 33703-2249 33714-1940 33701-4634 33705 33705 33711-4507 33716-2937 33705-2959 33714-1211 33713-6010 33716-3724 33711-1239 33713-8900 33716-1025 33709-2111 33711-4512 33710-1658

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SOUTHCARE PHARMACY INC THE MEDICINE SHOPPE THE PRESCRIPTION SHOP TRI MED MEDICAL PHARMACY MAGNOLIA PHARMACY DISCOUNT RX EXPEDIEN RX PHARMACY SANFORD DISCOUNT PHARMACY TRU-VALU DRUGS ISLAND PHARMACY SANTA ROSA PHARMACY AMERICA'S PHARMACY COMFORT IV THERAPY DAVIDSON DRUG DAVIDSON DRUGS INC DAVIDSON DRUGS INC FAMILY PHARMACY GULF GATE PHARMACY HEALTHCITE PHARMACY HEDGES HEALTHMART PHARMACY MEDICAL ARTS PHARMACY MEDPLUS PHARMACY MEDS MADE EASY OLSON LIGGETT DRUG PRIME PHARMACY SERVICES SARASOTA APOTHECARY SARASOTA DISCOUNT PHARMACY

Provider Name

(727) 344-3902 (727) 527-5778 (727) 822-4546 (727) 527-4569 (352) 588-3330 (407) 322-2244 (407) 357-2600 (407) 323-7922 (407) 323-6413 (239) 472-6188 (850) 622-3313 (941) 955-7700 (941) 355-8330 (941) 349-1111 (941) 365-9116 (941) 349-4343 (941) 921-6645 (941) 493-6500 (941) 312-2777 (941) 366-2424 (941) 706-1777 (941) 960-2549 (941) 225-2005 (941) 366-0090 (954) 919-1818 (941) 218-4090 (941) 444-6888

6499 38TH AVE N STE A1 6401 DR MARTIN LUTHER KING JR 600 1ST AVE N STE 100 5779 49TH ST N 12304 CURLEY ST 1402 W 1ST ST 582 MONROE RD SUITE 1412 B 1808 S FRENCH AVE 503 E 1ST ST 2330 PALM RIDGE RD STE 12 19 TOWN CENTER LOOP #1A 3076 17TH ST 1800 NORTHGATE BLVD STE A-7 5124 OCEAN BLVD 1281 S TAMIAMI TRL 6595 MIDNIGHT PASS RD 3644 WEBBER ST 2134 GULF GATE DR 343 INTERSTATE BLVD 24 N LIME AVE 4417 BEE RIDGE RD 5751 BENEVA RD 3830 BEE RIDGE RD #101 75 S TUTTLE AVE 2427 PORTER LAKE DR STE 109 8620 S TAMIAMI TRL STE N-P 110 N LIME AVE

SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAINT PETERSBURG SAN ANTONIO SANFORD SANFORD SANFORD SANFORD SANIBEL SANTA ROSA BEACH SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33710-1658 33702-6623 33701-3609 33709 33576-8210 32771-1647 32771-8821 32771-3376 32771-1409 33957-3278 32459 34234-8753 34234-2142 34242-1637 34239-2200 34242-2506 34232-4413 34231-4813 34240-8597 34237-6120 34233 34233-4105 34233 34237-6329 34240-8853 34238-3049 34237-6122

SARASOTA PHCY SV C/O BEE RIDGE PHCY ST SIMON PHARMACY SUN DISCOUNT PHARMACY UNIVERSITY PHARMACY WE-CARE PHARMACY WORLD TRIUMPH MEDICAL BAY STREET PHARMACY GILBERT DRUGS HEARTLAND PHARMACY HIGHLANDS PHARMACY JARES PHARMACY SEBRING PHARMACY SEBRING PHARMACY IMED PHARMACY

(941) 378-0008 (941) 552-6054 (941) 556-9622 (941) 355-2500 (941) 893-3050 (941) 366-0090 (772) 589-2043 (863) 385-0741 (863) 385-5588 (863) 304-8146 (863) 304-8792 (863) 471-0007 (863) 471-0007 (813) 685-4444

4086 BEE RIDGE RD 4012 SAWYER RD STE 107 2817 BEE RIDGE RD 8451 SHADE AVE STE 108 5561 PALMER CROSSING CIR 2850 RINGLING BLVD 7746 BAY ST 2190 LAKEVIEW DR 6360 US HIGHWAY 27 N 7217 US HIGHWAY 27 N 1542 LAKEVIEW DR STE 1 3023 US HIGHWAY 27 N 3023 US HIGHWAY 27 N 1812 S PARSONS AVE STE 104

SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SARASOTA SEBASTIAN SEBRING SEBRING SEBRING SEBRING SEBRING SEBRING SEFFNER

FL FL FL FL FL FL FL FL FL FL FL FL FL FL

34233-2551 34233-1231 34239-7116 34243-2878 34233-3335 34237 32958-3427 33870-4967 33870-1225 33870-1051 33870-7957 33870-1630 33870-1630 33584-7201

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 148 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SALLYKAY PHARMACY SEFFNER PHARMACY LAKE SEMINOLE PHARMACY PRIME RX PHARMACY SNEADS PHARMACY HEALTH PLUS PHARMACY DAYTONA DISCOUNT PHARMACY SMP PHARMACY SOLUTIONS SOUTH MIAMI PHARMACY II 4 CORNERS PHARMACY CAREPOINT RX PHARMACY NATURE COAST PHCY INC PINE BROOK PHARMACY RELIANT PHARMACY SEVEN HILLS PHARMACY SHERWOOD PHARMACY SIGMA PHARMACY BAY DERMAT & COSMETIC SURGERY CURANT HEALTH FLORIDA EMPATH HEALTH PHARMACY MAIL MEDS CLINICAL PHARMACY ST. PETERSBURG PHARMACY URBAN SPECIALTY PHARMACY WECARE PHARMACY DAP PHARMACY MANAGEMENT AND CONSULT MADISON STREET PHARMACY STEINHATCHEE DRUGS CHEMISTS N DRUGGISTS PHARMACY CHOICE RX PHARMACY, INC. PARK PHARMACY SCRIPTS TO YOU PHARMACY STUART ONCOLOGY ASSOCIATES PA HEALING PHARMACY SUNRISE PHARMACY SOLUTIONS PHARMACY NAVARRO DISCOUNT PHARMACY AMERICAN CARE PHARMACY DIRECT PHARMACY SOURCE INC FASTMED HEALTH MART PHARMACY PHYSICIAN CHOICE PHARMACY REHOBOTH PHARMACY

NR_0009_10823 10/2017

Provider Phone Number

State

ZIP code

(813) 409-3840 (813) 655-9800 (727) 592-4588 (727) 398-1969 (850) 593-5288 (352) 720-3104 (386) 322-5969 (855) 255-5007 (305) 740-9696 (352) 610-4355 (352) 515-6311 (352) 597-5757 (352) 610-4437 (352) 596-1044 (352) 684-8477 (352) 835-7937 (352) 556-4649 (727) 585-8591 (866) 448-8040 (727) 209-3500 (239) 939-9226 (727) 201-9500 (727) 327-9881 (727) 544-2525

735 W MARTIN LUTHER KING BLVD 2007 S PARSONS AVE 9117 PARK BLVD N 10720 PARK BLVD STE E 7995 HIGHWAY 90 25444 STATE ROAD 46 STE 3 815 BEVILLE RD STE D 6050 S DIXIE HWY STE 200 6050 S DIXIE HWY 11001 SPRING HILL DR 7347 SPRING HILL DR 4654 COMMERCIAL WAY 5340 SPRING HILL DR 10507 SPRING HILL DR 1248 MARINER BLVD 4127 MARINER BLVD 13107 SPRING HILL DR 7500 GULF BLVD STE B 11001 ROOSEVELT BLVD N STE 3050 1ST AVE S 3251 3RD AVE N SUITE 125 6399 38TH AVE N STE A-5 1617 34TH ST SOUTH STE A 5665 PARK ST N

Provider Street

SEFFNER SEFFNER SEMINOLE SEMINOLE SNEADS SORRENTO SOUTH DAYTONA SOUTH MIAMI SOUTH MIAMI SPRING HILL SPRING HILL SPRING HILL SPRING HILL SPRING HILL SPRING HILL SPRING HILL SPRING HILL ST PETE BEACH ST PETERSBURG ST PETERSBURG ST PETERSBURG ST PETERSBURG ST PETERSBURG ST PETERSBURG

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33584-4533 33584 33777-4133 33772-5461 32460 32776-8101 32119-1859 33143-5046 33143-5042 34608-5052 34606-4300 34606-1944 34606 34608-5047 34609-5657 34609-2469 34609-5052 33706-1821 33716-2338 33712-1010 33713-7602 33710-1651 33711-2855 33709

(727) 460-1855 (904) 964-7774 (352) 498-0680 (772) 678-4000 (772) 214-3676 (772) 287-3201 (772) 463-1244 (772) 223-5955 (352) 693-2773 (813) 633-8222 (305) 945-8977 (305) 792-4388 (954) 451-5578 (954) 233-0100 (954) 741-6644 (888) 389-2014 (954) 741-4000

11880 28TH ST N STE 300 395 W MADISON ST 102 9TH ST SE 6083 SE FEDERAL HWY 2090 NW FEDERAL HWY 700 SE OCEAN BLVD 3202 SE FEDERAL HWY 501 SE OSCEOLA ST STE 301 17860 SE 109TH AVE STE 616A 139 S PEBBLE BEACH BLVD # 103 17036 COLLINS AVE 18500 COLLINS AVE 2053 N UNIVERSITY DR 4574 N HIATUS RD 8237 SUNSET STRIP 4529 N PINE ISLAND RD 7800 W OAKLAND PARK BLVD STE 2

ST PETERSBURGH STARKE STEINHATCHEE STUART STUART STUART STUART STUART SUMMERFIELD SUN CITY CENTER SUNNY ISLES SUNNY ISLES BEACH SUNRISE SUNRISE SUNRISE SUNRISE SUNRISE

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33716 32091 32359 34997-8104 34994-9306 34994-2332 34997-4912 34994-2347 34491-8909 33573-4711 33160-3642 33160-2427 33322-3936 33351-7987 33322-3058 33351-5376 33351-1100

Page 149 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUNRISE DISCOUNT PHARMACY USAV PHARMACY CARE RX PHARMACY EASTWOOD PHARMACY

Provider Name

(954) 746-5890 (954) 530-4865 (850) 577-1890 (850) 877-7108

2804 N UNIVERSITY DR 3533 NW 88TH AVE 1167 E TENNESSEE ST 1605 E PLAZA DR

SUNRISE SUNRISE TALLAHASSEE TALLAHASSEE

FL FL FL FL

33322-2450 33351-6638 32308 32308-5362

FAMU HEALTH DEPARTMENT PHARMACY LAKE ELLA PHARMACY CORP SHS PHARMACY LLC STEWART'S PHARMACY TALLAHASSEE CANCER INST PHCY WCRX PHARMACY LLC YOURX PATIENT PHCY @ BONDCHC ARTHUR'S ORIGINAL PHARMACY PRESCRIPTION DEPOT RX MARINE INC TAMARAC PHARMACY 5 STAR PHARMACY ADVANCE PHARMACY SERVICE ADVANCED MEDICAL PHARMACY INC ALL CHILDRENS HOSP O/P PHARMAC

(850) 606-8250 (850) 270-9424 (850) 270-5302 (850) 216-1021 (850) 727-5502 (850) 222-1963 (850) 521-5112 (954) 726-1911 (954) 773-2450 (786) 310-7099 (954) 586-4546 (813) 971-5557 (813) 350-9999 (813) 374-2065 (813) 631-5006

872 W ORANGE AVE 2525 S MONROE ST STE 6 1733 N MONROE ST STE A 1350 E TENNESSEE ST 1653 MAHAN CENTER BLVD SUITE A 100 SALEM CT 1720 S GADSDEN ST 5816 N UNIVERSITY DR 8225 NW 88TH AVE 7800 N UNIVERSITY DR, STE 103 7120 N NOB HILL RD 13757 N NEBRASKA AVE 5124 N ARMENIA AVE 3614 W KENNEDY BLVD STE C 12220 BRUCE B DOWNS BLVD

TALLAHASSEE TALLAHASSEE TALLAHASSEE TALLAHASSEE TALLAHASSEE TALLAHASSEE TALLAHASSEE TAMARAC TAMARAC TAMARAC TAMARAC TAMPA TAMPA TAMPA TAMPA

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

32310-6123 32301-6395 32303-5534 32308-5179 32308 32301-2810 32301 33321-4634 33321-1541 33321-2113 33321 33613-3320 33603 33609 33612-9201

AMERICAN CARE OF TAMPA INC- N.TAMPA AMERICAN CARE OF TAMPA INC W BAY DISCOUNT PHARMACY BAYCARE PHARMACY BEARSS PHARMACY BENZER PHARMACY BENZER PHARMACY BENZER PHARMACY BEST DEAL RX PHARMACY BULLS COUNTRY PHARMACY CAREPLUS PHARMACY CARROLLWOOD PHARMACY CCM PHARMACY, LLC CHOICE PHARMACY CITY CARE PHARMACY CITY PHARMACY DAVIDS PHARMACY DAVIS ISLANDS PHARMACY DOLLEX PHARMACY EXACT DOSE PHARMACY INC EXACTUS PHARMACY SOLUTIONS INC

(813) 514-2333 (813) 712-1726 (813) 885-4000 (813) 357-0630 (813) 341-1555 (813) 443-4796 (813) 644-7277 (813) 963-6800 (813) 644-6845 (813) 974-2071 (813) 849-0991 (813) 961-8798 (813) 559-1010 (813) 870-6426 (813) 402-0444 (813) 248-5405 (813) 870-1967 (813) 254-1888 (813) 971-5551 (813) 626-7353 (866) 458-9246

11211 NORTH NEBRASKA AVE 8726 W WATERS AVE 8802 ROCKY CREEK DR STE 105 3003 W DR MLK JR BLVD 3606 MADACA LN 2812 W MLK JR BLVD 5908 BRECKENRIDGE PKWY 14306-D NORTH DALE MAYBRY HWY 4160 N ARMENIA AVE STE C 4103 USF CEDAR CIR 701 W DR M L K JR BLVD STE 1 11775 N DALE MABRY HWY 6821 W HILLSBOROUGH AVE STE 6 5913 N ARMENIA AVE 5557 S 78TH ST 3302 E DR MARTIN LUTHER KING J 2302 W DR MARTIN LUTHER KING J 232 E DAVIS BLVD 7756 PALM RIVER RD 10004 EAST DR MLK JR BLVD 4110 GEORGE RD STE 100

TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33612 33615-1714 33615-4315 33607-6307 33618-2057 33607-6306 33610-4233 33618-2052 33607 33620 33603 33618-3503 33634 33603 33619 33610-7837 33607-6406 33606-3729 33619-4215 33610 33634-7411

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 150 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

EXPRESS SPECIALTY PHARMACY EXTRA CARE PHARMACY INC FLETCHER MEDICAL CENTER PHCY FOUNDATIONAL HEALTH PHARMACY FREEDOMED PHARMACY FRIENDS PHARMACY GENOA-QOL HEALTHCARE GOOD HEALTH PHARMACY GRACE RX PHARMACY HEALTHLINK PHARMACY HEALTHWISE PHARMACY INC

Provider Name

(813) 288-0777 (813) 558-9300 (813) 972-3774 (813) 527-0765 (813) 889-9779 (813) 632-3200 (813) 239-8116 (813) 933-5830 (813) 221-3131 (813) 868-6800 (813) 932-6337

4111 HENDERSON BLVD 2001 E FLETCHER AVE STE 101 3000 E FLETCHER AVE STE 130 3031 W CYPRESS ST STE A 5535 MEMORIAL HWY 1813 E FOWLER AVE 5707 N 22ND ST 1911 W DR MARTIN L KNG JR BLVD 4602 N ARMENIA AVE STE A2 3301 W WATERS AVE STE 101 2708 W WATERS AVE

TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA

FL FL FL FL FL FL FL FL FL FL FL

33629 33612-3711 33613-4643 33609-1647 33634-7370 33612-5525 33610-4350 33607 33603-2625 33614 33614-1837

HILLSBORO SPECIALTY PHCY BLOOD PRSS HOYE'S PHARMACY HUDSON DRUGS IDEL PHARMACY J & S RX PHARMACY JRX PHARMACY KABS PHARMACY KAY PHARMACY KING PHARMACY LOGOS PHARMACY MACDILL PHARMACY MEDICA SCRIPTS MEDICINE PLACE MEDICINE SHOPPE MEDS TO HOME MEMORIAL FAMILY PHARMACY MICHAEL'S PHARMACY MOFFITT CANCER CTR PUBLIX PHCY MOFFITT CANCER CTR PUBLIX PHCY MY PHARMACY OF TAMPA NEW WATERS PHARMACY NORTH TAMPA PHARMACY NORTHDALE PHARMACY OAKS COMMUNITY PHARMACY OMEGA DRUGS ONESTOP RX PHARMACY ORANGE BAY PHARMACY OUSIA PHARMACY CORP PALMA CEIA HEALTH MART PHARMACY PALMS PHARMACY

(813) 628-8400 (813) 839-8861 (813) 961-5790 (813) 877-6679 (813) 234-4200 (813) 874-2900 (813) 988-4000 (813) 632-9032 (813) 374-0365 (813) 886-2800 (813) 870-6300 (813) 968-0520 (813) 961-6546 (813) 971-8401 (813) 886-2023 (813) 874-0795 (813) 907-0099 (813) 978-1694 (813) 745-8484 (813) 628-4441 (813) 249-6593 (813) 265-4925 (813) 264-6300 (813) 237-2300 (813) 985-0044 (813) 877-8900 (813) 418-6780 (813) 252-4076 (813) 839-8700 (813) 252-9063

4505 E HILLSBOROUGH AVE STE D 4330 S MANHATTAN AVE 11010 N DALE MABRY HWY STE 104 3314 W COLUMBUS DR 1252 E HILLSBOROUGH AVE 3940 W HILLSBOROUGH AVE 2812 E BEARSS AVE 3500 E FLETCHER AVE STE 120 1405 TAMPA PARK PLAZA STREET 8315 SHELDON RD 2800 N MACDILL AVE STE C 15511 N FLORIDA AVE 14936 N FLORIDA AVE 10905 N NEBRASKA AVE 4801 GEORGE RD SUITE 190 3609 HENDERSON BLVD 1329 E FLETCHER AVE 10920 N MCKINLEY DR # 11.1114 12902 USF MAGNOLIA DR STE 1170 7108 CAUSEWAY BLVD 4311 W WATERS AVE STE 590 104 E FLETCHER AVE 3851 NORTHDALE BLVD 7501 N FLORIDA AVE STE C-104 11410 N 56TH ST 4830 N ARMENIA AVE 4625 N NEBRASKA AVE 4343 GUNN HWY 2506 S MACDILL AVE STE A 17008 PALM POINTE DR

TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33610-5200 33611 33618-3820 33607-1820 33604-7208 33614-5628 33613-2653 33613-4789 33605 33615-1607 33607-2208 33613-1263 33613-1641 33612-5724 33634 33609-4501 33612-3629 33612-6471 33612-9416 33619 33614-2134 33612-3429 33624-1861 33604 33617-2237 33603-1431 33603-4013 33618-8729 33629-7261 33647-3504

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 151 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PATIENT RX SOLUTIONS PHARMACY PEAK PHARMACY INC PHARMACORE RX PHARMA-VILLE RX & MEDICAL SUPPLY PHARMAX SPECIALTY PHARMACY PHARMEXPRESS PHARMACY PRECISION RX PRECISIONMED PHARMACY PREMIER PHARMACY LLC QUICK N SAVE PHARMACY RITE RX CARE ROYAL RX PHARMACY RX OASIS RX SOLUTIONS INC SAVE-RITE PHARMACY SCRIPT CHOICE PHARMACY SCRIPTS DIRECT LLC SENIORCARE COMM PHARMACY ST JOSEPH PHARMACY STAYWELL PHARMACY TAMPA DRUGS & DIABETIC CENTER TAMPA FAMILY PHARMACY TAMPA GENERAL HOSPITAL OP PHCY TAMPA PALMS PHARMACY THE DRUG SHOPPE TIMES PHARMACY UNIV PAIN MANAGEMENT CENTER USF HEALTH PHARMACY PLUS V & T PHARMACY V & T PHARMACY VALUED CHOICE PHARMACY VISTACARE PHARMACY VISTARA PHARMACY VP PHARMACY WECARE PHARMACY LLC WELLNESS PHARMACY INC WEST SHORE PHARMACY WILLIAM'S PHARMACY ANCLOTE PHARMACY PEGASUS RX PHARMACY TARPON DISCOUNT DRUGS TAVARES PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (813) 426-8234 (813) 443-0833 (813) 580-8040 (813) 605-0732 (813) 880-2500 (813) 406-4491 (813) 463-8009 (813) 703-8839 (813) 873-7470 (813) 549-5599 (813) 333-5343 (813) 980-6334 (813) 570-7194 (813) 988-7600 (813) 623-1800 (813) 374-9944 (727) 359-0040 (813) 884-4090 (813) 930-6000 (813) 249-9999 (813) 231-7788 (813) 871-5161 (813) 844-7688 (813) 605-0300 (813) 870-3939 (813) 237-6900 (813) 615-0742 (813) 974-0133 (813) 443-4732 (813) 926-3470 (813) 881-0600 (813) 444-4410 (813) 667-6075 (813) 988-0818 (813) 908-6868 (813) 774-8856 (813) 837-9095 (813) 223-4303 (727) 944-5800 (727) 938-6400 (727) 934-3400 (352) 508-6449

Provider Street 3450 E FLETCHER AVE STE 140 4707 E BUSCH BLVD #101 5406 HOOVER BLVD STE 19 14857 N DALE MABRY HWY 7808 WOODLAND CENTER BLVD 507 E DR M.L.K. JR BLVD#101 6919 N DALE MABRY HWY STE 125 6919 N DALE MABRY HWY STE 150 4307 N ARMENIA AVE 8207 N FLORIDA AVE 7520 W WATERS AVE STE 6 4941 E BUSCH BLVD STE 240 6102 S MACDILL AVE #B 5144 E BUSCH BLVD 7402 N 56TH ST STE 907 1721 W FLETCHER AVE 8313 W HILLSBOROUGH AVE #260 6712 HANLEY RD 7933 N ARMENIA AVE 4002 W . WATERS AVE STE 7 3209 N 22ND ST 2919 W SWANN AVE STE 101 5 TAMPA GENERAL CIR 15309 AMBERLY DR 4060 N ARMENIA AVE 2210 E HILLSBOROUGH AVE # 4 3220 COVE BEND DRIVE 13330 USF LAUREL DR 4040 W WATERS AVE STE 105 11967 SHELDON RD 5537 SHELDON RD STE Y 1441 E FLETCHER AVE STE 113 2931 W HILLSBOROUGH AVE 7617 N 56TH STREET 7830 GUNN HWY # A 120 W BOUGAINVILLEA AVE 3206 S WEST SHORE BLVD 2808 NORTH TAMPA STREET 1933 N PINELLAS AVE 1992 ALT US HIGHWAY 19 742 S PINELLAS AVE 524 S DUNCAN DR

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Provider City TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TAMPA TARPON SPRINGS TARPON SPRINGS TARPON SPRINGS TAVARES

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33613-4651 33617 33634-5330 33618-2027 33614 33603 33614 33614 33607 33604-3003 33615-1599 33617-6056 33611-4779 33617 33617 33612-1820 33615-3818 33634-4753 33604-3830 33614 33605 33609 33606-3601 33647-2112 33607 33610-4403 33613 33612-6601 33614-8155 33626-3644 33615-3173 33612-3670 33614 33617 33626-1612 33612-7437 33629-7652 33602 34689-5780 34689 34689-3710 32778-4146

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MERIDIAN PHARMACY SALHAB PHARMACY TEMPLE TERRACE PHARMACY VETERANS PHARMACY MED CHEST BROWNWOOD TOWN CTR PREMIER PHARMACY THE MEDICINE CHEST KAY PHARMACY CENTURY PHARMACY EAST COAST PHARMACY HOPKINS PHARMACY ITANI FAMILY PHARMACY TITUSVILLE DISCOUNT PHARMACY BEST DRUGS OF TRENTON UMATILLA DRUG STORE VALRICO PHARMACY BARCLAY PHARMACY SUN PHARMACY OF VENICE VENICE APOTHECARY WE CARE WE CARE PHARMACY VERNON DISCOUNT DRUG BAILEY'S PHARMACY COREY'S PHARMACY MICHAELA G SCOTT MD & ASSOC PLC MILLERS HEALTH MART PHARMACY OSCEOLA PHARMACY PERKINS COMPOUNDING PHARMACY PERKINS INDIAN RIVER PHARMACY WHOLE FAMILY HEALTH CENTER WHOLE FAMILY HEALTH CENTER HEARTLAND PHARMACY WAUCHULA PHARMACY OAK HILL PHARMACY DIABETIC SUPPORT PHARMACY MY COMMUNITY PHARMACY LLC ROYAL WELLINGTON PHARMACY INC SCHAEFER DRUGS-WELLINGTON ANOINTED PHARMACY AXCESS PHARMACY BENZER PHARMACY FL MED CLINIC PHCY OF WIREGRASS

NR_0009_10823 10/2017

Provider Phone Number (813) 374-0395 (813) 515-7918 (813) 989-1351 (813) 964-6881 (352) 653-1510 (352) 259-2159 (352) 753-1877 (813) 413-8242 (321) 747-0600 (321) 747-0206 (321) 607-6802 (321) 269-7772 (321) 268-0911 (352) 463-2240 (352) 669-1166 (813) 681-7800 (941) 484-2494 (941) 584-2080 (941) 485-8205 (941) 786-9181 (941) 786-9181 (850) 535-2803 (772) 492-8559 (772) 231-6931 (772) 562-7777 (772) 778-8585 (772) 562-3660 (772) 978-6470 (772) 567-2555 (772) 925-8402 (772) 925-8400 (863) 767-8920 (863) 774-3536 (352) 597-0017 (561) 472-7088 (561) 753-6768 (561) 899-3273 (561) 793-0151 (813) 388-2908 (813) 333-1494 (813) 991-9200 (813) 751-3377

Provider Street 8890 N 56TH ST 12643 N 56TH ST 5671 E FOWLER AVE SUITE 215 11434 N 53RD ST 3633 KIESSEL RD 1580 SANTA BARBARA BLVD 910 OLD CAMP RD BLDG 170 10802 MAIN ST STE A 695 N WASHINGTON AVE UNIT 101 504 GARDEN ST 4401 S HOPKINS AVE STE 102 2507 GARDEN ST 2175 CHENEY HWY STE B 405 SE 1ST AVE 901 N CENTRAL AVE 2224 STATE ROAD 60E 200 TAMIAMI TRL N STE A 1214 E VENICE AVE STE C 560 THE RIALTO 1849 TAMIAMI TRL S 1849 TAMIAMI TRL S 3248 MAIN ST 780 US HIGHWAY 1 STE 101 2912 OCEAN DR 1460 36TH ST 777 37TH ST STE C100 1635 14TH AVE 4015 20TH ST 3721 10TH CT 981 37TH PL 981 37TH PL 116 HEARTLAND WAY 518 S 6TH AVE 10101 CORTEZ BLVD 3381 FAIRLANE FARMS RD STE 2B 2615 S STATE ROAD 7 STE B530 3141 FORTUNE WAY STE 1 12797 W FOREST HILL BLVD STE C 32733 EILAND BLVD STE 103 5504 GATEWAY BLVD STE 102 2653 BRUCE B DOWNS BLVD #115 2352 BRUCE B DOWNS BLVD

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Provider City TEMPLE TERRACE TEMPLE TERRACE TEMPLE TERRACE TEMPLE TERRACE THE VILLAGES THE VILLAGES THE VILLAGES THONOTOSASSA TITUSVILLE TITUSVILLE TITUSVILLE TITUSVILLE TITUSVILLE TRENTON UMATILLA VALRICO VENICE VENICE VENICE VENICE VENICE VERNON VERO BEACH VERO BEACH VERO BEACH VERO BEACH VERO BEACH VERO BEACH VERO BEACH VERO BEACH VERO BEACH WAUCHULA WAUCHULA WEEKI WACHEE WELLINGTON WELLINGTON WELLINGTON WELLINGTON WESLEY CHAPEL WESLEY CHAPEL WESLEY CHAPEL WESLEY CHAPEL

State

ZIP code

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33617 33617 33617 33617 32163 32159 32162-5604 33592-2840 32796-2107 32796-3405 32780-6679 32796-4612 32780-6792 32693-3219 32784-8655 33594 34285-1914 34285-7165 34285-2900 34293-3128 34293-3128 32462-2223 32962 32963-1949 32960-4849 32960-4873 32960-0435 32960-2403 32960-6559 32960-6541 32960-6541 33873-5000 33873 34613-6380 33414 33414-9370 33414 33414-4763 33545-5233 33544-1970 33544-9206 33543

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUMMERGATE PHARMACY LA CUBANA PHCY & DISCOUNT INC PINO PHARMACY VICTORY PHARMACY CORPORATION 45TH STREET PHARMACY ANTHONYS PHARMACY APNAR PHARMACY & SUPERMARKET CENTER CITY PHARMACY CHARLES PHARMACY CITY PLACE PHCY MED SHOPPE COASTAL COMPOUNDING PHARMACY FAMILY CHOICE PHARMACY FARMACIA LAS AMERICAS FOREST HILL PHCY MED SHOPPE GARDENS DRUGS HEALTH FIRST INFUSION MD OMEGA PHARMACY INC MOTTO PHARMACY INC PALM BEACH PHARMACY ROBALO PHARMACY SPEEDY SCRIPTS PHARMACY WEST PALM PHARMACY FRIENDLY DRUG & SURGICAL CLEVELAND CLINIC WESTON PHCY PILL BOX PHARMACY BUY RITE DRUGS SAFESCRIPT PHARMACY SUNSHINE DRUGS AHF PHARMACY WILTON MANORS BIO-CARE PHARMACY QUICK SCRIPT PHARMACY THE MEDICINE SHOPPE FORMULA PHARMACY THE MEDICINE SHOPPE WINTERGARDEN PHARMACY

Provider Name

(813) 667-6100 (305) 267-6767 (305) 262-2920 (786) 542-5670 (561) 670-2001 (561) 847-4820 (561) 967-7193 (561) 805-7135 (561) 507-5300 (561) 833-9960 (561) 683-1095 (561) 822-3511 (561) 642-7590 (561) 965-4288 (561) 841-1801 (561) 842-2828 (561) 547-7710 (561) 881-0022 (561) 721-7395 (561) 844-1191 (561) 296-3795 (561) 249-2130 (954) 983-3777 (954) 659-6337 (954) 389-7455 (229) 435-4571 (352) 748-9900 (352) 529-6966 (954) 318-6997 (954) 566-6151 (954) 514-7685 (954) 563-8407 (407) 614-1737 (407) 656-0081 (407) 656-2604

27432 CASHFORD CIR STE 101 5965 SW 8TH ST STE A 1350 SW 57TH AVE STE 105 1003 SW 67TH AVE 5335 N MILITARY TRL STE 44 9121 N MILITARY TRL STE 106 2650 S. MILITARY TRAIL 416 CLEMATIS STREET 5081 OKEECHOBEE BLVD 4047 OKEECHOBEE BLVD STE 217 3111 45TH ST STE 3 1897 PALM BEACH LAKES BLVD 1800 FOREST HILL BLVD STE B12 2939 FOREST HILL BLVD 2100 45TH ST STE B1 1959 W 9TH ST STE A 4915 S DIXIE HWY 4152 W BLUE HERON BLVD 1411 N FLAGLER DR. SUITE 1200 228 US HIGHWAY 1 1115 45TH ST STE 3 5760 OKEECHOBEE BLVD 7 BARRY RD 2950 CLEVELAND CLINIC BLVD 1932 WESTON RD 218 SOUTH HWY 71 342 SHOPPING CENTER DR 219 S MAIN ST 2097 WILTON DR 1409 NE 26TH ST 2412 WILTON DR 1905 N ANDREWS AVE 1201 WINTER GARDEN VINELAND RD 646 S DILLARD ST 736 S DILLARD ST

WESLEY CHAPEL WEST MIAMI WEST MIAMI WEST MIAMI WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PALM BEACH WEST PARK WESTON WESTON WEWAHITCHKA WILDWOOD WILLISTON WILTON MANORS WILTON MANORS WILTON MANORS WILTON MANORS WINTER GARDEN WINTER GARDEN WINTER GARDEN

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL

33544-6916 33144-5037 33144-5700 33144-4757 33407 33410-5985 33415 33401 33417-4533 33409-3239 33407-1981 33409-3507 33406-6070 33406-5962 33407-2063 33404-6440 33405-2926 33404-4811 33401 33403-3552 33407-2378 33417-4343 33023-5271 33331-3609 33326-3214 32465 34785-4533 32696-2657 33305-2121 33305 33305-1251 33311-3914 34787-4380 34787-3903 34787-3908

AMERICAN CARE OF TAMPA WINTER HAVEN BENZER PHARMACY DUNDEE COMMUNITY PHARMACY GENOA-QOL HEALTHCARE GOOD HEALTH PHARMACY KAY PHARMACY #003

(863) 291-4590 (863) 292-6111 (863) 324-4100 (863) 291-4707 (863) 229-5974 (863) 268-8218

2791 LAKE ALFRED ROAD 700 1ST ST S STE 1 5999 DUNDEE RD STE 200 1201 1ST ST S 1501 1ST ST S 637 1ST ST S

WINTER HAVEN WINTER HAVEN WINTER HAVEN WINTER HAVEN WINTER HAVEN WINTER HAVEN

FL FL FL FL FL FL

33881 33880-3605 33884-1109 33880-3904 33880-4307 33880-3604

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 154 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ONE-STOP PHARMACY 101

Provider Name

(863) 845-5800

1130 6TH ST NW

WINTER HAVEN

FL

33881-4021

PHARMACY ONE PRO SPECIALTY CARE PH VILLA MEDICAL HEALTH SOLUTIONS VILLA PHARMACY WINTER HAVEN PHARMACY ALOMA PHARMACY COLONIAL DRUGS OF ORLANDO LLC MAYASCRIPT PHARMACY MILLENIUM SPECIALTY PHARMACY TAYLORS PHARMACY WELLS SPECIALTY PHARMACY WINTER PARK PHARMACY FERTILITY PHARMACY WINTER SPRINGS PHARMACY MEDCITY PHARMACY EMPIRE PHARMACY FLORIDA MEDICAL CLINIC SOUTH LAKE PHARMACY ST JOSEPH'S PHARMACY XTRA DISCOUNT DRUGS ABBEVILLE DISCOUNT DRUGS DOLLAR PRESCRIPTION SHOP TOO LACEY DRUG COMPANY INC RED CARPET PHARMACY WELLSTAR PHARMACY NETWORK ADAIRSVILLE DRUG FORD'S PHARMACY CHANCY DRUGS ADEL LLC HARVEYS PHARMACY U SAVE IT ADEL FREDS PHARMACY GENOA-QOL HEALTHCARE MEDI-SAVE PHARMACY INC

(863) 401-9300 (863) 229-5978 (863) 229-5978 (863) 291-0400 (407) 420-7996 (407) 647-2311 (407) 740-6292 (407) 636-5222 (407) 644-1025 (407) 478-2663 (407) 636-4670 (407) 327-0910 (321) 316-4615 (904) 432-3810 (813) 602-8729 (813) 715-0354 (813) 395-5667 (813) 782-4854 (813) 788-7885 (229) 467-2221 (770) 672-0846 (770) 974-3131 (770) 529-9277 (470) 956-0005 (770) 773-3521 (770) 773-1800 (229) 896-4564 (229) 896-4391 (229) 435-5199 (229) 446-4290 (229) 352-9368 (229) 435-1306

65 3RD ST NW STE 59 105 AVENUE R NW 105 AVENUE R NW 345 CYPRESS GARDENS BLVD 6804 ALOMA AVE 155 E NEW ENGLAND AVE 1141 ORANGE AVE 110 S ORLANDO AVE #5 306 S PARK AVE 3796 HOWELL BRANCH RD 3090 ALOMA AVE STE 140 120 W STATE ROAD 434 STE B 5942 RED BUG LAKE RD 463688 SR 200 STE #6 6834 GALL BLVD STE 105 38045 MARKET SQ 38101 5TH AVE 35780 STATE ROAD 54 STE 101 6953 GALL BLVD 201 MAIN ST W 2151 CEDARCREST RD 4797 S MAIN ST 3450 COBB PKWY NW STE 110 4550 COBB PARKWAY NW 6000 JOE FRANK HARRIS PKY #F 7441 ADAIRSVILLE HWY 800 N PARRISH AVE 400 W 4TH ST 714 W 4TH ST 1705 PHILEMA RD S 601 11TH AVE 800 S SLAPPEY BLVD

WINTER HAVEN WINTER HAVEN WINTER HAVEN WINTER HAVEN WINTER PARK WINTER PARK WINTER PARK WINTER PARK WINTER PARK WINTER PARK WINTER PARK WINTER SPRINGS WINTER SPRINGS YULEE ZEPHYRHILLS ZEPHYRHILLS ZEPHYRHILLS ZEPHYRHILLS ZEPHYRHILLS ABBEVILLE ACWORTH ACWORTH ACWORTH ACWORTH ADAIRSVILLE ADAIRSVILLE ADEL ADEL ADEL ALBANY ALBANY ALBANY

FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL FL GA GA GA GA GA GA GA GA GA GA GA GA GA

33881-4674 33881 33881-2147 33880-4452 32792-6802 32789-4330 32789-4907 32789 32789-4318 32792-1740 32792-3743 32708-2551 32708-5035 32097 33542-2506 33542-7504 33542 33541-1920 33542-2586 31001-4211 30101 30101-5339 30101-8351 30101 30103 30103-2014 31620 31620-2644 31620-2656 31701-4706 31701-1645 31701-2616

SCOTT'S PHCY AND COMPOUNDING LAB THE PRESCRIPTION SHOPPE U SAVE IT DOWNTOWN U SAVE IT NW U SAVE IT PALMYRA U SAVE IT PHARMACY U SAVE IT SOUTH ALBANY

(229) 483-7908 (229) 434-1414 (229) 435-8351 (229) 435-4571 (229) 439-4939 (229) 436-1518 (229) 435-5199

2205 E OGLETHORPE BLVD 610 N SLAPPEY BLVD 400 N JEFFERSON ST 2624 MEREDYTH DR 2112 PALMYRA RD 1315 DAWSON RD 1310 NEWTON RD

ALBANY ALBANY ALBANY ALBANY ALBANY ALBANY ALBANY

GA GA GA GA GA GA GA

31705-2939 31701-1412 31701-2359 31707-0206 31701-1320 31707-3853 31701-3480

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 155 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ALMA DISCOUNT PHARMACY BACON COUNTY HOSPITAL LAMAR'S PHARMACY THE MEDICINE CABINET OF ALMA NORTH FULTON PHARMACY NSH ALPHARETTA PHARMACY PRESTIGE PHARMACY CLINIC DRUG CLINIC DRUG STORE DOCTORS PHARMACY VITAL CARE FOOD LION PHARMACY ARLINGTON REXALL DRUGS HARRIS PHARMACY R & M CASH DRUGS RAINES PHARMACY ADD DRUG ATHENS INFUSION & PHARMACY ATHENS NEIGHBORHOOD PHARMACY ATHENS REGIONAL PHARMACY BENZER PHARMACY BUY-WISE DISCOUNT DRUGS HAWTHORNE DRUG COMPANY HODGSON'S PHARMACY HORTONS DRUG STORE

Provider Name

(912) 632-4267 (912) 632-8961 (912) 632-8925 (912) 632-6337 (770) 751-7575 (770) 667-4023 (678) 869-6000 (229) 924-2783 (229) 924-2783 (229) 928-9010 (229) 931-6312 (229) 725-4212 (229) 725-4911 (229) 567-2393 (229) 567-2515 (706) 548-2239 (706) 369-3050 (706) 850-8057 (706) 475-1920 (706) 510-4040 (706) 353-7847 (706) 548-5227 (706) 543-7386 (706) 543-3454

442 W 12TH ST 302 S WAYNE ST 905 S PIERCE ST 102 S PIERCE ST 11775 NORTHFALL LN STE 101 3400A OLD MILTON PKWY STE 140 6375 MCGINNIS FERRY RD STE 102 1001 E FORSYTH ST 1001 E FORSYTH ST 611 E LAMAR ST STE B 107 PRINCE ST 84 MAXWELL ST SE 465 PIONEER RD NW 362 E WASHINGTON AVE 346 E WASHINGTON AVE 1695 S LUMPKIN ST 1135 CEDAR SHOALS DR BLDG 6S 402 MCKINLEY DR 1199 PRINCE AVE 484 NORTH AVE 740 N CHASE ST 975 HAWTHORNE AVE STE A 1260 S MILLEDGE AVE STE F-1 101 E CLAYTON ST

ALMA ALMA ALMA ALMA ALPHARETTA ALPHARETTA ALPHARETTA AMERICUS AMERICUS AMERICUS AMERICUS ARLINGTON ARLINGTON ASHBURN ASHBURN ATHENS ATHENS ATHENS ATHENS ATHENS ATHENS ATHENS ATHENS ATHENS

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31510-2142 31510-2922 31510 31510-2999 30009 30005-4438 30005-3669 31709-3721 31709-3721 31709-3744 31709-3643 39813-8712 39813-8417 31714-5222 31714 30606-4742 30605-5299 30601-3261 30606 30601-2255 30601-1902 30606-2139 30605-1496 30601-2702

NORTHEAST GEORGIA CANCER CARE LLC SPINE CARE & PAIN MANAGEMENT UNIV. OF GEORGIA HEALTH CTR VILLAGE DRUG SHOP AT ADVANTAGE VILLAGE DRUG SHOP INC AHF PHARMACY AHF PHARMACY ALLIANCE COMMUNITY PHARMACY ASA YANCEY HEALTH CENTER ATLANTA CANCER CARE ATLANTA CITY PHARMACY BARNES HEALTHCARE SERVICES BRIARCLIFF PHARMACY INC BUDD TERRACE PHARMACY CONCORD DRUGS CONCORD DRUGS CONCORD DRUGS

(706) 353-4344 (706) 433-0933 (706) 542-9979 (706) 850-4955 (706) 548-4444 (404) 879-3990 (470) 447-6471 (404) 461-9105 (404) 616-9951 (404) 851-2368 (404) 590-3785 (678) 627-0077 (404) 728-0092 (404) 728-6807 (404) 523-4908 (404) 252-2280 (404) 250-9656

3320 OLD JEFFERSON RD # 700A 1620 PRINCE AVE STE C 55 CARLTON ST 250 NORTH AVE 740 PRINCE AVE 1605 PEACHTREE ST NE 1858 CHESHIRE BRIDGE RD NE 1529 PIEDMONT AVE NE STE C 1247 DONALD LEE HOLLOWELL PKWY 5670 PEACHTREE DUNWOODY RD 2215 CHESHIRE BRIDGE RD NE #D 2030 POWERS FERRY RD STE 325 2724 CLAIRMONT RD NE 1833 CLIFTON RD NE RM 115 550 PEACHTREE ST NE STE 1450 960 JOHNSON FERRY RD NE STE 14 5505 PEACHTREE DUNWOODY RD NE

ATHENS ATHENS ATHENS ATHENS ATHENS ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30607-1400 30606-6008 30602-1503 30601 30606-5908 30309 30324-4945 30324-5000 30318-6657 30342 30324-4234 30339 30329-2713 30329-4021 30308-2242 30342-1601 30342-1705

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 156 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CONCORD MEDICAL QUARTERS PHCY EAST POINT GRADY HEALTH CENTER EASTLAKE PHARMACY EXPRESS DRUGS EXPRESS FOOD & PHARMACY EXPRESS FOOD AND PHARMACY GENOA-QOL HEALTHCARE GRADY BEHAVIORAL HEALTH CTR PHCY GRADY MEMORIAL OUTPATIENT PHCY GRADY MEMORIAL SR CARE PHCY

Provider Name

(404) 252-3607 (404) 768-8917 (404) 968-9332 (404) 688-2211 (404) 818-0075 (404) 755-4232 (404) 750-4161 (404) 616-0888 (404) 616-4115 (404) 616-5080

5555 PEACHTREE DUNWOODY RD NE 1595 CLEVELAND AVE 1308 GLENWOOD AVE SE 212 EDGEWOOD AVE 50 UPPER ALABAMA ST, STE 92 2111 CAMPBELLTON RD SW 23 WARREN ST SE 10 PARK PLACE 80 JESSE HILL JR DR 80 JESSE HILL JR DR, RM GF003

ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA

GA GA GA GA GA GA GA GA GA GA

30342-1778 30344-3200 30316 30303-3027 30303 30311-4605 30317-2201 30346 30303 30303

GRADY MEMRL HOSP CORP CTRL REFILL P

(404) 416-0970

1575 NORTHSIDE DR NW BLDG 400

ATLANTA

GA

30318

GUARDIAN PHARMACY OF ATLANTA, LLC HEADLAND PHARMACY KIRKWOOD FAMILY MEDICINE CENTE MARKET PHARMACY, INC MCARTHUR'S APOTHECARY MLK PHARMACY MS-RX NORTH DEKALB GRADY HEALTH CTR NSH HOMECARE PHARMACY NSH PHARMACY AT MEDICAL TOWER NSH PHARMACY AT MERIDIAN MARK PAYLOW PHARMACY

(678) 441-0045 (404) 344-0209 (404) 616-9351 (770) 630-4037 (404) 523-6337 (470) 428-3478 (404) 856-4810 (404) 785-9634 (404) 851-8897 (404) 851-6310 (404) 459-1740 (404) 349-9940

5 DUNWOODY PARK STE 102 2973B HEADLAND DR 1863 MEMORIAL DR SE 209 EDGEWOOD AVE SE 593 EDGEWOOD AVE SE STE B 2457 MLK JR DR SW STE A 3200 DOWNWOOD CIR NW STE 430A 3807 CLAIRMONT RD 1000 JOHNSON FERRY RD NE 5670 PEACHTREE DUNWOODY RD NE 5445 MERIDIAN MARKS RD NE STE 1180 FAIRBURN RD STE 500

ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA

GA GA GA GA GA GA GA GA GA GA GA GA

30338 30311-5434 30317-2103 30303-3012 30312 30311-1712 30327-1659 30341-4911 30342-1606 30342-4717 30342-4793 30331

PEACHTREE HEMATOLOGY & ONCOLGY PHCY PHARMALIFE LTC

(678) 298-3228 (404) 261-7775

1800 HOWELL MILL RD NW STE 775 2915 PIEDMONT RD STE B

ATLANTA ATLANTA

GA GA

30318-2538 30305

PHARMASOUTH GOVERNMENT SERVICES POLY PLEX PHARMACY PONCE INFECTIOUS DISEASE CTR SHEPHERD APOTHECARY ST JOSEPHS APOTHECARY STAMPS HEALTH SERVICES THE PHARMACY AT EMORY THE PHARMACY AT EMORY MIDTOWN THE PHARMACY CENTER CNTRPOINT TRINITY PHARMACY TRINITY PHARMACY II TUXEDO PHARMACY VN PHARMACY III

(404) 592-0585 (404) 799-3315 (404) 616-2466 (404) 350-7743 (678) 843-7400 (404) 894-1430 (404) 778-2022 (404) 686-1820 (404) 845-3201 (678) 705-5690 (404) 343-1624 (404) 255-3022 (470) 275-6170

2915 PIEDMONT RD NE STE B 2596 DONALD LEE HOLLOWELL PKWY 341 PONCE DE LEON AVENUE 2020 PEACHTREE RD NW 5671 PEACHTREE DUNWOODY RD NE 740 FERST DRIVE NW 1365A CLIFTON RD NE 550 PEACHTREE ST NE 1100 JOHNSON FERRY RD STE 107 3565 MARTIN LUTHER KING JR DR 3886 PRINCETON LAKES WAY #180 164 W WIEUCA RD 5000 BUFORD HWY STE A-106

ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA ATLANTA

GA GA GA GA GA GA GA GA GA GA GA GA GA

30305-2782 30318-8300 30308-2012 30309-1426 30342-5000 30318 30322-1013 30308-2225 30342 30331-4016 30331 30342-3316 30341-3500

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 157 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WENDER & ROBERTS DRUGS - WPF WEST END PHARMACY YOUR PHARMACY SOLUTION INGLES PHARMACY AU MEDICAL CENTER RETAIL PHCY AU MEDICAL CTR EMPLOYEE PHCY AUGUSTA ONCOLOGY ASSOCIATES PC AUGUSTA ONCOLOGY ASSOCIATES PC BARNEY'S PHARMACY BARNEY'S PHARMACY AT SERENITY BARNEYS PHARMACY INC LIVING WELL PHARMACY MEDICAL ASSOCIATES PLUS PHARMACY MEDICAL ASSOCIATES PLUS PHARMACY MEDICAL CENTER PHARMACY MILLER DRUG PEACH ORCHARD DRUGS PHARMACY CARE PROVIDERS OF GA SUMMERVILLE PHARMACY SURREY CENTER PHARMACY CONCORD PHARMACY RELIABLE PHARMACY THOMAS DRUGS TREASURE PHARMACY AND STORE WELLSTAR PHARMACY NETWORK BAINBRIDGE PHARMACY GRIMSLEY PHARMACY CENTER RX DRUG CENTER FIELDALE FARMS FAMILY HEALTH PHCY BALL GROUND PHARMACY HINES PRESCRIPTION SHOP INGLES PHARMACY APPLING HEALTHCARE SYSTEM BARNES PHARMACY FULGHUM DRUGS INC STAN'S PHARMACY INC MED-4-YOU PHARMACY BARBER'S DRUG SHOPPE BLACKSHEAR DRUG COMPANY HEALTH MART

Provider Name

(404) 237-7551 (404) 758-8988 (404) 856-7080 (770) 277-5284 (706) 446-1234 (706) 723-0900 (706) 821-2944 (706) 736-1830 (706) 863-3456 (706) 432-7924 (706) 798-5645 (706) 262-4455 (706) 922-0682 (706) 434-1590 (706) 792-5130 (762) 994-1051 (706) 798-3253 (706) 305-1359 (706) 481-7140 (706) 738-4558 (770) 819-1584 (770) 819-0032 (770) 944-3100 (770) 672-6913 (678) 945-2111 (229) 246-7200 (229) 246-7733 (229) 246-1000 (706) 894-2716 (770) 735-6161 (770) 358-2266 (770) 358-6815 (912) 367-9841 (912) 367-7708 (912) 367-2488 (912) 367-1155 (470) 299-5292 (912) 449-4444 (912) 449-6616 (912) 449-1400

1262 W PACES FERRY RD NW 868 YORK AVE SW 2140 PEACHTREE RD STE 232 1502 ATLANTA HWY 1120 15TH ST 1120 15TH ST 820 ST SEBASTIAN WAY STE 3A 3696 WHEELER RD 215 FURYS FERRY RD 3421 MIKE PADGETT HWY BLDG A 2604 PEACH ORCHARD RD 3736 MIKE PADGETT HWY 2467 GOLDEN CAMP RD 2050 WALTON WAY 3121 PEACH ORCHARD RD 3664 WHEELER RD 2529 PEACH ORCHARD RD 4046 JIMMIE DYESS PKWY STE 100 2279 WRIGHTSBORO RD 483 HIGHLAND AVE 1700 HOSPITAL SOUTH DR 3999 AUSTELL RD STE 903 2704 JEFFERSON ST 3753 AUSTELL RD STE 130 3950 AUSTELL RD 1420 E EVANS ST 1508 E EVANS ST 1205 E SHOTWELL ST 184 PROFESSIONAL DR 470 VALLEY ST 302 COLLEGE DR 631 VETERANS PKWY 163 E TOLLISON ST 694 S MAIN ST 34 NW PARK AVE 438 W PARKER ST 3970 PEACHTREE INDUSTRIAL BLVD 731 CAMERON DR 3487 US HIGHWAY 84 3150 W HIGHWAY 84

ATLANTA ATLANTA ATLANTA AUBURN AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUGUSTA AUSTELL AUSTELL AUSTELL AUSTELL AUSTELL BAINBRIDGE BAINBRIDGE BAINBRIDGE BALDWIN BALL GROUND BARNESVILLE BARNESVILLE BAXLEY BAXLEY BAXLEY BAXLEY BERKELEY LAKE BLACKSHEAR BLACKSHEAR BLACKSHEAR

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30327-2306 30310-2750 30309 30011-3648 30912-0004 30912 30901 30909-6520 30907 30906 30906-2406 30906-0719 30906 30904-2305 30906-3521 30909-6520 30906-2412 30909 30904-4717 30909-3798 30106-6810 30106-1160 30168 30106 30106-1121 39819-4336 39819-4364 39819-4237 30511-4012 30107-4067 30204-1602 30204-1555 31513-0120 31513-0124 31513-0049 31513-0649 30096 31516-1309 31516-2293 31516

BRASSTOWN PROFESSIONAL PHARMACY INC

(706) 745-2303

23 MURPHY HWY # B

BLAIRSVILLE

GA

30512-3071

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 158 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name INGLES PHARMACY HALL DRUG COMPANY INC HARVEYS PHARMACY MIKE'S PHARMACY, INC PIONEER COMMUN HOSPITAL EARLY GORDON'S PHARMACY BLUE RIDGE PHARMACY INGLES PHARMACY RIVERSTONE PHARMACY ADD'S PERSONAL CARE PHARMACY BOWDON HEALTHMART PHARMACY JOHNSON PHARMACY BRASELTON PHARMACY JOHNSON'S RIVER PLACE PHARMACY MEDICAL CENTER PHARMACY CLAYTON PHARMACY GARRETT DRUG COMPANY INGLES PHARMACY LOVVORN DRUG CO BROOKLET DRUG BROXTON PHARMACY,LLC ALTAMA DISCOUNT PHARMACY FREDS PHARMACY GENOA-QOL HEALTHCARE GOLDEN ISLES PHARMACY RAINBOW DRUG STORE BUCHANAN DRUGS BECKY'S DRUGSTORE SHERWOODS DRUG SHOP BUTLER LONG TERM CARE SOLUTIONS SMITHS PHARMACY U SAVE IT PHARMACY CENTER DRUGS COX PHARMACY HARVEYS PHARMACY U SAVE IT CAIRO CALHOUN DRUG CO. CALHOUN PRESCRIPTIONS CROWLEY DRUG CO INC SCOTTS PHARMACY SONORAVILLE PHARMACY THE PRESCRIPTION SHOP

NR_0009_10823 10/2017

Provider Phone Number (706) 745-1700 (229) 723-3441 (229) 723-5202 (229) 724-4461 (229) 724-4208 (912) 988-1780 (706) 632-2244 (706) 632-3654 (706) 258-4157 (678) 726-2111 (770) 258-3366 (678) 257-5400 (770) 967-7000 (770) 967-1000 (770) 848-6337 (770) 537-2321 (770) 537-2364 (770) 537-9501 (770) 537-8889 (912) 842-9886 (912) 359-2362 (912) 264-2622 (912) 554-1602 (912) 574-4210 (912) 266-8140 (912) 265-5040 (770) 646-3570 (229) 649-3784 (770) 945-9526 (478) 862-5655 (478) 862-5655 (229) 435-4571 (229) 377-2777 (229) 377-9017 (229) 377-3688 (229) 435-4571 (706) 629-2426 (706) 629-1001 (706) 979-2400 (706) 625-8311 (706) 383-8374 (706) 629-9139

Provider Street 43 B HIGHWAY 515 90 COURT SQ 12246 COLUMBIA ST STE F 11189 COLUMBIA STREET 11740 COLUMBIA ST 3010 US HWY 80 UNIT B 793 EAST MAIN STREET 5679 APPALACHIAN HWY 101 RIVERSTONE VISTA STE 107 1020 GARLAND DR STE 700 301 W COLLEGE ST 205 E COLLEGE ST 5745 OLD WINDER HWY STE G 2625 OLD WINDER HWY STE H 1515 RIVER PL STE 180 503 ALABAMA AVE S 116 BUCHANAN ST N 2865 BREMEN MT ZION RD 404 ALABAMA AVE S 114 PARKER AVE # B 402 ALABAMA ST N 5711 ALTAMA AVE STE G 5485 NEW JESUP HWY 600 COASTAL VILLAGE DR STE 107 3010 ALTAMA AVE 4319 NEW JESUP HWY 406 CARROLLTON ST 128 N BROAD ST 4700 NELSON BROGDON BL STE 190 10B N POPLAR ST 10 N POPLAR ST 101 WHITE RD 133 2ND AVE SE 300 2ND AVE SE 1000 1ST AVE NE 445 9TH STREET SE 450 RED BUD RD 1100 RED BUD RD 1201 DEWS POND ROAD STE 1 845 CURTIS PKWY SE 6824 FAIRMOUNT HWY SE 1042 RED BUD RD NE

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Provider City BLAIRSVILLE BLAKELY BLAKELY BLAKELY BLAKELY BLOOMINGDALE BLUE RIDGE BLUE RIDGE BLUE RIDGE BOGART BOWDON BOWDON BRASELTON BRASELTON BRASELTON BREMEN BREMEN BREMEN BREMEN BROOKLET BROXTON BRUNSWICK BRUNSWICK BRUNSWICK BRUNSWICK BRUNSWICK BUCHANAN BUENA VISTA BUFORD BUTLER BUTLER BYRON CAIRO CAIRO CAIRO CAIRO CALHOUN CALHOUN CALHOUN CALHOUN CALHOUN CALHOUN

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30512-3571 39823-2340 39823-2560 39823 39823-2574 31302-4557 30513 30513-4202 30513-6648 30622-3200 30108-1309 30108-1108 30517 30517-7021 30517-5603 30110-2007 30110-1606 30110-2542 30110-2006 30415-8208 31519-6001 31525-2200 31523-1119 31520-1973 31520-4607 31520-1605 30113 31803 30518 31006 31006-4505 31008-3711 39828-2706 39828-2726 39828-2276 39828-3187 30701-1959 30701 30701 30701-3688 30701 30701-2081

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LIVE OAK PHARMACY TOTAL CARE PHARMACY CANTON NORTHSIDE PHARMACY MID-CITY PHARMACY PHARMOORE PHARMACY MARKETPLACE PHARMACY SULLIVAN DRUG INC BROOKE'S PHARMACY HANEYS DRUG CORNER TURNER PHARMACY HOLT'S PHARMACY INGLES PHARMACY INGLES PHARMACY WEST END PHARMACY YOUNG BROTHERS PHARMACY INC J&J PHARMACY BRADFORD DRUG COMPANY U SAVE IT PHARMACY MEDICINE CENTER OF ATLANTA GA CARLTON'S PHARMACY INC CORNER DRUGS INC FOOD CITY INGLES PHARMACY LIVING WELL CENTRAL PHARMACY INC LIVING WELL EXPRESS PHARMACY LIVING WELL PHARMACY CLARKESVILLE DRUG INC EXPRESSMED INC INGLES PHARMACY GLOBAL PHARMACY OPTION CARE ZAK PHARMACY LLC KEMPS PHARMACY INC THE DRUG STORE CLAYTON PHARMACY INGLES PHARMACY U SAVE IT PHARMACY WAUKA MOUNTAIN PHARMACY, INC. WOODY'S PHARMACY CLEVELAND DRUG CO INGLES PHARMACY MCDANIEL PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (229) 336-2255 (229) 787-5765 (770) 479-2171 (770) 479-5533 (770) 213-3341 (706) 384-2085 (706) 384-2022 (770) 834-9050 (770) 834-3393 (770) 832-7076 (770) 382-5757 (770) 382-8226 (770) 607-5897 (770) 606-0697 (770) 382-4010 (706) 777-3373 (770) 748-3100 (478) 953-8118 (770) 934-7703 (706) 695-5555 (706) 695-0444 (706) 695-0423 (706) 517-7312 (706) 695-0909 (706) 517-1901 (706) 422-9355 (706) 754-3763 (706) 754-0101 (706) 754-3933 (404) 299-8255 (404) 292-1812 (404) 500-1451 (912) 739-2745 (912) 739-9393 (706) 782-3211 (706) 782-3380 (229) 435-4571 (770) 983-9556 (770) 983-3510 (706) 219-2626 (706) 348-1571 (478) 934-6885

Provider Street 98 OAKLAND AVE E 7544 NORTH TURKEY RD 170 MARIETTA HWY 196 E MAIN ST 3422 SIXES RD STE 106 9205 LAVONIA RD 9563 LAVONIA RD 812 S PARK ST STE 5A 623 DIXIE ST 821 DIXIE ST 406 GRASSDALE RD 879 JOE FRANK HARRIS PKWY 825 WEST AVE 824 WEST AVE 2 W MAIN ST 1 ALABAMA ST 500 N MAIN ST 202 GUNN RD 3650 CHAMBLEE TUCKER RD 101 MURRAY PLZ 430 N 3RD AVE 502 GI MADDOX PARKWAY 964 GI MADDOX PKWY 2976 HIGHWAY 76 UNIT A 824 GI MADDOX PKWY STE B 79A HIGHWAY 286 596 W LOUISE ST STE D 410A W LOUISE ST 199 E LOUISE ST 926B MONTREAL RD 808 PARK NORTH BLVD STE 100 4600 E PONCE DE LEON AVE STE E 107A S DUVAL ST 305 E LONG ST 100 S MAIN ST 176 HIGHWAY 441 N 321 HIGHWAY 441 N 5233 CLEVELAND HWY 5226 DAHLONEGA HWY 19 E JARRARD ST 55 HELEN HWY 195 E DYKES ST

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Provider City CAMILLA CAMILLA CANTON CANTON CANTON CARNESVILLE CARNESVILLE CARROLLTON CARROLLTON CARROLLTON CARTERSVILLE CARTERSVILLE CARTERSVILLE CARTERSVILLE CARTERSVILLE CAVE SPRING CEDARTOWN CENTERVILLE CHAMBLEE CHATSWORTH CHATSWORTH CHATSWORTH CHATSWORTH CHATSWORTH CHATSWORTH CHATSWORTH CLARKESVILLE CLARKESVILLE CLARKESVILLE CLARKSTON CLARKSTON CLARKSTON CLAXTON CLAXTON CLAYTON CLAYTON CLAYTON CLERMONT CLERMONT CLEVELAND CLEVELAND COCHRAN

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31730-1529 31730 30114-2303 30114-2707 30114-9120 30521 30521-3254 30117 30117-3816 30117-4415 30121-1975 30120-2482 30120-6133 30120-6100 30120-3506 30124-2611 30125-2302 31028-8045 30341-4420 30705-2513 30705-2540 30705 30705-4000 30705-6352 30705-2073 30705-6501 30523-5849 30523-5808 30523-6019 30021-1315 30021-1946 30021 30417-2029 30417-1411 30525-5480 30525-4207 30525 30527-2205 30527-1900 30528-1212 30528-1092 31014-6514

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PORTER PHARMACY & GIFTS INC COLBERT PHARMACY FAITH PHARMACY OLD NATIONAL DRUG PHARMACY GROW DRUG CO MILLER COUNTY HOSPITAL PHCY ACARIAHEALTH PHARMACY, INC. COMMUNITY HEALTH PHARMACY DINGLEWOOD PHARMACY DURHAMS PHARMACY FITZGERALD'S PHARMACY MIDTOWN PHARMACY NORTH COLUMBUS PHARMACY OPEN GATE PHARMACY OPEN GATE PHARMACY RIVER ROAD PHARMACY INC ST FRANCIS OUTPATIENT PHARMACY THE MEDICAL CENTER O/P PHARMACY THE VILLAGE APOTHECARY THOMAS DRUGS VALLEY HEALTHCARE SYSTEM, INC. INGLES PHARMACY U SAVE IT COMMERCE BEASLEY DRUG COMPANY CONYERS PHARMACY INC GENOA-QOL HEALTHCARE INGLES PHARMACY REAGAN HOME CARE PHCY ROCKDALE PHARMACY ADAMS DRUG STORE INC HARVEYS PHARMACY U SAVE IT PHARMACY ARNOLD DRUG COMPANY BRIOVARX INGLES PHARMACY MEDICINE SHOPPE PHARMACY TIMS PHARMACY CARMICHAELS PHARMACY CITIZENS EXPRESS PHARMACY BETHELVIEW PHARMACY GOODSON DRUG COMPANY HIGHLANDS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (478) 934-6344 (706) 788-2102 (770) 997-1112 (404) 209-0070 (229) 758-3316 (229) 758-4245 (706) 780-4700 (706) 321-3700 (706) 322-0616 (706) 322-6721 (706) 323-0306 (706) 596-8871 (706) 327-5125 (706) 225-0022 (706) 323-0306 (706) 317-2583 (706) 320-3078 (706) 571-1992 (706) 327-4242 (706) 569-8680 (706) 507-1186 (706) 335-4650 (229) 435-4571 (770) 483-7211 (770) 929-1414 (678) 509-8455 (770) 922-3507 (770) 483-4727 (678) 933-8965 (229) 273-3433 (229) 273-8231 (229) 273-6422 (706) 778-4918 (706) 776-1955 (706) 778-8099 (706) 778-7174 (706) 776-3784 (678) 712-4570 (770) 788-9191 (470) 253-4893 (770) 887-5040 (770) 887-1670

Provider Street 129 N 2ND ST 5674 HIGHWAY 72 W 1720 PHOENIX BLVD STE 400 5615 OLD NATIONAL HWY STE B 207 W GEER ST 209 N CUTHBERT ST 3021 SANDY PKWY BLDG 2 STE A B 2100 COMER AVE 1939 WYNNTON RD 1420 17TH ST 2051 10TH AVE 2660 BUENA VISTA RD STE A 6298 VETERANS PKWY STE 2H 4519 WOODRUFF RD STE 16 1807 S LUMPKIN RD STE C 5100 RIVER RD 2300 MANCHESTER EXPY STE A4 710 CENTER ST 6801 RIVER RD BLDG 2 STE 201 4105 BUENA VISTA RD STE C 1600 FT BENNING RD 220 HWY 334 1751 N ELM ST 933 CENTER ST NE 1179 WEST AVE SW 977B TAYLOR ST SW 2455 SALEM RD SE 1600 MILSTEAD RD NE 405 SIGMAN RD NW 408 E 16TH AVE 1011 16TH AVE 405 4TH AVE EAST 639 IRVIN ST 166 COMMERCE PKWY STE A&B 199 HABERSHAM COUNTY SHOP CTR 1667 WILLINGHAM AVE 130 MAGNOLIA LN 9148 HIGHWAY 278 NE STE D 4104 TATE STREET 5610 BETHELVIEW RD STE 700 116 W MAPLE ST 260 ELM STREET

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Provider City COCHRAN COLBERT COLLEGE PARK COLLEGE PARK COLQUITT COLQUITT COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COMMERCE COMMERCE CONYERS CONYERS CONYERS CONYERS CONYERS CONYERS CORDELE CORDELE CORDELE CORNELIA CORNELIA CORNELIA CORNELIA CORNELIA COVINGTON COVINGTON CUMMING CUMMING CUMMING

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31014-8742 30628-2934 30349 30349-3817 39837-3533 39837 31909-1695 31904-8725 31906-2964 31901-2022 31901 31906-3914 31909-3526 31904 31903-2794 31904-5841 31904 31901-1527 31904-3303 31907-3866 31903-2834 30530 30529-2316 30012-4567 30012-5280 30012-5357 30013-6743 30012-3738 30012-3625 31015-1671 31015-1539 31015-3620 30531-3267 30531-5357 30531-3412 30531-4209 30531-2241 30014-7032 30014 30040-7530 30040-2634 30040

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name INGLES PHARMACY LAKESIDE PHARMACY NSH HOMECARE PHARMACY FORSYTH SAWNEE DRUG COMPANY FREDS PHARMACY SOUTHWEST GA REG MED CTR DACULA PHARMACY EXPRESS FOOD & PHARMACY DAHLONEGA PHARMACY INC MULLINS PHARMACY WOODY'S PHARMACY ASHLYN DRUGS C & C PHARMACY THE MEDICINE SHOPPE WENDER & ROBERTS DRUGS-DALLAS CHEROKEE PHARMACY DART DRUGS FAMILY PHARMACY FOOD CITY GENOA-QOL HEALTHCARE HMC RX CARE PROFESSIONAL PHARMACY S & W PHARMACY SUTTON FAMILY PHARMACY VALURITE DISCOUNT PHARMACY WHITES PHARMACY OF DALTON LLC THE MEDICINE SHOPPE DARIEN PHARMACY DAWSON PHARMACY MOSELEY DRUG COMPANY DAWSON PHARMACY GOODSON'S PHARMACY PROMINENCE PHARMACY BRYANT PHARMACY & COMPOUNDING GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE LONGS DEKALB HEALTH PHARMACY MCKINNEYS APOTHECARY INC CROSSROADS PHARMACY JENNINGS PHARMACY & EQUIPMENT THE APOTHECARY, INC ROBERTS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (678) 455-0799 (770) 205-0290 (770) 844-3396 (770) 889-8900 (229) 732-2892 (229) 209-1343 (770) 339-1593 (678) 889-2131 (706) 864-2522 (706) 867-0514 (706) 867-9493 (770) 443-0205 (770) 445-2600 (770) 445-6422 (770) 445-2148 (706) 278-6600 (706) 278-1900 (706) 226-6000 (706) 259-9223 (706) 229-6999 (706) 272-6450 (706) 278-2490 (706) 259-9787 (706) 852-1802 (706) 217-2700 (706) 259-9707 (706) 795-0920 (912) 437-3784 (229) 995-2131 (229) 995-2126 (706) 265-3934 (706) 265-2020 (706) 265-1332 (404) 709-2941 (404) 594-8492 (404) 594-8491 (404) 270-9242 (404) 378-5408 (706) 839-7000 (770) 535-8860 (229) 782-5500 (229) 524-2313

Provider Street 1090 BUFORD RD 1505 NORTHSIDE BLVD STE 1600 1200 NORTHSIDE FORSYTH DR 2515 BUSINESS DR 101 N WEBSTER ST 361 RANDOLPH ST 2555 2ND AVE 3685 BRASELTON HWY STE 101 70 MEMORIAL DR 24 ALICIA LN STE 2 130 LONG BRANCH RD 1160 OLD HARRIS RD 621 W MEMORIAL DR 760 PAULDING PLZ 318 MAIN ST 1506 N THORNTON AVE STE A 1101 MEMORIAL DR 1100 E WALNUT AVE STE 16 1287 CLEVELAND HWY 900 SHUGART RD STE 209 1200 MEMORIAL DR 1100 BURLEYSON RD 1710 CLEVELAND HWY 3957 CLEVELAND RD UNIT A 1006 PROFESSIONAL BLVD 2955B CLEVELAND RD 7 JOHNSON DR 1229 NORTH WAY 101 E LEE ST 412 JOHNSON ST SE 66 S.400 CENTER LN STE 125 159 HIGHWAY 53 W 131 PROMINENCE CT STE 140 2626 RAINBOW WAY 445 WINN WAY FL 2 3110 CLIFTON SPRINGS RD STE B 1428 SCOTT BLVD 225 E PONCE DE LEON AVE STE 14 4654 HIGHWAY 115 UNIT 1 638 HISTORIC HWY 441 STE A 130 W BROAD AVE 803 N WILEY AVE

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Provider City CUMMING CUMMING CUMMING CUMMING CUTHBERT CUTHBERT DACULA DACULA DAHLONEGA DAHLONEGA DAHLONEGA DALLAS DALLAS DALLAS DALLAS DALTON DALTON DALTON DALTON DALTON DALTON DALTON DALTON DALTON DALTON DALTON DANIELSVILLE DARIEN DAWSON DAWSON DAWSONVILLE DAWSONVILLE DAWSONVILLE DECATUR DECATUR DECATUR DECATUR DECATUR DEMOREST DEMOREST DOERUN DONALSONVILLE

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30041-2720 30041-7660 30041-7659 30028-4394 39840-2522 39840-6127 30019-2101 30019-5920 30533-0800 30533-1637 30533-7132 30132 30132-4120 30132-5028 30132-4266 30720-8515 30720-8742 30721-4185 30721 30720-2467 30720-2529 30720-3016 30721-8313 30721-7444 30720-2505 30721-8004 30633 31305-0000 39842-1485 39842 30534 30534-3415 30534-8933 30034 30030-1707 30034-4600 30030-1424 30030-3443 30535 30535 31744-0490 39845-1121

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SEMINOLE HARTZOG PHARMACY COLLIERS PHARMACY WAI-KIU FAMCARE PHARMACY FULCO DISCOUNT DRUG CENTER HARVEYS PHARMACY HARVEYS PHARMACY HOSPITAL DISCOUNT DRUGS MALCOLMS DISCOUNT PHARMACY MCRAES PHARMACY MOBLEYS PHARMACY ROY POWELLS DRUG STORE THE MEDICINE CABINET THE MEDICINE CABINET WARD ST D & B PHARMACY INGLES PHARMACY PREMIER DRUGSTORE THE APOTHECARY SHOPPE VILLAGE PHARMACY, INC. WILLIAMS PHARMACY MAX BROWN PHARMACY MEDICAL PARK PHARMACY

Provider Name

(229) 524-5364 (770) 455-4433 (770) 455-8882 (912) 384-7026 (912) 393-3289 (912) 383-6862 (912) 384-0693 (912) 384-1898 (912) 384-5255 (912) 383-7947 (912) 384-1793 (912) 383-8510 (912) 383-6337 (678) 391-1139 (678) 383-8715 (770) 635-8509 (770) 949-7977 (678) 501-5165 (678) 695-7927 (478) 272-8086 (478) 272-8065

111 E 2ND ST 5705 BUFORD HWY NE 5150 BUFORD HWY NE STE B180 301 SHIRLEY AVE 901 W WARD ST 813 S PETERSON AVE 308 WESTSIDE DR 250 S PETERSON AVE 1002 WARD ST 800 N PETERSON AVE 223 ASHLEY ST W 722 SHIRLEY AVE 235 W WARD ST 9459 HIGHWAY 5 STE U 1817 DALLAS NEBO RD 8446 CAMPBELLTON ST 6126 PRESTLEY MILL RD UNIT K 3697 HIGHWAY 5 STE 6 8697 HOSPITAL DR STE 201 809 N JEFFERSON ST # 02791 2406 BELLEVUE RD

DONALSONVILLE DORAVILLE DORAVILLE DOUGLAS DOUGLAS DOUGLAS DOUGLAS DOUGLAS DOUGLAS DOUGLAS DOUGLAS DOUGLAS DOUGLAS DOUGLASVILLE DOUGLASVILLE DOUGLASVILLE DOUGLASVILLE DOUGLASVILLE DOUGLASVILLE DUBLIN DUBLIN

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

39845-1601 30340-1206 30340-1164 31533-2333 31533-3517 31533-5234 31533-3530 31533 31533-1189 31533 31533-2349 31533-2008 31533 30135-1539 30134-4865 30134 30134-2273 30135-6901 30134-2225 31021-6305 31021-2885

THE MEDICINE CABINET OF DUBLIN LLC THE PRESCRIPTION SHOPPE TOMLINSON PHARMACY ANNA'S DULUTH PHARMACY CORNER PHARMACY INC DULUTH PHARMACY EXPRESS PHARMACY INC HANA PHARMACY HANA PLUS PHARMACY YES PHARMACY CARLTON'S DUNWOODY PHARMACY DUNWOODY PHARMACY FREDS PHARMACY MICHAELS PHARMACY INC HUFF'S EXPRESS PHARMACY HUFF'S EXPRESS PHARMACY RIVERSIDE DRUGS BAZE SPECIALTY PHARMACY DISCOUNT PHARMACY SERVICES WASHINGTON ROAD PHARMACY

(478) 272-1822 (478) 275-7400 (478) 272-7722 (470) 268-8922 (770) 622-0688 (770) 476-2820 (770) 557-0306 (678) 878-2445 (706) 490-1104 (770) 837-0571 (770) 394-3233 (770) 455-1144 (478) 296-7336 (478) 274-8876 (706) 635-4310 (706) 635-4310 (706) 635-5151 (404) 761-4448 (404) 305-8002 (404) 761-6488

1819 RICE AVE 302 INDUSTRIAL BLVD 108 ROWE ST 4470 SATELLITE BLVD STE 108 2550 PLEASANT HILL RD STE 120 3890 PLEASANT HILL RD STE #10 1630 PLEASANT HILL RD STE C3 4195 PLEASANT HILL RD STE D 3590 PEACHTREE INDUSTRIAL BLVD 3500 GWINNETT PLACE DR STE 15 5484 CHAMBLEE DUNWOODY RD 4675 N SHALLOWFORD RD STE 101 705 CENTRAL DR 203 CENTRAL DR 97 HEFNER ST STE 201 97 HEFNER ST STE 201 941 MADDOX DR STE 202 1526 E FORREST AVE STE 102 1514 E CLEVELAND AVE STE 114 3518 WASHINGTON RD

DUBLIN DUBLIN DUBLIN DULUTH DULUTH DULUTH DULUTH DULUTH DULUTH DULUTH DUNWOODY DUNWOODY EAST DUBLIN EAST DUBLIN EAST ELLIJAY EAST ELLIJAY EAST ELLIJAY EAST POINT EAST POINT EAST POINT

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31021-3603 31021-2800 31021-5238 30096-8852 30096-9278 30096-4807 30096 30096-6393 30096 30096 30338-4133 30338 31027-7507 31027-7407 30540-8268 30540-8268 30540-8186 30344-6979 30344 30344-5844

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

EASTMAN DRUGS MEDICAL CENTER PRES SHOP SHOPPERS PHARMACY LANE DRUG COMPANY ELBERTON PHARMACY INC INGLES PHARMACY MADDENS PHARMACY WARDS PHARMACY GILL DRUG COMPANY HUFFS DRUG STORE INGLES PHARMACY MEDICAL CENTER WEST PHARMACY PROVIDENCE PHARMACY FAIRMOUNT DRUGS JONES PHARMACY COLONY DISCOUNT DRUGS EAST GEORGIA RESPICARE, INC FLINTSTONE PHARMACY CITIZENS PHARMACY INGLES PHARMACY BENNETTS HOMETOWN PHARMACY FOLKSTON PHARMACY CHRISTIANS PHARMACY

Provider Name

(478) 374-6670 (478) 374-5514 (706) 485-6262 (229) 835-2212 (706) 283-3161 (706) 283-7095 (706) 283-1701 (706) 283-1412 (912) 937-2002 (706) 635-7931 (706) 635-7176 (706) 854-2424 (678) 489-2069 (706) 337-5541 (770) 461-3911 (229) 423-9801 (229) 424-0018 (706) 820-9971 (770) 967-3324 (770) 965-8928 (912) 496-3784 (912) 496-2522 (404) 366-4320

1221 PLAZA AVE 710 MEDICAL CENTER DR 303 S JEFFERSON AVE 19427 HARTFORD ST 556 ELBERT ST 903 ELBERT ST 101 COLLEGE AVE 8 S PUBLIC SQ 54 E OGLETHORPE ST 136 INDUSTRIAL BLVD 100 OLD ORCHARD SQ 465 N BELAIR RD STE 1A 216 NW BROAD ST STE B 2688 HIGHWAY 411 SE 575 GLYNN ST N 502 S GRANT ST 611 S GRANT ST 3255 CHATTANOOGA VALLEY RD 5325 ATLANTA HWY 4260 WINDER HWY 4402 N SECOND ST STE C 100 W MAIN ST 1032 MAIN ST

EASTMAN EASTMAN EATONTON EDISON ELBERTON ELBERTON ELBERTON ELBERTON ELLAVILLE ELLIJAY ELLIJAY EVANS FAIRBURN FAIRMOUNT FAYETTEVILLE FITZGERALD FITZGERALD FLINTSTONE FLOWERY BRANCH FLOWERY BRANCH FOLKSTON FOLKSTON FOREST PARK

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31023-9007 31023-6736 31024-1129 39846-5627 30635-2347 30635-2633 30635-1705 30635-2448 31806-3527 30540-3713 30540-8172 30809-3189 30213-4106 30139-2924 30214-1198 31750-3312 31750 30725-2387 30542-3336 30542-3603 31537 31537-3018 30297

CHRISTIANS PHARMACY & HEALTH SERVIC KAYTON PHARMACY TRUSTEE DRUG INC. CASTLEBERRY DRUG CO U SAVE IT PHARMACY BUY RITE DRUGS BATTLEFIELD PHARMACY FOOD CITY

(404) 362-2990 (404) 600-5666 (404) 366-9088 (478) 994-2051 (478) 994-2015 (229) 768-2422 (706) 956-8605 (706) 861-8072

4980 PHILLIPS DRIVE 541 FOREST PKWY STE 4 381 FOREST PKWY 67 N LEE 25 W JOHNSTON ST 114 S HANCOCK ST 1543 BATTLEFIELD PKWY 531 BATTLEFIELD PKWY

FOREST PARK FOREST PARK FOREST PARK FORSYTH FORSYTH FORT GAINES FORT OGLETHORPE FORT OGLETHORPE

GA GA GA GA GA GA GA GA

30297 30297-2147 30297-2165 31029 31029 39851-4338 30742-4015 30742

LOOKOUT MOUNTAIN COMMUNITY SERVICE FIVE POINTS PHARMACY U SAVE IT PHARMACY FRANKLIN PHARMACY DIAGNOSTIC CLINIC PHARMACY DIXIE CITY PHARMACY HST PHARMACY LANIER PHARMACY LAWRENCE PHARMACY

(706) 861-3387 (478) 822-0555 (478) 825-8226 (706) 675-3376 (678) 450-7855 (770) 536-3108 (678) 248-3131 (770) 536-8861 (770) 532-0186

1875 FANT DR 115 COMMERCIAL HEIGHTS 609 BLUEBIRD BLVD 271 E COURT SQUARE 1240 JESSE JEWELL PKWY STE 550 1079 JESSE JEWELL PKWY SW 1267 PROFESSIONAL PKWY STE 200 3560 THOMPSON BRIDGE RD 631 BROAD ST SE

FORT OGLETHORPE FORT VALLEY FORT VALLEY FRANKLIN GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE

GA GA GA GA GA GA GA GA GA

30742-3307 31030 31030-5082 30217-0000 30501-3862 30501-6103 30507 30506-1518 30501-3729

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LONGSTREET CLINIC PC MCELVEENS PHARMACY MEDICAL PARK PHARMACY NGHS LTC RX RIVERSIDE PHARMACY QUICK RX PHARMACY CENTRAL PHARMACY STRICKLANDS PHARMACY GORDON DRUG COMPANY GRANTVILLE PHARMACY GRAY DRUG COMPANY HOMETOWN PHARMACY INGLES PHARMACY COVENANT HEALTH PHARMACY BENZER PHARMACY LAKE COUNTRY PHCY & CMPD CTR TENDERCARE CLINIC PHARMACY U SAVE IT PHARMACY BOWEN PHARMACY INC CLAXTON COLE PHARMACY DAVID'S DRUG & SURGICAL SHOP HOBBS PHARMACY & GIFTS HOSPITAL DISCOUNT DRUGS INGLES PHARMACY U SAVE IT GRIFFIN WYNN'S PHARMACY INC BARNEY'S PHARMACY GROVETOWN MEDICAP PHARMACY CHANCY DRUGS HARVEYS PHARMACY HOLMES PHARMACY AT HAMILTON MOYES PHARMACY HAMPTON VICTORY PHARMACY CHAPMAN DRUG CO INC ECONOMY DRUG STORE HARTWELL DRUGS INGLES PHARMACY SCOTTIE STORES DISCOUNT DRUG BATTS DRUG COMPANY COMM CARE PHCY-HAWKINSVILLE INSTITUTIONAL PHCY SOLUTIONS CHIP'S DISCOUNT DRUGS

NR_0009_10823 10/2017

Provider Phone Number (770) 533-6680 (770) 534-7675 (770) 535-8860 (770) 219-7794 (770) 532-6253 (912) 966-5665 (912) 654-3031 (912) 654-2184 (478) 628-2425 (770) 583-9973 (478) 986-3161 (478) 986-4827 (478) 986-3592 (678) 585-4962 (706) 999-9792 (706) 923-2933 (706) 454-5150 (706) 672-4221 (770) 227-5770 (770) 227-2428 (770) 227-6338 (770) 228-2788 (770) 227-7045 (770) 228-5815 (770) 227-7772 (770) 227-9432 (706) 869-8535 (912) 772-9100 (229) 794-2750 (229) 794-2989 (706) 628-9995 (770) 946-5172 (678) 519-3399 (404) 761-1136 (706) 376-4483 (706) 376-5801 (706) 376-3212 (706) 376-5026 (478) 892-9021 (478) 783-4556 (478) 892-9053 (912) 375-3218

Provider Street 725 JESSE JEWELL PKWY SE 1210 THOMPSON BRIDGE RD 2551 LIMESTONE PARKWAY 825 JESSE JEWELL PKWY SE 935 GREEN ST 5204 AUGUSTA RD 114 W BARNARD ST 111 E BARNARD ST 240 MILLEDGEVILLE HWY 16 MAIN ST 157 BILL CONN PKWY 236 W CLINTON ST 261 W CLINTON ST 1132 ATHENS HWY STE 206 1031 VILLAGE PARK DR STE 104 1110 COMMERCE DR STE 110 803 S MAIN ST 121 S COURT SQUARE 1378 EXPERIMENT ST 131 W TAYLOR ST 315 S 8TH ST 220D WEST COLLEGE ST 622 S 8TH ST 1735 ZEBULON RD 222 W POPLAR ST 566 S 8TH ST 5135 WRIGHTSBORO RD 1 HIDDEN CREEK DR 205 E MAIN ST 775 GA HWY 122 W 111 DOGWOOD LN 34 E MAIN ST S 11328 TARA BLVD 615 N CENTRAL AVE 380 W FRANKLIN ST 118 ATHENS ST 1000 E FRANKLIN ST 20 N FOREST AVE 115 COMMERCE ST 150 COMMERCE ST 115 COMMERCE ST 240 S TALLAHASSEE ST

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Provider City GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE GAINESVILLE GARDEN CITY BRANCH GLENNVILLE GLENNVILLE GORDON GRANTVILLE GRAY GRAY GRAY GRAYSON GREENSBORO GREENSBORO GREENSBORO GREENVILLE GRIFFIN GRIFFIN GRIFFIN GRIFFIN GRIFFIN GRIFFIN GRIFFIN GRIFFIN GROVETOWN GUYTON HAHIRA HAHIRA HAMILTON HAMPTON HAMPTON HAPEVILLE HARTWELL HARTWELL HARTWELL HARTWELL HAWKINSVILLE HAWKINSVILLE HAWKINSVILLE HAZLEHURST

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30501-3834 30501-1779 30501 30501-3830 30501-3325 31408-1606 30427-2000 30427-1553 31031-3827 30220-3402 31032-6349 31032 31032-6123 30017-1760 30642 30642 30642-1211 30222 30223-1735 30223-3046 30224-4206 30224-4250 30224 30224-5103 30224-3033 30224 30813-2803 31312-4590 31632-1121 31632-1066 31811-6089 30228-2930 30228-6229 30354-1917 30643-1574 30643-1851 30643-2204 30643-7214 31036-1301 31036 31036-8420 31539

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HARDIE'S DRUG STORE INC RANDYS HELEN PHARMACY HEPHZIBAH PHARMACY CHATUGE PHARMACY FREDS PHARMACY INGLES PHARMACY HINESVILLE PHARMACY BLOSSOM PHARMACY WELLSTAR PHCY NTWK HOMER DRUG CO INC JACKSON PHARMACY INGLES PHARMACY BIG DS DISCOUNT DRUGS CITY PHARMACY JACKSON DRUG CO INGLES PHARMACY JASPER DRUG STORE NORTHSIDE PHARMACY - JASPER CRAWFORD W LONG PHARMACY JEFFERSON DRUGS IHS PHARMACY HARVEYS PHARMACY JONES DRUG COMPANY JONES PRESCRIPTION SHOP WAYNE DRUG COMPANY WAYNE MEM HOSP PHCY RETAIL LILYS PHARMACY OH PHARMACY PREMIER SPECIALTY PHARMACY REFF HEALTHMART PHARMACY COBB PHARMACY, INC. INNOVATION COMPOUNDING LEDFORD RX EXPRESS PHARMACY MEDI-THRIFT PHARMACY PROFESSIONAL PARK ASSOCIATES CORLEY DRUGS HOLMES PHARMACY THE MEDICINE CABINET THE MEDICINE CABINET CHANCY DRUGS LAKELAND DRUG COMPANY SGMC LANIER CAMPUS

NR_0009_10823 10/2017

Provider Phone Number (912) 375-2545 (706) 878-0066 (706) 592-4646 (706) 896-4686 (706) 896-1774 (706) 896-4489 (912) 876-8125 (678) 217-5645 (470) 644-8095 (706) 677-3223 (706) 658-0064 (706) 613-1734 (770) 775-7650 (770) 775-7812 (770) 775-7880 (706) 692-2686 (706) 692-6427 (706) 692-1171 (706) 367-5285 (706) 367-5221 (478) 945-3500 (912) 427-6239 (912) 427-3726 (912) 427-8825 (912) 427-4288 (912) 530-3375 (678) 964-5459 (470) 223-4775 (770) 622-8901 (770) 603-5555 (888) 761-8093 (770) 421-1399 (706) 638-1281 (706) 638-3114 (706) 638-1606 (706) 884-2843 (706) 884-7301 (706) 298-4930 (706) 298-4928 (229) 559-9394 (229) 482-3677 (229) 482-8409

Provider Street 38 S TALLAHASSEE ST 8016 S MAIN ST STE A1 4819 WINDSOR SPRING RD 579 N MAIN ST 534 BELL CREEK RD 94 N MAIN ST 481 ELMA G MILES PKWY 4109 JIMMY LEE SMITH PKWY #C 144 BILL CARRUTH PKWY #2000 1228 HISTORIC HOMER HWY 55 FREEDOM PKWY STE 101 9161 HIGHWAY 29 S 38 OAK ST 22 MULBERRY ST 4 2ND ST 1449 W CHURCH ST 1 N MAIN ST 55 BURNT MOUNTAIN RD 86 N PUBLIC SQ 23 LEE ST 13762 US HIGHWAY 80 955 S 1ST ST 149 NW BROAD ST 101 PEACHTREE ST 192 N 1ST ST 865 SOUTH FIRST ST 11670 JONES BRIDGE RD STE E 10900 MEDLOCK BRIDGE RD #308 11720 MEDLOCK BRIDGE RD. #162 188 UPPER RIVERDALE RD STE C 3745 CHEROKEE ST NW STE 604 6095 PINE MTN RD NW STE 108 1201 N MAIN ST 324 W PATTON ST 611 E VILLANOW ST 18 NEW AIRPORT RD STE B 136 COMMERCE AVE 300 MOOTY BRIDGE RD STE 112 205 VERNON ST 453 LAKES BLVD 42 W MAIN ST 116 WEST THIGPEN AVE

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Provider City HAZLEHURST HELEN HEPHZIBAH HIAWASSEE HIAWASSEE HIAWASSEE HINESVILLE HIRAM HIRAM HOMER HOSCHTON HULL JACKSON JACKSON JACKSON JASPER JASPER JASPER JEFFERSON JEFFERSON JEFFERSONVILLE JESUP JESUP JESUP JESUP JESUP JOHNS CREEK JOHNS CREEK JOHNS CREEK JONESBORO KENNESAW KENNESAW LA FAYETTE LA FAYETTE LA FAYETTE LAGRANGE LAGRANGE LAGRANGE LAGRANGE LAKE PARK LAKELAND LAKELAND

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31539-6154 30545-3620 30815-4848 30546-2219 30546-2300 30546-2254 31313-4015 30141 30141 30547-2737 30548-1996 30646-3772 30233 30233-1933 30233-1920 30143-4075 30143-1500 30143-1299 30549-1084 30549-1345 31044-3509 31545-0331 31545 31545-0211 31545-1333 31545 30005 30097 30097 30236 30144-6785 30152-3332 30728-2150 30728-3612 30728 30240-1410 30241-2338 30240 30240 31636-6607 31635-6835 31635

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RIGGINS PHARMACY SPINE CARE & PAIN MGMT SRVCS CONCORD PHARMACY CONCORD PHARMACY GENOA-QOL HEALTHCARE GWINNETT CLINIC PHARMACY GWINNETT DRUGS GWINNETT PHARMACY INGLES PHARMACY TOTALCARE PHARMACY U SAVE IT PHARMACY SKRIP SHOPPE PHARMACY LILBURN COMMUNITY PHARMACY CITY PHARMACY CRAWFORD & BREAZEALE PHARMACY LITHIA SPRINGS PHARMACY WYATTS PHARMACY AHF PHARMACY BAY PHARMACY INC EAGLES LANDING PHARMACY INGLES PHARMACY MOYES PHARMACY LOCUST GROVE FREEDOM PHARMACY FAIRYLAND PHARMACY BARNEY'S PHARMACY #819 FREDS PHARMACY LOUISVILLE DRUG COMPANY PEACHTREE PHARMACY & GIFTS INC LUDOWICI DRUGS LULA PHARMACY LUMBER CITY DRUGS INC

Provider Name

(706) 356-8863 (706) 433-0940 (770) 338-0971 (678) 990-8920 (678) 993-0687 (678) 226-6212 (770) 995-5911 (770) 338-1111 (678) 985-2732 (770) 962-4071 (229) 435-4571 (706) 743-5477 (770) 710-0478 (706) 359-3618 (706) 359-3343 (770) 948-5208 (770) 948-8825 (770) 808-3705 (770) 957-0040 (770) 957-5556 (678) 583-8094 (770) 957-6004 (678) 292-6243 (706) 820-1627 (478) 625-8980 (478) 625-1928 (478) 625-7575 (478) 625-9450 (912) 545-2125 (770) 869-3616 (912) 363-4979

12240 AUGUSTA RD 12134 AUGUSTA RD STE C 575 PROFESSIONAL DR STE 170 771 OLD NORCROSS RD 175 GWINNETT DR STE 111 475 PHILIP BLVD 905 PARKSIDE WALK LN STE 108 1880 BRASELTON HWY STE 121 1154 LAWRENCEVILLE HWY 845 SCENIC HWY STE 200 100 TABITHA ST 778 ATHENS RD 4025 LAWRENCEVILLE HWY #D 114 MAIN ST 125 N WASHINGTON ST 6935 S. SWEETWATER RD. 3750 VETERANS MEMORIAL HWY 5700 HILLANDALE DR STE 100 3340 HIGHWAY 155 3758 HIGHWAY 42 STE 201 4920 BILL GARDNER PKWY 3798 HIGHWAY 42 257 MAIN ST 100 MCFARLAND RD 819 PEACHTREE ST 119 US HIGHWAY 1 BYP N 101 E BROAD ST 802 PEACHTREE ST 1 E CYPRESS ST 6102 BANKS ST 3316 EAST GOLDEN ISLES PKY

LAVONIA LAVONIA LAWRENCEVILLE LAWRENCEVILLE LAWRENCEVILLE LAWRENCEVILLE LAWRENCEVILLE LAWRENCEVILLE LAWRENCEVILLE LAWRENCEVILLE LEESBURG LEXINGTON LILBURN LINCOLNTON LINCOLNTON LITHIA SPRINGS LITHIA SPRINGS LITHONIA LOCUST GROVE LOCUST GROVE LOCUST GROVE LOCUST GROVE LOGANVILLE LOOKOUT MOUNTAIN LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LUDOWICI LULA LUMBER CITY

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30553-1210 30553-1224 30046 30046-4386 30046-8401 30046 30043 30043-2877 30046 30046 31763-4933 30648-1908 30047-2876 30817-6300 30817-1784 30122 30122-1800 30058-4104 30248-3513 30248-3653 30248-3647 30248-3632 30052-2676 30750-3121 30434-1449 30434-6134 30434 30434-1450 31316-3154 30554-2858 31549

ALLCARE PHARMACY & HEALTHCARE SVCS IDEAL PHARMACY MABLETON PHARMACY & UNIFORMS ANDERSON HEALTH CNTR PHARMACY CENTRAL GEORGIA CANCER CARE CGHS EMPLOYEE APOTHECARY CHI-CHES-TERS BACONSFIELD PHCY CHICHESTERS HARTLEY BRIDGE PHC CHICHESTERS INSTITUTIONAL PHCY COLISEUM PARK PROFESSIONAL PHY

(912) 526-3200 (912) 526-8531 (770) 948-3133 (478) 633-1145 (478) 314-1667 (478) 633-3200 (478) 743-4421 (478) 781-1051 (864) 582-1216 (478) 745-5431

112 S OXLEY DR 160 S VICTORY DR 5390 FLOYD RD 777 HEMLOCK ST MSC 113 800 1ST ST STE 415 777 HEMLOCK ST 656 BACONSFIELD CENTER 4226 HARTLEY BRIDGE RD 655 NORTH AVE 380 HOSPITAL DR STE 175

LYONS LYONS MABLETON MACON MACON MACON MACON MACON MACON MACON

GA GA GA GA GA GA GA GA GA GA

30436-5645 30436-1444 30126-2216 31201-2102 31201-8300 31201-2102 31211-2944 31216 31211-3188 31217-8000

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 167 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

EXPRESS RX PHARMACY LLC FIRST CHOICE COMMUNITY PHCY GRAVES PHARMACY KENNEDY DRUGS MACON PHARMACY MEDICAL ARTS PHARMACY MIKES MEDICAL PHARMACY ORTHO GEORGIA PHARMACY POWELLS BLOOMFIELD PHARMACY POWELLS NORTHSIDE PHARMACY RIVER EDGE BEHAVIORAL HEALTH SCOTTS PHARMACY 1 SCOTTS PHARMACY 2 THE PHARMACY CENTER MACON U SAVE IT PHARMACY YOUR CORNER DRUGSTORE INGLES PHARMACY MADISON DRUG COMPANY THE MEDICINE SHOPPE THRIFTY MAC DISCOUNT DRUGS THE MEDICINE CABINET JASPER DRUG STORE AT FOOTHILLS BETA DISCOUNT PHARMACY EAST MARIETTA DRUG INC GENOA-QOL HEALTHCARE LACEY'S MARIETTA PHARMACY MOUNTAINVIEW PHARMACY

Provider Name

(478) 742-3020 (478) 741-5098 (478) 745-0476 (478) 743-4700 (478) 812-8980 (478) 746-8331 (478) 742-1448 (478) 750-2802 (478) 781-1213 (478) 474-6767 (478) 803-7693 (478) 742-3098 (478) 741-3718 (478) 741-8599 (478) 781-1565 (478) 254-8484 (706) 342-3119 (706) 342-1722 (706) 342-2070 (706) 342-4141 (706) 846-2002 (770) 893-3784 (678) 909-3455 (770) 973-7600 (678) 213-2001 (770) 424-3131 (770) 272-9612

743 SHURLING DR 770 WALNUT STREET, STE 100 770 PINE ST STE 100 524 POPLAR ST 4683 LOG CABIN DR 1193 FORSYTH ST 1381 PIO NONO AVE 3708 NORTHSIDE DR 4839 BLOOMFIELD RD 440 CHARTER BLVD STE 1107 175 EMERY HWY 635 PIO NONO AVE 900 GRAY HWY 308 COLISEUM DR FL 1 3576 PIO NONO AVE 4260 LOG CABIN DR STE C 1441 EATONTON RD 213 N MAIN ST 1400 EATONTON RD STE 600 218 S MAIN ST 1194 WARM SPRINGS HWY 80 FOOTHILLS PKWY 776 SANDTOWN RD 1480 ROSWELL RD 1650 COUNTY SVCS PKWY STE 200 790 CHURCH ST NE STE 170 1275 POWERS FERRY RD SE #170

MACON MACON MACON MACON MACON MACON MACON MACON MACON MACON MACON MACON MACON MACON MACON MACON MADISON MADISON MADISON MADISON MANCHESTER MARBLE HILL MARIETTA MARIETTA MARIETTA MARIETTA MARIETTA

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31211-1947 31201 31201-7565 31201-2717 31204-6317 31201-1735 31204-4633 31210-2404 31206-4399 31210-4883 31217-3692 31204-3531 31211-1834 31217 31206-3036 31204 30650-4630 30650-1312 30650-4625 30650-1303 31816 30148-2255 30008 30062-3670 30008 30060-8902 30067-8600

NORTHWEST GEORGIA ONCOLOGY CTRS PC PEACHVIEW DRUGS POOLE'S PHARMACY WELLSTAR PHARMACY NETWORK WELLSTAR PHARMACY NETWORK WINDY HILL APOTHECARY MCCAYSVILLE DRUG CENTER INC RYALS DRUG STORE FREDS PHARMACY MOYES PHARMACY MCD NORTH MOYES PHARMACY MCDONOUGH FREDS PHARMACY CROSSROADS FAMILY PHARMACY FREDS PHARMACY

(770) 281-5115 (678) 581-1223 (770) 514-1414 (470) 956-0170 (770) 644-1011 (770) 644-1005 (706) 492-4126 (229) 868-6735 (770) 957-2363 (770) 957-1852 (770) 957-1851 (229) 868-2580 (706) 862-2064 (912) 685-3339

340 KENNESTONE HOSPITAL BLVD 550 FRANKLIN RD SE STE C 660 WHITLOCK AVE NW STE G-1 3747 ROSWELL RD NE, STE 113 677 CHURCH ST NE 2520 WINDY HILL RD SE #203A 131 BLUE RIDGE DR 12 S SECOND AVE 1550 S ZACH HINTON PKWY 85 CLAIRE CT 62 KEYS FERRY ST 112 W OAK ST 7838 HIGHWAY 48 978 GA HWY 46 E

MARIETTA MARIETTA MARIETTA MARIETTA MARIETTA MARIETTA MC CAYSVILLE MC RAE MCDONOUGH MCDONOUGH MCDONOUGH MCRAE MENLO METTER

GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30060-1152 30067-7740 30064-3174 30062 30060-1101 30067-8664 30555-2767 31055-4659 30253 30252-4837 30253-3298 31055 30731-6337 30439

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 168 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

IHS PHARMACY METTER PHARMACY COASTAL DISCOUNT PHARMACY INC H & M DRUGS MEDICAL ARTS PHARMACY MILLEDGEVILLE MED CTR PHCY RIVER EDGE BALDWIN COUNTY EAGLE PHARMACY INC CARMICHAEL DRUG COMPANY FLINT RIVER PHARMACY FREDS PHARMACY MONTICELLO DRUGS MORROW PHARMACY ARWOOD DRUG CO INC CONVENIENT CARE PHARMACY CONVENIENT CARE PHARMACY CONVENIENT CARE PHARMACY #2 CONVENIENT RX LTC CRYSTAL PHARMACY HARVEYS PHARMACY FREDS PHARMACY MURRAYVILLE PHARMACY

Provider Name

(912) 685-2803 (912) 685-6337 (912) 884-9255 (478) 453-7715 (478) 452-1222 (478) 452-3591 (478) 718-2611 (478) 982-7979 (770) 267-2559 (478) 472-0111 (478) 472-7561 (706) 468-6836 (404) 205-5508 (229) 985-9080 (229) 985-9296 (229) 890-6054 (229) 890-6054 (229) 890-6054 (229) 985-4137 (229) 985-0101 (912) 583-4026 (770) 534-2245

150 S LEROY ST 705 S LEWIS ST 204 BUTLER ST 295 HAMMOCK RD 811 N COBB ST 750 N COBB ST 60 GA HIGHWAY 22 W 936 E WINTHROPE AVE 150 MLK JR BLVD 506-C SPAULDING ROAD 112 S DOOLY ST 228 FORSYTH ST 2320 LAKE HARBIN RD 101 N MAIN ST 203 31ST AVE SE 640 VETERANS PKWY N 720 W CENTRAL AVE 720 W CENTRAL AVE SUITE 1 705 S MAIN ST 1209 1ST AVE SE 421 S RAILROAD AVE 5304 THOMPSON BRIDGE RD

METTER METTER MIDWAY MILLEDGEVILLE MILLEDGEVILLE MILLEDGEVILLE MILLEDGEVILLE MILLEN MONROE MONTEZUMA MONTEZUMA MONTICELLO MORROW MOULTRIE MOULTRIE MOULTRIE MOULTRIE MOULTRIE MOULTRIE MOULTRIE MOUNT VERNON MURRAYVILLE

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30439-4631 30439 31320-0000 31061 31061-2389 31061-2390 31061-6606 30442-1840 30655 31063 31063 31064-1210 30260-1930 31768-3863 31768-6703 31788-4122 31768-3560 31768-3560 31768 31768-5007 30445-3048 30564-1941

BENNETTS HOMETOWN PHARMACY & GIFTS MARKS DISCOUNT DRUGS DOGWOOD PHARMACY HARVEYS PHARMACY HOMETOWN PHARMACY AHF PHARMACY

(912) 462-3784 (912) 462-6386 (229) 686-2620 (229) 686-2025 (229) 686-9339 (678) 432-5250

13202 CLEVELAND ST W 118 N MAIN ST # C 501 N DAVIS ST 207 MCPHERSON ST 407 E MCPHERSON AVE 770 GREISON TRL STE H

NAHUNTA NAHUNTA NASHVILLE NASHVILLE NASHVILLE NEWNAN

GA GA GA GA GA GA

31553-2842 31553-9806 31639 31639-2131 31639-2267 30263-6401

CANCER TREATMENT CENTERS OF AMERICA LEE-GOODRUM EASTSIDE PHARMACY LEE-GOODRUM PHARMACY LEE-KING PHARMACY NEWNAN PHARMACY INC. NEWNAN PLAZA PHARMACY LLC NICHOLLS PHARMACY LLC ALPHA PHCY & WELLNESS CTR ATLANTA PHARMACY EXPRESS PHARMACY MANAGED HEALTH SOLUTIONS NORCROSS PHARMACY

(770) 400-6392 (770) 251-4808 (770) 253-1121 (770) 253-1622 (770) 683-6771 (770) 683-3784 (912) 345-1021 (770) 840-9995 (770) 807-7779 (770) 864-5645 (770) 496-5314 (770) 448-2288

600 PARKWAY NORTH 134 MILLARD FARMER BLVD 40 HOSPITAL RD 18 CAVENDER ST 15 BAKER RD STE 2 775 POPLAR RD STE 100 1003 VAN STREAT HWY BOX 247 3466 HOLCOMB BRIDGE RD STE B 5456 JIMMY CARTER BLVD STE 160 3330 PEACHTREE COR CIR, STE G 3070 BUSINESS PARK DR STE A 510A BEAVER RUIN RD

NEWNAN NEWNAN NEWNAN NEWNAN NEWNAN NEWNAN NICHOLLS NORCROSS NORCROSS NORCROSS NORCROSS NORCROSS

GA GA GA GA GA GA GA GA GA GA GA GA

30265 30263-1808 30263-1201 30263-1932 30265 30265-8301 31554 30092 30093-1511 30092 30071 30071-3919

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 169 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PHARMALIFE ATLANTA SOLEO HEALTH INC OCILLA PHARMACY THE MEDICINE CABINET DOCTOR'S PHARMACY OMEGA PHARMACY LAMBERT PHARMACY PATTERSON PHARMACARE THE PHARMACY PLACE PEACHTREE PHARMACY MORRIS DRUG CO MOYE'S DRUG STORE INC BEDINGFIELD PHARMACY PEMBROKE PHARMACY INC PERRY DRUG COMPANY INC U SAVE IT PINE MOUNTAIN PINEVIEW PHARMACY PLAINS PHARMACY APOLLO PHARMACY CARTER'S PHARMACY INC POOLER PHARMACY QUICK RX DRUGS INC COOPER DRUGS ADAMS FAMILY PHARMACY HARVEYS PHARMACY LEE & PICKELS DRUGSTORE PRESBYTERIAN HOME PHARMACY REIDSVILLE PHARMACY THE DRUG STORE KNIGHT'S PHARMACY RHINE DRUG COMPANY U SAVE IT PHARMACY RICHMOND HILL PHARMACY QUICK RX DRUGS TOWNE PHARMACY

Provider Name

(404) 261-7775 (470) 226-2300 (229) 468-5929 (229) 468-9868 (478) 472-2040 (229) 528-4276 (770) 463-4031 (912) 647-0777 (678) 271-3970 (678) 691-9079 (912) 422-3631 (229) 294-4058 (912) 653-4596 (912) 653-2772 (478) 988-1144 (229) 435-4571 (229) 624-2711 (229) 824-7401 (912) 999-6101 (912) 748-1414 (912) 348-4420 (912) 748-3194 (770) 943-3566 (229) 828-2273 (229) 605-0140 (229) 263-4061 (229) 263-6130 (912) 557-4000 (912) 557-4701 (478) 847-3666 (229) 385-5351 (229) 435-4571 (912) 756-3331 (912) 826-6008 (912) 826-0250

6330 PRIMROSE HILL CT STE 103 3100 MEDLOCK BRIDGE RD STE 200 121 E 4TH ST 615 N IRWIN AVE 298 MEDICAL COURT 246 OAK ST 405 CARLTON RD 6460 HWY 84 2005 COMMERCE DR N 5270 PEACHTREE PKWY STE 114A 646 N MAIN ST 162 E RAILROAD ST SE 27 N MAIN ST 137 E BACON ST 1036A MACON RD 145 N MAIN AVE 117 COMMERCE ST E 103 MAIN ST 111 CANAL ST STE 101 1017 E HWY 80 SUITE 10 990 PINE BARREN RD STE 102 110 MEDICAL PARK DR 4045 LINDLEY CIR STE D 6381 HAMILTON ST 1106 W SCREVAN ST 302 E SCREVEN ST 1901 SCREVEN ST 246 S MAIN ST 214 S MAIN ST 2 E WILLIAM WAINWRIGHT ST 119 1ST ST 676 ALSTON ST 2409 US HIGHWAY 17 100 GOSHEN RD 6014 HWY 21 SOUTH STE P

NORCROSS NORCROSS OCILLA OCILLA OGLETHORPE OMEGA PALMETTO PATTERSON PEACHTREE CITY PEACHTREE CORNERS PEARSON PELHAM PEMBROKE PEMBROKE PERRY PINE MOUNTAIN PINEVIEW PLAINS POOLER POOLER POOLER POOLER POWDER SPRINGS PRESTON QUITMAN QUITMAN QUITMAN REIDSVILLE REIDSVILLE REYNOLDS RHINE RICHLAND RICHMOND HILL RINCON RINCON

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30092 30071-1432 31774-1542 31774-5009 31068-0000 31775-3087 30268-1052 31557 30269-3538 30092 31642 31779-2235 31321-0326 31321 31069-3328 31822-0833 31071-3444 31780 31322-4054 31322-0000 31322 31322-1956 30127-2765 31824 31643-1817 31643-2178 31643-3913 30453-4662 30453-4602 31076-3150 31077-3044 31825-1104 31324-3756 31326-5545 31326

NORTH GEORGIA HEALTH CARE CTR PHCY PARKWAY PHARMACY PRICE RINGGOLD DRUGS GLOBAL CARE PHARMACY HEART PHARMACY ROBERTA DRUGS

(706) 935-5444 (706) 866-8475 (706) 935-3131 (770) 731-2641 (770) 997-6500 (478) 836-3515

6120 ALABAMA HWY 4700 BATTLEFIELD PKWY STE 110 7566 NASHVILLE ST 773 HWY 138 SW STE 13 706 SPRINGDALE DR 4 WRIGHT AVE

RINGGOLD RINGGOLD RINGGOLD RIVERDALE RIVERDALE ROBERTA

GA GA GA GA GA GA

30736-2804 30736-5167 30736-2361 30296-1599 30274-2327 31078

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 170 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROCHELLE DRUG COMPANY INC ROCKMART PHARMACY SMITH-LOCKWOOD DRUG STORE SMITH-LOCKWOOD PHARMACY WEAVER'S ROCKY FACE PHARMACY ARMUCHEE PHARMACY AVERY DRUGS INC FIRST CARE PHARMACY FREDS PHARMACY GENOA-QOL HEALTHCARE GMC PHARMACY HARBIN CLINIC CANCER CTR PHCY ROME COMMUNITY PHARMACY SHANNON PHARMACY SPINE CARE & PAIN MANAGEMENT THE MEDICINE SHOPPE THE PHARMACY AT FLOYD WINSLETTE PHARMACY FOOD CITY LONGLEY PHARMACY ADDISON HEALTHCARE

Provider Name

(229) 365-7447 (770) 684-8448 (770) 684-6573 (770) 684-7889 (706) 259-0668 (706) 235-1303 (706) 291-0999 (706) 204-8590 (706) 378-7947 (706) 237-6306 (706) 234-7616 (706) 528-9096 (706) 622-2063 (706) 295-4772 (706) 314-0617 (706) 295-5713 (706) 509-5908 (706) 290-0300 (706) 866-6981 (706) 866-1220 (678) 395-3213

600 2ND AVE 407 N PIEDMONT AVE 114 S MARBLE ST 701B HOGUE AVE 2600 OLD CHATTANOOGA RD 4334 MARTHA BERRY HWY NE 710 N 5TH AVE NE 209 TURNER MCCALL BLVD 1916 REDMOND CIR NW 6 MATHIS DR NW 3402 ALABAMA HWY NW 255 W 5TH ST 501 E 2ND AVE 5855 NEW CALHOUN HWY NE 18 RIVERBEND DR SW STE 120A 411 W 10TH ST NE 304 TURNER MCCALL BLVD 2444 SHORTER AVE NW 820 MISSION RIDGE ROAD 785 CHICKAMAUGA AVE 11205 ALPHARETTA HWY STE F1

ROCHELLE ROCKMART ROCKMART ROCKMART ROCKY FACE ROME ROME ROME ROME ROME ROME ROME ROME ROME ROME ROME ROME ROME ROSSVILLE ROSSVILLE ROSWELL

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31079-2046 30153 30153-2642 30153-1923 30740-8511 30165-8642 30165-2704 30165 30165-1320 30165-1242 30165-9652 30165-2817 30161-3249 30161-8253 30161-6013 30165-2640 30165 30165-1959 30741 30741 30076-1444

CONCORD MEDICAL CENTER PHARMACY GEORGIA UROLOGY WENDER & ROBERTS - CRABAPPLE COMMUNITY CARE PHCY OF ROYSTON ELDERCARE PHARMACY MEDICAP PHARMACY ROYSTON DRUG STORE INC SCOTTIE'S DISCOUNT DRUGS CAMDEN PHARMACY INC ST SIMONS DRUG COMPANY WINN DIXIE PHARMACY NORTH POINTE PHCY & GIFTS WEST DRUG COMPANY WEST PRESCRIPTION SHOP D&B PHARMACY APOLLO PHARMACY CANDLER PRESCRIPTION CTR CURTIS V COOPER PRIMARY HC CURTIS V COOPER PRIMARY HC EXPRESS DRUGS HEALTHMART PHCY

(770) 664-5428 (770) 475-7550 (770) 992-4111 (762) 847-7400 (706) 245-1467 (706) 245-9959 (706) 245-7223 (706) 245-9211 (912) 673-8220 (912) 638-8676 (912) 634-4817 (478) 552-6114 (478) 552-2521 (478) 552-6111 (404) 996-2372 (912) 999-6101 (912) 819-7275 (912) 527-1105 (912) 527-2742 (912) 777-3230

2500 HOSPITAL BLVD STE 300 1357 HEMBREE RD STE 250 791 ATLANTA ST 637 COOK ST 635 COOK ST 100 FRANKLIN SPRINGS ST 26 FRANKLIN SPRING ST 699 COOK ST 214 PROFESSIONAL CIR STE B 209 LONGVIEW PLZ 220 RETREAT VLG 528 SPARTA RD 102 N HARRIS ST 514 WASHINGTON AVE 284 HAMMOND DR NE 418 W BROUGHTON ST 5354 REYNOLDS ST STE 100 106 E BROAD ST 2 ROBERTS ST 824 E DE RENNE AVE

ROSWELL ROSWELL ROSWELL ROYSTON ROYSTON ROYSTON ROYSTON ROYSTON SAINT MARYS SAINT SIMONS ISLAND SAINT SIMONS ISLAND SANDERSVILLE SANDERSVILLE SANDERSVILLE SANDY SPRINGS SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30076-4947 30076-5724 30075-4452 30662-3905 30662 30662-4134 30662-4109 30662-3905 31558-3783 31522-2573 31522-2403 31082-1859 31082-1736 31082-1971 30328-5010 31401-3218 31405-6007 31401-2917 31408-3524 31405

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 171 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE LO COST PHARMACY MEDICAL CENTER PHARMACY MEDICAP PHARMACY MLK PHARMACY QUICK RX DRUGS SOUTHCOAST PHARMACY SUMMIT CANCER CARE PC THE PRESCRIPTION SHOP VILLAGE WALK PHARMACY PCI PHARMACY INC. SENOIA DRUG COMPANY INC. LAMBERT PHARMACY SHELLMAN DRUG COMPANY SILVER CREEK PHARMACY CURANT HEALTH GEORGIA K & Y PHARMACY LLC MEDICINE SHOPPE PHARMACY EASTSIDE FAMILY PHARMACY HARRY'S PHARMACY PRESTIGE PHARMACY SNELL'S PHARMACY SOCIAL CIRCLE PHARMACY DENNARD DRUGS FREDS PHARMACY WEBSTER'S PHARMACY HARVEYS PHARMACY QUICK RX FOREST HEIGHT PHARMACY MCCOOKS PHARMACY INC MEDICAL CENTER PHARMACY

Provider Name

(912) 421-0317 (912) 352-0375 (912) 350-6337 (912) 920-1500 (912) 662-0300 (912) 898-7535 (912) 691-3528 (912) 651-5767 (912) 355-0122 (912) 598-8669 (404) 549-8447 (770) 727-3060 (470) 414-7644 (229) 679-5070 (706) 292-0106 (866) 437-8040 (770) 989-1332 (770) 436-0811 (770) 807-0137 (770) 696-4828 (470) 735-4700 (770) 972-0700 (770) 464-4330 (912) 529-4545 (912) 529-3234 (706) 444-5296 (912) 754-7009 (912) 754-6444 (912) 489-7979 (912) 764-2223 (912) 764-5643

800 E 70TH ST RM 4 612 E 69TH ST 4700 WATERS AVE 1080 KING GEORGE BLVD 718 MARTIN LUTHER KING JR #A 1001 MEMORIAL LN 1326 EISENHOWER DR BLDG 1 225 CANDLER DR STE 300 911 E 65TH ST 1 SKIDAWAY VILLAGE WALK 3500 N DECATUR RD STE 108 7285 HWY 16 EAST STE A 15 THOMAS GRACE ANNEX LN 75 W RAILROAD ST 4450 ROCKMART RD SE 200 TECHNOLOGY CT SE STE B 969 WINDY HILL RD SE STE A 3903 S COBB DR SE STE 103 1795 PRESIDENTIAL CIR 4017 ANNISTOWN RD STE E 1551 JANMAR RD SUITE B 2295 OAK RD 1027A BATEMAN DR 794 SECOND ST 4097 W MAIN ST 12707 BROAD ST 1451 HIGHWAY 21 SOUTH 504 N LAUREL ST 4439 COUNTRY CLUB RD 23630 US HWY 80 E 57 GRANADE ST

SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH SCOTTDALE SENOIA SHARPSBURG SHELLMAN SILVER CREEK SMYRNA SMYRNA SMYRNA SNELLVILLE SNELLVILLE SNELLVILLE SNELLVILLE SOCIAL CIRCLE SOPERTON SOPERTON SPARTA SPRINGFIELD SPRINGFIELD STATESBORO STATESBORO STATESBORO

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31405-4813 31405-4714 31404-6220 31419-9569 31401-5570 31410-1220 31406-3928 31405-6091 31405-4412 31411-2908 30079-6817 30276 30277-3653 39886-3100 30173-2438 30082-5201 30080 30080-6301 30078 30039-6901 30078-5606 30078-2356 30025-5025 30457-2400 30457-2325 31087-1734 31329-5125 31329-6814 30458-9188 30461-6019 30458-5106

MEDICAL CENTER PHCY AT COTTON RIDGE SOUTHERN PHARMACY WALKER PHARMACY & BOUTIQUE WALKER PHARMACY INC STATHAM CITY PHARMACY EAGLE'S LANDING PHARMACY HUDSON BRIDGE PHARMACY INGLES PHARMACY MOYES PHARMACY STOCKBRIDGE COMFORT PHARMACY#2

(912) 681-2333 (912) 225-9279 (912) 681-3784 (912) 764-6175 (678) 726-7416 (770) 474-5005 (770) 474-0842 (770) 507-1846 (770) 474-0704 (770) 469-4688

1601 FAIR RD STE 1200 606 BRANNEN ST STE B 1198 MERCHANTS WAY 2425 NORTHSIDE DRIVE WEST 333 JEFFERSON ST 1090 EAGLES LANDING PKWY 1110 EAGLES LANDING PKWY 3701 WALT STEPHENS RD 4467 N HENRY BLVD 870 MAIN ST

STATESBORO STATESBORO STATESBORO STATESBORO STATHAM STOCKBRIDGE STOCKBRIDGE STOCKBRIDGE STOCKBRIDGE STONE MOUNTAIN

GA GA GA GA GA GA GA GA GA GA

30458-0801 30458-5184 30458 30458 30666-1710 30281-5012 30281-7271 30281-4224 30281-3656 30083-3621

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DISCOUNT PHARMACY MAKO PHARMACY WHOLECARE PHARMACY FREDS PHARMACY CAREPOINT PHARMACY CONCORD PHARMACY FORSYTH PHARMACY GAYCO HEALTHCARE NORTH SHINNS PHARMACY YOO PHARMACY

Provider Name

(770) 755-5904 (770) 696-9146 (470) 225-1433 (706) 857-3300 (470) 655-2480 (678) 417-0122 (678) 513-7473 (770) 495-9250 (770) 932-3023 (770) 814-4515

827-D NORTH HAIRSTON ROAD 1525 E PARK PLACE BLVD STE 500 1183 S HAIRSTON RD STE B 103 HIGHWAY 48 80 HORIZON DR STE 504-601A 3890 JOHNS CREEK PKWY STE 160 3592 OLD ATLANTA RD STE 105 4090 JOHNS CREEK PKWY STE D 2790 LWRNCVLE SWNEE RD STE150 1299 OLD PEACHTREE RD NW STE 1

STONE MOUNTAIN STONE MOUNTAIN STONE MOUNTAIN SUMMERVILLE SUWANEE SUWANEE SUWANEE SUWANEE SUWANEE SUWANEE

GA GA GA GA GA GA GA GA GA GA

30083-3441 30087-3404 30088-2796 30747 30024-2936 30024-1285 30024-6889 30024 30024 30024-2028

EAST GEORGIA COMMUNITY PHARMACY MEDICAL CENTER PHARMACY PLAZA PHARMACY SHOP RITE PHARMACY WILSON'S PHARMACY MEDICAP PHARMACY ROSS DRUG INC FREDS PHARMACY GLENN'S CORNER PHARMACY HARVEYS PHARMACY TALLAPOOSA DRUG COMPANY TAYLORSVILLE DRUG CO INC INGLES PHARMACY TEMPLE PHARMACY CHEROKEE PHARMACY INGLES PHARMACY NORTHSIDE DRUGS INC THOMASTON PRESCRIPTION SHOP ARCHBOLD HIGH TECH SERVICES GENOA-QOL HEALTHCARE HARVEYS PHARMACY JACKSON STREET PHARMACY THOMAS DRUG STORE THOMAS DRUG STORE TRUMARX DRUGS LMN PHARMACY, INC MOYE PHARMACY FREDS PHARMACY HARVEYS PHARMACY MOONS PHARMACY INC ROYAL PHARMACY

(478) 237-6262 (478) 237-3838 (478) 237-6621 (478) 237-7032 (478) 237-8835 (912) 564-2720 (912) 564-7002 (229) 777-0777 (229) 776-3600 (229) 776-3908 (770) 574-2339 (770) 684-9060 (770) 562-2716 (770) 562-3268 (706) 646-3100 (706) 648-4048 (706) 648-2181 (706) 647-8965 (229) 228-2234 (229) 379-3125 (229) 225-1402 (229) 226-2203 (229) 226-2535 (229) 226-4201 (229) 226-8700 (706) 595-6126 (706) 595-4842 (229) 382-6465 (229) 386-9252 (229) 382-3711 (229) 382-0480

215 N COLEMAN ST STE 100 132 VICTORY DR 204 S MAIN ST 224 W MAIN ST 104 S GREEN ST 331 MIMS RD 127 N MAIN ST 620 E FRANKLIN ST STE A 631 E FRANKLIN ST 502 ASHBURN HWY 24 W ALABAMA ST 105 CHURCH ST 488 CARROLLTON ST 285 SAGE ST 200 CHEROKEE RD 730 N CHURCH ST 1109 HIGHWAY 19 N 500 W GORDON ST 400 OLD ALBANY RD 1102 SMITH AVE STE L 1404 E JACKSON ST 519 W JACKSON ST 108 S BROAD ST 816 GORDON AVE 501 GORDON AVE 501 MOUNT PLEASANT RD 433 W HILL ST 1442 N TIFT AVE 2201 US HIGHWAY 41 N 717 2ND ST W 1620 JOHN ORR DR

SWAINSBORO SWAINSBORO SWAINSBORO SWAINSBORO SWAINSBORO SYLVANIA SYLVANIA SYLVESTER SYLVESTER SYLVESTER TALLAPOOSA TAYLORSVILLE TEMPLE TEMPLE THOMASTON THOMASTON THOMASTON THOMASTON THOMASVILLE THOMASVILLE THOMASVILLE THOMASVILLE THOMASVILLE THOMASVILLE THOMASVILLE THOMSON THOMSON TIFTON TIFTON TIFTON TIFTON

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

30401-3530 30401-3235 30401-3648 30401-3150 30401-3131 30467-1992 30467-1818 31791 31791-7231 31791-1400 30176-1464 30178-1904 30179-4144 30179-3846 30286-3402 30286-3618 30286-2207 30286-3415 31792-4013 31792-5740 31792-3937 31792-3105 31792-5541 31792-6611 31792 30824-8140 30824-2116 31794-3545 31794-2767 31794-4201 31794-3641

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Provider Phone Number

Provider Street

Page 173 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name TIFTON DRUG COMPANY CLINIC PHARMACY INGLES PHARMACY JERRY WHITES PHARMACY MADDOX DRUGS SANDERS DRUGS EULONIA PHARMACY,INC. FOOD CITY FREDS PHARMACY PRICE PHARMACY INC TRION DRUGS SPECIALTY CARE, LLC TRACYS MEDICINE CENTER TUNNEL HILL PHARMACY INC TWIN CITY DRUG CO UNADILLA DRUG CO INC UNION PHARMACY INC AMERIMED PHARMACY BARNES DRUG STORE OF VALDOSTA CHANCY DRUGS VALDOSTA FREDS PHARMACY HOGANS ADVANCED PHCY SERVICES HOGAN'S PHARMACY MEDICAL CENTER PHARMACY THE MEDICINE SHOPPE CHAPMAN HEALTHCARE PHARMACY CITY DRUG STORE PHILLIP'S PHARMACY VIDALIA PHARMACY INC FORBES DRUG COMPANY INC THE APOTHECARY SHOPPE PHARMACY VILLA RICA DRUGS GUNN DRUG COMPANY NORTHSIDE PHARMACY WALESKA CENTRAL GEORGIA CANCER CARE PHCY GENOA-QOL HEALTHCARE J & M DRUGS MEDICINE STOP FIEVET PHARMACY JENNINGS MILL DRUG COMPANY OCONEE DRUGS BATTEN'S PRESCRIPTION SHOPPE

NR_0009_10823 10/2017

Provider Phone Number (229) 396-5552 (706) 886-2151 (706) 886-8711 (706) 886-2662 (706) 886-3119 (706) 297-0111 (912) 832-6194 (706) 657-3734 (706) 657-8100 (706) 657-4061 (706) 734-2481 (770) 496-8998 (770) 939-1642 (706) 673-5211 (478) 763-2151 (478) 627-3041 (706) 486-2131 (229) 253-0067 (229) 245-6013 (229) 245-9922 (229) 242-6909 (229) 244-5353 (229) 244-5353 (229) 249-4144 (229) 244-0640 (912) 538-0053 (912) 537-4147 (912) 537-3049 (912) 537-4134 (229) 268-2111 (770) 459-9499 (770) 456-4663 (478) 252-5252 (770) 479-2172 (478) 314-1667 (478) 352-0916 (478) 333-6652 (478) 922-2067 (706) 678-2260 (706) 621-5996 (706) 552-1720 (912) 283-1646

Provider Street 302 MAIN ST SOUTH 58 BIG A RD STE 101 1197 BIG A RD 3741 GA HIGHWAY 17 1330 BIG A RD 61 FALLS RD 15268 US HIGHWAY 17 112 CRIMSON DR 11997 S MAIN ST 4655 GA HWY 136 WEST 49 HARRELL ST 4229 1ST AVE STE B 3171 TUCKER NORCROSS RD 3535 CHATTANOOGA RD 507 S. RAILROAD AVE 413 SECOND STREET 624 SIBLEY AVE 3782 OLD US HWY 41 N STE C 200 S PATTERSON ST 2333 N ASHLEY ST 4401 BEMISS RD 2704 N OAK ST BLDG B-1A 2704 NORTH OAK ST STE B1 2202 FLEMING ST 2921 N ASHLEY ST 305 MAPLE DR 1704 MEADOWS LN 306 W 1ST ST 209 JACKSON ST 101 S 3RD ST 712 DALLAS HWY 222 W WILSON ST 48 N MAIN ST 6824 REINHARDT COLLEGE PKWY 114 SUTHERLIN DR STE C-2 940A GA HIGHWAY 96 STE 200 4851 RUSSELL PKWY STE 100 1550 WATSON BLVD 115 E ROBERT TOOMBS AVE 1360 CADUCEUS WAY 1305 JENNINGS MILL RD ST 100 1401 ALICE ST

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Provider City TIFTON TOCCOA TOCCOA TOCCOA TOCCOA TOCCOA TOWNSEND TRENTON TRENTON TRENTON TRION TUCKER TUCKER TUNNEL HILL TWIN CITY UNADILLA UNION POINT VALDOSTA VALDOSTA VALDOSTA VALDOSTA VALDOSTA VALDOSTA VALDOSTA VALDOSTA VIDALIA VIDALIA VIDALIA VIDALIA VIENNA VILLA RICA VILLA RICA WADLEY WALESKA WARNER ROBINS WARNER ROBINS WARNER ROBINS WARNER ROBINS WASHINGTON WATKINSVILLE WATKINSVILLE WAYCROSS

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA

31794 30577-6000 30577-6028 30577 30577-6013 30577 31331-3854 30752 30752 30752 30753-1479 30084-4469 30084-2124 30755-9393 30471 31091 30669-1140 31602 31601-5621 31602-2621 31605-6049 31602-1744 31602 31602-2501 31602-1696 30474-8908 30474-8913 30474-3369 30474-4713 31092-1511 30180-1203 30180 30477-0000 30183-3266 31088-2259 31088-2502 31088-8675 31093 30673 30677-7300 30677 31501-4528

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BROWNINGS MEDICAL ARTS PHCY GRIFFINS PRESCRIPTION SHOP INC HARVEYS PHARMACY MEDICINE CABINET OF WAYCROSS PEARCE DRUGS WAYCROSS FAMILY PHARMACY LIBERTY SQUARE PHARMACY BENNETTS HOMETOWN PHARMACY FARMERS PRESCRIPTION SHOP INC INGLES PHARMACY MEDLINK PHARMACY - WINDER SPINE CARE AND PAIN MANAGEMENT WOODBINE PHARMACY INC U SAVE IT PHARMACY INC BARNEYS PHARMACY FREDS XPRESS MEDICAL ASSOCIATES PLUS PHARMACY WRENS DRUG SUMNER PHARMACY YOUNG HARRIS PHARMACY CITY PHARMACY OF ZEBULON, PC MEGA DRUG II SUPER DRUG DEDEDO SUPER DRUG AGANA COMMUNITY PHARMACY GUAM REXALL DRUGS ITC PHARMACY I MEGA DRUG OKA PHARMACY SUPER DRUG OKA AIEA MEDICAL PHARMACY NEWTOWN SQUARE PHARMACY INC PHARMACARE TIMES PHARMACY MALAMA PHARMACY SOUTH PHARMACARE WESTSIDE PHARMACY FOODLAND PHARMACY #26 KTA PUAINAKO PHARMACY MEDIPHARM PHARMACY SHIIGI DRUG CO., INC. ULULANI PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (912) 283-5504 (912) 283-3010 (912) 285-7281 (912) 490-6337 (912) 283-2772 (912) 548-0511 (706) 437-8494 (912) 778-3784 (770) 867-9072 (770) 867-7116 (678) 975-3493 (678) 963-2160 (912) 576-6998 (706) 553-3351 (706) 547-4111 (706) 547-3456 (706) 547-2550 (706) 547-2225 (478) 864-2217 (706) 379-3700 (770) 567-8844 (671) 632-3385 (671) 637-9783 (671) 477-3627 (671) 646-6160 (671) 646-4827 (671) 646-6395 (671) 646-5355 (671) 647-1193 (671) 646-6183 (808) 840-5680 (808) 488-5458 (808) 840-5660 (808) 483-3071 (808) 324-6888 (808) 840-5630 (808) 335-5342 (808) 959-7300 (808) 959-8700 (808) 969-9163 (808) 935-0001 (808) 934-9400

Provider Street 1919 ALICE ST 1408 TEBEAU ST 1312 PLANT AVE 2607 PLANT AVE 620 TEBEAU ST 1303 TEBEAU ST 119 W 6TH ST 26826 HWY 82 232 E BROAD ST 283 N BROAD ST 133 W ATHENS ST STE A 24 AMHERST DR STE B 908 GEORGIA AVE # 1 18126 MAIN ST 104 BROAD ST 605 N MAIN ST 501 E BROAD ST 206 BROAD ST 8691 N. MARCUS ST. 929 MURPHY ST 460 THOMASTON ST 134 KAYEN CHANDO STE 106 214 W MARINE DR 302 S ROUTE 4 STE 118 177C CHALAN PASAHERU 646 S MARINE DR 590 S MARINE DR 255 FARENHOLT AVE 241 FARENHOLT AVE STE 105 291 FARENHOLT AVE 99-128 AIEA HEIGHTS DR STE 103 98-1247 KAAHUMANU ST STE 320A 98-1079 MOANALUA RD 99-115 AIEA HEIGHTS DR 82-6066 MAMALAHOA HWY STE 14 91-2139 FORT WEAVER RD STE 106 1-3845 KAUMUALII HIGHWAY 2100 KANOELEHUA AVE 50 E PUAINAKO ST 234 WAIANUENUE AVE STE 107 333 KILAUEA AVE STE 109 868 ULULANI ST STE 107

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Provider City WAYCROSS WAYCROSS WAYCROSS WAYCROSS WAYCROSS WAYCROSS WAYNESBORO WAYNESVILLE WINDER WINDER WINDER WINDER WOODBINE WOODBURY WRENS WRENS WRENS WRENS WRIGHTSVILLE YOUNG HARRIS ZEBULON DEDEDO DEDEDO HAGATNA TAMUNING TAMUNING TAMUNING TAMUNING TAMUNING TAMUNING AIEA AIEA AIEA AIEA CAPTAIN COOK EWA BEACH HANAPEPE HILO HILO HILO HILO HILO

State

ZIP code

GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GA GU GU GU GU GU GU GU GU GU HI HI HI HI HI HI HI HI HI HI HI HI

31501-6207 31501-5325 31501-3537 31501-6062 31501-4728 31501-5318 30830-1459 31566 30680-2277 30680-2155 30680 30680-7463 31569-3574 30293 30833-1107 30833-1178 30833-1185 30833-1109 31096 30582-4027 30295 96929-5933 96929-5913 96910-4341 96913-4127 96913-3503 96913-3507 96913-3209 96913-3222 96913-3209 96701-3916 96701-5301 96701-4713 96701-3924 96704-8204 96706-3607 96716 96720-6500 96720-5243 96720-2418 96720-3013 96720-3913

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name 5 MINUTE PHARMACY ALA MOANA 5 MINUTE PHARMACY KALIHI 5 MINUTE PHARMACY KKV CHINATOWN PHARMACY DON QUIJOTE DRUGS FOODLAND PHARMACY HAWAII ONCOLOGY INC MEDIPHARM PHARMACY MEDIPHARM PHARMACY, LLC ONCARE HAWAII INC OPEN DOOR RX OPTION CARE PHARMACARE PHARMACARE PHARMACARE PHARMACARE NO. 1 PHARMACYONE PLAZA PHARMACY QUEENS POB 2 PHARMACY QUEENS POB I PHARMACY QUEENS POB III PHARMACY ST LUKES CLINIC THE HONOLULU PHARMACY THE QUEENS MEDICAL CENTER PHCY TIMES PHARMACY TIMES PHARMACY TIMES PHARMACY TIMES PHARMACY TIMES PHARMACY KAMEHAMEHA WAIKIKI HEALTH CENTER PHARMACY WAIKIKI HEALTH CENTER PHARMACY WEINSTEIN PHARMACY WELLNESS PHARMACY INC WELLNESS PHARMACY STORE #2 CASTLE MEDICAL CENTER ELIX RX FOODLAND MEDICINE CABINET KOOLAU PHARMACY TIMES PHARMACY KTA KEAUHOU PHARMACY KALAHEO PHARMACY FOODLAND MEDICINE CABINET

NR_0009_10823 10/2017

Provider Phone Number (808) 797-2905 (808) 845-5550 (808) 600-3368 (808) 533-6288 (808) 973-6661 (808) 949-2990 (808) 532-0315 (808) 791-6077 (808) 523-7088 (808) 524-6115 (808) 536-8686 (808) 489-9384 (808) 840-5640 (808) 836-0223 (808) 840-5670 (808) 840-5620 (808) 548-2299 (808) 547-9440 (808) 547-4560 (808) 547-4745 (808) 545-8925 (808) 945-3719 (808) 533-8887 (808) 547-4238 (808) 522-5071 (808) 733-2031 (808) 522-5078 (808) 973-5851 (808) 853-2268 (808) 791-9309 (808) 739-7363 (808) 312-3437 (808) 550-2833 (808) 550-2888 (808) 263-5142 (808) 260-9894 (808) 261-7329 (808) 263-5060 (808) 266-2702 (808) 322-2511 (808) 332-6000 (808) 885-2075

Provider Street 1441 KAPIOLANI BLVD STE 806 916 GULICK AVE STE A 2229 N SCHOOL ST STE 101 70 N HOTEL ST 801 KAHEKA ST 1450 ALA MOANA BLVD #8000 1380 LUSITANA ST STE 608 875 WAIMANU ST 1188 BISHOP ST STE 802 1329 LUSITANA ST STE 307 1130 N NIMITZ HWY #A153 1121 S BERETANIA ST STE 102 888 S KING ST 3375 KOAPAKA ST STE G320 1319 PUNAHOU ST 2228 LILIHA ST STE 100 1712 LILIHA ST STE 101 321 N KUAKINI ST STE 105 1329 LUSITANA ST STE 101 1380 LUSITANA ST 550 S BERETANIA ST STE 102 1441 KAPIOLANI BLVD STE 2000 1188 BISHOP ST STE 2303 1301 PUNCHBOWL ST 1290 S BERETANIA ST 1173 21ST AVE 1425 LILIHA ST 1772 S KING ST 1620 N SCHOOL ST 277 OHUA AVE 935 MAKAHIKI WAY 846 POHUKAINA ST STE F 100 N BERETANIA ST STE 148 1120 MAUNAKEA ST STE # 102 640 ULUKAHIKI ST 1090 KEOLU DR STE 112/113 108 HEKILI ST 642 ULUKAHIKI ST STE 101 590 KAILUA RD 78-6831 ALII DR 2436 KAUMUALII HIGHWAY 67-1185 MAMALAHOA HWY

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Provider City HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU HONOLULU KAILUA KAILUA KAILUA KAILUA KAILUA KAILUA KONA KALAHEO KAMUELA

State

ZIP code

HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI

96814-4404 96819 96819-2588 96817-5105 96814-3725 96814 96813 96813 96813-3303 96813-2435 96817-5777 96814-1621 96813-3009 96819-1898 96826-1001 96817-1651 96817-5409 96817-2375 96813-2401 96813-2449 96813-2496 96814 96813-3309 96813-2402 96814-1513 96816-4653 96817-3522 96826-2135 96817-1844 96815 96826-2896 96813-5300 96817-4708 96817-5100 96734-4454 96734-3871 96734-2848 96734-4418 96734-2827 96740-2495 96741 96743-7304

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KTA KAMUELA PHARMACY CASTLE PROFESSIONAL CTR PHCY TIMES PHARMACY TIMES PHARMACY FOODLAND PHARMACY FOODLAND PHARMACY MOLOKAI DRUGS INC MALAMA COMPOUNDING PHARMACY RAINBOW PHARMACY LLC WAILEA PHARMACY LIFEWAY PHARMACY (KOLOA) NAPILI MARKET PHARMACY TIMES PHARMACY #24 (HONOKOWAI) FOODLAND PHARMACY RAINBOW PHARMACY HAWAII HOME INFUSION ASSOCIATES HO OLA LAHUI HAWAI I LIFEWAY PHARMACY-LIHUE LIHUE PHARMACY

Provider Name

(808) 885-0033 (808) 263-5090 (808) 233-4601 (808) 239-3204 (808) 821-6979 (808) 674-1156 (808) 553-5790 (808) 324-6888 (808) 879-9924 (808) 879-0123 (808) 742-7511 (808) 669-1600 (808) 661-8008 (808) 293-9919 (808) 565-9332 (808) 245-3787 (808) 240-0200 (808) 245-2471 (808) 246-9100

65-1158 MAMALAHOA HWY 46-001 KAMEHAMEHA HWY STE 108 45-934 KAMEHAMEHA HWY 47-388 HUI IWA ST 4-771 KUHIO HWY 4850 KAPOLEI PARKWAY 28 KAMOI STREET STE 100 81-6629 MAMALAHOA HWY 2349 S KIHEI RD # 4 34 WAILEA GATEWAY PL STE A103 5330 KOLOA RD STE 2 5095 NAPILIHAU ST 3350 LOWER HONOAPIILANI RD 55-510 KAMEHAMEHA HWY 431 SEVENTH ST 4490 KOLOPA ST STE B 4491 RICE ST STE 105-A 3-3295 KUHIO HWY STE 102 4491 KOLOPA ST STE A

KAMUELA KANEOHE KANEOHE KANEOHE KAPAA KAPOLEI KAUNAKAKAI KEALAKEKUA KIHEI KIHEI KOLOA LAHAINA LAHAINA LAIE LANAI CITY LIHUE LIHUE LIHUE LIHUE

HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI HI

96743-8442 96744-3720 96744-3243 96744-4416 96746-1543 96707 96748-0000 96750-8130 96753-7202 96753-6525 96756-8624 96761-8800 96761-8402 96762-1138 96763 96766-2037 96766-1805 96766-1035 96766-2034

WILCOX MEM HOSPITAL OUTPATIENT PHCY THE FOODLAND MEDICINE CABINET PAHOA PHARMACY TIMES PHARMACY FOODLAND PHARMACY PHARMACARE WAIKOLOA VILLAGE MARKET PHCY LIFEWAY PHARMACY WAIMEA 5 MINUTE PHARMACY LLC DON QUIJOTE DRUGS TIMES PHARMACY TIMES PHARMACY NUCARA PHARMACY FAY PHARMACY ADEL HEALTHMART SUMPTER PHARMACY AND WELLNESS THORSON DRUG KRHC FAMILY PHARMACY MEDICAP PHARMACY AMANA PHARMACY MEDICAP PHARMACY NUCARA PHARMACY #28

(808) 245-1480 (808) 572-8266 (808) 965-0601 (808) 483-3078 (808) 826-4228 (808) 628-2800 (808) 883-8434 (808) 338-0600 (808) 677-5550 (808) 681-6831 (808) 677-1513 (808) 677-5999 (641) 847-2585 (641) 742-3440 (515) 993-3644 (515) 993-1119 (712) 568-2013 (515) 295-4567 (515) 957-0001 (319) 622-3341 (515) 232-1653 (515) 292-3604

3-3420 KUHIO HWY 55 PUKALANI ST 15-2660 PAHOA VLG RD STE 205 98-1264 KAAHUMANU ST 5-4280 KUHIO HWY 86-032 FARRINGTON HWY STE 101 68-3916 PANIOLO AVE 4643 WAIMEA CANYON DR STE A 94-216 FARRINGTON HWY # B1-102 94-144 FARRINGTON HWY 94-766 FARRINGTON HWY 94-615 KUPUOHI ST 722 MAIN ST 400 AUDUBON ST 113 N 9TH ST 628 NILE KINNICK DR S STE A 233 REED ST 1519 S PHILLIPS ST 950 28TH AVENUE SW 507 39TH AVE 105 LINCOLN WAY 2709 NORTHRIDGE PKWY

LIHUE MAKAWAO PAHOA PEARL CITY PRINCEVILLE WAIANAE WAIKOLOA WAIMEA WAIPAHU WAIPAHU WAIPAHU WAIPAHU ACKLEY ADAIR ADEL ADEL AKRON ALGONA ALTOONA AMANA AMES AMES

HI HI HI HI HI HI HI HI HI HI HI HI IA IA IA IA IA IA IA IA IA IA

96766 96768-8544 96778 96782-3252 96722-5438 96792-3039 96738 96796 96797-1922 96797-1918 96797-3348 96797-5329 50601-1538 50002 50003-1443 50003-2071 51001-8591 50511-3649 50009 52203-8229 50010-3323 50010-4097

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Provider Phone Number

Provider Street

Page 177 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PHARMACY CARE CENTRE ANITA CLINIC PHARMACY ANKENY MEDICAL PARK PHARMACY ANKENY PHARMACY MEDICAP PHARMACY MERCY NORTH PHARMACY RIGHT DOSE PHARMACY MILLS PHARMACY ATKINS FAMILY PHARMACY ATLANTIC MEDICAL CENTER PHCY REX PHARMACY REX PHARMACY INC MEDICAP PHARMACY BEDFORD REXALL DRUG CORNERSTONE APOTHECARY HARTIG DRUG CO BELLEVUE PHARMACY AMICARE PHARMACY, INC. MAIN HEALTHCARE PHARMACY CLINIC PHARMACY MEDICAL ASSOCIATES PHARMACY MEDICAP PHARMACY ELIZABETHS PHARMACY ON MAIN MEDICAP PHARMACY CARROLL APOTHECARY CLINIC PHARMACY OF CARROLL CUSTOM CARE COMPOUNDING PHCY LINCOLN HWY PHARMACY MERCY FAMILY PHARMACY-CASCADE MEDICAP PHARMACY PRAIRIE PARKWAY PHARMACY ARJ INFUSION SERVICES INC CAREPRO PHARMACY A AVENUE CAREPRO PHARMACY-PAVILION CLARKS PHARMACY HALL-PERRINE CANCER CTR PHCY IA BLOOD & CANCER CARE OF PCI MEDICAL PHARMACY MERCY MEDICAL CENTER CEDAR OPTUMRX PHCY AT ROCKWELL COLLINS REUTZEL PHARMACY RIGHT DOSE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (319) 462-3306 (712) 762-3945 (515) 965-4680 (515) 289-4008 (515) 964-8550 (515) 643-7590 (515) 963-1640 (712) 373-5256 (319) 446-6231 (712) 243-3367 (712) 243-2110 (712) 243-2110 (712) 563-2655 (712) 523-2385 (319) 444-2290 (319) 444-2480 (563) 872-4259 (563) 344-7450 (563) 324-5004 (515) 432-7123 (515) 432-3460 (515) 432-2311 (641) 843-3885 (515) 989-3261 (712) 792-2671 (712) 792-5393 (712) 792-2671 (712) 792-2402 (563) 852-7757 (319) 277-1829 (319) 222-2906 (866) 451-8804 (319) 364-1586 (319) 364-2406 (319) 393-3210 (319) 398-6343 (319) 297-2900 (319) 362-8976 (319) 398-6063 (319) 377-5497 (319) 364-4181 (319) 214-5265

Provider Street 1791 HIGHWAY 64 E STE 1 710 MAIN STREET 3625 N ANKENY BLVD SUITE A 1325 SW ORALABOR RD STE 200 107 NE DELAWARE AVE STE 6 800 E 1ST ST STE 1800 1325 SW ORALABOR RD STE 204 120 E MAIN ST 401 CARDINAL AVE 1501 E 10TH ST 507 CHESTNUT ST 507 CHESTNUT ST 316 BROADWAY ST 419 MAIN ST 731 12TH ST 810 12TH ST 115 STATE ST 3740 UTICA RIDGE RD 2151 KIMBERLY RD 1115 S MARSHALL ST 120 S STORY ST 403 STORY ST 52 MAIN AVE N 800 SCHOOL ST 425 W US HIGHWAY 30 STE 140 405 S CLARK ST STE 102 425 W US HIGHWAY 30 859 E US HIGHWAY 30 805 JOHNSON ST SW 103 E 18TH ST 5100 PRAIRIE PKWY STE 106 1847 1ST AVE SE STE 100 717 A AVE NE STE 202 202 10TH ST SE STE 115 1946 42ND ST NE 701 10TH ST SE 855 A AVE NE STE 402 830 4TH AVE SE STE 2 701 10TH ST SE 5070 ROCKWELL DR NE 617 8TH AVE SE 1825 29TH ST NE

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Provider City ANAMOSA ANITA ANKENY ANKENY ANKENY ANKENY ANKENY ANTHON ATKINS ATLANTIC ATLANTIC ATLANTIC AUDUBON BEDFORD BELLE PLAINE BELLE PLAINE BELLEVUE BETTENDORF BETTENDORF BOONE BOONE BOONE BRITT CARLISLE CARROLL CARROLL CARROLL CARROLL CASCADE CEDAR FALLS CEDAR FALLS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS CEDAR RAPIDS

State

ZIP code

IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA

52205-2112 50020 50023-4604 50023 50021-6691 50021-2062 50023 51004 52206 50022-1936 50022-1249 50022-1249 50025-1104 50833-1321 52208 52208 52031-1307 52722-1657 52722-3628 50036-5304 50036 50036-3533 50423-1657 50047-9716 51401-2262 51401 51401-2262 51401-2617 52033-8636 50613-4288 50613-8155 52402-5434 52401-1024 52403-2404 52402-3041 52403 52402-5064 52403 52403 52402-2003 52401-2117 52402-3452

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE GHOSH CENTER CENTER POINT FAMILY PHARMACY OWL PHARMACY CENTRAL CITY FAMILY PHARMACY CHEROKEE MAIN STREET PHARMACY TAYLOR PHARMACY COMMUNITY PHARMACY ECONOFOODS PHARMACY

Provider Name

(319) 294-1899 (319) 849-2799 (641) 437-7200 (319) 438-1988 (712) 225-2320 (712) 542-3522 (515) 532-2801 (641) 357-2169

1951 51ST ST NE 900 BANK CT 213 N 13TH ST 402 E MAIN ST 206 W MAIN ST 122 N 16TH ST # 124 215 13TH AVE SW 20 S 4TH ST

CEDAR RAPIDS CENTER POINT CENTERVILLE CENTRAL CITY CHEROKEE CLARINDA CLARION CLEAR LAKE

IA IA IA IA IA IA IA IA

52402 52213-9477 52544-1707 52214-9454 51012 51632-1601 50525-2078 50428-1817

MERCY FAMILY PHARMACY - CLEAR LAKE WHITE DRUG OSCO PHARMACY WAGNER CLINIC PHARMACY WAGNER PHARMACY MERCY WEST PHARMACY BENZER PHARMACY NUCARA PHARMACY COON RAPIDS PHARMACY NUCARA PHARMACY

(641) 231-8900 (641) 357-5271 (563) 243-6641 (563) 242-5944 (563) 242-0626 (515) 222-7979 (515) 674-3503 (641) 366-2441 (712) 999-7979 (319) 354-6006

1410 6TH AVE S STE 200 1907 US HIGHWAY 18 E 1307 N 2ND ST 915 13TH AVE N 1726 N 2ND ST 1601 NW 114TH ST STE 234 101 N WALNUT ST 110 CENTER ST 515 MAIN ST 1150 5TH ST STE 142

CLEAR LAKE CLEAR LAKE CLINTON CLINTON CLINTON CLIVE COLFAX CONRAD COON RAPIDS CORALVILLE

IA IA IA IA IA IA IA IA IA IA

50428-2606 50428 52732-5243 52732-5067 52732-2645 50325-7007 50054-1039 50621-7822 50058-1611 52241-2929

UI HEALTHCARE RIVER LANDING PHARMAC ALL CARE HEALTH CENTER CHI HLTH PHCY - WEST BROADWAY

(319) 467-2050 (712) 256-6583 (712) 242-2070

105 E 9TH STREET SUITE A 900 S 6TH ST 3135 WEST BROADWAY, STE 101

CORALVILLE COUNCIL BLUFFS COUNCIL BLUFFS

IA IA IA

52241 51501 51501

HEARTLAND ONCOLOGY&HEMATOLOGY MEDICAP PHARMACY OARD ROSS DRUG INC S-S PHARMACY SUPER SAVER PHARMACY CRESCO FAMILY PHARMACY STERLING DRUG MEDICAP PHARMACY MEDICAP PHARMACY FIRST MED EAST PHARMACY FIRST MEDICAL PHARMACY HEMATOLOGY AND ONCOLOGY CARE IOWA CANCER SPECIALISTS MAIN AT LOCUST PHARMACY UROLOGICAL ASSOCIATES PC FAMILY PHARMACY BROADLAWNS MED CTR OP PHARMACY SCOTT DRUG CLINIC PHARMACY

(712) 322-4136 (712) 325-8676 (712) 322-2501 (712) 328-3344 (712) 322-9019 (563) 547-6666 (563) 547-5111 (641) 782-6558 (515) 992-3784 (563) 421-6366 (563) 421-3308 (563) 359-9876 (563) 421-1960 (563) 324-1641 (563) 359-1641 (515) 547-2384 (515) 282-6149 (563) 659-8910

1 EDMUNDSON PL STE 100 2201 W BROADWAY 701 16TH AVE 235 W BROADWAY 1141 N BROADWAY 235 8TH AVE W 303 2ND AVE SW 405 S SUMNER AVE 504 14TH ST 1227 E RUSHOLME ST 1803 E KIMBERLY RD STE A 1409 KIMBERLY RD 1351 W CENTRAL PARK AVE 129 W LOCUST ST 3319 SPRING ST 21 S MAIN 1801 HICKMAN RD 1021 11TH ST

COUNCIL BLUFFS COUNCIL BLUFFS COUNCIL BLUFFS COUNCIL BLUFFS COUNCIL BLUFFS CRESCO CRESCO CRESTON DALLAS CENTER DAVENPORT DAVENPORT DAVENPORT DAVENPORT DAVENPORT DAVENPORT DAYTON DE MOINES DE WITT

IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA

51503 51501-3605 51501-6378 51503-9004 51503-1513 52136-1062 52136-1843 50801-3330 50063-0369 52803-2459 52807-2027 52807-1923 52804-1853 52803-2803 52807 50530-0000 50314 52742-1209

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Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SCOTT'S THRIFTY WHITE DRUG DONLON PHARMACY DONLON PHARMACY WHITE DRUG DENVER DRUG CASH SAVER CASH SAVER CASSADY PHARMACY FIFIELD DRUG STORE IMMC OUTPATIENT PHARMACY MEDICAP PHARMACY MEDICAP PHARMACY MEDICAP PHARMACY MEDICAP PHARMACY MERCY OUTPATIENT PHARMACY PRICE CHOPPER PRICE CHOPPER PRICE CHOPPER HARTIG DRUG CO HARTIG DRUG CO HARTIG DRUG CO HARTIG DRUG CO. MERCY FAMILY PHARMACY MERCY FAMILY PHARMACY MERCY FAMILY PHARMACY-ELM MERCY FAMILY PHARMACY-MERCY THE FINLEY HOSP PHARMACY UNION FAMILY PHARMACY DUNLAP FAMILY PHARMACY WESTFAIR DRUG INC HARTIG DRUG CO. MERCY FAMILY PHARMACY THE PRESCRIPTION SHOPPE EAGLE PHARMACY MONTROSS PHARMACY INC ELDORA PRESCRIPTION PHARMACY MEDICAP PHARMACY NORTH SCOTT PHARMACY ELK HORN PHARMACY MOSER FAMILY PHARMACY HUGHES HEALTH MART PHARMACY ESTHERVILLE DRUG INC

NR_0009_10823 10/2017

Provider Phone Number (563) 659-5042 (563) 382-3929 (563) 382-3929 (712) 263-4646 (319) 984-5691 (515) 285-5927 (515) 265-5946 (515) 285-2474 (515) 244-3221 (515) 241-5936 (515) 263-1782 (515) 277-3702 (515) 266-2694 (515) 274-4609 (515) 643-4429 (515) 276-4845 (515) 279-4382 (515) 255-8642 (563) 588-8708 (563) 588-8702 (563) 588-8703 (563) 588-8704 (563) 584-3405 (563) 584-4405 (563) 583-7379 (563) 589-9370 (563) 589-2472 (563) 556-1493 (712) 643-5162 (563) 785-4930 (563) 875-2552 (563) 875-7624 (563) 875-7455 (515) 448-3814 (515) 758-2174 (641) 939-3091 (641) 858-3567 (563) 285-2001 (712) 764-2334 (563) 245-2530 (712) 852-2886 (712) 362-3154

Provider Street 629 6TH AVE 201 W WATER ST 201 W WATER ST 1320 BROADWAY 340 S STATE ST 4121 FLEUR DR 1320 E EUCLID AVE 4505 SW 9TH ST 501 UNIVERSITY AVE 1200 PLEASANT ST 1300 E.14TH 2804 BEAVER AVE 2527 EASTON BLVD 5802 FRANKLIN AVE 1111 6TH AVE 4343 MERLE HAY RD 1819 BEAVER AVE 3425 INGERSOLL AVE 1600 UNIVERSITY AVE 157 LOCUST ST 2255 JOHN F KENNEDY RD 2225 CENTRAL AVE 1000 LANGWORTHY ST 1500 ASSOCIATES DR 1920 ELM ST 250 MERCY DR 350 N GRANDVIEW AVE 2541 CENTRAL AVE 612 IOWA AVE 621 5TH AVE 711 16TH AVE SE 1111 3RD ST SW 1020 12TH AVE SE 311 W BROADWAY ST 115 N CHESTNUT AVE 1274 EDGINGTON AVE 1602 EDGINGTON AVE 225 E LE CLAIRE RD 4022 MAIN ST 135 N MAIN 2216 MAIN ST 522 CENTRAL AVE

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Provider City DE WITT DECORAH DECORAH DENISON DENVER DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DES MOINES DUBUQUE DUBUQUE DUBUQUE DUBUQUE DUBUQUE DUBUQUE DUBUQUE DUBUQUE DUBUQUE DUBUQUE DUNLAP DURANT DYERSVILLE DYERSVILLE DYERSVILLE EAGLE GROVE EARLHAM ELDORA ELDORA ELDRIDGE ELK HORN ELKADER EMMETSBURG ESTHERVILLE

State

ZIP code

IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA

52742-1635 52101-1727 52101-1727 51442-1924 50622-9998 50321 50316-1218 50315-3939 50314-2702 50309-1406 50316 50310-4038 50317-6119 50322-6132 50314-2610 50310-1411 50310-3899 50312-3976 52001-5937 52001-7660 52002-2846 52001-3506 52001-7313 52002-2201 52001-3641 52001-7320 52001-6388 52001-3305 51529-1334 52747-9774 52040-2158 52040 52040-1919 50533-1711 50072-7709 50627-1739 50627-0551 52748-1721 51531-2102 52043-9011 50536-2447 51334-2239

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name EVANSDALE PHARMACY NUCARA PHARMACY SCOTT PHARMACY INC FONTANELLE DRUG MILLER PHARMACY DANIEL PHARMACY GENOA-QOL HEALTHCARE RASHID PHARMACY PLC TAMMYS PHARMACY MEDICAP PHARMACY COMMUNITY PHARMACY II MERCY FAMILY PHARMACY - GREENE MEDICAP PHARMACY MEDICAP PHARMACY ENGLAND MEDICAL CLINIC MANLY DRUG STORE DOWD DRUG GUTTENBERG PHARMACY HARTIG DRUG CO STONER DRUG COMPANY INC KOERNER WHIPPLE DRUG MEDICAL CENTER PHARMACY RICKS PHARMACY KWIK RX PHARMACY PEXTON PHARMACY HARTLEY HOMETOWN PHARMACY BOOTH PHARMACY INC BLAIRS FERRY FAMILY PHARMACY LARRY'S PHARMACY HARTIG DRUG CO. RYAN PHARMACY MEDICAP PHARMACY MEDICAP PHARMACY - CD HARTIG DRUG CO. TOWNCREST PHARMACY U OF IA HOSPITALS AND CLINICS CORNER PHARMACY RIEBER CLINIC PHARMACY MEDICAP PHARMACY JESUP PHARMACY FAMILY PHARMACY PRICE CHOPPER

NR_0009_10823 10/2017

Provider Phone Number (319) 233-3395 (641) 469-3001 (563) 425-4530 (641) 745-3221 (641) 585-3931 (515) 573-3431 (515) 206-2057 (319) 372-2300 (641) 923-2649 (712) 527-1200 (515) 352-3876 (641) 816-3013 (515) 986-0101 (641) 236-3663 (712) 778-2395 (319) 824-5446 (641) 747-8317 (563) 252-1172 (563) 329-1471 (712) 382-2551 (614) 456-3171 (641) 456-4146 (641) 456-3538 (712) 755-3823 (712) 755-2101 (712) 928-7070 (712) 551-2374 (319) 393-4944 (515) 332-1627 (319) 334-7155 (319) 334-7171 (515) 961-5303 (515) 962-9399 (319) 338-5778 (319) 337-3526 (319) 356-2577 (641) 648-5550 (641) 648-3733 (515) 386-2164 (319) 827-6889 (515) 827-5134 (515) 331-0300

Provider Street 3506 LAFAYETTE RD 2000D S MAIN ST 238 S MAIN ST 401 WASHINGTON ST 635 E US HIGHWAY 9 1114 CENTRAL AVE 720 KENYON RD STE 3 2404 AVENUE L 930 W US HIGHWAY 18 1206 S LOCUST ST 1800 MAIN ST 104 E TRAER ST 250 SE GATEWAY DR 320 6TH AVE 506 MAIN 621 G AVE 307 STATE ST 807 S HWY 52 200 MAIN ST STE 1 1105 MAIN ST 104 1ST ST NW 1720 CENTRAL AVE E 6 1ST ST NW 2308 12TH ST 1812 CHATBURN PLZ 177 S CENTRAL AVE 903 CENTRAL AVE 1790 BLAIRS FERRY RD 1310 10TH AVE N 200 1ST ST E 1100 1ST ST E 208 E EUCLID AVE 404 E EUCLID AVE 701 MORMON TREK BLVD 2306 MUSCATINE AVE 200 HAWKINS DR # CC101GH 504 ROCKSYLVANIA AVE 920 S OAK ST, STE 2 400 N ELM ST 1094 220TH ST 633 MAIN ST 5440 NW 86TH ST

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Provider City EVANSDALE FAIRFIELD FAYETTE FONTANELLE FOREST CITY FORT DODGE FORT DODGE FORT MADISON GARNER GLENWOOD GOWRIE GREENE GRIMES GRINNELL GRISWOLD GRUNDY CENTER GUTHRIE CENTER GUTTENBERG GUTTENBERG HAMBURG HAMPTON HAMPTON HAMPTON HARLAN HARLAN HARTLEY HAWARDEN HIAWATHA HUMBOLDT INDEPENDENCE INDEPENDENCE INDIANOLA INDIANOLA IOWA CITY IOWA CITY IOWA CITY IOWA FALLS IOWA FALLS JEFFERSON JESUP JEWELL JOHNSTON

State

ZIP code

IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA

50707-1025 52556-9572 52142-9301 50846-9900 50436-1028 50501-4004 50501-5759 52627-3933 50438-1034 51534-1889 50543-7438 50636-7702 50111-2045 50112-1845 51535-0000 50638-1549 50115-1351 52052 52052-9108 51640-1233 50441-1702 50441-1859 50441-1902 51537-2002 51537-1980 51346 51023-2233 52233-2033 50548-1112 50644-2813 50644-3116 50125-1816 50125-1730 52246-1812 52240 52242-1009 50126-2234 50126-9506 50129-1420 50648-9400 50130-2038 50131

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MILLERS MEDICINE CABINET LEE PHARMACY MEDICAP PHARMACY LA PORTE CITY PHARMACY COMMUNITY PHARMACY HARRIS DRUG WOODLAWN PHARMACY COMMUNITY PHARMACY L&M PHARMACY CARE NUCARA PHARMACY CHCSI PHARMACY EBY DRUG STORE INC MEDICAP PHARMACY KOHLL'S PHARMACY & HOMECARE BREHME DRUG INC WIDNER REXALL DRUG MANNING PHARMACY INC MEDICAP PHARMACY MAIER FAMILY PHARMACY OSTERHAUS PHARMACY CORNERSTONE APOTHECARY PETERSON PHARMACY NUCARA PHARMACY FOREST PARK CLINIC PHCY PC MERCY FAMILY PHARMACY-REGENCY MERCY HOME INFUSION PHARMACY MERCY WESTSIDE PHARMACY MCGREGOR PHARMACY CARRUTHERS PHARMACY LEHAN PHARMACY VALLEY DRUG STORE MONONA PHARMACY HARTIG DRUG CO THE PRESCRIPTION SHOPPE CAREPRO PHARMACY MOUNT VERNON CAPSTONE PHARMACY WESTER DRUG NUCARA PHARMACY PARKVIEW PHARMACY STORY COUNTY HOSPITAL BENNETT PHARMACY, INC. MEDICAP PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (319) 656-3134 (319) 293-3128 (641) 828-7312 (319) 342-3620 (712) 464-7281 (712) 464-3165 (712) 464-8811 (712) 665-8554 (712) 546-8005 (641) 333-2260 (641) 446-3400 (712) 644-2160 (515) 795-4252 (712) 624-9050 (563) 927-3509 (563) 927-4463 (712) 655-9490 (712) 469-2214 (712) 881-1033 (563) 652-5611 (319) 741-6300 (319) 642-3312 (641) 752-4115 (641) 428-6100 (641) 428-6940 (641) 428-5732 (641) 428-5630 (563) 873-3781 (319) 394-3420 (712) 483-2884 (712) 642-2747 (563) 539-2348 (319) 465-4906 (319) 465-4404 (319) 895-6248 (319) 385-0733 (563) 263-7044 (515) 382-2485 (515) 382-2134 (515) 382-7010 (515) 394-4156 (641) 792-3528

Provider Street 214 5TH ST 601 FIRST ST 318 N LINCOLN ST 601 HIGHWAY 218 N 1321 W MAIN ST 121 E MAIN ST 101 N WOODLAWN AVE 1160 3RD ST 22 1ST ST NE 107 N MAIN ST 302 NE 14TH ST 103 N 4TH AVE 411 ANNEX RD 401 MAIN ST 220 E MAIN ST 111 S FRANKLIN ST 317 MAIN ST 1224 10TH AVE 411 MAIN ST 918 W PLATT ST # 2 1099 COURT AVE 104 E WASHINGTON ST 303 NICHOLAS DR 1010 4TH ST SW STE 110 621 S ILLINOIS AVE STE 101 1000 4TH ST SW 910 N EISENHOWER AVE 230 MAIN ST 526 MAIN ST 317 MAIN ST 318 E ERIE ST 118 W CENTER ST 419 E 1ST ST 304 E 1ST ST 113 1ST ST NE 210 N JEFFERSON ST 315 E 2ND ST 1002 6TH ST 1727 S B AVE 640 19TH ST 1 W MAIN ST 400 1ST AVE W

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Provider City KALONA KEOSAUQUA KNOXVILLE LA PORTE CITY LAKE CITY LAKE CITY LAKE CITY LAKE VIEW LE MARS LENOX LEON LOGAN MADRID MALVERN MANCHESTER MANCHESTER MANNING MANSON MAPLETON MAQUOKETA MARENGO MARENGO MARSHALLTOWN MASON CITY MASON CITY MASON CITY MASON CITY MC GREGOR MEDIAPOLIS MINDEN MISSOURI VALLEY MONONA MONTICELLO MONTICELLO MOUNT VERNON MT PLEASANT MUSCATINE NEVADA NEVADA NEVADA NEW HAMPTON NEWTON

State

ZIP code

IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA

52247-0337 52565 50138-2714 50651-1012 51449-1585 51449-1712 51449-1723 51450-7474 51031-3547 50851 50144-1206 51546-1335 50156-1471 51551-8137 52057-1534 52057-2132 51455-1030 50563-0490 51034-1212 52060-2038 52301-1439 52301-1545 50158-4443 50401-2856 50401-5489 50401 50401-1525 52157 52637-7788 51553-2125 51555-1619 52159-8224 52310 52310-1503 52314-1422 52641 52761-4109 50201-1826 50201-2804 50201-2401 50659-2101 50208-3001

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE MEDICINE SHOPPE CAREPRO PHARMACY NORTH LIBERTY MAIN HEALTHCARE PHARMACY VER HELST DRUG CENTER MEDICAP PHARMACY OAKLAND PHARMACY, INC. OELWEIN FAMILY PHARMACY

Provider Name

(641) 792-3111 (319) 626-6188 (563) 324-5004 (641) 324-2116 (515) 285-2026 (712) 482-3015 (319) 283-5254

212 1ST ST NORTH 555 W CHERRY ST 655 LIBERTY WAY STE 3 98 10TH ST N 2521 SUNSET DR 601 PIONEER AVE 32 S FREDERICK AVE

NEWTON NORTH LIBERTY NORTH LIBERTY NORTHWOOD NORWALK OAKLAND OELWEIN

IA IA IA IA IA IA IA

50208 52317-9797 52317-9154 50459-1438 50211 51560-0000 50662

SCHUCHMANNS' HEALTHMART PHCY,INC SWANSON DRUG STANGEL PHARMACY DUTCH MILL PHARMACY HOMETOWN PHARMACY SMART PHARMACY MEDICAP PHARMACY MAHASKA DRUGS NUCARA PHARMACY SOUTH SIDE DRUG, INC. MEDICAP PHARMACY SIECH'S PARKERSBURG PHARMACY PELLA REGIONAL HEALTH CTR PHCY VERMEER FAMILY PHARMACY FINLEY PHARMACY MEDICAP PHARMACY NUCARA PHARMACY NUCARA SPECIALTY PHARMACY ANDERSON PHARMACY MEDICAP PHARMACY RED OAK PHARMACY REINBECK PHARMACY REMSEN PHARMACY RICEVILLE PHARMACY PC COMMUNITY PHARMACY SAC CITY DRUG BROWER PHARMACY MONTROSS PHARMACY SERGEANT BLUFF PHARMACY SHEFFIELD PHARMACY GEORGE JAY DRUG CO PENN DRUG JACKS CORNER DRUG LLC DRILLING PHARMACY

(319) 283-2161 (515) 275-2362 (712) 423-1131 (712) 737-4844 (712) 737-4919 (641) 732-6161 (641) 342-6557 (641) 673-3439 (641) 684-5453 (641) 682-3467 (641) 755-2312 (319) 346-1970 (641) 628-1612 (641) 621-7470 (563) 557-2950 (515) 465-3391 (515) 264-1503 (515) 264-1503 (563) 689-3301 (712) 623-1900 (712) 623-7245 (319) 788-7445 (712) 786-2093 (641) 985-4114 (712) 297-7337 (712) 662-7146 (641) 713-4381 (641) 396-2445 (712) 943-1494 (641) 892-4640 (712) 246-2635 (712) 374-2513 (641) 622-3184 (712) 276-4621

12 S FREDERICK AVE 305 W WALNUT ST 821 IOWA AVE 104 ALBANY NORTH EAST 512 8TH ST SE 616 N 8TH ST 214 S MAIN ST 205 N E ST 107 W MAIN ST 337 CHURCH ST 615 EAST MAIN ST 226 3RD ST 802 WASHINGTON ST 1610 E VERMEER RD 8456 PEOSTA COMMERCIAL CT 601 1ST AVE 4927 MAPLE DR 4929 MAPLE ST 61 W GILLET ST 600 SENATE AVE 1400 SENATE AVE STE 104 401 MAIN ST 111 S WASHINGTON 120 W MAIN ST 507 E LAKE ST 514 MAIN ST 140 W 4TH ST 134 E MAIN ST 105 GAUL DR STE A 115 GILMAN 612 W SHERIDAN AVE 714 ILLINOIS STREET 118 S MAIN ST 4010 MORNINGSIDE AVE

OELWEIN OGDEN ONAWA ORANGE CITY ORANGE CITY OSAGE OSCEOLA OSKALOOSA OTTUMWA OTTUMWA PANORA PARKERSBURG PELLA PELLA PEOSTA PERRY PLEASANT HILL PLEASANT HILL PRESTON RED OAK RED OAK REINBECK REMSEN RICEVILLE ROCKWELL CITY SAC CITY SAINT ANSGAR SAINT CHARLES SERGEANT BLUFF SHEFFIELD SHENANDOAH SIDNEY SIGOURNEY SIOUX CITY

IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA

50662-2305 50212-3048 51040-1629 51041 51041 50461-1456 50213-1416 52577-2016 52501-2542 52501-4212 50216 50665-7730 50219-1525 50219-7658 52068 50220-1804 50327-2030 50327 52069-7709 51566-1283 51566-1271 50669-1049 51050 50466 50579-1711 50583-1727 50472-1352 50240 51054-8963 50475-0000 51601-1708 51652 52591-1420 51106-2447

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 183 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name GREENVILLE PHARMACY LEEDS HM PHARMACY THOMPSON DEAN DRUG SOLON TOWNCREST PHARMACY WHITE DRUG NUCARA PHARMACY BVRMC PHARMACY NUCARA PHARMACY FAMILY PHARMACY CLAYTON DRUG WRIGHT PHCY MEDICAP PHCY CLAYTON DRUG STONER DRUG CO TIFFIN PHARMACY CAREPRO PHARMACY TIPTON MEDICAP PHARMACY NUCARA PHARMACY MEDICAP PHARMACY CORNERSTONE APOTHECARY VICTOR DRUG HONEYMAN DRUG STORE CLINGMAN PHARMACY LAGRANGE PHARMACY BEANS PHARMACY RX4PREVENTION SMARTSCRIPTS ALLEN CLINIC PHARMACY COVENANT FAMILY PHARMACY GREENWOOD DRUG ON KIMBALL AVE NUCARA PHARMACY UNITED MEDICAL PARK CLINIC PHCY MEDICAP PHARMACY HARTIG DRUG CO CENTER PHARMACY MEYER HEALTHMART PHARMACY WHITE DRUG PHARMACY ON 8TH HERITAGE FAMILY PHARMACY HERITAGE PARK PHARMACY WEST LIBERTY PHARMACY NUCARA PHARMACY UNION DRUG INC

NR_0009_10823 10/2017

Provider Phone Number (712) 258-0113 (712) 239-2051 (712) 252-2781 (319) 624-2239 (712) 262-1523 (641) 483-2975 (712) 213-8065 (515) 733-2233 (515) 838-2322 (563) 933-4762 (515) 523-1525 (563) 578-5068 (712) 629-2945 (319) 545-3120 (563) 886-2158 (641) 484-6198 (319) 478-8711 (515) 276-3471 (319) 228-8100 (319) 647-8292 (712) 826-5262 (319) 472-4731 (319) 472-4274 (319) 653-4646 (888) 235-2820 (844) 597-6278 (319) 235-3777 (319) 272-5700 (319) 234-6673 (319) 236-8891 (319) 833-5725 (515) 987-8111 (563) 568-6315 (319) 483-4100 (319) 352-3120 (515) 832-4137 (319) 646-3388 (319) 753-3681 (319) 768-3950 (319) 653-1043 (563) 422-3151 (563) 422-3721

Provider Street 2705 CORRECTIONVILLE RD 2729 OUTER DR N 911 W 7TH ST 101 WINDFLOWER LN STE 100 715 S GRAND AVE 108 W MAIN 620 NORTHWESTERN DR (POD 2) 621 BROAD ST 803 SHAKESPEARE 104 W MISSION ST 303 SW 7TH ST STE A 100 E 1ST ST 712 MAIN ST 1100 TALL GRASS AVE 124 E 5TH ST 108 2ND AVE W 500 2ND ST 7641 DOUGLAS AVE 122 MAIN ST 205 WASHINGTON ST 408 S 3RD AVE 106 E 4TH ST 111 W 4TH ST 222 S IOWA AVENUE 1010 W MADISON ST 1010 W MADISON ST STE 1 146 W DALE ST STE 103 2710 SAINT FRANCIS DR STE 101 2104 KIMBALL AVE 209 E SAN MARNAN DR STE 100 1731 W RIDGEWAY AVE 10 WARRIOR LN 21 W MAIN ST 312 9TH ST SW STE 1000 110 10TH ST SW 848 2ND STREET 221 8TH AVE 1201 W AGENCY RD 1223 S GEAR AVE STE 105 311 W RAINBOW DR STE 1 119 N VINE ST 315 HIGHWAY 150 N

Page 184 of 679

Provider City SIOUX CITY SIOUX CITY SIOUX CITY SOLON SPENCER STATE CENTER STORM LAKE STORY CITY STRATFORD STRAWBERRY PT STUART SUMNER TABOR TIFFIN TIPTON TOLEDO TRAER URBANDALE VAN HORNE VICTOR VILLISCA VINTON VINTON WASHINGTON WASHINGTON WASHINGTON WATERLOO WATERLOO WATERLOO WATERLOO WATERLOO WAUKEE WAUKON WAVERLY WAVERLY WEBSTER CITY WELLMAN WEST BURLINGTON WEST BURLINGTON WEST LIBERTY WEST UNION WEST UNION

State

ZIP code

IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA IA

51105-3627 51104-1590 51103-5336 52333 51301-4037 50247 50588 50248 50249-0000 52076 50250-2164 50674-1430 51653-0000 52340 52772-1731 52342-2140 50675-1139 50322-3017 52346-9718 52347-7778 50864-1213 52349-1757 52349-1121 52353 52353-1624 52353-1624 50703-1925 50702-5493 50702-5037 50702-5839 50701-4595 50263 52172-1637 50677-2929 50677-2924 50595-2214 52356-4707 52655-1645 52655-1690 52776 52175-1346 52175-1048

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WHITING FAMILY PHARMACY HARTIG DRUG CO WESTER DRUG MEDICAP PHARMACY MONTROSS PHARMACY, INC. FOOD LAND PHARMACY NUCARA PHARMACY #29 WALLACE DRUG ROCKLAND PHARMACY ALBERTSON'S PHARMACY BROULIMS PHARMACY TETON PHARMACY IN AMMON BENGAL PHARMACY @ LOST RIVERS ASHTON COMMUNITY PHARMACY BINGHAM MEMORIAL HOSPITAL MEDICAL PLAZA PHARMACY PHARMACY SHOP PHARMACY SHOP EXPRESS RIDLEY'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY CUSTOMEDICA PHARMACY NORTH END FAMILY MEDICINE HLTH CNTR PHCY GENOA-QOL HEALTHCARE LADD FAMILY PHARMACY MEDNOW PHCY AT ST ALPHONSUS MEDSYNC PHARMACY MOUNTAIN CARE PHARMACY SAV-ON PHARMACY

Provider Name

(712) 458-2500 (319) 668-1520 (563) 732-5238 (515) 462-2880 (515) 462-2282 (712) 647-2840 (641) 487-7450 (208) 397-4540 (208) 226-2411 (208) 524-1616 (208) 522-3257 (208) 529-1795 (208) 282-3407 (208) 652-3932 (208) 785-3866 (208) 782-2990 (208) 785-3510 (208) 684-7011 (208) 785-1311 (208) 344-8660 (208) 426-9639 (208) 375-8386 (208) 343-1696 (208) 342-7341 (208) 433-9905 (208) 338-3722 (208) 376-1382 (208) 939-5149 (208) 322-7788 (208) 343-2901 (208) 429-1088 (208) 515-2211 (208) 514-2512 (208) 576-4500 (208) 947-0877 (208) 367-4847 (208) 364-7777 (208) 287-4667 (208) 319-0882

723 WHITTIER ST 517 COURT ST 400 OVESEN DR STE 102 904 N 1ST ST 118 N 1ST AVE # 120 423 WALKER ST 110 W MAIN ST 44 S MAIN ST 524 TYHEE AVE 1901 S 25TH E 2730 E SUNNYSIDE RD 3160 E 17TH ST STE 164 551 HIGHLAND 23 SOUTH 8TH STREET STE 2 98 POPLAR ST 98 POPLAR ST 69 N PINE ST 1441 PARKWAY DR 1295 PARKWAY BLVD 1650 W STATE ST 3614 W STATE ST 1520 N COLE RD 5100 W OVERLAND RD 1653 S VISTA AVE 1219 BROADWAY AVE 909 E PARKCENTER BLVD 10500 W OVERLAND RD 4700 N EAGLE RD 10700 USTICK RD 7100 W STATE ST 6560 S FEDERAL WAY 1915 W STATE ST 6565 W EMERALD ST 1276 W RIVER ST STE 138 1109 BROADWAY AVE 999 N CURTIS RD STE 102 801 S VISTA AVE 286 N MAPLE GROVE RD 10565 LAKE HAZEL RD

WHITING WILLIAMSBURG WILTON WINTERSET WINTERSET WOODBINE ZEARING ABERDEEN AMERICAN FALLS AMMON AMMON AMMON ARCO ASHTON BLACKFOOT BLACKFOOT BLACKFOOT BLACKFOOT BLACKFOOT BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE BOISE

IA IA IA IA IA IA IA ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID

51063-1035 52361 52778-9612 50273-1232 50273-1551 51579 50278-7728 83210-0000 83211-1224 83406-5710 83406-7547 83406 83213 83420 83221-1758 83221-1758 83221-2053 83221-1667 83221-1683 83702-4040 83703-5218 83704-8563 83705-2634 83705-3172 83706-3701 83706-6721 83709-1435 83713-0744 83713-5103 83714-7497 83716-9277 83702-3966 83704-8737 83702-7066 83706-3626 83706-1331 83705-2424 83704-8239 83709

MEDICINE MAN BONNERS FERRY PHARMACY BUHL DRUG

(208) 267-4021 (208) 543-5353

6452 MAIN ST 419 BROADWAY AVE S

BONNERS FERRY BUHL

ID ID

83805 83316-1310

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 185 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RIDLEY'S PHARMACY

Provider Name

(208) 543-9944

705 E HWY 30

BUHL

ID

83316-5054

FAMILY HEALTH SERVICES BURLEY PHCY KWIK MEDS SMITH'S PHARMACY STOKES PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY MEDICAL CLINIC PHARMACY WATKINS PHARMACY BENGAL PHARMACY AT CHALLIS SMITH'S PHARMACY INTERLAKE PHARMACY KOOTENAI CLINICS CANCER SVCS P MEDICINE MAN NORTH PHARMACY MEDICINE MAN PHARMACY ARNZEN DRUG ACHC PHARMACY BROULIMS PHARMACY CORNER DRUG CO ALBERTSON'S PHARMACY CUSTOMEDICA PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY THE PRESCRIPTION PAD GOODING PHARMACY RIDLEY'S PHARMACY LONDON DRUG IRWIN DRUG INC SYRINGA CLINIC PHARMACY ALBERTSON'S PHARMACY LUKE'S FAMILY PHARMACY THE DRUG STORE ALBERTSON'S PHARMACY MEDICINE MAN HAYDEN PHARMACY MEDICINE MAN PRAIRIE PHARMACY HOMEDALE DRUG SAV-ON PHARMACY ALBERTSON'S PHARMACY MIKES PHARMACY PRESCRIPTION CENTER INC SMITH'S PHARMACY

(208) 650-7854 (208) 878-6337 (208) 678-3286 (208) 878-7455 (208) 459-3411 (208) 454-0484 (208) 459-1503 (208) 382-4204 (208) 879-4600 (208) 237-3900 (208) 664-6664 (208) 625-5672 (208) 765-2268 (208) 666-2502 (208) 962-3401 (208) 253-4957 (208) 354-0057 (208) 354-2334 (208) 939-9854 (208) 939-8008 (208) 365-4128 (208) 272-9454 (208) 452-7075 (208) 934-4000 (208) 934-4709 (208) 425-3766 (208) 983-1090 (281) 749-4764 (208) 788-6713 (208) 788-4970 (208) 788-9714 (208) 772-7864 (208) 772-3311 (208) 762-9355 (208) 337-3898 (208) 337-4888 (208) 523-1090 (208) 525-8700 (208) 523-3360 (208) 529-5300

1309 BENNETT AVE 256 OVERLAND AVE 937 E MAIN ST 1310 POMERELLE AVE 415 CLEVELAND BLVD 2500 BLAINE ST 315 E ELM ST # 150 104 N MAIN 609 CLINIC RD 4845 YELLOWSTONE AVE 700 W IRONWOOD DR STE 100 700 W IRONWOOD DR 305 W KATHLEEN AVE 1114 W IRONWOOD DR 429 MAIN ST 205 N BERKLEY 242 N MAIN 10 S MAIN ST 250 S EAGLE RD 149 W STATE ST #101 640 HIGHWAY 16 179 W HIGHWAY 52 1118 NW 16TH ST # 150B 414 MAIN ST 1427 MAIN ST 6TH SOUTH MAIN 146 W MAIN ST 607 WEST MAIN STREET SUITE 100 911 N MAIN ST 101 S MAIN ST 91 E CROY ST 197 W PRAIRIE AVE 240 W HAYDEN AVE 8093 N CORNERSTONE DR 5 N MAIN 20 E WYOMING AVE 590 E 17TH ST 180 S HOLMES AVE 2252 CORONADO ST 400 S WOODRUFF AVE

BURLEY BURLEY BURLEY BURLEY CALDWELL CALDWELL CALDWELL CASCADE CHALLIS CHUBBUCK COEUR D ALENE COEUR D ALENE COEUR D ALENE COEUR D ALENE COTTONWOOD COUNCIL DRIGGS DRIGGS EAGLE EAGLE EMMETT EMMETT FRUITLAND GOODING GOODING GRACE GRANGEVILLE GRANGEVILLE HAILEY HAILEY HAILEY HAYDEN HAYDEN HAYDEN HOMEDALE HOMEDALE IDAHO FALLS IDAHO FALLS IDAHO FALLS IDAHO FALLS

ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID

83318 83318-1023 83318-2035 83318-2048 83605-3627 83605-4461 83605-4869 83611-0797 83226 83202-2333 83814-2666 83814-2656 83815-8338 83814-2605 83522 83612-5015 83422 83422-9700 83616-5906 83616 83617-9461 83617-9738 83619 83330 83330-1838 83241 83530-1932 83530 83333-8608 83333-8408 83333-8407 83835-8284 83835-8194 83835-8753 83628-0000 83628 83404-6154 83401-3945 83404-7552 83401-4367

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Provider Phone Number

Provider Street

Page 186 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name TETON CLINICAL PHARMACY INC TETON PHARMACY ON BROADWAY JEROME DRUG R & R PHARMACY RIDLEY'S PHARMACY KAMIAH DRUG KOHAL PHARMACY SUNNYSIDE DRUG YOKES PHARMACY CHAUTEAU DRUG CENTER VALLEY APOTHECARY RIDLEY'S PHARMACY CUSTOM RX RIDLEYS PHARMACY SAV-ON PHARMACY ALBERTSON'S PHARMACY HELLS CANYON PHARMACY ISVH L PHARMACY OWL SOUTHWAY PHARMACY ROSAUERS PHARMACY THE OWL DRUG CPS ALLEN UNITED DRUGS SAV-ON PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ID UROLOGIC INSTITUTE PHARMACY MEDICAP LTC PHARMACY MEDICAP PHARMACY OPTION CARE PORTICO PHARMACY ROSAUER PHARMACY ST LUKES MERIDIAN MEDICAL CTR RIDLEY'S PHARMACY BEAR LAKE DRUG LLC BROULIM'S PHARMACY MARKETIME DRUG ROSAUERS PHARMACY ALBERTSON'S PHARMACY SAV-MOR DRUG ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY MED NOW PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (208) 529-3636 (208) 529-3638 (208) 324-2440 (208) 324-3784 (208) 324-2411 (208) 935-2301 (208) 786-9303 (208) 784-6221 (208) 682-2127 (208) 726-5696 (208) 726-2679 (208) 423-4248 (208) 922-4400 (208) 922-9566 (208) 922-9836 (208) 743-1529 (208) 743-5515 (208) 799-3422 (208) 743-5528 (208) 743-6511 (208) 746-6755 (208) 766-2241 (208) 634-2433 (208) 884-5475 (208) 888-4414 (208) 639-4900 (208) 287-3733 (208) 288-1496 (208) 884-0669 (208) 288-4341 (208) 287-9218 (208) 706-5255 (208) 585-2900 (208) 847-1421 (208) 847-0806 (208) 882-7541 (208) 882-0900 (208) 587-3365 (208) 587-3346 (208) 466-3592 (208) 463-2903 (208) 463-5355

Provider Street 2470 JAFER CT 1855 W BROADWAY ST 111 PIONEER CT STE 2 133 W AVENUE A 1016 S LINCOLN AVE 318 MAIN 740 MCKINLEY AVE 131 W CAMERON AVE 117 N HILL ST 451 4TH ST 201 N. WASHINGTON AVE 210 S MAIN 173 W 4TH ST 1403 N MERIDIAN RD 700 E AVALON 1024 21ST ST 523 THAIN RD 821 21ST AVE 720 16TH AVE 332 THAIN RD 720 16TH AVE STE 2 4 N MAIN ST 1001 N 2ND ST 3301 W CHERRY LN 20 E FAIRVIEW AVE 2855 E MAGIC VIEW DR 800 S. INDUSTRY WAY STE 330 2790 W CHERRY LN STE 100 800 S INDUSTRY WAY STE 240 3355 E LOUISE DR 2986 N EAGLE RD 520 S EAGLE RD STE 1000 430 E MAIN ST 836 WASHINGTON 130 S 4TH ST 209 E 3RD ST 411 N MAIN ST 528 N MAIN ST 490 N 2ND E 715 12TH AVE S 2400 12TH AVE RD 1512 12TH AVE RD

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Provider City IDAHO FALLS IDAHO FALLS JEROME JEROME JEROME KAMIAH KELLOGG KELLOGG KELLOGG KETCHUM KETCHUM KIMBERLY KUNA KUNA KUNA LEWISTON LEWISTON LEWISTON LEWISTON LEWISTON LEWISTON MALAD CITY MCCALL MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MIDDLETON MONTPELIER MONTPELIER MOSCOW MOSCOW MOUNTAIN HOME MOUNTAIN HOME NAMPA NAMPA NAMPA

State

ZIP code

ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID

83404 83402-3043 83338-5193 83338-2630 83338-3048 83536 83837-2523 83837-2359 83837-2224 83340 83340 83341 83634-2046 83634 83634 83501-3416 83501-5530 83501-6389 83501-3768 83501-5337 83501-3768 83252-1247 83638-3849 83642-1119 83642-1732 83642-6245 83642-1137 83642-1137 83642-3559 83642-5047 83646-6251 83642-6353 83644-3036 83254 83254-1538 83843-2919 83843-2630 83647-2117 83647-2729 83651-4254 83686-6300 83686-6008

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

REDDISH PHARMACY UNITED DRUG VICS FAMILY PHARMACY VIC'S FAMILY PHARMACY INC. OSBURN DRUG MEDICAP PHARMACY ALBERTSON'S PHARMACY KOHAL PHARMACY ALBERTSON'S PHARMACY BENGAL PHARMACY ED SNELLS' PHARMACY MAAG PRESCRIPTION CENTER LLC RIDLEY'S PHARMACY RIDLEY'S PHARMACY #7156 SHAVER PHCY AND COMPOUNDING CT YOKES PHARMACY

Provider Name

(208) 466-7823 (208) 465-7000 (208) 442-1000 (208) 556-1139 (208) 722-5269 (208) 642-9331 (208) 682-3920 (208) 233-0651 (208) 282-3407 (208) 232-0049 (208) 233-2063 (208) 478-8510 (208) 233-4051 (208) 233-3341 (208) 265-8066

215 E HAWAII AVE 1603 12TH AVE RD STE A 118 S MIDLAND BLVD 805 E MULLAN AVE 410 EAST GROVE AVENUE 405 S MAIN ST 504 N DIVISION 330 E BENTON ST 990 S 8TH AVE 1015 E YOUNG ST 333 W CENTER ST 911 N MAIN ST 1000 POCATELLO CREEK RD 235 S 4TH AVE 212 BONNER MALL WAY

NAMPA NAMPA NAMPA OSBURN PARMA PAYETTE PINEHURST POCATELLO POCATELLO POCATELLO POCATELLO POCATELLO POCATELLO POCATELLO PONDERAY

ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID

83686-6011 83686-6100 83686-2601 83849 83660-0054 83661-3317 83850-0000 83201-6526 83201 83201-5282 83204-3243 83204-2831 83201-2926 83201-6438 83852-9748

MEDICINE MAN SOUTHWEST PHARMACY MEDICINE MAN WEST PHARMACY WELL LIFE POST FALLS PHARMACY YOKES PHARMACY NORTHWEST PHARMACY LARRYS FAMILY PHARMACY INC PRESTON DRUG MEDICINE MAN RATHDRUM RATHDRUM DRUG BROULIMS PHARMACY

(208) 777-7732 (208) 773-3566 (208) 773-2499 (208) 773-3383 (208) 875-1212 (208) 852-0163 (208) 852-1563 (208) 687-5717 (208) 687-0731 (208) 356-5416

805 E POLSTON AVE 802 E MEDICAL CT 565 N VEST ST 1501 E SELTICE WAY 525 PINE ST 217 S STATE ST 39 N 1ST E 15837 N WESTWOOD DR 16376 N HIGHWAY 41 124 W MAIN ST

POST FALLS POST FALLS POST FALLS POST FALLS POTLATCH PRESTON PRESTON RATHDRUM RATHDRUM REXBURG

ID ID ID ID ID ID ID ID ID ID

83854-6044 83854-7298 83854-7066 83854 83855-9700 83263-1455 83263-1325 83858-6432 83858-8735 83440-1827

BYU IDAHO STUDENT HLTH CTR PHARMACY SAV-ON PHARMACY THE MEDICINE SHOPPE BROULIMS PHARMACY IDAHO DRUG TETON PHARMACY OF RIGBY MINIDOKA MEM HOSPITAL PHARMACY RIDLEY'S PHARMACY FALLS UNITED DRU TETON PHARMACY OF ST ANTHONY JACK'S PHARMACY INC SAVEWAY MARKET INC MEDICINE MAN SANDPOINT SANDPOINT DRUG INC WHITE CROSS PHARMACY SANDPOINT

(208) 496-9342 (208) 542-2088 (208) 356-4481 (208) 745-0267 (208) 745-6831 (208) 745-9450 (208) 436-0481 (208) 436-1200 (208) 624-3202 (208) 624-4411 (208) 245-4578 (208) 756-1940 (208) 597-7466 (208) 263-1408 (208) 263-9080

179 STUDENT HEALTH CENTER 490 N 2ND E 167 W MAIN ST STE 1 150 N STATE ST 139 E MAIN ST 527 RIGBY LAKE DR STE C 1224 8TH ST 310 ONEIDA ST 23 N BRIDGE ST 104 N BRIDGE ST STE 112 103 E COLLEGE AVE 1200 SHOUP ST 624 LARCH 604 N 5TH AVE 1319 HWY 2 STE A

REXBURG REXBURG REXBURG RIGBY RIGBY RIGBY RUPERT RUPERT SAINT ANTHONY SAINT ANTHONY SAINT MARIES SALMON SANDPOINT SANDPOINT SANDPOINT

ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID

83460 83440-1654 83440-1826 83442-1443 83442-1417 83442-5117 83350-1527 83350-1756 83445-2110 83445-1457 83861-2247 83467-4300 83864 83864-1520 83864

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 188 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BROULIMS PHARMACY SHOSHONE PHARMACY BROULIMS PHARMACY EASTMAN DRUG STORE STAR PHARMACY DICK'S PHARMACY FAMILY HEALTH SERVICES PHARMACY KJS PHARMACY KURT'S PRESCRIPTION CENTER MEDICAL OFFICE PHARMACY ORCHARD DRUG SAV-MOR DRUG SMITH'S PHARMACY BI-MART PHARMACY RIDLEY'S PHARMACY WENDELL PHARMACY ABINGDON TELEPHARMACY ADDISON PHARMACY LIFECARE PHARMACY OSCO PHARMACY PRO PHARMACY RIGG FAMILYCARE PHARMACY GENESIS FIRSTMED PHARMACY WAGNER PHARMACY OSCO PHARMACY OSCO PHARMACY ALWOOD PHARMACY DOUBEK PHARMACY INC OSCO PHARMACY ALTAMONT PHARMACY INC B & D PHARMACY FAMILY CARE PHCY AT ALTON MEM GENOA-QOL HEALTHCARE SHIELDS FAMILY PHARMACY AMBOY HOMETOWN PHARMACY MEDICAP PHARMACY OSCO PHARMACY BROWNE'S PHARMACY OSCO DRUG OSCO DRUG OSCO PHARMACY ROUNDYS ILLINOIS LLC PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (208) 357-0473 (208) 886-2000 (208) 745-9201 (208) 547-3585 (208) 286-0906 (208) 734-7373 (208) 732-1645 (208) 733-9242 (208) 734-8177 (208) 734-3007 (208) 736-7060 (208) 733-8323 (208) 734-4581 (208) 549-8777 (208) 549-0172 (208) 536-5761 (309) 703-1094 (630) 543-0988 (630) 543-1000 (630) 628-6904 (800) 755-9503 (618) 445-2581 (309) 582-5151 (309) 582-5678 (847) 658-5635 (847) 854-0242 (309) 629-4506 (708) 293-1122 (708) 389-2725 (618) 483-5614 (618) 463-0000 (618) 463-7865 (618) 208-6937 (618) 467-7003 (815) 857-7005 (618) 833-9858 (847) 395-7101 (217) 268-3838 (847) 368-1795 (847) 439-8892 (847) 255-8740 (847) 253-5494

Provider Street 570 S STATE ST 120 SOUTH APPLE SUITE A 89 W 2ND ST 116 S MAIN ST 9732 W STATE ST 526 SHOUP AVE W STE K 388 MARTIN ST 615 FILER AVE 1203 FILER AVE E 476 CHENEY DR W STE 140 995 WASHINGTON ST S 139 MAIN AVE W 1913 ADDISON AVE E 1545 E 6TH ST 652 E 1ST ST 280 S IDAHO ST 503 S COMMERCIAL DR 414 W LAKE ST 276 W FULLERTON AVE 140 W LAKE ST 45-47 E FULLERTON AVE 37 W MAIN ST 105 S COLLEGE AVE 108 N COLLEGE AVE 1501 E ALGONQUIN RD 107 S RANDALL RD 211 SOUTH 1ST STREET 11350 S CICERO AVE 12003 S PULASKI RD 12 N 3RD ST 1 PROFESSIONAL DR STE 170 1 MEMORIAL DR RM G247 2615 EDWARDS ST STE 102 2526 STATE ST 202 E MAIN STREET 1785 EAST VIENNA ST 966 IL ROUTE 59 121 W SPRINGFIELD RD 122 N VAIL AVE 1860 S ARLINGTON HEIGHTS RD 442 E RAND RD 802 E NORTHWEST HWY

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Provider City SHELLEY SHOSHONE SODA SPRINGS SODA SPRINGS STAR TWIN FALLS TWIN FALLS TWIN FALLS TWIN FALLS TWIN FALLS TWIN FALLS TWIN FALLS TWIN FALLS WEISER WEISER WENDELL ABINGDON ADDISON ADDISON ADDISON ADDISON ALBION ALEDO ALEDO ALGONQUIN ALGONQUIN ALPHA ALSIP ALSIP ALTAMONT ALTON ALTON ALTON ALTON AMBOY ANNA ANTIOCH ARCOLA ARLINGTON HEIGHTS ARLINGTON HEIGHTS ARLINGTON HEIGHTS ARLINGTON HEIGHTS

State

ZIP code

ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID ID IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

83274-1470 83352 83276-1509 83276-1428 83669-5766 83301-5050 83301-4544 83301 83301-4118 83301 83301-5530 83301-6160 83301-5305 83672-1494 83672-2241 83355 61410-1603 60101-2305 60101-3767 60101-2720 60101-4601 62806-1006 61231 61231-1519 60102 60102-9773 61413 60803-2830 60803-1221 62411-1408 62002-5069 62002-6722 62002-3915 62002 61310 62906 60002-1454 61910-1302 60005-1432 60005-3764 60004-3101 60004-6233

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DICKS PHARMACY ATHENS PHARMACY SAV-MOR PHARMACY HARRY'S PHARMACY AURORA PHARMACY BENIVEX PHARMACY EASY CARE PHARMACY KINGSWAY PHARMACY MARIANO'S PHARMACY MEDICAL PARK PHARMACY MERCY PROFESSIONAL BLDG PHCY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY PHARMACY PLUS INC BARTLETT PHARMACY OSCO PHARMACY THE HALLMARK PHARMACY OSCO PHARMACY MORELAND & DEVITT PHARMACY PAMIDAA RX FAGEN PHARMACY COPPER BEND PHARMACY GENOA-QOL HEALTHCARE HIDEG PHARMACY INC MEDICINE SHOPPE SHOP N SAVE PHARMACY SHOP N SAVE PHARMACY O'BRIEN & DOBBINS LIFEMED ILLINOIS LLC OSCO DRUG KIMMEL-CHAPLAIN PHARMACY BIENESTAR PHARMACY II CAREPLUS DISCOUNT PHARMACY GENOA-QOL HEALTHCARE 5 GUYS MEDICINE SHOPPE SHOP N SAVE PHARMACY MARIANOS PHARMACY WILLOW LAKE PHARMACY AXLINE PHARMACY ILLINOIS CANCER CARE MERLE PHARMACY , INC.

NR_0009_10823 10/2017

Provider Phone Number (217) 543-2913 (217) 636-3888 (217) 578-2850 (217) 438-6141 (630) 820-3360 (630) 800-1636 (630) 548-1729 (630) 236-9502 (630) 236-0847 (630) 801-3200 (630) 801-5733 (630) 851-4657 (630) 892-9075 (847) 381-0013 (217) 335-4444 (630) 855-5178 (630) 837-8602 (630) 855-4100 (630) 879-8858 (217) 909-4333 (217) 323-4422 (708) 946-6600 (618) 234-7181 (618) 398-5127 (618) 398-4400 (800) 633-4227 (618) 277-0419 (618) 277-0423 (815) 544-3433 (888) 806-3379 (630) 238-0280 (618) 438-2822 (708) 956-7786 (708) 956-7105 (708) 393-4881 (618) 377-5356 (618) 377-2151 (630) 671-9138 (630) 307-6260 (309) 828-6767 (309) 243-3018 (309) 828-2242

Provider Street 118 S VINE ST 202 N WEST ST 112 S. MAIN 620 E JACKSON ST 475 N FARNSWORTH AVE 370 W INDIAN TRL 931 W GALENA BLVD 1649 MONTGOMERY RD STE 3 3025 E NEW YORK ST 403 W GALENA BLVD STE 210 1315 N HIGHLAND AVE 1157 N EOLA RD 1950 W GALENA BLVD 146 W MAIN ST 693 BAINBRIDGE ST 300 W BARTLETT AVE 125 E STEARNS RD 878 S IL RTE 59 129 RANDALL 201 S STATE ST 113 W 3RD ST 715 S DIXIE HWY 2900 FRANK SCOTT PKWY W STE 92 12 N 64TH ST STE 6 8601 W MAIN ST 1 ROYAL HEIGHTS CTR 800 CARLYLE AVE 4201 N BELT W 216 S STATE ST 871 ILLINOIS ROUTE 83 1127 S YORK RD 315 N MAIN ST 6447 W CERMAK AVE 6840 WINDSOR AVE 7000 CERMAK RD STE 145 333 W BETHALTO DR STE B 68 N BELLWOOD RD 144 S GARY AVE 303 E ARMY TRAIL RD STE 108 1210 TOWANDA AVE UNIT 11 3105 MAGORY DRIVE 203 E LOCUST ST STE 1

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Provider City ARTHUR ATHENS ATWOOD AUBURN AURORA AURORA AURORA AURORA AURORA AURORA AURORA AURORA AURORA BARRINGTON BARRY BARTLETT BARTLETT BARTLETT BATAVIA BEARDSTOWN BEARDSTOWN BEECHER BELLEVILLE BELLEVILLE BELLEVILLE BELLEVILLE BELLEVILLE BELLEVILLE BELVIDERE BENSENVILLE BENSENVILLE BENTON BERWYN BERWYN BERWYN BETHALTO BETHALTO BLOOMINGDALE BLOOMINGDALE BLOOMINGTON BLOOMINGTON BLOOMINGTON

State

ZIP code

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

61911-1334 62613-7665 61913 62615-9784 60505-3004 60506-2451 60506-3751 60504-4363 60504-5160 60506-3988 60506-1400 60502 60506-4306 60010-3010 62312-1203 60103-4002 60103-6534 60103-1633 60510-0000 62618-1219 62618-1142 60401-3668 62223-5000 62223-3809 62223-1719 62226-5705 62221-5509 62226-5613 61008 60106 60106-3342 62812 60402 60402-3441 60402-2112 62016-2010 62010-1794 60108-2225 60108-2140 61701-7415 61704 61701-8432

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

OSCO DRUG OSCO PHARMACY HIGH STREET PHARMACY

Provider Name

(309) 664-1333 (309) 663-6341 (708) 388-0033

2103 N VETERANS PKWY UNIT 3 2201 E OAKLAND AVE 2320 HIGH ST

BLOOMINGTON BLOOMINGTON BLUE ISLAND

IL IL IL

61704-0908 61701-5760 60406-2426

ADVENTIST BOLINGBROOK HOS OP PHCY BOLINGBROOK PHARMACY OSCO PHARMACY PHARMACY ADVANCED OSCO DRUG RIVERVIEW PHARMACY COMPREHENSIVE CARE PHARMACY FAMILY CARE PHARMACY SCOTTS DRUGS & NEWS CRESCENT PHARMACY GLOBAL PHARMACY BRIGHTON PHARMACY SHERMANS PHARMACY DIPLOMAT PHARMACY KEDVON PHARMACY INTEGRATIONS MARIANO'S PHARMACY OSCO PHARMACY MICHELLE'S PHARMACY, INC AMAR PHARMACY INC OSCO PHARMACY PREMIER FAMILY PHARMACY REEM MEDICAL PHARMACY METRO INFECTIOUS DISEASE PHCY AXLINE PHARMACY FELKER SNYDER PHARMACY THE MEDICINE SHOPPE PHCY CAMBRIDGE PHARMACY COUNTY MARKET PHARMACY GRAHAM HOSPITAL PHARMACY CARBONDALE FAMILY PHARMACY UNITED RX, LLC MICHELLES PHARMACY INC SULLIVAN DRUGS PLUM STREET PHARMACY LLC C.S. FAMILY PHARMACY, INC CAROL STREAM PHARMACY OSCO PHARMACY PHARMACY PLUS INC

(630) 312-3970 (630) 759-6464 (630) 759-1362 (815) 580-2020 (815) 929-0590 (815) 933-1735 (618) 526-8040 (618) 526-2800 (618) 945-3701 (708) 598-0505 (708) 907-3960 (618) 372-3313 (309) 446-3292 (610) 546-4089 (847) 947-2601 (847) 634-1130 (847) 537-0845 (618) 585-1293 (708) 857-8563 (708) 423-2098 (708) 952-0000 (708) 298-8222 (630) 986-4580 (309) 772-3155 (815) 234-5466 (618) 332-1028 (309) 707-1016 (309) 649-3385 (309) 647-5240 (618) 529-5351 (708) 375-5736 (217) 854-4022 (217) 854-6121 (618) 382-8400 (630) 213-0800 (630) 868-3722 (630) 289-3777 (217) 942-3427

500 REMINGTON BLVD 402 W BOUGHTON RD 1200 W BOUGHTON RD 335 REMINGTON BLVD 655 MAIN ST NW 475 BROWN BLVD STE 105 117 CLINTONIAN PLZ 20 N 4TH ST 208 MAIN 7261 W 87TH ST 7124 W 83RD ST STE D 108 RANSOM ST 91 E KNOXVILLE ST 1370 BUSCH PKWY 770 S BUFFALO GROVE 450 HALF DAY RD 79 MCHENRY RD 809 S FRANKLIN ST 4817 W 83RD ST 7910 S CICERO AVE 5600 W 87TH ST STE B 8519-8521 S HARLEM AVE 901 MCCLINTOCK DR STE 104 401 W MAIN ST 415 W BLACKHAWK DR 817 UPPER CAHOKIA RD 103 N PROSPECT ST 180 S MAIN ST 210 W WALNUT ST 2601 W MAIN ST STE 101 120 N TOWER RD 494 W SIDE SQ 920 W MAIN ST 311 PLUM ST 942 W ARMY TRAIL RD 620 E SAINT CHARLES RD UNIT B 760 W ARMY TRAIL RD 508 N MAIN ST

BOLINGBROOK BOLINGBROOK BOLINGBROOK BOLINGBROOK BOURBONNAIS BOURBONNAIS BREESE BREESE BRIDGEPORT BRIDGEVIEW BRIDGEVIEW BRIGHTON BRIMFIELD BUFFALO GROVE BUFFALO GROVE BUFFALO GROVE BUFFALO GROVE BUNKER HILL BURBANK BURBANK BURBANK BURBANK BURR RIDGE BUSHNELL BYRON CAHOKIA CAMBRIDGE CANTON CANTON CARBONDALE CARBONDALE CARLINVILLE CARLINVILLE CARMI CAROL STREAM CAROL STREAM CAROL STREAM CARROLLTON

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60440 60440-1872 60440-6568 60440-4922 60914-2303 60914-2325 62230-1501 62230-1436 62417 60455-1821 60455 62012 61517-8010 60089 60089-3708 60089-6555 60089-2433 62014-1480 60459-2718 60459-1507 60459-2902 60459-2293 60527 61422-1353 61010-8611 62206-1211 61238-1148 61520-2608 61520-2444 62901-1031 62901 62626-1753 62626-1200 62821-1632 60188-9068 60188-2692 60188-9297 62016-1027

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 191 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FAMILY DRUG MCHUGH DRUG STORE LLC WEAR DRUG OSCO PHARMACY THE PHARMACIE SHOPPE BANDY'S PHARMACY II BYRD WATSON DRUG MEDICINE SHOPPE PHARMACY SAV MOR PHARMACY COMPLETE CARE PHARMACY COUNTY MARKET PHARMACY 518 WELLCREEK PHARMACY CHARLESTON COUNTY MARKET PHARMACY 224

Provider Name

(618) 985-2441 (217) 357-2623 (217) 357-9327 (847) 639-3652 (217) 932-4004 (618) 533-3300 (618) 532-2200 (618) 533-5411 (217) 763-6131 (217) 355-6607 (217) 351-3108 (217) 512-2817 (217) 483-2496

1205 S DIVISION ST 70 S MADISON ST 408 WALNUT ST STE B 696 NORTHWEST HWY 202 W EDGAR AVE 724 E NOLEMAN ST 1071 W BROADWAY 817 E MCCORD ST 407 S JACKSON ST 14 E WASHINGTON ST STE C 2901 W KIRBY AVE 1 WEST LINCOLN AVENUE 1099 JASON PL

CARTERVILLE CARTHAGE CARTHAGE CARY CASEY CENTRALIA CENTRALIA CENTRALIA CERRO GORDO CHAMPAIGN CHAMPAIGN CHARLESTON CHATHAM

IL IL IL IL IL IL IL IL IL IL IL IL IL

62918-1909 62321-1331 62321-1356 60013-2073 62420 62801-3263 62801-5309 62801-3003 61818-4360 61820-3677 61821-5301 61920 62629

HEALTHDIRECT INSTUTUTIONAL PHARMACY UVANTA PHCY OF CENTRAL IL CHENOA RX CHENOA RX VICTORS MEDICENTER PHARMACY 200 PHARMACY INC 47TH STREET PHARMACY 6 CORNER PHARMACY A & D FAMILY MEDICAL CENTER PHCY A AND T PHARMACY INC AARON'S APOTHECARY ACCESS COMMUNITY HEALTH ALLCARE DISCOUNT PHARMACY ALPHACARE PHARMACY AMBER PHARMACY ARMITAGE PHARMACY INC. ASM PHARMACY AUSTIN OUTPATIENT PHARMACY B AND K DRUG INC BECKER PROFESSIONAL PHARMACY BIENESTAR PHARMACY INC BRAUN SPECIALTY PHARMACY BROADWAY PHARMACY BRONZEVILLE PHARMACY CARE CENTRAL PHARMACY CAREPLUS DISCOUNT PHARMACY CAREPLUS DISCOUNT PHARMACY CENTRAL CLEARING DRUG INC

(217) 483-7431 (217) 483-7431 (815) 945-4211 (815) 945-4211 (618) 826-2511 (773) 374-4800 (773) 847-6160 (708) 667-0525 (773) 826-1719 (773) 202-2929 (773) 360-8595 (773) 826-1817 (312) 432-4510 (773) 271-8100 (800) 921-1573 (773) 486-8800 (312) 738-4160 (773) 854-2500 (773) 292-9020 (773) 334-1060 (312) 226-2266 (773) 549-0634 (773) 271-9727 (312) 949-7713 (773) 993-0235 (844) 317-2737 (773) 424-4262 (773) 586-5555

1053 JASON PLACE 1053 JASON PL 209 GREEN ST 209 S GREEN ST 2323 OLD PLANK RD 9133 S STONY ISLAND AVE 1837 W 47TH ST 4211 N CICERO AVE STE 102 732 S PULASKI RD 5544 W BELMONT AVE 2338 N CLARK ST 3800 W MADISON ST STE 101 2750 W NORTH AVE 3702 W FULLERTON AVE 213 W INSTITUTE PL STE 206 3650 W ARMITAGE AVE STE 100 333 S ASHLAND AVE STE 402 645 S CENTRAL AVE 3758 W CHICAGO AVE 4744 N WESTERN AVE 966 W 21ST ST STE 104 2060 N CLARK ST 4564 N BROADWAY ST 3241 S MICHIGAN AVE STE 1583 3445 N CENTRAL AVE 1029 E 130TH ST 4255 W 63RD ST 6400 W 63RD ST

CHATHAM CHATHAM CHENOA CHENOA CHESTER CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

62629 62629-2018 61726-1129 61726-1133 62233-1153 60617-3512 60609-3844 60641-1650 60624-4058 60641 60614-3423 60624-2334 60647-5247 60647-2511 60610-3121 60647 60607-2703 60644-5059 60651-3823 60625-2013 60608-4511 60614-4830 60640-5602 60616-4201 60634-4420 60628-6908 60629-5041 60638-5004

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 192 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CERMAK PHARMACY CLYBOURN PARK PHARMACY COLUMBIA PHARMACY INC COMMUNITY PHARMACY CORE CENTER PHARMACY DEITCH PHARMACY DESAI PHARMACY INC DEVON DISCOUNT PHARMACY DRUG CENTER PHARMACY ELFMAN PHARMACY INC ELSDON MEDICAL PHARMACY ENGLEWOOD RX PHARMACY INC EXCLUSIVE PHARMACY FAMILY HOME CARE FANTUS HEALTH CENTER PHARMACY FANTUS HLTH CTR REFILL PHCY FARMACIA DE LAWNDALE INC FIRST FAMILY PHARMACY PLUS FMP PHARMACY SCMS FULLERTON PHARMACY GANESH PHARMACY INC GARFIELD PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GMP PHARMACY SCMS GREAT HEALTH PHARMACY HDK PHARMACY INC HEALTH RX INC HERITAGE PHARMACY HOME CARE SOLUTIONS HOWARD BROWN HWANG PHARMACY INC J & M PHARMACY J AND J PHARMACY LTD. JACKSON PARK PHARMACY JOHN H STROGER HOSP AMBLTRY

Provider Name

(773) 893-5744 (800) 266-4907 (312) 791-3334 (773) 238-4500 (312) 572-4880 (773) 486-1200 (773) 522-2900 (773) 465-8688 (773) 681-0080 (773) 292-1030 (773) 582-2660 (773) 994-0247 (773) 262-6800 (773) 486-3998 (312) 864-6189 (312) 864-1625 (773) 542-9595 (773) 338-7000 (773) 989-6280 (773) 887-4052 (773) 783-2865 (773) 424-7772 (773) 313-3075 (773) 977-7330 (773) 728-2310 (773) 989-3980 (773) 887-4497 (773) 509-9344 (773) 847-7233 (773) 857-1600 (773) 229-9300 (773) 248-3160 (773) 267-3344 (773) 285-6290 (773) 778-3420 (773) 947-7700 (312) 864-1610

2735 W CERMAK RD 1117 W WISCONSIN ST 2929 S WABASH AVE STE 101 9718 S HALSTED ST 2020 W HARRISON ST 1800 W CHICAGO AVE 2859 S PULASKI RD 1542 W DEVON AVE 4613 N SHERIDAN RD STE 100 3202 W NORTH AVE 4254 W 55TH ST 6508 S HALSTED ST 6374 N LINCOLN AVE STE 101 1000 N WESTERN AVE 1901 W HARRISON ST 1901 W HARRISON ST # B178 2621 S LAWNDALE AVE 2140 W DEVON AVE 5215 N CALIFORNIA AVE STE F103 5305 W FULLERTON AVE 327 W 76TH ST 6456 W ARCHER AVE 4423 N RAVENSWOOD AVE STE P100 1400 W GREENLEAF AVE STE 101 4740 N CLARK ST 5140 N CALIFORNIA AVE STE G105 5418 W FULLERTON AVE 4941 N KEDZIE AVE 1952 W CERMAK RD 2256 W ROSCOE ST 6456 W ARCHER AVE 3245 N HALSTED ST 3535 W LAWRENCE AVE 5050 S STATE ST FL 2 1608 W 69TH ST 7531 S STONY ISLAND AVE 1901 W HARRISON ST STE LL170

CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60608-3565 60614-7225 60616-3243 60628-1007 60612 60622-5512 60623-4456 60660-1344 60640-5019 60647-4940 60632-4642 60621-1812 60659-1277 60622-3685 60612-3714 60612-3714 60623-4520 60659-2125 60625-3513 60639-1424 60620-1604 60638-2537 60640 60626-2805 60640-4689 60625-3645 60639-1427 60625-5009 60608-4204 60618-6376 60638 60657-3419 60625-5627 60609-5302 60636-3316 60649-3913 60612-3714

JOHN H STROGER HSP BC OUTPATIENT PH K & J GLOBAL PHARMACY K & K PHARMACY KATSAROS PHARMACY

(312) 864-1607 (872) 208-6171 (773) 667-4400 (773) 288-8700

1901 W HARRISON RM 1230A 6237 N CLARK ST 401 E 61ST ST 1521 E 53RD ST

CHICAGO CHICAGO CHICAGO CHICAGO

IL IL IL IL

60612 60660 60637 60615-4509

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 193 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KEDVON PHARMACY KOMED HOLMAN PHARMACY LAGOM RX LAPUJA PHARMACY LAWNDALE CHRSTN HLTH CNTR PHCY LAWRENCE HOUSE DRUG COMPANY LIFE SOURCE PHARMACY INC LINDA'S PHARMACY LITTLE VILLAGE PHARMACY MADISON PINE PHARMACY MARIAM PHARMACY MARIANOS PHARMACY MARIANOS PHARMACY MARIANOS PHARMACY MARIANOS PHARMACY MARIANOS PHARMACY MARIANO'S PHARMACY MARIANO'S PHARMACY MARIANO'S PHARMACY MARIANO'S PHARMACY MAX CARE PHARMACY MEDICAL SPECIALISTS PHARMACY MERCY CLINIC PHCY AT PULASKI

Provider Name

(773) 338-7171 (773) 924-6000 (312) 265-0144 (773) 772-6731 (872) 588-3250 (773) 561-2288 (773) 321-2656 (312) 791-0533 (773) 522-2121 (773) 379-7773 (773) 478-1111 (773) 268-2862 (773) 799-9004 (773) 506-0910 (773) 334-3736 (773) 935-0713 (312) 475-9691 (773) 342-6680 (773) 247-3394 (773) 481-6936 (773) 508-9999 (773) 873-4400 (773) 432-0100

2763 W DEVON AVE 4259 S BERKELEY AVE 114 N ABERDEEN ST 3441 W NORTH AVE 3860 W OGDEN AVE 1001 W LAWRENCE AVE 11238 S WESTERN AVE 2347B S WENTWORTH AVE 3811 W 26TH ST 5470 W MADISON ST 3514 W LAWRENCE AVE 3857 S MARTIN LUTHER KING DR 2021 W CHICAGO AVE 5201 N SHERIDAN RD 1800 W LAWRENCE AVE 3030 N BROADWAY ST SUITE 100 1500 N CLYBOURN AVE UNIT C104 2112 N ASHLAND AVE 3145 S ASHLAND AVE 5353 N ELSTON AVE 2810 W DEVON AVE 7845 S COTTAGE GROVE AVE 5525 S PULASKI RD

CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60659-1712 60653-3030 60607-2004 60647-4841 60623-2460 60640-5017 60643-4116 60616-2013 60623-3808 60644-4097 60625-5612 60653 60622-5549 60640-2512 60640-4002 60657-5316 60610 60614 60608-6251 60630-1610 60659-1502 60619-3100 60629-4417

MERCY COMM PHCY @ OAKWOOD SHRS MERCY FAMILY HEALTH CENTER PHCY MEXICARE PHARMACY MINI THUONG XA PHARMACY INC MONIK PHARMACY MORSE L DRUGS NAH OUT-PATIENT PHARMACY NATHAN PHARMACY NAZARETH FAMILY CENTER PHARMACY NEW ENGLAND PHARMACY NORTH PARK PHARMACY NORWOOD HIGGINS DRUGS OSCO DRUG OSCO DRUG OSCO DRUG OSCO DRUG OSCO DRUG OSCO DRUG

(773) 451-0712 (312) 567-2050 (773) 890-1800 (773) 728-1007 (773) 880-9045 (773) 743-8400 (773) 292-8321 (773) 973-6107 (312) 770-3444 (773) 586-2233 (773) 654-3658 (773) 631-5333 (312) 666-5612 (312) 642-2951 (773) 327-1485 (773) 348-7421 (773) 731-9650 (773) 327-2723

3753 S COTTAGE GROVE AVE 2525 S MICHIGAN AVE 3200 W 26TH ST 1069 W ARGYLE ST 2266 N LINCOLN AVE 1407 W MORSE AVE 1044 N FRANCISCO AVE 6420 N CALIFORNIA AVE 1127 N OAKLEY BLVD 6918 W ARCHER AVE 3324 W FOSTER AVE 7124 W HIGGINS AVE 1340 S CANAL STREET 424 W DIVISION ST 3630 N SOUTHPORT AVE 2550 N CLYBOURN AVE 1655 E 95TH ST 3400 N WESTERN AVE

CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60653 60616-2333 60623-4031 60640-3707 60614-7600 60626-3481 60622-2743 60645-5253 60622-3507 60638-2320 60625-4813 60656-1904 60607 60610-1727 60613-3710 60614-1941 60617-4707 60618-6012

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 194 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name OSCO DRUG OSCO DRUG OSCO DRUG OSCO DRUG OSCO DRUG OSCO DRUG OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY PEACE PHARMACY PHARMACY HEADQUARTERS PHARMACY ONE PLUS PILSEN PHARMACY PROFESSIONAL BUILDING PHARMACY PROMED PHARMACY INC PROVIDENT HOSP OF COOK COUNTY PULSE PHARMACY REEM PHARMACY RISHI PHARMACY INC ROLET PHARMACY ROSELAND PHARMACY ONE ROSENS MORSEVIEW PHARMACY ROSENS-MORSEVIEW PHARMACY SAPSTEIN DRUGS SAVE RITE PHARMACY DISC CENTER SCRIPTS RX PHARMACY SEELEY MEDICAL PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (773) 274-1293 (773) 637-1819 (773) 202-1042 (773) 288-7000 (773) 775-3777 (312) 775-0995 (773) 568-8370 (773) 625-5525 (312) 663-4646 (773) 927-5040 (773) 523-1700 (773) 525-4766 (773) 583-9858 (773) 483-6500 (773) 779-0017 (773) 342-5217 (773) 478-8752 (773) 284-7402 (773) 725-2900 (773) 735-0396 (773) 784-7348 (773) 334-2083 (773) 528-6615 (773) 348-4155 (312) 842-2500 (312) 448-8382 (773) 267-5050 (312) 993-9500 (773) 768-7868 (773) 265-6300 (312) 572-2000 (773) 762-1100 (773) 436-5000 (773) 287-1200 (773) 994-7762 (773) 660-8606 (773) 743-7585 (773) 743-7585 (773) 874-0425 (773) 525-0766 (800) 592-7174 (773) 994-2845

Provider Street 1763 W HOWARD ST 2520 N NARRAGANSETT AVE 4660 W IRVING PARK RD 7530 S STONY ISLAND AVE 7342 W FOSTER AVE 370 N DESPLAINES ST 11730 S MARSHFIELD AVE 4734 NORTH PUEBLO AVENUE 1224 S WABASH AVE 1220 S ASHLAND AVE 3644 S ARCHER AVE 4355 N SHERIDAN RD 3572 N ELSTON AVE 101 W 87TH ST 9402 S ASHLAND AVE 1343 N PAULINA ST 4032 W FOSTER AVE 5234 S PULASKI RD 6426 W IRVING PARK RD 6107 S ARCHER AVE 5532 N CLARK ST 5345 N BROADWAY ST 3531 N BROADWAY ST 2940 N ASHLAND AVE 2320 S WENTWORTH AVE 67 W CHICAGO AVE 4753 N KEDZIE AVE 1868 S BLUE ISLAND AVE 2315 E 93RD ST STE 215 3600 W ROOSEVELT RD 430 E 50TH PLACE 2875 W 19TH ST STE # 201 5456 S KEDZIE AVE 4909 W DIVISION ST 6032 S HALSTED ST 104 W 111TH ST 2955 W DEVON AVE 2955 W DEVON AVE STE 1 8419 S COTTAGE GROVE AVE 3479 N BROADWAY ST 1333 W BELMONT AVE STE 320 2024 W 79TH ST

Page 195 of 679

Provider City CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO

State

ZIP code

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60626-1626 60639-1041 60641-2888 60649-3914 60656-3600 60661-1106 60643 60706 60605-2401 60608-1402 60609-1044 60613-1414 60618-4318 60620-1304 60620-5121 60622-2145 60630-2747 60632-4222 60634-2459 60638-2743 60640-1214 60640-2311 60657-1825 60657-4004 60616-2014 60654-3321 60625-4420 60608 60617-3910 60624-4225 60615 60623-3501 60632-2620 60651-3161 60621 60628-4215 60659-1555 60659-1555 60619-6113 60657-2519 60657 60620-5720

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SEOUL PHARMACY INC SHREE PHARMACY SINAI COMMUNITY PHARMACY, INC. SINAI TOUCHY PHCY SNS PHARMACY SPECIALTY CARE RX ST. BERNARD HOSPITAL AMBULATORY SURECARE PHARMACY THE APOTHECARY CHICAGO

Provider Name

(773) 539-1234 (773) 907-0407 (773) 257-6900 (773) 274-3593 (773) 722-4405 (773) 769-6200 (773) 420-1560 (773) 475-7711 (773) 792-5030

3757 W LAWRENCE AVE 1624 W MONTROSE AVE CALIFORNIA AVE AT 15TH ST 2907 W TOUHY AVE 3900 W MADISON ST 5310 N SHERIDAN RD 6307 S. STEWART AVENUE. RM 101 2001 S CALIFORNIA AVE STE 103 7447 W TALCOTT AVE

CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO

IL IL IL IL IL IL IL IL IL

60625-5712 60613-1214 60608 60645-2937 60624-2354 60640-2514 60621 60608 60631-3760

THE NEW ROSELAND OUTPATIENT PHCY THOREK MEMORIAL HOSPITAL TOUHY FAMILY PHARMACY UPTOWN PHARMACY VAISHALI PHARMACY INC VALUE CARE PHARMACY, INC. VITAL RX, LLC VIVEK PHARMACY INC WELL FUTURE PHARMACY LLC WELLS RX PHARMACY FAGEN PHARMACY

(773) 291-1530 (773) 975-3235 (708) 831-5910 (773) 944-0525 (773) 521-7422 (773) 930-3685 (773) 862-1699 (773) 548-3133 (312) 589-7620 (872) 818-5559 (708) 503-0391

45 W 111 TH ST 850 W IRVING PARK RD 6201 W TOUHY AVE STE 101 4535 N SHERIDAN RD 3140 W CERMAK RD 4332 N ELSTON AVE 2837 N MILWAUKEE AVE 300 E PERSHING RD 1442 S MICHIGAN AVE 400 E 41ST ST STE 103 571 W LINCOLN HWY

CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO CHICAGO HEIGHTS

IL IL IL IL IL IL IL IL IL IL IL

60628 60613-3077 60646-1100 60640-7611 60623-3306 60641-2144 60618-7403 60653-2204 60605-2811 60653-2757 60411-2323

COMMUNITY PHARMACY OF CHICAGO RIDGE KIRKS PHARMACY PRIMERX PHARMACY OSCO PHARMACY COAL CITY PHARMACY ASHMANN PRESCRIPTION PHARMACY KHOURY PHARMACY THE MEDICINE SHOPPE OSCO PHARMACY TOWNCARE PHARMACY WALT'S PHARMACY OSCO DRUG MEDPLUS PHARMACY POLYCLINIC PHARMACY THE APOTHECARY OSCO PHARMACY CANCER CARE SPECLST CTRL IL SC COLEE'S COMMUNITY PHARMACY COUNTY MARKET PHARMACY DALE'S SOUTHLAKE PHARMACY

(708) 229-2100 (618) 724-2741 (708) 303-5151 (630) 325-3265 (815) 634-2391 (618) 344-2300 (618) 281-7133 (618) 281-5135 (708) 354-2689 (708) 388-2329 (708) 672-9175 (815) 356-8592 (217) 431-6662 (217) 446-3784 (217) 443-2306 (630) 852-0070 (217) 329-3239 (217) 330-5004 (217) 221-5615 (217) 429-5165

9830 RIDGELAND AVE 114 W MARKET ST 1607 S CICERO AVE 303 HOLMES AVE 175 S BROADWAY ST 209 E MAIN ST 101 N MAIN ST 134 S MAIN ST 5545 S BRAINARD AVE 13180 S CICERO AVE 1100 E EXCHANGE ST 6140 NORTHWEST HWY 511 W FAIRCHILD ST UNIT B 707 N LOGAN AVE 800 N LOGAN AVE STE 100 7329 S CASS AVE 210 W MCKINLEY AVE STE 1 320 E CENTRAL AVE 1400 E PERSHING RD 245 W FIRST DR STE B

CHICAGO RIDGE CHRISTOPHER CICERO CLARENDON HILLS COAL CITY COLLINSVILLE COLUMBIA COLUMBIA COUNTRYSIDE CRESTWOOD CRETE CRYSTAL LAKE DANVILLE DANVILLE DANVILLE DARIEN DECATUR DECATUR DECATUR DECATUR

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60415-2667 62822-1222 60804-1520 60514-1615 60416-1532 62234-3006 62236-1701 62236-2306 60525-3542 60445-1470 60417-3433 60014-7931 61832-3801 61832-4360 61832-3741 60561-3660 62526-5858 62521-4665 62526 62521

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 196 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE OSCO PHARMACY LEHAN DRUGS OSCO PHARMACY DELAVAN EASY CARE PHARMACY HOLY FAMILY PLAZA PHARMACY MAC RX, LLC MARIANO'S PHARMACY OSCO PHARMACY OSCO PHARMACY POEHLERS PHCY LLC MEDICINE SHOPPE FELKERS SNYDER PHARMACY DOUGLAS-MAIN PHARMACY OSCO PHARMACY OSCO PHARMACY THE MEDICINE SHOPPE DURAND TELEPHARMACY INC OSCO PHARMACY MEDICATE PHARMACY

Provider Name

(217) 619-0950 (847) 498-4150 (815) 758-0911 (815) 756-1328 (309) 244-7115 (847) 296-1400 (224) 220-2700 (847) 635-7785 (847) 439-4230 (847) 299-8185 (217) 925-2838 (815) 284-8000 (630) 969-0036 (630) 963-0749 (630) 971-0220 (618) 542-2575 (815) 248-3850 (309) 751-0960 (618) 875-1000

151 N MAIN ST RM 332 16 S WAUKEGAN RD 1407 S 4TH ST 1322 SYCAMORE RD 402 PINE ST 1400 E GOLF RD STE 101 2307 S MOUNT PROSPECT RD 10 E GOLF RD 811 ELMHURST RD 1480 LEE ST 203 S MAIN ST STE A 301 N GALENA AVE 5207 MAIN ST STE 102 1148 OGDEN AVE 6215 MAIN ST 207 E MAIN ST 202 N. CENTER ST 107 AVENUE OF THE CITIES 100 N 8TH ST STE 100

DECATUR DEERFIELD DEKALB DEKALB DELAVAN DES PLAINES DES PLAINES DES PLAINES DES PLAINES DES PLAINES DIETERICH DIXON DOWNERS GROVE DOWNERS GROVE DOWNERS GROVE DU QUOIN DURAND EAST MOLINE EAST SAINT LOUIS

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

62523-1206 60015-5216 60115-4605 60115-2443 61734 60016-1236 60018-1811 60016-2228 60016-5605 60018-1517 62424 61021 60515-5071 60515-2826 60516-1909 62832-1424 61024-8945 61244-4018 62201-2989

DIERSBERGS EDWARDSVILLE CROSSING PH SHOP N SAVE PHARMACY ANDES HEALTH MART PHARMACY BROWN'S DRUG STORE MARTIN'S HEALTH MART PHARMACY OSCO PHARMACY SHAMROCK SPECIALTY RX BECKS DRUGS MEDICAP PHARMACY ELGIN WEST PHARMACY GENOA-QOL HEALTHCARE ILLINOIS CANCER SPECIALISTS MEDICINE STOP OF ELGIN OSCO DRUG OSCO PHARMACY PRIMISHA PHARMACY

(618) 307-3817 (618) 655-0386 (217) 342-9393 (217) 342-2185 (217) 342-4301 (630) 365-4240 (630) 365-2372 (618) 273-8111 (618) 273-4941 (847) 627-4600 (224) 276-7236 (847) 931-0909 (847) 742-7740 (847) 695-0198 (847) 695-7467 (847) 742-6700

6671 EDWARDSVILLE CROSSING DR 2122 TROY RD 805 W FAYETTE AVE 115 W JEFFERSON AVE 101 S MERCHANT ST 800 NORTH MAIN ST 747 HERRA ST UNIT E 1409 LOCUST ST 1101 N US 45 1554 TODD FARM DR 1845 GRANDSTAND PL STE 300 1710 N RANDALL RD STE 300 860 SUMMIT ST 1670 LARKIN AVE 1038 SUMMIT ST 750 FLETCHER DR STE 103

EDEARDSVILLE EDWARDSVILLE EFFINGHAM EFFINGHAM EFFINGHAM ELBURN ELBURN ELDORADO ELDORADO ELGIN ELGIN ELGIN ELGIN ELGIN ELGIN ELGIN

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

62025 62025-2540 62401-2415 62401-2344 62401-2425 60119 60119-8437 62930-1629 62930-0449 60123-1287 60123-4987 60123-9405 60120-5145 60123-5945 60120-4320 60123-4703

NORTHWEST ONCOLOGY & HEMATOLOGY SC

(847) 981-5578

800 BIESTERFIELD RD STE 210

ELK GROVE VILLAGE

IL

60007-3363

ORSINI PHARMACEUTICAL SERVICES INC OSCO PHARMACY MARIANO'S PHARMACY

(847) 734-7373 (847) 593-1226 (630) 782-0031

1107 NICHOLAS BLVD 20 BIESTERFIELD RD 678 N YORK ST

ELK GROVE VILLAGE ELK GROVE VILLAGE ELMHURST

IL IL IL

60007-2516 60007-3668 60126-1605

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 197 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NUCARA PHARMACY NUCARA PHARMACY LONG TERM CARE OSCO PHARMACY OSCO PHARMACY SOLEO HEALTH INC ELMWOOD PHARMACY ELMWOOD PARK PHARMACY PHILS PRESCRIPTION DRUGS EVANSTON HEALTHMART PHARMACY EVANSTON HOSPITAL ASSOC PHCY NORTHWESTERN U HLTH SERV PHCY OSCO PHARMACY OSCO PHARMACY SFH PROF BLDG PHARMACY SIMPLY PURE RX EVERGREEN PARK PHARMACY MARIANOS PHARMACY PRIME PLUS PHARMACY WELLCARE PHARMACY LLC EDS MEDICENTER PHARMACY FOREST PARK PHARMACY NEW VENTURE PHARMACY

Provider Name

(630) 834-1223 (630) 834-1260 (630) 530-9468 (630) 834-2000 (630) 478-8240 (309) 742-2611 (708) 395-5623 (618) 942-4631 (847) 859-6788 (847) 570-2210 (847) 491-2144 (847) 869-3520 (847) 328-9951 (847) 316-2677 (847) 227-8020 (708) 423-4700 (708) 422-2056 (708) 741-7501 (708) 930-5927 (618) 842-6007 (618) 607-0200 (618) 628-8868

101 W VALLETTE ST STE 100 101 W VALLETTE ST STE 120 153 E SCHILLER ST 942 S YORK ST 655 W. GRAND AVENUE SUITE 240 108 E MAIN ST 7613 W BELMONT AVE 639 N PERSHING ST 1706 MAPLE AVE 2650 RIDGE AVE 633 EMERSON ST 1128 CHICAGO AVE 2491 HOWARD ST 800 AUSTIN ST STE 101 1607 BENSON AVE 2850 W 95TH ST STE 100 2559 W 95TH ST 2955 W 95TH ST 9760 S KEDZIE 1116 W MAIN ST 331 SALEM PL STE 125 815 LINCOLN HWY STE 103

ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMWOOD ELMWOOD PARK ENERGY EVANSTON EVANSTON EVANSTON EVANSTON EVANSTON EVANSTON EVANSTON EVERGREEN PARK EVERGREEN PARK EVERGREEN PARK EVERGREEN PARK FAIRFIELD FAIRVIEW HEIGHTS FAIRVIEW HEIGHTS

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60126-4419 60126 60126-2869 60126-5115 60126 61529-7963 60707-1113 62933-3606 60201-3134 60201-1718 60208-0844 60202-1351 60202-3638 60202-3468 60201-3717 60805-2703 60805 60805-2409 60805-3109 62837 62208-1367 62208-2230

THE MEDICINE SHOPPE OF FARMER CITY COUNTY MARKET PHARMACY FLANAGAN HEALTH MART PHARMACY SAV MOR PHARMACY INGALLS PROF PHARMACY III COLEE'S CORNER DRUGS OSCO DRUG OSCO DRUG HIGZE PHARMACY INSTANT PHARMACY LLC MARIANO'S PHARMACY OSCO PHARMACY OSCO PHARMACY FREEBURG PHARMACY TOMS PHARMACY CUB PHARMACY HARTIG DRUG CO ILLINOIS CANCERCARE GALVA PHARMACY

(309) 928-2491 (309) 245-2335 (815) 796-2274 (618) 662-9470 (708) 915-8453 (217) 330-9552 (847) 587-4206 (847) 516-4326 (815) 469-8111 (815) 534-5813 (815) 464-3562 (815) 464-5050 (847) 455-0633 (618) 539-5577 (618) 539-3164 (815) 297-0881 (815) 777-2700 (309) 243-3017 (309) 932-3440

217 S MAIN ST 1050 E FORT ST # 290 116 S MAIN ST 121 W NORTH AVE 19550 GOVERNORS HWY 845 S US ROUTE 51 UNIT B 1350 S US HIGHWAY 12 800 NORTHWEST HWY 222 COLORADO AVE 21000 S FRANKFORT SQ RD STE M 21001 S LAGRANGE RD 354 N LA GRANGE RD 10203 GRAND AVE 10 SOUTHGATE CTR 369 MARKETPLACE DR 1512 IL ROUTE 26 N 11002 BARTEL BLVD 336 HOME BLVD 120 EXCHANGE ST

FARMER CITY FARMINGTON FLANAGAN FLORA FLOSSMOOR FORSYTH FOX LAKE FOX RIVER GROVE FRANKFORT FRANKFORT FRANKFORT FRANKFORT FRANKLIN PARK FREEBURG FREEBURG FREEPORT GALENA GALESBURG GALVA

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

61842-1455 61531-9572 61740-7536 62839-1613 60422-2036 62535-9759 60020-1949 60021-1208 60423-1334 60423-9386 60423-2006 60423-2008 60131-3140 62243-1541 62243-4075 61032-8334 61036-8215 61401-7408 61434-1710

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 198 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NORTHSIDE REXALL PHARMACY VORAC PHARMACY RILEY DRUG GENOA PHARMACY SCOTTS FAMILY PHARMACY THE MEDICINE SHOPPE MICHELLES PHARMACY INC SULLIVAN DRUGS INC OSCO PHARMACY

Provider Name

(309) 944-2442 (309) 944-2166 (630) 232-0650 (815) 784-2122 (217) 784-8241 (217) 784-8545 (217) 839-9901 (217) 839-2877 (630) 790-2294

201 N STATE ST 114 S STATE ST 415 W STATE ST 228 W MAIN ST 220 N SANGAMON AVE 104 N SANGAMON AVE 120 S MACOUPIN ST 113 S MACOUPIN ST 599 ROOSEVELT RD

GENESEO GENESEO GENEVA GENOA GIBSON CITY GIBSON CITY GILLESPIE GILLESPIE GLEN ELLYN

IL IL IL IL IL IL IL IL IL

61254 61254-1348 60134-2157 60135-1146 60936-1345 60936-1343 62033-1515 62033-1516 60137-5797

ADVENTIST GLENOAKS HOSP OP PHARMACY CENTRAL DUPAGE PHARMACY OSCO PHARMACY C AND M PHARMACY LLC GLENBROOK OUTPATIENT PHARMACY MARIANOS PHARMACY NSHORE UNIV HS KELLOGG GB PHCY OSCO DRUG OSCO DRUG OSCO PHARMACY UROPARTNERS BODE DRUG INC DENMAN COUNTRY DRUG GOREVILLE PROFESSIONAL PHARMACY GENOA-QOL HEALTHCARE MEDICAP PHARMACY MEDICATE PHARMACY SHOP 'N SAVE PHARMACY THE MEDICINE SHOPPE AXLINE PHARMACY OSCO DRUG GABLE FAMILY PHARMACY CO WATSONS DRUG STORE MARIANO'S PHARMACY MEDCARE PHARMACY INC OSCO PHARMACY HAMPSHIRE PHARMACY FOX FAMILY PHARMACY THE MEDICINE SHOPPE FCHC PHARMACY INGALLS PROFESSIONAL PHARMACY

(630) 545-7310 (630) 682-8888 (630) 980-4301 (847) 299-1920 (847) 657-1785 (847) 724-4821 (847) 503-1206 (847) 657-9151 (847) 486-0571 (847) 564-8480 (224) 260-9310 (618) 683-3311 (217) 696-2820 (618) 995-1555 (618) 709-4030 (618) 451-8001 (618) 451-2000 (618) 451-5353 (618) 451-4200 (815) 339-2323 (847) 543-9082 (217) 368-2667 (618) 664-3600 (847) 856-8701 (847) 336-3800 (847) 855-0990 (847) 683-2244 (618) 576-2619 (618) 252-5349 (708) 893-0763 (708) 333-5388

701 WINTHROP AVE 155 E NORTH AVE 2164 BLOOMINGDALE RD 4339 DI PAOLO CTR 2050 PFINGSTEN RD STE 100 25 WAUKEGAN RD 2180 PFINGSTEN RD STE 1008 1340 PATRIOT BLVD 2502 WAUKEGAN RD 2775 PFINGSTEN RD 2600 PATRIOT BLVD UNIT J 225 E MAIN ST 102 PRAIRIE MILLS RD 901 S BROADWAY 50 N GATE INDSTRIAL DR RM 717 2770 MADISON AVE 2166 MADISON AVE 3451 NAMEOKI RD 1529 JOHNSON RD 324 S MCCOY ST 885 E BELVIDERE RD 502 CHESTNUT ST 214 W MAIN ST 6655 GRAND AVE 15 TOWER CT #195 6507 GRAND AVE 260-262 N STATE ST 110 N COUNTY RD 304 S COMMERCIAL ST 31 W 155TH ST 71 W 156TH ST STE 104

GLENDALE HEIGHTS GLENDALE HEIGHTS GLENDALE HEIGHTS GLENVIEW GLENVIEW GLENVIEW GLENVIEW GLENVIEW GLENVIEW GLENVIEW GLENVIEW GOLCONDA GOLDEN GOREVILLE GRANITE CITY GRANITE CITY GRANITE CITY GRANITE CITY GRANITE CITY GRANVILLE GRAYSLAKE GREENFIELD GREENVILLE GURNEE GURNEE GURNEE HAMPSHIRE HARDIN HARRISBURG HARVEY HARVEY

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60139-1405 60139-3746 60139-1699 60025-5202 60026-1324 60025 60026 60026 60025-1774 60026-1198 60026-8024 62938 62339-0070 62939-2448 62040 62040-3607 62040-4700 62040-3709 62040-3831 61326-9333 60030-2581 62044-1305 62246-1736 60031-5274 60031 60031-1643 60140-9618 62047 62946-2108 60426-3556 60426-4259

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 199 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

RX COMMUNITY MEDICAL PHARMACY INC MARIANO'S PHARMACY WOLTERS DRUG STORE HEALING HEALTH PHARMACY HERRIN HEALTH MART LOGAN PRIMARY PHARMACY LOGAN PROFESSIONAL PHARMACY LOYOLA HOME INFUSION PHARMACY OSCO PHARMACY FAMILY CARE PHARMACY NSHORE UNIV HS KELLOGG HP PHCY OSCO PHARMACY JOHN'S MEDICAL PHARMACY SULLIVANS DRUGS INC UNITED RX LLC XCELRX ELM PLAZA PHARMACY

(708) 333-9522 (708) 867-8564 (309) 543-2444 (708) 991-2249 (618) 942-3750 (618) 997-9997 (618) 993-5555 (708) 233-5390 (708) 598-0500 (618) 654-2323 (847) 926-6560 (847) 579-0884 (217) 532-5060 (217) 532-2377 (708) 449-7600 (708) 564-5052 (630) 455-4377

392 E 159TH ST 7401 W LAWRENCE AVE 201 W MAIN ST 3330 W 177TH ST STE 3E 116 N PARK AVE 401 RUSHING DR 303 RUSHING DR 9608 S ROBERTS RD 9534 S ROBERTS RD 1106 BROADWAY 757 PARK AVE WEST RM 1851 1600 DEERFIELD RD 300 S MAIN ST 325 S MAIN ST 150 FENCL LN 150 FENCL LN STE 2B 908 N ELM ST STE 100

HARVEY HARWOOD HEIGHTS HAVANA HAZEL CREST HERRIN HERRIN HERRIN HICKORY HILLS HICKORY HILLS HIGHLAND HIGHLAND PARK HIGHLAND PARK HILLSBORO HILLSBORO HILLSIDE HILLSIDE HINSDALE

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60426-5237 60706-3411 62644-1137 60429-2196 62948-3148 62948-3730 62948-3749 60457-2238 60457-2239 62249-1917 60035 60035-3708 62049-1432 62049-1431 60162-2041 60162-2041 60521-2601

HINSDALE HOSPITAL OUTPATIENT PHCY HOME RX 1 MARIANO'S PHARMACY OSCO PHARMACY OSCO PHARMACY SMART MEDS PHARMACY WHOLESOME HEALTH PHARMACY DR. Z'S PHARMACY OSCO DRUG OSCO PHARMACY OSCO PHARMACY WALT'S PHARMACY CENTEGRA CARE CONNECTIONS OSCO PHARMACY BANDYS PHARMACY THE MEDICINE SHOPPE JACKSONVILLE THE MEDICINE SHOPPE BASINGER PHARMACY BASINGER'S MADISON PHARMACY BASINGER'S PHARMACY CITY CENTER

(630) 856-3946 (630) 655-9199 (847) 490-2047 (847) 882-6477 (847) 202-9283 (847) 490-3995 (224) 653-9878 (708) 966-0785 (708) 301-3246 (708) 922-9564 (708) 799-8411 (708) 957-2974 (224) 654-0899 (847) 961-5625 (618) 249-6905 (217) 245-1551 (618) 498-6461 (815) 725-1102 (815) 582-3440 (815) 722-3200

120 N OAK ST 119 E OGDEN AVE # LL20 2575 W GOLF RD 1071 N ROSELLE RD 1489 PALATINE RD 1056 W GOLF RD 2069 N BARRINGTON RD 14322 S WILL COOK RD 14200 S BELL RD 17705 HALSTED ST 3153 183RD ST REAR 2345 183RD ST 10400 HALIGUS RD 13200 VILLAGE GREEN DR 207 HURON 200 W MORTON AVE 400A W CARPENTER 2130 W JEFFERSON ST 330 MADISON ST STE 102 300 N OTTAWA ST

HINSDALE HINSDALE HOFFMAN ESTATES HOFFMAN ESTATES HOFFMAN ESTATES HOFFMAN ESTATES HOFFMAN ESTATES HOMER GLEN HOMER GLEN HOMEWOOD HOMEWOOD HOMEWOOD HUNTLEY HUNTLEY IRVINGTON JACKSONVILLE JERSEYVILLE JOLIET JOLIET JOLIET

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60521-3829 60521-3590 60169-1165 60169 60192 60169 60169 60491-9211 60491-8122 60430-2009 60430-2806 60430-3140 60142-9553 60142-8039 62848 62650-2812 62052-2522 60435-6622 60435-6572 60432-4009

BASINGER'S PRIMARY CARE PHARMACY J D BROWN PHARMACY

(815) 723-0300 (815) 723-0611

2025 S CHICAGO ST 837 PLAINFIELD RD

JOLIET JOLIET

IL IL

60436-3172 60435-4660

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name JOHA PHARMACY JOLIET PROFESSIONAL PHARMACY KODO CARE INC OSCO PHARMACY OSCO PHARMACY JAFFE DRUG STORES OSCO PHARMACY RIVERSIDE FAMILY PHARMACY HWY 72 PHARMACY ASHLAND HEALTH JW PHARMACY OSCO PHARMACY ARKINS REXALL DRUG STORE PHARMBLUE ILLINOIS LLC FAMILY DISCOUNT DRUGS LOW COST PHARMACY OSCO PHARMACY MARIANO'S PHARMACY OSCO DRUG OSCO PHARMACY LANARK PHARMACY FAGEN PHARMACY QUIKSCRIPTS PRESCRIPTIONS PLUS OSCO PHARMACY LENA DRUG STORE LEROY PHARMACY COUNTY MARKET PHARMACY OSCO PHARMACY PETRANEK'S PHARMACY STACYS FAMILY PHARMACY OSCO PHARMACY THE PHCY OF DUPAGE MEDICAL GRP SULLIVAN DRUGS OSCO PHARMACY HIGHLAND PHARMACY LOMBARD PHARMACY INC OPTION CARE OSCO PHARMACY RX AT HOME PHARMACY SAV MOR PHARMACY NORTH PARK PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (815) 730-3030 (815) 725-9314 (815) 727-4722 (815) 729-2487 (815) 725-1290 (815) 933-3369 (815) 935-2041 (815) 935-4356 (815) 522-3898 (708) 482-4000 (708) 588-0300 (708) 352-5747 (815) 223-0460 (800) 609-1574 (309) 246-2770 (309) 246-2555 (847) 735-1032 (847) 438-4012 (847) 438-2450 (847) 540-0130 (815) 493-2080 (708) 418-3159 (708) 474-9540 (618) 537-6202 (630) 243-1803 (815) 369-4111 (309) 962-3627 (309) 547-3731 (847) 680-8300 (847) 362-2005 (217) 735-1972 (630) 964-7100 (630) 539-6000 (217) 324-2001 (815) 834-9910 (630) 705-0020 (630) 495-2333 (630) 495-2777 (630) 629-5050 (630) 755-6115 (618) 665-4828 (815) 633-3431

Provider Street 2614 W JEFFERSON ST 2100 GLENWOOD AVE 221 SPRINGFIELD AVENUE STE A 1535 N LARKIN AVE 1403 W JEFFERSON ST 217 E COURT ST 446 S WASHINGTON AVE 350 N WALL ST 527 W. MAIN STREET UNIT 1W 12 N CATHERINE AVE 5101 WILLOW SPRINGS RD 507 WOODLAWN 1033 8TH ST 2960 CHARTRES ST STE 100 405 5TH ST 415 5TH ST 892 N WESTERN AVE 1350 E IL ROUTE 22 345 S RAND RD 485 ELA RD 102 N BROAD ST 16831 TORRENCE AVE 3330 RIDGE RD 753 TRUE VALUE DR 1202 STATE ST 154 W MAIN ST 304 SUNSET DR 518 S MAIN ST 1300 S MILWAUKEE AVE 426 N MILWAUKEE AVE 709 WOODLAWN RD 1156 MAPLE AVE 430 WARRENVILLE RD STE 215 320 E UNION AVE 16625 W 159TH ST 2340 S HIGHLAND AVE STE 140 805 S MAIN ST 2050 S FINLEY RD STE 20 1177 S MAIN ST 892 E ROOSEVELT RD 326 N ROUTE 45 7924 N 2ND ST

Page 201 of 679

Provider City JOLIET JOLIET JOLIET JOLIET JOLIET KANKAKEE KANKAKEE KANKAKEE KIRKLAND LA GRANGE LA GRANGE LA GRANGE PARK LA SALLE LA SALLE LACON LACON LAKE FOREST LAKE ZURICH LAKE ZURICH LAKE ZURICH LANARK LANSING LANSING LEBANON LEMONT LENA LEROY LEWISTOWN LIBERTYVILLE LIBERTYVILLE LINCOLN LISLE LISLE LITCHFIELD LOCKPORT LOMBARD LOMBARD LOMBARD LOMBARD LOMBARD LOUISVILLE MACHESNEY PARK

State

ZIP code

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60435 60435-5487 60435 60435-3768 60435-6701 60901-3824 60901-3744 60901-2901 60146 60525-5930 60525-2600 60526 61301-1935 61301-1097 61540-1211 61540-1210 60045-1738 60047-2905 60047-2271 60047-2367 61046-1004 60438-6019 60438-3137 62254-1593 60439-4489 61048-9247 61752 61542-1565 60048-3724 60048-2248 62656-1445 60532-2128 60532-1348 62056-1575 60441-6631 60148-5395 60148-3300 60148-4837 60148-3952 60148-4745 62858-2652 61115-2812

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MACKINAW PHARMACY MANITO PHARMACY BRANDT PHARMACY INC

Provider Name

(309) 359-5960 (309) 968-2800 (815) 568-7242

116 S MAIN ST 406 S ADAMS ST 101 N STATE ST

MACKINAW MANITO MARENGO

IL IL IL

61755-7510 61546-9315 60152-2217

MARENGO COMMUNITY PHARMACY INC HEALTHDIRECT INSTITUTIONAL THE MEDICINE SHOPPE MARISSA DISCOUNT PHARMACY SHAW PHARMACY HARVEY HEALTH CENTER PHARMACY SCHOTTS PHARMACY INC THE MEDICINE SHOPPE MARTINSVILLE PHARMACY MARYVILLE PHARMACY INC DAUBER PHARMACY MASON CITY PHARMACY J & P PHARMACY INC MULCAHY PHARMACY YORK PHARMACY

(815) 568-7866 (618) 993-2900 (618) 997-1393 (618) 295-2317 (618) 295-2241 (708) 225-1984 (815) 795-2700 (217) 826-6374 (217) 382-4004 (618) 288-7474 (618) 566-8521 (217) 482-5985 (708) 345-4658 (708) 216-9100 (618) 643-3524

308 S STATE ST 7846 AVIATION DRIVE 1315 W MAIN ST 700 E LYONS ST 219 N MAIN ST 3530 W 159TH ST 800 W BLUFF ST 201 ARCHER AVE 890 RIDGELAWN RD 2700 N CENTER ST 16 E MAIN ST 149 E CHESTNUT 1516 MADISON ST 2160 S 1ST AVE 107 E MAIN ST

MARENGO MARION MARION MARISSA MARISSA MARKHAM MARSEILLES MARSHALL MARTINSVILLE MARYVILLE MASCOUTAH MASON CITY MAYWOOD MAYWOOD MC LEANSBORO

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60152 62959-5818 62959-1139 62257-1141 62257-1343 60428 61341-1342 62441-1069 62442 62062-5624 62258-2133 62664-1403 60153-1824 60153-3328 62859-1460

CENTEGRA HOSP MCHENRY RETAIL PHCY GENOA-QOL HEALTHCARE OSCO PHARMACY BROADWAY AVE PHARMACY GOTTLIEB PROF BLDG PHARMACY JAMES MEDICAL CENTER PHARMACY OSCO PHARMACY SAAHIL PHARMACY LTD. NEIGHBORHOOD PHARMACY OSCO DRUG METAMORA PHARMACY METROLPOLIS DRUGS II METROPOLIS DRUGS MILLSTADT PHARMACY OSCO DRUG OSCO PHARMACY TRINITY RETAIL PHARMACY AXLINE PHARMACY LYNNS FAMILY PHARMACY MORRIS PHARMACY OSCO DRUG MORTON ALWAN PHARMACY

(815) 759-4899 (815) 344-3263 (815) 385-7030 (708) 450-0400 (708) 450-4941 (708) 316-1698 (708) 547-8735 (708) 450-0064 (708) 389-5300 (708) 389-9021 (309) 367-2385 (618) 524-8400 (618) 524-8316 (618) 476-1701 (815) 467-1254 (309) 797-9320 (309) 779-5010 (309) 734-5196 (217) 762-3377 (815) 942-0985 (815) 941-2353 (309) 291-0180

4201 W MEDICAL CENTER DR 5342 W ELM ST STE P 4222 W ELM ST 153 1/2 BROADWAY AVE 675 W NORTH AVE 1835 N 19TH AVE STE 101 806 W NORTH AVE 1905 RICE ST 11600 S KEDZIE AVE 3243 W 115TH ST 117 W MOUNT VERNON ST 1201 W 10TH ST 1001 E 5TH ST 120 W WASHINGTON ST 2051 RIDGE RD 2014 1ST STREET A 500 JOHN DEERE RD 220 N MAIN ST 1402 N MARKET ST 1600 W US ROUTE 6 RM 111 1414 DIVISION ST 419 MAXINE DR

MCHENRY MCHENRY MCHENRY MELROSE PARK MELROSE PARK MELROSE PARK MELROSE PARK MELROSE PARK MERRIONETTE PARK MERRIONETTE PARK METAMORA METROPOLIS METROPOLIS MILLSTADT MINOOKA MOLINE MOLINE MONMOUTH MONTICELLO MORRIS MORRIS MORTON

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60050-8409 60050-4029 60050-4030 60160-3702 60160-1634 60160-2040 60160-1611 60160-3733 60803-6307 60803-4555 61548-7000 62960-2433 62960-2311 62260-1156 60447 61265-7728 61265-6892 61462-1741 61856-8002 60450-8854 60450-1583 61550-2495

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 202 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ONEPOINT PATIENT CARE BODE DRUG

Provider Name

(847) 583-5611 (618) 748-9253

8130 LEHIGH AVE 211 MAIN ST

MORTON GROVE MOUND CITY

IL IL

60053-2627 62963-1163

MT CARROLL PHARMACY & COMPOUNDING SULLIVANS DRUGS INC KEEFER'S PHARMACY MT. PROSPECT HEALTH MART PHCY OSCO PHARMACY SAV MOR PHARMACY MORELAND AND DEVITT INC BOROWIAK'S IGA PHARMACY BYRD-WATSON TIMES SQUARE DRUG GOOD SAMARITAN PLAZA PHARMACY LINCOLNSHIRE PHARMACY OHLEY PHARMACY THE MEDICINE SHOPPE MOWEAQUA PHARMACY DELIVERCARERX PHARMACY LLC SAV-MOR PHARMACY OSCO DRUG OSCO PHARMACY SHAWNEE HEALTH CARE PHARMACY

(815) 244-2171 (217) 999-7321 (847) 255-3220 (224) 735-2218 (847) 255-6030 (217) 792-5624 (217) 773-2020 (618) 242-7025 (618) 244-5400 (618) 899-4999 (618) 244-3044 (618) 244-5501 (618) 242-8776 (217) 768-3832 (847) 965-1600 (217) 864-0910 (847) 970-9324 (847) 566-0984 (618) 684-9362

101 W MARKET ST 105 W MAIN ST 5 W PROSPECT AVE 1012 S ELMHURST RD 335 E EUCLID AVE 1110 N TOPPER DR 200 PITTSFIELD RD STE B 500 S 10TH ST 3401 BROADWAY ST 2 GOOD SAMARITAN WAY STE 120 4230 STE F LINCOLNSHIRE PL 4704 BROADWAY ST 2339 BROADWAY ST 620 N PUTNAM ST 1471 E BUSINESS CENTER DR #200 1410 VILLAGE PKWY 1150 W MAPLE AVE 1501 S LAKE ST 7 S HOSPITAL DR

MOUNT CARROLL MOUNT OLIVE MOUNT PROSPECT MOUNT PROSPECT MOUNT PROSPECT MOUNT PULASKI MOUNT STERLING MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOWEAQUA MT PROSPECT MT ZION MUNDELEIN MUNDELEIN MURPHYSBORO

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

61053-1031 62069-1609 60056-3213 60056-4240 60056-1288 62548 62353-1626 62864-5307 62864-2201 62864-2475 62864-0000 62864-6724 62864-2925 62550-9418 60056-6058 62549-1253 60060-1409 60060-4258 62966-3333

CAREPLUS DISCOUNT PHARMACY IL INC EDWARD PHARMACY GOOD HEALTH PHARMACY MARIANOS PHARMACY MARTIN AVENUE PHARMACY INC NAPERVILLE PHARMACY OSCO DRUG OSCO DRUG OSCO PHARMACY OSCO PHARMACY OSWALD'S PHARMACY PURE COMPOUNDING PHARMACY DOEHRING'S PHARMACY NASHVILLE PHARMACY INC NAUVOO PHARMACY SAV MOR PHARMACY PRESCRIPTIONS PLUS CUSTOM MED PLUS OSCO PHARMACY

(630) 448-5212 (630) 527-5204 (630) 210-8995 (630) 637-9921 (630) 355-6400 (630) 922-1100 (630) 357-1040 (630) 904-7709 (630) 637-1370 (630) 961-3210 (630) 355-2500 (630) 995-4300 (618) 327-3214 (618) 327-8522 (217) 453-2717 (217) 895-2238 (618) 588-3517 (779) 205-3184 (815) 463-4954

1309 MACOM DR STE 101 100 SPALDING DR STE 101 1999 SPRINGBROOK SQ DR #105 1300 S NAPER BLVD 1247 RICKERT DR STE 100 1020 E OGDEN AVE SUITE 114 127 E OGDEN AVE 2855 W 95TH ST 1755 W OGDEN AVE 1225 S NAPER BLVD 88 W GARTNER RD STE 112 603 E DIEHL RD STE 131 143 S WASHINGTON ST 1251 S MILL ST 1350 MULHOLLAND ST 596 OAK ST 450 W HANOVER ST 222 STONE COURT 2021 E LARAWAY

NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NAPERVILLE NASHVILLE NASHVILLE NAUVOO NEOGA NEW BADEN NEW LENOX NEW LENOX

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60564-3202 60540-6551 60564 60540-7354 60540-1010 60563 60563-3154 60564-9004 60540-3937 60540-8312 60540-7554 60563-4907 62263-1430 62263-2004 62354-1010 62447 62265-1658 60451 60451

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 203 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

OSCO PHARMACY THE MEDICINE SHOPPE ALBANY PHARMACY GOLF MILL PHCY AND MED SUPPLY NWMS PHARMACY OAKMILL PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY BOB'S PHARMACY SAV MOR DRUG IL STATE UNIV STUDENT HLTH PHC MID ILL HEM AND ONC ASSOC LTD OSCO PHARMACY GLORIA PHARMACY OSCO PHARMACY BIOLOGIC TX PHARMACY DUNDEE PHARMACY MARIANOS PHARMACY MARIANO'S PHARMACY MARIANOS PHARMACY OAK CENTRAL FILL PHARMACY OAK FOREST OUTPATIENT PHARMACY OSCO PHARMACY AFFILIATED ONCOLOGISTS AVICENNA PHARMACY BARCUS PHARMACY INC CRESCENT PHARMACY MARIANOS PHARMACY OAK LAWN HEALTH MART PHARMACY OSCO PHARMACY OSCO PHARMACY OSCO PHARMACY XPRESS PHARMACY INC OSCO DRUG SEARS PHARMACY INC SEGRETI PHARMACY IMMEDIATE CARE PHARMACY OKAWVILLE FAMILY PHARMACY, LLC WEBER MEDICAL CLINIC PHARMACY

Provider Name

(815) 462-1034 (618) 783-2838 (773) 237-8041 (847) 803-3340 (847) 954-3480 (847) 518-0750 (847) 965-3916 (847) 647-1933 (847) 296-8847 (217) 563-2701 (217) 563-8346 (309) 438-8713 (309) 452-9701 (309) 454-6080 (708) 716-3008 (708) 447-5170 (888) 892-7607 (847) 480-1000 (847) 559-1214 (847) 272-2877 (847) 446-4102 (708) 633-4365 (708) 633-4365 (708) 687-0122 (708) 424-9710 (708) 529-7222 (708) 425-2400 (708) 576-8373 (708) 346-0726 (708) 443-4310 (708) 599-6300 (708) 857-8274 (708) 422-2334 (708) 598-5000 (708) 358-0935 (708) 848-9050 (708) 383-6758 (630) 282-6003 (618) 243-1038 (618) 395-8561

475 NELSON RD 600 W JOURDAN ST 8850 N MILWAUKEE AVE 8941 W GOLF RD 8915 W GOLF RD STE 128 8118 N MILWAUKEE AVE STE 104 7900 N MILWAUKEE AVE 5665 W TOUHY AVE 8730 W DEMPSTER ST 116 W STATE ST 110 E STATE ST 201 N UNIVERSITY 407 E VERNON AVE STE 104 901 S COTTAGE AVE 8336 W LAWRENCE AVE 7201 W 24TH ST 1976 RAYMOND DR 2750 DUNDEE RD 784 SKOKIE BLVD 2323 CAPITAL DR 1822 WILLOW ROAD 15900 S CICERO AVE 15900 S CICERO AVE 5610 159TH ST 4400 W 95TH ST STE 311 10837 S CICERO AVE STE 110C 4708 W 103RD ST 4647 W 103RD ST STE 1IA 11000 S CICERO AVE 4700 W 95TH ST STE 101 8801 RIDGELAND AVE 9424 S PULASKI RD 4650 W 103RD ST 6700 W 95TH ST #150 438 MADISON ST 1003 MADISON ST 6144 ROOSEVELT RD 1 S 210 SUMMIT AVE 210 W HIGH ST 1200 N EAST ST

NEW LENOX NEWTON NILES NILES NILES NILES NILES NILES NILES NOKOMIS NOKOMIS NORMAL NORMAL NORMAL NORRIDGE NORTH RIVERSIDE NORTHBROOK NORTHBROOK NORTHBROOK NORTHBROOK NORTHFIELD OAK FOREST OAK FOREST OAK FOREST OAK LAWN OAK LAWN OAK LAWN OAK LAWN OAK LAWN OAK LAWN OAK LAWN OAK LAWN OAK LAWN OAK LAWN OAK PARK OAK PARK OAK PARK OAKBROOK TERRACE OKAWVILLE OLNEY

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60451-2944 62448-1056 60714-1735 60714-5812 60714-5905 60714-2836 60714-3159 60714-4019 60714-5108 62075-1657 62075-1340 61761 61761-3813 61761-3360 60706-3152 60546-1591 60062-6715 60062-2600 60062 60062-6144 60093-2926 60452 60452-4006 60452-3104 60453-2660 60453-6459 60453-4706 60453-4779 60453 60453 60453-1002 60453-1935 60453-4719 60453-2106 60302-4012 60302-4404 60304-2316 60181 62271-1799 62450

WILLIAMS BROS HEALTH CARE PHARMACY

(618) 395-2144

1029 E MAIN ST

OLNEY

IL

62450-2625

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 204 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ST JAMES OUTPATIENT PHARMACY

Provider Name

(708) 747-7283

3700 W 203RD ST STE 108

OLYMPIA FIELDS

IL

60461-1181

OREGON HEALTHCARE PHARMACY SERVICES OREGON SNYDER PHARMACY ORION FAMILY PHARMACY LLC AMERICAN SERVICE AND PRODUCT MARIANO'S PHARMACY MEDSCRIPT PHARMACY OSCO DRUG OSCO PHARMACY OSCO DRUG OSCO PHARMACY MEDI-RX PHARMACY INC OTTAWA HEALTH MART THE PHARMACY STOP THE PHARMACY STOP MEDICAL CENTER MARIANO'S PHARMACY OSCO DRUG OSCO PHARMACY PROHEALTH DRUGS HARMON'S HEALTHMART PALESTINE OSCO PHARMACY OSCO PHARMACY PARIS CLINIC PHARMACY PEARMAN PHARMACY MARIANOS PHARMACY ONCOLOGY SPECIALISTS SC OSCO DRUG DOUG'S PHARMACY HUDSON DRUG SHOP PECATONICA PHARMACY PARK COURT PHARMACY PEKIN PRESCRIPTION LABORATORY ALWAN PHARMACY ESSENTIAL WELLNESS PHARMACY GENOA-QOL HEALTHCARE

(815) 732-1422 (815) 732-7340 (309) 526-8008 (708) 671-1200 (708) 226-0027 (885) 900-6001 (708) 479-1744 (708) 460-8212 (630) 551-2672 (630) 892-0030 (815) 433-2255 (815) 434-6337 (815) 434-5355 (815) 433-4666 (847) 963-4175 (847) 358-5890 (847) 358-1200 (224) 993-3737 (618) 586-5010 (708) 448-3250 (708) 361-8090 (217) 465-4114 (217) 465-8455 (847) 696-3846 (847) 268-8200 (847) 696-3680 (217) 379-3684 (217) 379-4858 (815) 239-1200 (309) 347-9455 (309) 346-2141 (309) 676-6333 (309) 681-8850 (309) 285-8231

1100 W PINES RD 201 N 4TH ST 201 11TH AVE. 16612 107TH CT 9504 W 142ND ST 14400 JOHN HUMPHREY DR STE 110 17930 WOLF RD 9352 W 159TH ST 3795 ORCHARD RD 2540 US HIGHWAY 30 411 W MAIN ST 900 1ST AVE 113 W MICHIGAN ST 1614 E NORRIS DR 545 N HICKS RD 423 DUNDEE RD 33 S PLUM GROVE RD 777 N QUENTIN RD 101 N MAIN ST 7127 W 127TH ST 9650 W 131ST ST 719 E COURT ST 116 W COURT ST 1900 S CUMBERLAND AVE 1700 LUTHER LN FL 2 481 BUSSE HWY 137 N MARKET ST 108 N MARKET ST 413 MAIN ST 616 S 13TH ST 1016 COURT STREET 311 N WESTERN AVE 4625 N UNIVERSITY ST 228 NE JEFFERSON AVE STE 207

OREGON OREGON ORION ORLAND PARK ORLAND PARK ORLAND PARK ORLAND PARK ORLAND PARK OSWEGO OSWEGO OTTAWA OTTAWA OTTAWA OTTAWA PALATINE PALATINE PALATINE PALATINE PALESTINE PALOS HEIGHTS PALOS PARK PARIS PARIS PARK RIDGE PARK RIDGE PARK RIDGE PAXTON PAXTON PECATONICA PEKIN PEKIN PEORIA PEORIA PEORIA

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

61061-9551 61061-1418 61273 60467 60462 60462-2898 60467-5492 60462-5541 60543 60543-8975 61350-2801 61350-4048 61350-2028 61350-3681 60067-3608 60074 60067-6242 60067-2309 62451-1263 60463-1559 60464-1640 61944-2478 61944-1735 60068-5235 60068-1270 60068-3252 60957 60957-1220 61063-9753 61554-4936 61554-4818 61604-5638 61614-5828 61603-3802

ONCOLOGY HEMATOLOGY ASSOC OF CTL IL SMITH PHARMACY ILLINOIS CANCER CARE PETERSBURG PHARMACY POTTER DRUG

(309) 243-3404 (309) 688-3684 (309) 243-3019 (217) 632-7778 (217) 632-2288

8940 N WOOD SAGE RD 4600 N PROSPECT RD STE 2 4391 VENTURE DR 1 CENTRE DR STE 100 200 S 6TH ST

PEORIA PEORIA HEIGHTS PERU PETERSBURG PETERSBURG

IL IL IL IL IL

61615-7822 61616 61354-1018 62675-9420 62675-1553

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 205 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STOTLAR DRUG COMPANY INC COUNTY MARKET PHARMACY IHS PHARMACY OSCO PHARMACY OSCO PHARMACY CHARLEY'S PHARMACY SNYDER PHARMACY FAWCETTS PHARMACY PRINCETON PHARMACY PRINCEVILLE PHARMACY LLC HARTIG DRUG CO ROGANS COUNTRY PHARMACY BROWN DRUG COMPANY SULLIVAN DRUG DETERDING DRUGS INC KEIL PHARMACY INC MEDICINE SHOPPE PHARMACY OSCO PHARMACY CURRY'S FAMILY PHARMACY ROANOKE PHARMACY BERTRAM PHARMACY INC ROCHELLE PHARMACY

Provider Name

(618) 357-8781 (217) 285-5515 (217) 285-4214 (815) 577-2613 (815) 254-3391 (815) 946-4073 (815) 765-1300 (815) 872-3251 (815) 875-1237 (309) 385-4955 (815) 537-2400 (618) 342-6737 (217) 228-6400 (217) 229-3022 (618) 282-6231 (618) 282-2870 (618) 272-3841 (708) 771-4445 (217) 629-7001 (309) 923-7431 (618) 544-2167 (815) 562-4444

1 N WALNUT ST 825 W WASHINGTON ST 121 N FRANKLIN ST 13460 S ROUTE 59 2480 STATE ROUTE 59 110 E MASON ST 13521 IL ROUTE 76 519 S MAIN ST 610 N MAIN ST 206 E MAIN ST 316 WASHINGTON ST # 318 201 E COMMERCIAL ST 1121 MAINE ST 801 N O'BANNON ST 1506 S MAIN ST 1375 S MAIN ST 101 E MAIN ST 7523 LAKE ST 1279 N 7TH ST 322 N MAIN ST 1300 N ALLEN ST 314 LINCOLN HWY

PINCKNEYVILLE PITTSFIELD PITTSFIELD PLAINFIELD PLAINFIELD POLO POPLAR GROVE PRINCETON PRINCETON PRINCEVILLE PROPHETSTOWN PULASKI QUINCY RAYMOND RED BUD RED BUD RIDGWAY RIVER FOREST RIVERTON ROANOKE ROBINSON ROCHELLE

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

62274-1025 62363 62363-1317 60585 60586 61064-1522 61065-8815 61356-2012 61356-1329 61559-7516 61277-1184 62976 62301-4040 62560 62278-1316 62278-1352 62979-1210 60305-1819 62561-9355 61561 62454-1001 61068-1638

DISTRICT DRUGS AND COMPOUNDING CNTR DIVVYDOSE DOWNTOWN DISCOUNT DRUGS GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE ROCK VALLEY COMPOUNDING PHCY SWEDISH AMERICAN HOSPITAL OSCO PHARMACY SAF-T DRUGS OSCO PHARMACY PHARMACY PLUS INC CAREPOINT EXPRESS SNYDER-MARK DRUG ROSELLE INC AXLINE PHARMACY HARDIN COUNTY DISCOUNT PHCY OSCO PHARMACY COUNTY MARKET PHARMACY MORELAND & DEVITT DRUG OSCO DRUG

(309) 786-8431 (312) 375-9987 (815) 962-2166 (815) 516-0246 (815) 977-9046 (779) 423-0542 (779) 696-1130 (847) 818-0095 (847) 749-0048 (815) 293-0858 (217) 589-4313 (855) 237-9112 (630) 529-3400 (309) 426-2954 (618) 285-6619 (847) 223-7056 (217) 322-3383 (217) 322-3333 (630) 587-0855

319 18TH ST 3416 46TH AVE STE 104 325 W STATE ST 2662 ELMWOOD RD STE 101 2704 N MAIN ST RM A104 811 S PERRYVILLE RD STE 109 1401 E STATE ST 3004 KIRCHOFF RD 3315 ALGONQUIN RD STE 320 20 S WEBER RD 213 W CLAY 33 E IRVING PARK RD 384 E IRVING PARK RD 125 N MAIN ST 7 FERRELL RD 900 E ROLLINS RD 218 N CONGRESS ST 124 N CONGRESS ST 652 KIRK RD

ROCK ISLAND ROCK ISLAND ROCKFORD ROCKFORD ROCKFORD ROCKFORD ROCKFORD ROLLING MEADOWS ROLLING MEADOWS ROMEOVILLE ROODHOUSE ROSELLE ROSELLE ROSEVILLE ROSICLARE ROUND LAKE BEACH RUSHVILLE RUSHVILLE SAINT CHARLES

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

61201-8715 61201-7082 61101-1103 61103-1573 61103-3112 61108-4323 61104-2315 60008-1818 60008-3249 60446-4947 62082 60172-2017 60172-2007 61473-9574 62982 60073-2247 62681-1402 62681-1434 60174-4723

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 206 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name OSCO PHARMACY ST JOSEPH DRUGS INC BANDY'S PHARMACY THE MEDICINE SHOPPE HARTIG DRUG CO CAREPOINT PHARMACY FRIENDLY REMEDIES OSCO PHARMACY OSCO PHARMACY SUPERIOR BIOLOGICS IL INC MEDICENTER PHARMACY SHEFFIELD PHARMACY FAMILY DRUG SAV MOR FAMILY DRUG PHARMACY DIERBERGS GREEN MOUNT CROSSING MARIANO'S PHARMACY OSCO PHARMACY ILLINI CLINIC PHARMACY OSCO PHARMACY COMMUNITY HEALTH PHARMACY MARIANOS PHARMACY MDS PHARMACY INC. NORTH SUBURBAN PHARMACY, INC. NORTHSHORE UNIV HEALTHSYSTEM OSCO DRUG SUPER CARE PHARMACY, INC SMITHTON PHARMACY OSCO PHARMACY OSCO DRUG OSCO PHARMACY WALT'S PHARMACY MOODY PHARMACY OSCO PHARMACY JOHNSONS PHARMACY COMPLETE CARE PHARMACY COUNTY MARKET PHARMACY COUNTY MARKET PHARMACY COUNTY MARKET PHARMACY 083 COUNTY MARKET PHARMACY 228 FORUM EXT CARE SVCS OF CNTRL I OSCO PHARMACY OSCO PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (630) 377-1655 (217) 469-2232 (618) 548-4000 (618) 548-0070 (815) 273-2713 (855) 237-9112 (630) 981-8130 (847) 895-1600 (630) 529-1660 (847) 469-2400 (618) 625-8400 (815) 454-8054 (217) 774-7838 (217) 774-4050 (618) 628-8085 (815) 577-2747 (815) 730-3973 (309) 792-7002 (309) 792-5990 (847) 579-0093 (847) 763-9023 (847) 972-2616 (847) 674-0707 (847) 933-6890 (847) 677-2564 (847) 983-8856 (618) 207-3186 (708) 756-7775 (847) 622-1220 (708) 339-0453 (708) 333-4492 (618) 443-2715 (815) 675-6984 (815) 664-5050 (217) 528-8096 (217) 528-3182 (217) 744-2296 (217) 793-4091 (217) 787-2830 (217) 717-4407 (217) 523-7002 (217) 527-8408

Provider Street 2038 PRAIRIE ST 204 N MAIN ST 1413 W WHITTAKER ST 215 N BROADWAY 218 CHICAGO AVE 9 E COMMERCE DR 350 W SCHAUMBURG RD STE PWD 1151 S ROSELLE RD 2503 W SCHAUMBURG RD 2050 E ALGONQUIN RD STE 606 6294 STATE HIGHWAY 154 SUITE A 134 S MAIN ST 1603 W MAIN ST 415 N CEDAR ST 4000 GREEN MOUNT CROSSING DR 950 BROOK FOREST AVE 199 BROOK FOREST AVE 855 ILLINI DR STE 200 1312 JOHN DEERE EXPY 4043 MAIN ST 3358 W TOUHY AVE 7348 LAWNDALE AVE 4913 OAKTON ST 9669 KENTON AVE STE 1726 9449 SKOKIE BLVD 8305 SKOKIE BLVD 3981 STATE ROUTE 159 STE 5 3240 CHICAGO RD 375 RANDALL RD 763 E 162ND ST 16145 STATE ST 109 E BROADWAY ST 2401 N US HIGHWAY 12 203 E SAINT PAUL ST 201 N 5TH ST 210 E CARPENTER ST 2777 S 6TH ST 3001 S VETERANS PKWY 1903 W MONROE ST 614 N SIXTH ST, UNIT 200 200 N GRAND AVE W 1501 S DIRKSEN PKWY

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Provider City SAINT CHARLES SAINT JOSEPH SALEM SALEM SAVANNA SCHAUMBURG SCHAUMBURG SCHAUMBURG SCHAUMBURG SCHAUMBURG SESSER SHEFFIELD SHELBYVILLE SHELBYVILLE SHILOH SHOREWOOD SHOREWOOD SILVIS SILVIS SKOKIE SKOKIE SKOKIE SKOKIE SKOKIE SKOKIE SKOKIE SMITHTON SOUTH CHICAGO HEIGHT SOUTH ELGIN SOUTH HOLLAND SOUTH HOLLAND SPARTA SPRING GROVE SPRING VALLEY SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD

State

ZIP code

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60174-3578 61873 62881-2015 62881-1511 61074-1918 60173 60194 60193-4071 60194-3887 60173-4161 62884-2163 61361-9357 62565 62565-1245 62269-7287 60404 60404 61282-2904 61282-1973 60076-2778 60076 60076-4022 60077-2903 60076-1266 60077-1312 60077-2546 62285-2531 60411-5421 60177-2248 60473-2331 60473-1237 62286-1619 60081-9691 61362-2139 62701-1001 62702-5128 62703-4071 62704-6405 62704-1530 62702 62702-2551 62703-2128

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name OSCO PHARMACY SPRINGFIELD CLINIC LLP THE MEDICINE SHOPPE SULLIVAN DRUGS INC TONY'S MEDICENTER PHARMACY CGHMC OUTPATIENT PHARMACY THE MEDICINE SHOPPE OSCO PHARMACY HARTIG DRUG CO OSCO PHARMACY STREATOR DRUGS OSCO PHARMACY OAKWOOD APOTHECARY THE SULLIVAN PHARMACY SUMMIT MEDICAL PHARMACY MEDICINE EXPRESS LEHAN DRUGS AT THE DEKALB CLINIC OSCO DRUG KREMER PHARMACY ALPHA MED PHYS GRP - TINLEY DISCOUNT DRUGS INC INGALLS PROFESSIONAL PHARMACY II LA GRANGE ROAD PHARMACY MEDIZONE PHARMACY INC OSCO PHARMACY TINLEY PARK APOTHECARY LLC TINLEY PARK PHARMACY WALT'S PHARMACY TOLEDO PHARMACY FAMILY PHARMACY SAV-MOR PHARMACY COVENANT OUTPATIENT PHARMACY CAINS DRUG STORE MARIANOS PHARMACY BODE DRUG INC VILLA GROVE PHARMACY CRITICAL HOME CARE PHARMACY OSCO PHARMACY VILLA PARK PHARMACY INC SAV-MOR DRUGS MORELAND & DEVITT WARREN DRUG STORE

NR_0009_10823 10/2017

Provider Phone Number (217) 546-2573 (217) 391-6940 (217) 525-0058 (618) 635-2595 (618) 965-3511 (815) 564-4633 (815) 622-5000 (708) 484-8410 (815) 947-3411 (630) 837-2020 (815) 672-5600 (630) 466-3769 (217) 728-2760 (217) 728-2331 (708) 728-0638 (618) 236-1144 (815) 217-3890 (815) 895-9435 (217) 857-3000 (708) 957-2100 (708) 468-8603 (708) 429-9923 (708) 226-7100 (708) 429-1100 (708) 532-7477 (708) 778-3669 (708) 995-7290 (708) 532-5775 (217) 849-2666 (618) 224-7316 (217) 253-2309 (217) 337-4545 (618) 283-0196 (847) 816-3247 (618) 658-3784 (217) 681-1014 (630) 530-0280 (630) 279-8900 (630) 501-0751 (217) 965-4926 (217) 452-3301 (815) 745-3700

Provider Street 1755 WABASH AVE 900 N 1ST ST RM 4066 133 N GRAND AVE E 101 E MAIN ST 324 W BROADWAY 100 E LE FEVRE RD 4 W 3RD ST 7122 40TH ST 101 S MAIN ST 217 E IRVING PARK RD 109 E MAIN ST 465 N RT 47 17 N HAMILTON ST 102 E HARRISON ST 6252 S ARCHER RD 1704 N ILLINOIS ST 1850 GATEWAY DR STE A 220 W PEACE RD 206A N PEARL ST 6701 159TH ST STE 2 16650 HARLEM AVE 6701 159TH ST 17495 LA GRANGE RD 6700 167TH ST STE 2 17113 HARLEM AVE 17320 OAK PARK AVE 18210 LA GRANGE RD STE 101 16039 HARLEM AVE 104 COURTHOUSE SQUARE 405 E BROADWAY 104 E SOUTHLINE RD 1400 W PARK ST 1401 N 8TH ST 1720 N MILWAUKEE AVE 803 1/2 N 1ST ST 4 N MAIN ST 401 E NORTH AVE STE 16 31 W SAINT CHARLES RD 616 N ADDISON RD 105 E JACKSON ST 118 E BEARDSTOWN ST 137 E MAIN ST

Page 208 of 679

Provider City SPRINGFIELD SPRINGFIELD SPRINGFIELD STAUNTON STEELVILLE STERLING STERLING STICKNEY STOCKTON STREAMWOOD STREATOR SUGAR GROVE SULLIVAN SULLIVAN SUMMIT ARGO SWANSEA SYCAMORE SYCAMORE TEUTOPOLIS TINLEY PARK TINLEY PARK TINLEY PARK TINLEY PARK TINLEY PARK TINLEY PARK TINLEY PARK TINLEY PARK TINLEY PARK TOLEDO TRENTON TUSCOLA URBANA VANDALIA VERNON HILLS VIENNA VILLA GROVE VILLA PARK VILLA PARK VILLA PARK VIRDEN VIRGINIA WARREN

State

ZIP code

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

62704-5301 62702 62702-3859 62088-1446 62288 61081-1278 61081-3503 60402-4198 61085-1323 60107-2948 61364-2924 60554 61951-1452 61951-2002 60501-1720 62226-3948 60178-3192 60178-8913 62467 60477-1758 60477-1847 60477-1758 60487 60477 60477-3369 60477-3404 60487-7723 60477-1611 62468 62293-1663 61953-2075 61801-2334 62471-1028 60061-1538 62995-1544 61956-1517 60181-1218 60181-2423 60181-1419 62690-1450 62691-1303 61087-9367

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HEALY PHARMACY MEDICATE CENTRAL PHARMACY WIGHTMAN PHARMACY WATERMAN TELEPHARMACY OSCO PHARMACY WAUCONDA PHARMACY GENOA-QOL HEALTHCARE NYJ VITAL RX INC OSCO PHARMACY OSCO PHARMACY SHOE CREEK PHARMACY OSCO PHARMACY OSCO PHARMACY J & S PROFESSIONAL PHARMACY THE APOTHECARY SHOPPE W SALEM MARIANO'S PHARMACY OSCO PHARMACY WESTCHESTER PHARMACY MARIANOS PHARMACY MARIANO'S PHARMACY OSCO PHARMACY WESTMONT PHARMACY MEDPLUS PHARMACY DENSON SPECIALTY PHARMACY GENOA-QOL HEALTHCARE MARIANOS PHARMACY OSCO PHARMACY OSCO PHARMACY DESNA PHARMACY EXPRESS PHARMACY HEALTH MART PHARMACY KEDVON PHARMACY SOLUTIONS, INC. PHARMACY PLUS, INC. OSCO DRUG PHARMACY PLUS, INC. WINNEBAGO SNYDER PHARMACY CONNEYS PHARMACY OPTION CARE OSCO PHARMACY CAMPS DRUG STORE THE MEDICINE SHOPPE OSCO PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (630) 357-2900 (618) 874-3000 (618) 939-6218 (815) 283-1054 (847) 526-1239 (847) 526-2591 (224) 419-5100 (847) 263-9277 (847) 623-7066 (847) 336-1300 (618) 895-2844 (630) 293-5360 (847) 428-5522 (618) 937-2416 (618) 456-3716 (708) 562-8101 (708) 562-7334 (708) 897-2424 (708) 246-7530 (630) 964-4654 (630) 986-8065 (630) 969-2043 (217) 267-8077 (630) 668-1180 (331) 218-1362 (630) 690-6474 (630) 668-1211 (630) 668-7235 (847) 229-5477 (847) 947-7706 (773) 262-0202 (847) 459-0001 (217) 374-2222 (847) 853-8001 (217) 742-3333 (815) 335-3535 (847) 446-0032 (630) 616-0800 (630) 773-8068 (618) 254-6223 (618) 259-0085 (630) 985-5383

Provider Street 4580 WEAVER PARKWAY SUITE 103 1833 KINGSHIGHWAY 127 S MAIN ST 140 W LINCOLN HWY 543 E LIBERTY ST 222 S MAIN ST 3010 GRAND AVE RM 1104 2310 GRAND AVE 920 N GREEN BAY RD 3124 N LEWIS AVE 310 S MAIN 177 E ROOSEVELT RD 1260 W MAIN ST 309 W SAINT LOUIS ST 108 S MAIN ST 3020 WOLF RD 2128 S MANNHEIM RD 947 S MANNHEIM RD 4700 GILBERT AVE 150 W 63RD STREET 50 E OGDEN AVE 2 N CASS AVE 111 N STATE ST STE C 200 E WILLOW AVE 111 N COUNTY FARM RD STE 101 625 S MAIN ST 30 DANADA SQ W 2031 N MAIN ST 307 S MILWAUKEE AVE STE 109 716 S MILWAUKEE AVE 81 S MILWAUKEE AVE 56 S MILWAUKEE AVE 116 N MAIN ST 411 GREEN BAY RD 41 S MAIN ST 101 LANDMARK DR 736 ELM ST 1360 N WOOD DALE RD STE R 341 W IRVING PARK RD 600 E FERGUSON AVE 901 E EDWARDSVILLE RD 2317 75TH ST

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Provider City WARRENVILLE WASHINGTON PARK WATERLOO WATERMAN WAUCONDA WAUCONDA WAUKEGAN WAUKEGAN WAUKEGAN WAUKEGAN WAYNE CITY WEST CHICAGO WEST DUNDEE WEST FRANKFORT WEST SALEM WESTCHESTER WESTCHESTER WESTCHESTER WESTERN SPRINGS WESTMONT WESTMONT WESTMONT WESTVILLE WHEATON WHEATON WHEATON WHEATON WHEATON WHEELING WHEELING WHEELING WHEELING WHITE HALL WILMETTE WINCHESTER WINNEBAGO WINNETKA WOOD DALE WOOD DALE WOOD RIVER WOOD RIVER WOODRIDGE

State

ZIP code

IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL IL

60555 62204-2135 62298-1371 60556-9730 60084-1962 60084-1828 60085-2321 60085-3313 60085-2240 60087-2231 62895 60185-3966 60118-1930 62896-2099 62476-1202 60154-5622 60154-4339 60154-2515 60558-1753 60559 60559-1336 60559-1602 61883-1461 60187-5463 60187-3977 60187-5240 60189 60187-3152 60090 60090 60090-3187 60090-3108 62092-1054 60091-2725 62694-1249 61088-7702 60093-2578 60191-1075 60191-1325 62095-2146 62095-1823 60517-2302

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CENTEGRA HOSP WOODSTOCK RET PHC MERCY WOODSTOCK PHARMACY OSCO DRUG OSCO PHARMACY MRMC PHARMACY OSCO PHARMACY WEBBS FAMILY PHARMACY GENOA-QOL HEALTHCARE PHARMASAVE RX SWADLEY DRUGS

Provider Name

(815) 334-3899 (815) 337-4116 (815) 206-0716 (630) 553-8615 (847) 872-6085 (847) 746-2616 (574) 893-4413 (765) 649-1251 (765) 374-3444 (765) 762-3287

3701 DOTY ROAD 2000 LAKE AVE 145 S EASTWOOD DR 234 E VETERANS PKWY 2520 ELISHA AVE 1402 21ST ST 101 W ROCHESTER ST 2009 BROWN ST 4638 S SCATTERFIELD RD 300 S. PERRY ST

WOODSTOCK WOODSTOCK WOODSTOCK YORKVILLE ZION ZION AKRON ANDERSON ANDERSON ATTICA

IL IL IL IL IL IL IN IN IN IN

60098 60098-7401 60098-3519 60560-1363 60099-2676 60099-2304 46910-9997 46016-4216 46013-2900 47918

DEKALB HEALTH PHARMACARE GARRETT DEKALB PHARMACARE AUSTIN PHARMACY INC STEWARTS PHARMACY GENOA-QOL HEALTHCARE WEST RETAIL PHARMACY GEORGE'S FAMILY PHARMACY, INC. CROWDERS UPTOWN DRUG STORE JAY C PLUS PHARMACY LINCOLN PLAZA PHARMACY LLC MED SHOPPE PHARMACY MEDICINE PLUS KAUP PHARMACY FAMILY PHARMACY INC GENOA-QOL HEALTHCARE PANACEA PHARMACY INC. PHARMACY 1 EXPRESS

(260) 553-9200 (260) 925-8000 (812) 794-4311 (812) 794-3001 (317) 272-4804 (317) 217-3355 (812) 932-6251 (812) 275-5949 (812) 275-8167 (812) 277-1702 (812) 275-1340 (812) 275-3383 (260) 589-3330 (812) 735-4444 (812) 355-6340 (812) 287-8884 (812) 331-7979

1314 E SEVENTH STREET STE 104 1314 E 7TH ST STE 104 10 W MAIN ST 57 W MAIN ST 6655 E US HIGHWAY 36 1111 RONALD REAGAN PKWY 1198 STATE ROAD 46 E 631 16TH ST 2631 W 16TH ST 629 LINCOLN AVE 2900 16TH ST 2412 16TH ST 104 W MAIN STREET 508 W 11TH ST 645 S ROGERS ST 2424 S WALNUT ST 730 W 2ND ST

AUBURN AUBURN AUSTIN AUSTIN AVON AVON BATESVILLE BEDFORD BEDFORD BEDFORD BEDFORD BEDFORD BERNE BICKNELL BLOOMINGTON BLOOMINGTON BLOOMINGTON

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

46706-2533 46706-2533 47102-1304 47102-1303 46123-8923 46123-7085 47006 47421-3818 47421 47421-2142 47421-3510 47421-3010 46711 47512-9626 47403-2353 47401 47403-2210

WILLIAMS BROS. HEALTH CARE PHARMACY LYNNS PHARMACY BRISTOL PHARMACY GEORGE'S FAMILY PHARMACY BLUE RIVER PHARMACY GRANDVIEW HEALTHCARE INC FAMILY DRUG MEDICENTER ALTERNATE CARE PHCY CAMBY LOW COST PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE NORTH RETAIL PHARMACY OPTION CARE

(812) 335-0000 (812) 446-2381 (574) 848-0660 (765) 647-6251 (317) 286-3506 (866) 827-7575 (812) 358-4502 (765) 593-0119 (317) 548-8015 (317) 218-7709 (317) 815-5924 (765) 751-5316 (317) 569-2055

574 S LANDMARK AVE 22 W NATIONAL AVE 300 E ELKHART ST 480 MAIN ST 680 E 56TH ST STE I 474 SOUTHPOINT CIR 810 W COMMERCE ST 100 N FOOTE ST 8411 WINDFALL LN STE 90 703 PRO-MED LN STE 200 697 PRO-MED LN 11700 N MERIDIAN ST STE B106 867 W CARMEL DR

BLOOMINGTON BRAZIL BRISTOL BROOKVILLE BROWNSBURG BROWNSBURG BROWNSTOWN CAMBRIDGE CITY CAMBY CARMEL CARMEL CARMEL CARMEL

IN IN IN IN IN IN IN IN IN IN IN IN IN

47403-3239 47834-2537 46507-9205 47012-1406 46112-7777 46112-2203 47220-1200 47327-1104 46113-8027 46032-5318 46032-5323 46032 46032-5804

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 210 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GUTHRIE'S PHARMACY COOPER DRUGS INC JAY C PLUS PHARMACY OSCO DRUG CLAY CITY PHARMACY CLOVERDALE DRUGS COLUMBUS REGIONAL HOSP PHCY GENOA-QOL HEALTHCARE MEDICENTER PHARMACY BUTT REXALL DRUG VILLAGE APOTHE AT WILLIAMSBURG

Provider Name

(812) 925-3347 (812) 256-2500 (812) 256-2943 (219) 926-8723 (812) 939-2173 (765) 795-4100 (812) 376-5258 (812) 376-7295 (765) 827-1934 (812) 738-3272 (765) 364-0363

520 W LINCOLN AVE 830 MAIN ST 9501 HIGHWAY 403 747 INDIAN BOUNDARY RD 730 MAIN ST 900 N MAIN ST 2400 E 17TH ST 720 N MARR RD 1475 E STATE ROAD 44 115 E CHESTNUT ST 1609 LAFAYETTE RD RM 23

CHANDLER CHARLESTOWN CHARLESTOWN CHESTERTON CLAY CITY CLOVERDALE COLUMBUS COLUMBUS CONNERSVILLE CORYDON CRAWFORDSVILLE

IN IN IN IN IN IN IN IN IN IN IN

47610-9712 47111-1220 47111-8939 46304-1518 47841 46120 47201 47201-6660 47331 47112-1105 47933-1032

CANCER HEALTH TREATMENT CENTERS, PC FAGEN PHARMACY OSCO PHARMACY WINFIELD MEDICAL PHARMACY DALE PHARMACY SCOTTS PHARMACY FAGEN PHARMACY FAGEN PHARMACY DEVILLE PHARMACIES INC OSCO DRUG WALT'S PHARMACY FAGEN PHARMACY GENOA-QOL HEALTHCARE ST CATHERINE OUTPATIENT PHCY ELKHART GENERAL HOSPITAL GENOA-QOL HEALTHCARE HEART CITY HEALTH CTR PHARMACY MARTIN'S PHARMACY MARTIN'S PHARMACY MARTIN'S PHARMACY SEIFERT DRUGS ELWOOD LOW COST PHARMACY DEACONESS FAMILY PHARMACY DEACONESS FAMILY PHARMACY DC-DT GENOA-QOL HEALTHCARE INDIANA EXCEPTIONAL MED CARE LLC NATIONS MEDICINES NATION'S MEDICINES PAUL'S PHARMACY PAUL'S PHARMACY EAST

(219) 310-2550 (219) 663-9075 (219) 662-0200 (219) 488-1461 (812) 937-2071 (260) 724-9187 (219) 345-2200 (219) 987-2971 (812) 432-5684 (219) 864-4314 (219) 865-4363 (219) 398-1377 (412) 931-3131 (219) 392-7691 (574) 523-3101 (574) 970-0440 (574) 970-1440 (574) 970-6470 (574) 970-0004 (574) 875-9423 (574) 295-4333 (765) 552-0869 (812) 450-3784 (812) 450-3784 (812) 422-3448 (812) 402-3700 (812) 962-4664 (812) 422-8255 (812) 425-4364 (812) 962-3500

342 E 109TH AVE 10809 RANDOLPH ST 1276 N MAIN ST 9150 E 109TH AVE STE 2B 560 S WASHINGTON ST 929 S 13TH ST 10064 N 600 E 325 N HALLECK ST 12836 NORTH ST 805 JOLIET ST 1218 SHEFFIELD AVE 2002 E COLUMBUS DR 3903 INDIANAPOLIS BLVD 4321 FIR ST 600 EAST BLVD 2600 OAKLAND AVE 236 SIMPSON AVE 120 SANFORD SCHOOL RD 3900 E BRISTOL ST 201 CONCORD MALL DR 230 S MAIN ST 518 S ANDERSON ST 600 MARY STREET 421 CHESTNUT ST 415 MULBERRY ST 3700 BELLEMEADE AVE STE 101 4849 POLLACK AVE 3408 N 1ST AVE 2345 W FRANKLIN ST 1225 WASHINGTON SQ

CROWN POINT CROWN POINT CROWN POINT CROWN POINT DALE DECATUR DEMOTTE DEMOTTE DILLSBORO DYER DYER EAST CHICAGO EAST CHICAGO EAST CHICAGO ELKHART ELKHART ELKHART ELKHART ELKHART ELKHART ELKHART ELWOOD EVANSVILLE EVANSVILLE EVANSVILLE EVANSVILLE EVANSVILLE EVANSVILLE EVANSVILLE EVANSVILLE

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

46307-8693 46307-9406 46307-2757 46307-7686 47523-9693 46733-1805 46310 46310-9419 47018-8492 46311-1920 46311-1053 46312-2830 46312-2555 46312-3049 46514-2483 46517-1533 46516-4666 46514 46514-4466 46517-3109 46516-3120 46036-2322 47710 47713-1227 47713-1230 47714 47715-5750 47710-3302 47712-5100 47715

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 211 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ST MARY'S APOTHECARY GREENLEAF APOTHECARY LLC INDIANA PREMIER PHARMACY INNOVATIVE RX ROCHE HEALTH SOLUTIONS, INC SAXONY RETAIL PHARMACY JAY C PLUS PHARMACY FORT WAYNE CUSTOM RX INC

Provider Name

(812) 485-4365 (317) 436-8328 (317) 248-0400 (317) 845-9820 (317) 521-0156 (765) 751-5316 (812) 923-9013 (260) 490-3447

801 SAINT MARYS DR 10154 BROOKS SCHOOL RD 8395 E 116TH ST STE 121 11954 FISHERS CROSSING DR 11800 EXIT 5 PKWY STE 120 13100 E 136TH ST STE 1000 815 HIGHLANDER POINT DR 425 E DUPONT RD

EVANSVILLE FISHERS FISHERS FISHERS FISHERS FISHERS FLOYDS KNOBS FORT WAYNE

IN IN IN IN IN IN IN IN

47714-0511 46037-3842 46038 46038-2702 46037-7989 46037-9478 47119-9470 46825-2051

FT WAYNE MED ONCOLOGY & HEMOTOLOGY FT WAYNE MEDICAL ONC & HEMA GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE NO ANTHONY PHCY/WELLNESS CTR I PARKVIEW RANDALLIA OUTPATIENT SCOTTS PHARMACY SCOTTS PHARMACY SCOTTS PHARMACY SCOTTS PHARMACY SCOTTS PHARMACY SUMMIT CITY PHARMACY THE MEDICINE CHEST PHARMACY GARST RX GLOTZBACH PHARMACY FAGEN PHARMACY HOLDEN PHARMACY FRANKLIN COMMUNITY PHARMACY FAGEN PHARMACY FAGEN PHARMACY FAGEN PHARMACY FAGEN PHARMACY GENOA-QOL HEALTHCARE GOOD NEIGHBOR PHARMACY MATHES PHARMACY STORE 2 INC GENOA-QOL HEALTHCARE GOSHEN CANCER CTR OUTPTNT PHCY MARTINS PHARMACY NEPHEW PHARMACY MARTINS PHARMACY MARTIN'S PHARMACY MEDICAP PHARMACY

(260) 436-0800 (260) 969-7868 (260) 373-2039 (260) 557-1808 (260) 203-0998 (260) 373-1083 (260) 373-3456 (260) 483-3185 (260) 426-4487 (260) 747-4136 (260) 625-5949 (260) 493-1531 (260) 739-6069 (260) 483-3169 (317) 485-5555 (765) 884-1520 (219) 567-2222 (765) 654-4300 (317) 739-3257 (219) 938-1101 (219) 885-6355 (219) 887-1815 (219) 923-7907 (219) 728-5003 (765) 674-6976 (812) 923-8845 (574) 975-3656 (574) 364-2803 (574) 533-5600 (574) 537-1111 (574) 807-8222 (574) 807-8234 (317) 462-7877

7910 W JEFFERSON BLVD STE 108 11143 PARKVIEW PLZ DR STE 100 909 E STATE BLVD 1909 CAREW ST 2100 GOSHEN RD STE 111 3537 N ANTHONY BLVD STE A 2200 RANDALLIA DR 4120 N CLINTON ST 1125 W STATE BLVD 7008 BLUFFTON RD 10230 CHESTNUT PLAZA DR 6310 E STATE BLVD 1326 N COLISEUM BLVD 2803 E STATE BLVD 325 S MAIN ST 500 S GRANT AVE 115 E MONTGOMERY 359 W WALNUT ST STE A 30 S WATER ST STE B 5001 EAST DUNES HIGHWAY 506 BROADWAY STE 102 3612 VILLAGE CT 6010 W RIDGE RD 1100 W 6TH AVE 1030 E MAIN ST 1044 N LUTHER RD 336 LAKEVIEW DR 200 HIGH PARK AVE 1527 BASHOR RD 2824 ELKHART RD 7355 HERITAGE SQUARE DR 12850 ADAMS RD 1588 N STATE ST

FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORT WAYNE FORTVILLE FOWLER FRANCESVILLE FRANKFORT FRANKLIN GARY GARY GARY GARY GARY GAS CITY GEORGETOWN GOSHEN GOSHEN GOSHEN GOSHEN GRANGER GRANGER GREENFIELD

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

46804-4159 46845 46805-3404 46805-4707 46808-1493 46805-1423 46805-4638 46805-1230 46808-3185 46809-2706 46814-8970 46815-7023 46805 46805-4732 46040 47944-1636 47946 46041 46131 46403 46402-1911 46408-1430 46408-1701 46402-1711 46933 47122-9122 46528-9365 46526-4810 46528-1902 46526-1014 46530 46530-7183 46140-1060

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 212 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DECATUR COUNTY MEMORIAL HOSP HERBST PHARMACY GENOA-QOL HEALTHCARE GREENWOOD 65 LOW COST RX QUIK SCRIPTS FAGEN PHARMACY FRANCISCAN OP PHCY HAMMOND VYTO'S PHARMACY VYTO'S PHARMACY

Provider Name

(812) 663-1250 (765) 628-3446 (317) 807-6292 (317) 888-5373 (219) 924-9540 (219) 937-3467 (219) 852-1521 (219) 937-1600 (219) 845-2900

720 N. LINCOLN ST 710 W MAIN ST 896 E MAIN ST STE 500 988 E MAIN ST 303 N BROAD ST 5500 S HOHMAN AVE STE 1A 5454 HOHMAN AVE 4923 HOHMAN AVE 6949 KENNEDY AVE STE C

GREENSBURG GREENTOWN GREENWOOD GREENWOOD GRIFFITH HAMMOND HAMMOND HAMMOND HAMMOND

IN IN IN IN IN IN IN IN IN

47240 46936-1045 46143-1440 46143-1501 46319-2222 46320-1942 46320-1931 46320-1275 46323-2245

BLACKFORD COMMUNITY HEALTHCARE PHCY HIGHLAND CARE PHARMACY VYTO'S PHARMACY VYTO'S PHARMACY IIII, INC FAGEN PHARMACY SHELDONS EXPRESS PHARMACY OWENS PHARMACY AFFORDABLE RX HEALTHMART PHCY ALIVIO PHARMACY LLC COMMUNITY MEDICAL CTR PHCY CORDANT PHARMACY SOLUTIONS DR AZIZ PHARMACY EAST SIDE PRESCRIPTION SHOP EAST WASHINGTON PHARMACY ESKENAZI WEST 38TH ST PHARMACY FRANCISCAN OP PHCY INDIANAPOLIS GENOA-QOL HEALTHCARE LOW COST RX INC MARWOOD LOW COST PHARMACY METHODIST RETAIL PHARMACY RILEY RETAL PHARMACY UNIVERSITY RETAIL PHARMACY WELLFOUNT CORP SHAKAMAK PHARMACY FLICKS LONG TERM CARE PHCY SHELDON'S EXPRESS PHARMACY #4 GENOA-QOL HEALTHCARE HANGER DRUGS, INC. KENTUCKIANA PHARMACY PCA SO INDIANA PHARMACY RX ADVANTAGE

(765) 348-4989 (219) 961-2333 (219) 972-1700 (219) 228-7200 (219) 962-9726 (812) 683-9600 (260) 697-6498 (317) 879-5514 (317) 354-8160 (317) 356-6346 (765) 293-9211 (317) 842-5771 (317) 359-8278 (317) 591-9393 (317) 880-0100 (317) 528-7600 (317) 881-7061 (317) 881-8262 (317) 246-7600 (317) 962-9638 (317) 944-2335 (317) 944-3445 (317) 524-1515 (812) 665-9760 (812) 482-5744 (812) 634-7379 (812) 284-6418 (812) 283-3591 (812) 590-2355 (502) 964-5359 (812) 670-4105

400 PILGRIM BLVD 2727 HIGHWAY AVE 2914 HIGHWAY AVE 3100 45TH ST STE 1 7760 E RIDGE RD 312 E 12TH AVE 2718 GUILFORD ST 4103 W TROY AVE 2060 N SHADELAND AVE STE 101 5506 E 16TH ST 3500 DEPAUW BLVD STE 2041 7320 E 82ND ST STE D 5317 E 16TH ST 9650 E WASHINGTON ST STE 105 5515 W 38TH ST 8111 S EMERSON AVE 8320 MADISON AVE 8375 MADISON AVE 3381 KENTUCKY AVE 1801 N SENATE BLVD STE 105 705 RILEY HOSPITAL DR 550 UNIVERSITY BLVD # UH1425 5751 W 73RD ST 346 E MAIN ST 201 W 6TH ST 750 W 2ND ST 404 SPRING ST STE 242 207 SPARKS AVE STE 1 443 SPRING ST STE 303 1740 WILLIAMSBURG DR STE A 1802 E 10TH ST

HARTFORD CITY HIGHLAND HIGHLAND HIGHLAND HOBART HUNTINGBURG HUNTINGTON INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS INDIANAPOLIS JASONVILLE JASPER JASPER JEFFERSONVILLE JEFFERSONVILLE JEFFERSONVILLE JEFFERSONVILLE JEFFERSONVILLE

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

47348-1382 46322-1615 46322-1656 46322 46342-2490 47542 46750-9701 46241-5927 46219-1764 46218-4935 46268-6124 46256-1424 46218-4897 46229-3032 46254 46237 46227-6066 46227-6014 46221-2305 46202-1228 46202-5109 46202-5149 46278-1741 47438-1510 47546-3122 47546-2650 47130-3452 47130-3739 47130 47130 47130-6272

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 213 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

WESTMORELAND PHCY JEFFERSONVILLE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE HERBST APOTHECARY INC HERBST PHARMACY FRANCISCAN OP PHCY LAFAYETTE GENOA-QOL HEALTHCARE IU HEALTH ARNETT RETAIL PHCY PARKSIDE PHARMACY PAYLESS PHARMACY PAYLESS PHARMACY MILLERS PHARMACY NORTHSHORE HEALTH CENTERS PHIL'S DISCOUNT DRUG DEVILLE'S LAWRENCEBURG PHARMACY GENOA-QOL HEALTHCARE GEORGES FAMILY PHARMACY INC COWAN DRUG PARKSIDE PHARMACY PAVILION POINTE PHARMACY LIBERTY MEDICENTER PHARMACY LINTON FAMILY PHARMACY COMMUNITY PHARMACY GENOA-QOL HEALTHCARE MARTIN'S PHARMACY

(812) 284-6500 (260) 582-2151 (765) 252-0810 (765) 457-1191 (765) 455-5418 (765) 428-3550 (765) 588-3359 (765) 448-8900 (765) 447-1000 (765) 448-9159 (765) 474-8269 (260) 463-7464 (219) 962-5909 (219) 362-7133 (812) 537-1798 (412) 931-3131 (812) 637-6251 (765) 482-0180 (765) 482-1600 (765) 483-3900 (765) 223-2121 (812) 847-1978 (574) 732-0418 (574) 516-6576 (574) 239-1894

1495 E 10TH ST 1930 DOWLING ST STE P 322 N MAIN ST # 134 201 N DIXON RD 2330 S DIXON RD 1701 S CREASY LANE, RM 1K71 217 FARABEE DR N 5165 MCCARTY LN 2200 FERRY ST 2200 GREENBUSH ST 65 BECK LN 420 S DETROIT ST 2490 CENTRAL AVE STE B 702 E LINCOLNWAY 401 W EADS PARKWAY SUITE 180 281 BIELBY RD 24128 STATE LINE RD 112 N LEBANON ST 1639 N LEBANON ST 2705 N LEBANON ST STE 100 10 S MAIN ST STE A 60 A ST NW 1201 MICHIGAN AVE STE 100 1015 MICHIGAN AVE RM 201 3420 E MARKET ST

JEFFERSONVILLE KENDALLVILLE KOKOMO KOKOMO KOKOMO LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAGRANGE LAKE STATION LAPORTE LAWRENCEBURG LAWRENCEBURG LAWRENCEBURG LEBANON LEBANON LEBANON LIBERTY LINTON LOGANSPORT LOGANSPORT LOGANSPORT

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

47130-4204 46755-9436 46901-4622 46901-4131 46902-6411 47905 47905-5910 47905-8764 47904-3016 47904-2342 47909-2836 46761-2310 46405-2122 46350-3838 47025 47025-1055 47025 46052-2151 46052-1515 46052 47353 47441-1801 46947-1530 46947-1526 46947-2295

WILLIAMS BROTHERS HEALTHCARE PHCY FAGEN PHARMACY MADISON APOTHECARY GENOA-QOL HEALTHCARE FAGEN PHARMACY GENOA-QOL HEALTHCARE OPTION CARE FAGEN PHARMACY FRANCISCAN OP PHCY MICHIGAN CITY GENOA-QOL HEALTHCARE PHILS HEALTHMART PHARMACY GEORGE'S FAMILY PHARMACY HOMETOWN PHARMACY MISHAWAKA MARTINS PHARMACY MARTIN'S PHARMACY

(812) 295-4370 (219) 696-0212 (812) 265-4621 (765) 662-9670 (219) 791-9035 (219) 769-8171 (800) 883-3394 (219) 879-8620 (219) 878-8300 (219) 210-4122 (219) 877-5690 (812) 654-6251 (574) 255-2988 (574) 254-2323 (574) 968-1313

104 E BROADWAY ST 2080 E COMMERCIAL AVE 835 W MAIN ST 505 N WABASH AVE 251 W 84TH DR 8555 TAFT ST 9111 BROADWAY STE AA 710 FRANKLIN SQUARE 301 W HOMER ST 7224 W. 400 NORTH STE 116 3535 FRANKLIN ST 124 W INDIAN TRAIL STE C 606 N MAIN ST 314 N IRONWOOD DR 306 N BITTERSWEET RD

LOOGOOTEE LOWELL MADISON MARION MERRILLVILLE MERRILLVILLE MERRILLVILLE MICHIGAN CITY MICHIGAN CITY MICHIGAN CITY MICHIGAN CITY MILAN MISHAWAKA MISHAWAKA MISHAWAKA

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

47553-2007 46356-2116 47250-3131 46952-2608 46410 46410-6123 46410-7011 46360-3563 46360-4358 46360 46360-7010 47031 46545 46544-1543 46544

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

MICHIANA HEMATOLOGY ONCOLOGY PCS MISHAWAKA FAMILY PHARMACY MISHAWAKA FAMILY PHARMACY SAINT JOSEPH REGIONAL MED CTR UNITY MED AND SURG HOSPITAL ENGLEKING RX, LLC ACCESS TO CARE PHARMACY BALL STATE UNIVERSITY PHARMACY FAMILY HEALTHCARE PHARMACY GENOA-QOL HEALTHCARE PAVILION PHARMACY SOUTHWAY HEALTHCARE PHARMACY COMMUNITY SURGERY CENTER PHARM FAGEN PHARMACY FAIRMEADOWS PHARMACY OSCO PHARMACY MARTIN'S PHARMACY NEPHEW PHARMACY MATHES PHARMACY PRECISION COMPOUNDING PHARMACY WESTMORELAND PHARMACY

(574) 237-1328 (574) 247-1000 (574) 247-1000 (574) 335-8525 (574) 231-6140 (812) 653-1051 (765) 213-2866 (765) 285-1079 (765) 751-7900 (765) 288-3770 (765) 747-8461 (765) 751-2324 (219) 836-2480 (219) 836-6110 (219) 836-8700 (219) 836-7978 (574) 773-7873 (574) 773-2404 (812) 944-3612 (812) 941-9300 (812) 944-6500

5340 HOLY CROSS PARKWAY 611 E DOUGLAS RD STE 104 611 E DOUGLAS RD STE 104 60101 BODNAR BLVD 4455 EDISON LAKES PKWY 1494 W MAIN ST 3631 N MORRISON RD 1500 NEELEY AVE 5501 W BETHEL AVE 130 N TILLOTSON AVE 2525 W UNIVERSITY AVE 3813 S MADISON ST 801 MACARTHUR BLVD STE 102 7905 CALUMET AVE 800 MACARTHUR BLVD STE 32 740 RIDGE RD 242 N OAKLAND AVE 1953 WATERFALL DR 1621 CHARLESTOWN RD 2113 STATE ST STE 2 2125 STATE ST STE 17

MISHAWAKA MISHAWAKA MISHAWAKA MISHAWAKA MISHAWAKA MITCHELL MUNCIE MUNCIE MUNCIE MUNCIE MUNCIE MUNCIE MUNSTER MUNSTER MUNSTER MUNSTER NAPPANEE NAPPANEE NEW ALBANY NEW ALBANY NEW ALBANY

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

46545 46545-1464 46545-1464 46544 46545-1442 47446-9493 47304-5547 47303 47304-8513 47304-3987 47303-3421 47302-5758 46321-2916 46321-1215 46321-2917 46321-1612 46550-2319 46550 47150-3339 47150-4961 47150-4922

FOREST RIDGE NEIGHBORHOOD PHARMACY FREDS NEIGHBORHOOD PHARMACY MCGRADY PHARMACY CHRIS' PHARMACY ONCOLOGY HEMATOLOGY ASSOCIATES MEDSCRIPT LTC PHARMACY NOBLESVILLE LOW COST PHARMACY RIVERVIEW OUTPATIENT PHARMACY JAY C PLUS PHARMACY MEDICAP PHARMACY ODON PHARMACY LLC G.A. TRIPLETT & SON REXALL WILLIAMS BROS HLTH CARE PHCY MARTIN'S PHARMACY PEOPLE'S DRUG STORE NORTH SHORE HEALTH CENTERS H & R PHARMACY INC

(765) 599-3540 (765) 529-3313 (765) 529-9600 (812) 682-3044 (812) 471-1200 (317) 818-1059 (317) 531-4985 (317) 770-4567 (812) 352-1780 (812) 352-9700 (812) 636-4600 (812) 689-4748 (812) 723-3907 (574) 936-7334 (574) 936-3167 (219) 763-8950 (812) 874-2815

2200 FOREST RIDGE PKWY 320 S MAIN ST 1902 S MEMORIAL DR 511 MAIN STREET 3699 EPWORTH ROAD 14460 GETZ RD STE 200 758 WESTFIELD RD 395 WESTFIELD RD 2325 N STATE HIGHWAY 3 939 VETERANS DR STE B 200 W MAIN ST 111 N BUCKEYE ST 889 N GOSPEL ST # 2 865 E JEFFERSON ST 301 N MICHIGAN ST 3564 SCOTTSDALE 27 MAIN ST

NEW CASTLE NEW CASTLE NEW CASTLE NEW HARMONY NEWBURGH NOBLESVILLE NOBLESVILLE NOBLESVILLE NORTH VERNON NORTH VERNON ODON OSGOOD PAOLI PLYMOUTH PLYMOUTH PORTAGE POSEYVILLE

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

47362-2943 47362-4217 47362-1274 47631 47630 46060-3303 46062 46060-1425 47265-7483 47265-2603 47562-1218 47037-1133 47454-9217 46563-1847 46563 46368 47633

WILLIAMS BROS. HEALTH CARE PHARMACY

(812) 386-5194

101 W BRUMFIELD AVE

PRINCETON

IN

47670-1304

NR_0009_10823 10/2017

Page 215 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MIDTOWN PRESCRIPTION CENTER PHILLIPS DRUGS PHILLIPS DRUGS PHILLIPS DRUGS EAST REID HOSPITAL PHARMACY DEVILLE'S RISING SUN PHARMACY WEBB'S FAMILY PHARMACY INC ROCKPORT PHARMACY SHELDONS EXPRESS PHARMACY JR PHARMACY RUSHVILLE PHARMACY GOOD LIVING PHARMACY SALEM APOTHECARY HANCOCK'S DRUG STORE SCOTT COUNTY MEDICAL ARTS PHRM JAY C FOOD STORES MEDWORKS PHARMACY SHERIDAN ELLIOTT PHARMACY SHIPSHEWANA PHARMACY GENOA-QOL HEALTHCARE MARTIN'S PHARMACY MARTIN'S PHARMACY THE SOUTH BEND CLINIC PHARMACY UNIVERSITY COMMONS PHARMACY HIPP DRUG MCKAY FAMILY PHARMACY MILBURN PHARMACY GEORGES FAMILY PHARMACY INC WERNER DRUG STORE A P & S PHARMACY INC GENOA-QOL HEALTHCARE HOOSIERS PRESCRIPTION SHOP JR PHARMACY JR PHARMACY JR PHARMACY LLC II MED-PHARM PHARMACY VIGO HEALTH PHARMACY TOPEKA PHARMACY KAUP PHARMACY UPLAND FAMILY PHARMACY FAGEN PHARMACY FAGEN PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (765) 962-0025 (765) 966-5544 (765) 966-5546 (765) 966-2225 (765) 983-3305 (812) 438-3400 (574) 223-2216 (812) 649-9181 (812) 649-2227 (765) 569-6900 (765) 932-3328 (812) 404-4153 (812) 883-4500 (812) 752-2021 (812) 752-4226 (812) 522-4401 (317) 421-2020 (317) 758-4171 (260) 768-4433 (574) 208-6684 (574) 288-4854 (574) 299-8844 (574) 237-9295 (574) 273-2000 (260) 723-4468 (812) 829-4821 (812) 268-4737 (812) 623-6251 (812) 547-5586 (812) 242-3855 (812) 232-1730 (812) 232-9646 (812) 478-1006 (812) 235-7373 (812) 232-6655 (812) 232-2086 (812) 231-1040 (260) 593-2252 (765) 964-3098 (765) 998-8072 (219) 462-0047 (219) 462-4381

Provider Street 11 S 9TH ST 631 E MAIN ST 1390 NATIONAL RD W 1626 E MAIN ST 1100 REID PKWY 223 MAIN ST 724 MAIN ST 400 MAIN ST 509 MAIN ST 1330 N LINCOLN RD 302 N MAIN ST 1201 N JIM DAY RD STE B 3 PUBLIC SQ 120 W MCCLAIN AVE 1366 N GARDNER ST 1541 E TIPTON ST 1412 MILLER AVE 508 E 10TH ST 350 S VAN BUREN ST STE F 415 E MADISON ST RM S-304 525 MAYFLOWER RD 926 ERSKINE PLZ 211 N EDDY ST 6301 UNIVERSITY COMMONS STE 37 115 S STATE ST 305 E MORGAN ST 13 W JACKSON ST 308 N MERIDIAN STREET 1134 WASHINGTON ST 221 S 6TH ST 620 8TH AVE 3020 S 7TH ST 2902 POPLAR ST 1101 POPLAR ST 15 SOUTHLAND SHOPPING CTR 2723 S 7TH ST STE N 1635 N 3RD ST 101 N MAIN 366 W DEERFIELD RD 1809 S MAIN ST STE 150 1001 STURDY RD STE 201 3400 N CALUMET AVE

Page 216 of 679

Provider City RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RISING SUN ROCHESTER ROCKPORT ROCKPORT ROCKVILLE RUSHVILLE SALEM SALEM SCOTTSBURG SCOTTSBURG SEYMOUR SHELBYVILLE SHERIDAN SHIPSHEWANA SOUTH BEND SOUTH BEND SOUTH BEND SOUTH BEND SOUTH BEND SOUTH WHITLEY SPENCER SULLIVAN SUNMAN TELL CITY TERRE HAUTE TERRE HAUTE TERRE HAUTE TERRE HAUTE TERRE HAUTE TERRE HAUTE TERRE HAUTE TERRE HAUTE TOPEKA UNION CITY UPLAND VALPARAISO VALPARAISO

State

ZIP code

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN

47374-5503 47374-4309 47374-5143 47374-4323 47374-1157 47040 46975-1506 47635-1420 47635-1429 47872-1215 46173-1636 47167-7219 47167-2050 47170-2046 47170-7793 47274 46176-3135 46069-9188 46565-9197 46617-2322 46619 46614-3244 46617-2808 46635-3501 46787-1390 47460-1429 47882 47041 47586-1827 47807-4214 47804-2744 47802 47803-2661 47807-4565 47802-3943 47802-3584 47804 46571-9565 47390-1039 46989 46383 46383-2026

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FAGEN PHARMACY GENOA-QOL HEALTHCARE GIL DRUG COMPANY INC

Provider Name

(219) 762-7726 (219) 462-1603 (219) 462-4146

390 W US HIGHWAY 6 STE 1131 601 WALL ST 52 LINCOLNWAY

VALPARAISO VALPARAISO VALPARAISO

IN IN IN

46385-7950 46383-2512 46383-5522

VALPARAISO PROFESSIONAL PHARMACY PC GEORGE'S FAMILY PHARMACY, INC. GENOA-QOL HEALTHCARE RUSCH'S SOUTHSIDE PHARMACY WILLIAMS BROS. HEALTH CARE PHCY SEIFERT DRUG GENOA-QOL HEALTHCARE HOMETOWN PHARMACY- WARSAW MARTIN'S PHARMACY OWEN'S PHARMACY PILL BOX PHARMACY INC PRESCRIPTION SHOPPE WILLIAMS BROS HLTH CARE PHCY CUSTOM PLUS PHARMACY CUSTOMPLUS LONG TERM CARE PAYLESS PHARMACY WESTFIELD PHARMACY FAGEN PHARMACY FAGEN PHARMACY FAGEN PHARMACY RITE CARE PHARMACY IU HEALTH YORKTOWN PHARMACY AUBURN PHARMACY AUBURN PHARMACY PATTERSON HEALTHCARE PHARMACY TRAPP PHARMACY ANDOVER DRUG DILLON PHARMACY IRWIN-POTTER DRUG DILLON PHARMACY GRAVES DRUGS K AND D PHARMACY LLC TAYLOR DRUG KEX RX PHARMACY CURRIER DRUG INC COOPER DRUG INC DILLON PHARMACY HILGERS FAMILY PHARMACY

(219) 462-1484 (812) 689-0200 (812) 886-0907 (812) 316-0079 (812) 882-1800 (574) 295-4333 (574) 306-4455 (574) 267-7356 (574) 371-9080 (574) 269-6674 (574) 267-4900 (812) 254-7666 (812) 254-2497 (765) 463-2600 (765) 607-4103 (765) 464-1456 (317) 896-9378 (219) 785-2573 (219) 956-3992 (219) 659-0299 (219) 513-9038 (765) 759-4064 (785) 263-4330 (785) 263-3770 (785) 263-2229 (785) 263-4550 (316) 260-6030 (316) 733-3725 (620) 842-5119 (620) 442-7842 (620) 442-2300 (620) 307-6264 (620) 442-3500 (913) 367-5252 (785) 626-3214 (316) 775-2289 (316) 775-5456 (316) 262-2001

2101 ROOSEVELT RD 326 S. WASHINGTON ST. SUITE 22 515 BAYOU ST 1107 S 15TH ST 1216 WASHINGTON AVE 1028 E WATERFORD ST 850 N HARRISON ST RM 230 1775 E CENTER ST 1150 HUSKY TRAIL 2211 E CENTER ST 2306 DUBOIS DR 2005 STATE ST STE B 10 WILLIAMS BROTHERS DR 482 W NAVAJO SUITE A 482 W NAVAJO ST STE B 1032 SAGAMORE PKWY W 103 S UNION ST 156 W FLYNN RD 3892 W STATE ROAD 10 1301 119TH ST 2075 INDIANAPOLIS BLVD 1420 S PILGRIM BLVD 304 N BROADWAY ST 1812 N BUCKEYE AVE 105 NW 3RD ST 204 N CEDAR ST 307 W HWY 54 STE 200 225 E CLOUD AVE 202 W MAIN ST 425 N SUMMIT ST 212 S SUMMIT ST 224 S SUMMIT ST 201 S SUMMIT ST 807 MAIN ST 416 STATE ST 509 STATE ST 1510 OHIO ST 1630 N OHIO STREET

VALPARAISO VERSAILLES VINCENNES VINCENNES VINCENNES WAKARUSA WARSAW WARSAW WARSAW WARSAW WARSAW WASHINGTON WASHINGTON WEST LAFAYETTE WEST LAFAYETTE WEST LAFAYETTE WESTFIELD WESTVILLE WHEATFIELD WHITING WHITING YORKTOWN ABILENE ABILENE ABILENE ABILENE ANDOVER ANDOVER ANTHONY ARKANSAS CITY ARKANSAS CITY ARKANSAS CITY ARKANSAS CITY ATCHISON ATWOOD AUGUSTA AUGUSTA AUGUSTA

IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN IN KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

46383-2747 47042 47591-1034 47591-4223 47591-2245 46573-9305 46580-3163 46580 46582-1952 46580-3719 46580-3213 47501-8505 47501-4535 47906-1940 47906 47906-1446 46074-9458 46391 46392-9209 46394-1602 46394-1948 47396-9250 67410 67410-1570 67410-2628 67410-2651 67002 67002-8824 67003-2728 67005-2225 67005-2847 67005-2847 67005-2846 66002-2710 67730-1929 67010-1107 67010-2157 67010

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 217 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name AUBURN PHARMACY ROBERTS DRUG STORE THE MEDICINE STORE MONARCH PHARMACY WOLKAR DRUG INC. ARBUTHNOT DRUG COMPANY GRAY DRUG & FOUNTAIN S & S DRUG COMPANY MINNEOLA PHARMACY INC YUNGEBERG DRUG BONNER SPGS PRICE CHOPPER PHCY DEGOLER PHARMACY PRESTON PHARMACY PRESCRIPTION CENTRE THE MEDICINE SHOPPE CALDWELL PHARMACY CANEY DRUG AUBURN PHARMACY ASHLEY PHARMACY CARDINAL DRUGSTORE MEDICAP PHARMACY MEDICINE SHOPPE PHARMACY CHENEY PHARMACY CHERRYVALE PHARMACY RIGGS DRUG STORE CLARK PHARMACY FERGUSON REXALL DRUGS PATTERSON FAMILY APOTHECARY PATTERSON HEALTHMART PHARMACY RAUCH MED-ECON PHARMACY THE MEDICINE SHOPPE DILLON PHARMACY PALACE DRUG STORE INC EVAN'S DRUG INC AUBURN PHARMACY FUNK PHARMACY PANTHER PRIDE PHARMACY FREEMAN PHARMACY ALDRICH APOTHECARY CEDAR CREEK PHARMACY DAMM PHARMACY DERBY DRUG

NR_0009_10823 10/2017

Provider Phone Number (785) 594-0340 (785) 594-6867 (913) 724-3666 (620) 856-3030 (620) 856-5555 (785) 527-2146 (785) 534-1200 (785) 738-2285 (620) 885-4544 (785) 363-7444 (913) 422-1040 (913) 422-3066 (913) 596-0159 (620) 364-5523 (620) 364-3388 (620) 845-6916 (620) 879-5822 (785) 836-7202 (620) 431-2510 (620) 431-9150 (620) 431-4270 (620) 431-7193 (316) 542-0464 (316) 336-2144 (620) 236-7272 (620) 855-2242 (785) 632-3121 (785) 632-3032 (785) 632-3115 (620) 251-3533 (620) 251-2150 (785) 462-1310 (785) 460-7507 (620) 429-3322 (785) 243-1212 (785) 243-4414 (785) 614-3492 (620) 456-2220 (620) 767-6731 (913) 583-1117 (316) 788-5533 (316) 788-6669

Provider Street 400 AMES ST 112 8TH ST 15415 PINEHURST DR 1601 MILITARY AVE 2303 MILITARY AVE 1806 MAIN ST 100 S MILL 110 S MILL ST 131 MAIN ST 17 PUBLIC SQ 501 S COMMERCIAL DR 202 OAK ST 111 OAK ST 312 CROSS ST 716 N 4TH ST 7 N MAIN ST 208 W 4TH AVE 211 MAIN ST 505 S PLUMMER AVE 103 E MAIN ST 1720 S SANTA FE 421 MAIN ST 114 N MAIN 203 W MAIN ST STE A 426 MAPLE ST 101 S MAIN ST 713 5TH ST 708 LIBERTY ST 422 LINCOLN AVE 1205 W 8TH ST 1001 W 11TH ST 1605 S RANGE AVE 460 N FRANKLIN AVE 116 W PINE ST 1526 LINCOLN ST 1020 ELMHURST BLVD 124 W 6TH ST 100 E SPRING AVE 115 W MAIN ST 8960 COMMERCE DR STE 4A 1412 N WOODLAWN BLVD 1101 N ROCK RD

Page 218 of 679

Provider City BALDWIN CITY BALDWIN CITY BASEHOR BAXTER SPRINGS BAXTER SPRINGS BELLEVILLE BELOIT BELOIT BLOOM BLUE RAPIDS BONNER SPRINGS BONNER SPRINGS BONNER SPRINGS BURLINGTON BURLINGTON CALDWELL CANEY CARBONDALE CHANUTE CHANUTE CHANUTE CHANUTE CHENEY CHERRYVALE CHETOPA CIMARRON CLAY CENTER CLAY CENTER CLAY CENTER COFFEYVILLE COFFEYVILLE COLBY COLBY COLUMBUS CONCORDIA CONCORDIA CONCORDIA CONWAY SPRINGS COUNCIL GROVE DE SOTO DERBY DERBY

State

ZIP code

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

66006-3099 66006-4149 66007 66713-2032 66713-2324 66935-2206 67420 67420-3237 67865-8544 66411-1344 66012-9617 66012-1029 66012 66839-1189 66839-1286 67022-1529 67333-1462 66414-9714 66720-1950 66720-1844 66720 66720 67025 67335-1332 67336-0000 67835-8856 67432-2936 67432-1529 67432-2908 67337-3505 67337 67701-4011 67701-2326 66725-1705 66901 66901-3900 66901-2820 67031-3101 66846-1702 66018-8431 67037-2922 67037-3735

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DILLON PHARMACY DIGHTON PHARMACY DILLON PHARMACY GIBSON PHARMACY OF DODGE CITY MEDICAL CENTER PHARMACY CORNER DRUG & GIFT INC DILLON PHARMACY EL DORADO TRUECARE PHARMACY F & M DRUG LLC SEITZ DRUG COMPANY GENOA-QOL HEALTHCARE GRAVES DRUG STORE EMPORIA, INC. THE MEDICINE SHOPPE PHARMACY RICHEYS DRUG STORE AUBURN PHARMACY BYRNE'S PHARMACY EUREKA PHARMACY HEN HOUSE PHARMACY MERCY PHARMACY FORT SCOTT FREDONIA PHARMACY FOUR STATES PHARMACY DILLON PHARMACY DILLON PHARMACY PLAZA PHARMACY INC GARDNER PHARMACY PRICE CHOPPER PHARMACY AUBURN PHARMACY THE MEDICINE SHOPPE MATHIS DRUG STORE INC DILLON PHARMACY CENTRAL CARE CANCER CENTER DILLON PHARMACY MEDICAL PARK PHARMACY THE MEDICINE SHOPPE KIOWA COUNTY PHARMACY PIERSON HANOVER PROF PHARMACY HARPER PHARMACY DILLON PHARMACY DILLON PHARMACY GENOA-QOL HEALTHCARE MEDICAL PAVILION PHARMACY U-SAVE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (316) 554-2121 (620) 397-5778 (620) 225-6140 (620) 227-8193 (620) 227-8506 (785) 454-6614 (316) 321-0318 (316) 321-5330 (785) 472-3131 (785) 472-3212 (620) 412-8680 (620) 343-2323 (620) 342-1242 (620) 244-3661 (785) 690-7575 (785) 542-2533 (620) 583-5488 (913) 236-4983 (620) 223-7075 (620) 378-4422 (620) 783-1636 (316) 275-0194 (620) 275-1957 (620) 276-8251 (913) 856-8106 (913) 856-2425 (785) 448-6122 (785) 448-6650 (620) 724-4313 (620) 669-3135 (620) 792-5511 (620) 792-5944 (620) 792-1221 (620) 792-3030 (620) 723-3112 (785) 337-2241 (620) 896-7700 (785) 625-2523 (785) 628-6148 (785) 621-4488 (785) 650-2789 (785) 625-2529

Provider Street 1624 N ROCK RD 105 E PEARL ST 1700 N 14TH AVE 2610 CENTRAL AVE 2020 CENTRAL AVE 823 MORGAN AVE 700 N MAIN ST 205 N VINE ST 209 N DOUGLAS AVE 206 N DOUGLAS AVE 104 E 8TH AVE 609 COMMERCIAL ST 1400 W 12TH AVE 511 N MAIN STREET 310 E 15TH 600 E 20TH ST STE 300 1602 N ELM ST 2724 W 53RD ST 401 WOODLAND HILLS BLVD 628 MADISON ST 444 FOUR STATES DR STE 6 1211 BUFFALO JONES AVE 1305 E KANSAS AVE 911 N MAIN ST 131 E MAIN ST 830 E MAIN ST 429 N MAPLE ST 427 S OAK ST 400 W SAINT JOHN ST 20300 W KELLOGG DR 204 CLEVELAND 4107 10TH ST 1309 POLK ST 1000 ADAMS ST 721 W KANSAS AVE STE 101 103 E NORTH ST 615 W 12TH ST 27TH & HALL 1902 VINE ST 208 E 7TH ST 2214 CANTERBURY DR 2505 CANTERBURY DR

Page 219 of 679

Provider City DERBY DIGHTON DODGE CITY DODGE CITY DODGE CITY DOWNS EL DORADO EL DORADO ELLSWORTH ELLSWORTH EMPORIA EMPORIA EMPORIA ERIE EUDORA EUDORA EUREKA FAIRWAY FORT SCOTT FREDONIA GALENA GARDEN CITY GARDEN CITY GARDEN CITY GARDNER GARDNER GARNETT GARNETT GIRARD GODDARD GREAT BEND GREAT BEND GREAT BEND GREAT BEND GREENSBURG HANOVER HARPER HAYS HAYS HAYS HAYS HAYS

State

ZIP code

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

67037-3718 67839 67801-3413 67801-6209 67801-6411 67437-1623 67042-4526 67042-2055 67439-3215 67439-3216 66801-2929 66801-3901 66801 66733-1332 66025 66025 67045-1090 66205-1705 66701-8797 66736-1338 66739-4324 67846-4833 67846-5805 67846-5400 66030-1309 66030-1287 66032-1074 66032-1337 66743-1213 67052-9500 67530-3563 67530-3437 67530-3644 67530-4208 67054-1633 66945-9762 67058-1214 67601-0000 67601-3260 67601-4139 67601-2375 67601-2233

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HAYSVILLE HEALTH MART PHARMACY HOMELAND PHARMACY KAYS PHARMACY HESSTON PHARMACY KEX RX HILLSBORO HOMETOWN PHARMACY CARDINAL PHARMACY L.L.C. MEDICAL PHARMACY KEX RX PHARMACY & HOME CARE BATSON'S DRUG STORE MAHANNA PHARMACY HUGOTON DRUG STEVENS CO. RETAIL PHARMACY HUMBOLDT PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY GENOA-QOL HEALTHCARE HUTCHINSON CLINIC PHARMACY HUTCHINSON DRUG STORE THE MEDICINE SHOPPE GENOA-QOL HEALTHCARE INDEPENDENCE PHARMACY INC JANE PHILLIPS MEDCARE PHARMACY THE MEDICINE SHOPPE IOLA PHARMACY IOLA PHARMACY CLINIC HODGEMAN COUNTY PHARMACY WALDRON'S PHARMACY DILLON PHARMACY KOLLHOFF PHARMACY KONZA PRAIRIE COMM HLTH CTR INC ABRAMS PBA PHARMACY CHILDREN'S MERCY WEST HOSP PHY DEGOLER PHARMACY DEGOLER PHARMACY DEGOLER'S PHARMACY DEGOLER'S PRESCRIPTION PHCY GENOA-QOL HEALTHCARE HEN HOUSE PHARMACY PMA PHARMACY PRICE CHOPPER PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (316) 524-4234 (316) 522-5583 (785) 258-3703 (620) 327-2211 (785) 742-2125 (620) 947-3784 (620) 653-2200 (785) 364-2114 (785) 486-3651 (620) 374-2265 (785) 675-3461 (620) 544-4065 (620) 544-8512 (620) 473-2520 (620) 669-8238 (620) 663-3375 (620) 663-7628 (620) 921-3013 (620) 663-9542 (620) 669-6699 (620) 663-7681 (620) 331-1260 (620) 331-3784 (620) 330-8282 (620) 331-0036 (620) 365-3176 (620) 365-6848 (620) 357-8305 (620) 492-3263 (785) 238-4141 (785) 238-1000 (785) 238-4711 (913) 342-8000 (913) 233-4452 (913) 721-3133 (913) 299-9000 (913) 596-2133 (913) 342-4077 (913) 287-1600 (913) 334-1660 (816) 249-2780 (913) 647-5955

Provider Street 145 N MAIN ST 201 N MAIN ST 2 W MAIN ST 101 S MAIN ST 101 S 6TH ST 507 N ASH ST 821 N MAIN ST 1100 COLUMBINE DR STE A 1903 EUCLID AVE 102 N WABASH 833 MAIN 531 S MAIN ST 1006 S JACKSON ST 204 S 9TH ST 725 E 4TH AVE 206 W 5TH AVE 517 E 30TH AVE 1600 N LORRAINE ST 2101 N WALDRON ST 1100 N MAIN ST 1401 N MAIN ST 3751 W MAIN ST 205 N PENN AVE 800 W LAUREL ST 400 N PENN AVE 109 E MADISON AVE 1408 EAST ST 519 MAIN STREET 111 S MAIN ST 618 W 6TH ST 407 S WASHINGTON 361 GRANT AVE 819 N 7TH ST 4313 STATE AVE 2040 HUTTON RD 8101 PARALLEL PKWY STE 200 5701 STATE AVE 21 N 12TH ST STE 100 1301 N 47TH ST RM 169 8120 PARALLEL PKWY 4300 BRENNER DR STE 200 7600 STATE AVE

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Provider City HAYSVILLE HAYSVILLE HERINGTON HESSTON HIAWATHA HILLSBORO HOISINGTON HOLTON HORTON HOWARD HOXIE HUGOTON HUGOTON HUMBOLDT HUTCHINSON HUTCHINSON HUTCHINSON HUTCHINSON HUTCHINSON HUTCHINSON HUTCHINSON INDEPENDENCE INDEPENDENCE INDEPENDENCE INDEPENDENCE IOLA IOLA JETMORE JOHNSON JUNCTION CITY JUNCTION CITY JUNCTION CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY

State

ZIP code

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

67060-1202 67060-1204 67449-2244 67062-8940 66434-2306 67063-1102 67544-1842 66436-8824 66439-1238 67349 67740 67951-2432 67951-2842 66748-1908 67501-2275 67501-4807 67502-8430 67501-5670 67502-1131 67501-4406 67501-4003 67301-8446 67301-3323 67301-3211 67301-3012 66749-3330 66749-3004 67854 67855-9706 66441-3146 66441-3748 66441-4201 66101-3036 66102-3734 66109 66112-2073 66102-1236 66102-5172 66102-1705 66112-2011 66104-1163 66112-2818

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PRXP OF KS LLC THE MEDICINE SHOPPE KINGMAN DRUG STORE KIOWA PRESCRIPTIONS PLUS RUSH COUNTY PHARMACY SILVER CREEK PHARMACY & GIFTS J & J PHARMACY KARE HEALTHMART OF LANSING REED PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY JAYHAWK PHARMACY AT MT OREAD LMH HEALTH SYSTEM PHARMACY MEDICAL ARTS PHARMACY ORCHARDS DRUG SIGLER PHARMACY SIGLER PHARMACY DEGOLER PHARMACY DILLON PHARMACY GENOA-QOL HEALTHCARE KARE PHARMACY OF LEAVENWORTH PRICE CHOPPER PHARMACY AUBURN PHARMACY PRICE CHOPPER PHARMACY ALLEGRE REXALL DRUGS ACARIAHEALTH PHARMACY, INC. BRIOVARX HEALTHDIRECT IPS PERRY DRUG INC PRAIRIE STAR PHARMACY STARK EDLER APOTHECARY WICHITA COUNTY PHARMACY DILLON PHARMACY EL-KAN PBA DRUG PATTERSON HEALTH MART PHCY AUBURN PHARMACY AUBURN PHARMACY VOHS PHARMACY INC DILLON PHARMACY BARRY'S DRUG CENTER

NR_0009_10823 10/2017

Provider Phone Number (913) 233-4973 (913) 788-3344 (620) 532-5113 (620) 825-4782 (785) 222-9091 (913) 757-4744 (620) 355-7712 (913) 727-5273 (620) 285-6286 (785) 842-2434 (785) 841-5110 (785) 843-0847 (785) 838-0110 (785) 843-0111 (785) 505-2240 (785) 843-4160 (785) 843-8555 (785) 749-6740 (785) 842-1225 (913) 596-2447 (913) 250-3504 (913) 680-1652 (913) 832-4314 (913) 651-6134 (913) 469-9315 (913) 648-0133 (620) 256-6122 (816) 556-3914 (913) 307-2640 (913) 234-4664 (913) 541-5700 (913) 768-6000 (913) 541-5050 (620) 375-2323 (620) 626-4234 (620) 624-4065 (785) 524-4649 (785) 227-3374 (913) 837-5555 (913) 837-3784 (316) 722-2670 (785) 776-8833

Provider Street 300-340 SOUTHWEST BLVD #103 6523 PARALLEL AVE 211 N MAIN ST 530 MAIN ST 708 MAIN ST 945 MARKET ST 500 THORPE 844 N MAIN ST 326 W 14TH ST 1740 MASSACHUSETTS ST 1015 W 23RD ST 3000 W 6TH ST 4701 W 6TH ST 3510 CLINTON PL STE 220 325 MAINE ST 346 MAINE ST 1410 KASOLD DR STE A16 4951 W 18TH ST 4525 W 6TH ST 209B DELAWARE ST 720 EISENHOWER RD 500 LIMIT ST 426 DELAWARE ST 2107 S 4TH ST 13351 MISSION RD 3700 W 95TH ST 6 W BROADWAY ST 10409 W 84TH TERRACE 11142 RENNER BLVD 11131 W 79TH ST 12200 W 106TH ST STE 140 23351 PRAIRIE STAR PARKWAY 10600 QUIVIRA RD STE 100 111 W BROADWAY 1417 N KANSAS AVE 1033 N KANSAS AVE 204 W LINCOLN AVE 605 W LINCOLN ST 6 S METCALF RD 100 W CRESTVIEW #120 5340 N MAIZE RD 414 POYNTZ AVE

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Provider City KANSAS CITY KANSAS CITY KINGMAN KIOWA LA CROSSE LACYGNE LAKIN LANSING LARNED LAWRENCE LAWRENCE LAWRENCE LAWRENCE LAWRENCE LAWRENCE LAWRENCE LAWRENCE LAWRENCE LAWRENCE LEAVENWORTH LEAVENWORTH LEAVENWORTH LEAVENWORTH LEAVENWORTH LEAWOOD LEAWOOD LEBO LENEXA LENEXA LENEXA LENEXA LENEXA LENEXA LEOTI LIBERAL LIBERAL LINCOLN LINDSBORG LOUISBURG LOUISBURG MAIZE MANHATTAN

State

ZIP code

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

66103-2150 66102-1044 67068-1334 67070-1406 67548 66040-4100 67860-0000 66043 67550-2106 66044-4256 66046-4412 66049-4534 66049-4825 66047-2178 66044 66044-1359 66049-3428 66047-2090 66049-4815 66048-2823 66048-5500 66048-4435 66048-2733 66048-4555 66209-1753 66206-2037 66856-9709 66214-1641 66219-9621 66214-1482 66215-2305 66227 66215-2311 67861-7019 67901-2444 67901-2644 67455-1920 67456-2328 66053-4116 66053 67101-9482 66502-6039

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CANDLEWOOD HEALTH MART PHCY DEGOLER PHARMACY DILLON PHARMACY DILLON PHARMACY DUNNES PHARMACY KELLSTROM PBA PHARMACY LANNING PHARMACY AR-EX DRUG STORE DILLON PHARMACY CK PHARMACY - MCPHERSON BACHMAN DRUG INC HIBBARD'S PRESCRIPTIONS PLUS FW HUSTON PHARMACY OF MERIDEN GEORGETOWN PHARMACY HEN HOUSE PHARMACY AUBURN PHARMACY MONTEZUMA DRUG AUBURN PHARMACY CK PHARMACY MOUNDRIDGE THE MULVANE PHARMACY

Provider Name

(785) 776-4100 (913) 596-2447 (785) 539-9454 (785) 776-0060 (785) 539-2345 (785) 776-1200 (620) 382-2135 (785) 562-3196 (620) 241-6108 (620) 241-0022 (620) 873-2641 (620) 886-5161 (785) 484-2450 (913) 362-0313 (913) 831-4140 (785) 392-2213 (620) 846-2202 (913) 795-4435 (620) 345-8650 (316) 777-1601

3254 KIMBALL AVE 461 E POYNTZ AVE 1000 WESTLOOP PL 130 SARBER LN 2429 CLAFLIN RD 1860 CLAFLIN RD 217 E MAIN 801 BROADWAY 1320 N MAIN ST 400 W 4TH ST STE 1 129 S FOWLER ST 126 N MAIN 7210 K4 HWY STE D 5605 MERRIAM DR 5800 ANTIOCH RD 209 W 2ND ST 300 N AZTEC ST 625 MAIN ST 200 E PACK 1008 SE LOUIS DR

MANHATTAN MANHATTAN MANHATTAN MANHATTAN MANHATTAN MANHATTAN MARION MARYSVILLE MC PHERSON MCPHERSON MEADE MEDICINE LODGE MERIDEN MERRIAM MERRIAM MINNEAPOLIS MONTEZUMA MOUND CITY MOUNDRIDGE MULVANE

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

66503-2157 66502-5045 66502-2836 66502-5002 66502-2785 66502-3413 66861-1627 66508-1802 67460-2506 67460-2306 67864-6404 67104-1317 66512-9389 66203 66202-2017 67467-2311 67867-8874 66056-9100 67107-8854 67110

WELLS PHARMACY INC DBA PORTER DRUGS G & L PHARMACY DILLON PHARMACY DILLON PHARMACY GENOA-QOL HEALTHCARE MOFFET DRUG OAKLEY HEALTH MART PHARMACY WARD DRUG AUBURN PHARMACY COLLEGE PARK FAMILY CARE GENOA-QOL HEALTHCARE HEN HOUSE PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY ONAGA PHARMACY AUBURN PHARMACY SCHROEDER DRUGS INC AUTEN PHARMACY MAINSTREET DRUG OSWEGO DRUG STORE KRAMER PHARMACY

(620) 325-2671 (785) 798-2897 (316) 283-6770 (316) 284-3725 (316) 281-7902 (785) 877-2721 (785) 672-4727 (785) 475-2285 (913) 393-4440 (913) 428-1414 (913) 353-5544 (913) 782-2039 (913) 782-2323 (913) 393-8050 (785) 889-7181 (785) 528-4415 (785) 528-4322 (913) 755-4111 (785) 346-2136 (620) 795-2233 (785) 242-2055

506 MAIN ST 207 S PENNSYLVANIA AVE 1216 N MAIN ST 1410 S KANSAS AVE 215 S PINE ST 102 S STATE 103 CENTER AVE 142 S PENN AVE 20375 W 151ST ST STE 100A 801 MUR-LEN 1125 W SPRUCE ST STE 300 13600 S BLACKBOB RD 2101 E SANTA FE ST 15970 S MUR LEN RD 300 LEONARD 890 LAKIN ST 535 MARKET ST 125 E MAIN ST 103 W MAIN ST 413 COMMERCIAL ST 134 S MAIN ST

NEODESHA NESS CITY NEWTON NEWTON NEWTON NORTON OAKLEY OBERLIN OLATHE OLATHE OLATHE OLATHE OLATHE OLATHE ONAGA OSAGE CITY OSAGE CITY OSAWATOMIE OSBORNE OSWEGO OTTAWA

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

66757-1739 67560-1909 67114-1840 67114-5302 67114-3765 67654-0405 67748-1711 67749-2243 66061-5353 66062 66061-3123 66062-1934 66062-1606 66062-9512 66521-2644 66523 66523-1157 66064-1125 67473-2402 67356-2017 66067-2328

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Provider Phone Number

Provider Street

Page 222 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PRICE CHOPPER PHARMACY COSENTINO MARKET PHARMACY HEN HOUSE PHARMACY MEDICINE SHOPPE MIDWEST BIOLOGICS, INC OPTION CARE PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY QUEENS PRICE CHOPPER

Provider Name

(785) 242-4649 (913) 647-3604 (913) 814-9355 (913) 341-7244 (913) 851-0755 (800) 475-1101 (913) 432-3396 (913) 642-4140 (913) 338-2707 (913) 897-0023

120 E 19TH ST 8051 W 160TH ST 6900 W 135TH ST 7222 W 80TH ST 16124 FOSTER ST 8940 NIEMAN RD 7000 W 75TH ST 8686 ANTIOCH RD 7418 W 119TH ST 7201 W 151ST ST

OTTAWA OVERLAND PARK OVERLAND PARK OVERLAND PARK OVERLAND PARK OVERLAND PARK OVERLAND PARK OVERLAND PARK OVERLAND PARK OVERLAND PARK

KS KS KS KS KS KS KS KS KS KS

66067-4300 66085 66223-4800 66204-3718 66085-8417 66214-1747 66204-3029 66212-3648 66213-1110 66223-2229

SAINT LUKE'S SOUTH RETAIL PHARMACY SHAWNEE MISSION MED CTR PHCY SLS MISSION FARMS PHARMACY STARK PHARMACY AUBURN LTC AUBURN PHARMACY ROCKERS PHARMACY AUBURN PHARMACY BOWEN PHARMACY BOWEN PHARMACY SOUTH PARSONS FAMILY PHARMACY CK PHARMACY PEABODY MIDWEST FAMILY HEALTH WITMER DRUG STORE INC DILLON PHARMACY LINDBURG PHARMACY LINDBURG PHARMACY NORTH MIDWEST FAMILY HEALTH PLEASANTON DRUG COMPANY BRUCE SMITH DRUGS HEN HOUSE PHARMACY DILLON PHARMACY PRATT MEDICAL ARTS PHCY RAYS PHARMACY INC PRICE CHOPPER PHARMACY ROSE HILL PHARMACY DOUGS PHARMACY GREGWIRE DRUG STORE MIDWEST FAMILY HEALTH ASHCRAFT PHARMACY SABETHA FAMILY PHARMACY

(913) 317-7604 (913) 789-3976 (913) 323-4777 (913) 345-3800 (913) 294-9125 (913) 294-3516 (913) 294-2715 (620) 421-2360 (620) 421-4950 (620) 421-1700 (620) 421-2020 (620) 983-2162 (785) 543-5131 (785) 543-2032 (620) 232-3066 (620) 231-8130 (620) 231-3410 (785) 434-4615 (913) 352-8500 (913) 362-3100 (913) 362-3100 (316) 672-5584 (620) 672-7447 (785) 754-3312 (913) 236-2879 (316) 776-1100 (785) 584-6722 (785) 483-3301 (785) 483-2119 (620) 663-2258 (785) 284-3432

12300 METCALF AVE 8901 W 74TH ST STE 100 4061 INDIAN CREEK PWY STE 120 5701 W 119TH ST 1011 BAPTISTE DR 311 N HOSPITAL DR 304 BAPTISTE DR 2020 MAIN ST 1519 MAIN ST 1902 S HWY 59 BLDG E STE 100 2517 MAIN ST 126 N WALNUT ST 300 STATE ST 779 3RD ST 2600 N BROADWAY ST 909 E CENTENNIAL 2720 N BROADWAY 210 W MILL ST 11240 TUCKER RD 25 ON THE MALL 6950 MISSION ROAD 1108 E 1ST ST 420 COUNTRY CLUB RD 414 MAIN ST 4950 ROE BLVD 323 N ROSE HILL RD 430 N MAIN ST 714 N MAIN ST 725 N MAIN 503 N MAIN ST 1118 MAIN ST

OVERLAND PARK OVERLAND PARK OVERLAND PARK OVERLAND PARK PAOLA PAOLA PAOLA PARSONS PARSONS PARSONS PARSONS PEABODY PHILLIPSBURG PHILLIPSBURG PITTSBURG PITTSBURG PITTSBURG PLAINVILLE PLEASANTON PRAIRIE VILLAGE PRAIRIE VILLAGE PRATT PRATT QUINTER ROELAND PARK ROSE HILL ROSSVILLE RUSSELL RUSSELL S HUTCHINSON SABETHA

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

66213-1324 66204-2201 66207-4030 66209-3722 66071-1342 66071-1303 66071 67357-2700 67357-3332 67357 67357-2727 66866-1060 67661-1930 67661-1915 66762-2623 66762-6600 66762 67663 66075-8402 66208-2606 66208 67124-2060 67124-3125 67752-5205 66205-1110 67133-9428 66533-9799 67665-1931 67665 67505 66534-1833

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 223 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name KRIEN PHARMACY, INC ST MARYS PHARMACY B & K PRESCRIPTION SHOP DILLON PHARMACY DILLON PHARMACY DILLONS PHARMACY GENOA-QOL HEALTHCARE KEY REXALL HEALTHMART PATTERSON DAILY CARE SALINA FAMILY HEALTHCARE PHCY SCOTT CITY PHARMACY SEDAN PHARMACY DIXON DRUG-WALLACE COUNTY GENOA-QOL HEALTHCARE PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY FAMILY DRUG CENTER MIDWEST FAMILY HEALTH SPRING HILL PRICE CHOPPER REED PHARMACY INC STOCKTON PHARMACY HAMILTON COUNTY DRUG STORE THE DOWNTOWN DRUGSTORE THE MEDICINE STORE CONTINENTAL PHARMACY LLC DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE HUNTERS RIDGE PHARMACY JAYHAWK PHCY AT MISSION WOODS MEDICAL ARTS PBA PHARMACY TALLGRASS PHARMACY GRANT COUNTY DRUG VALLEY DRUG INC VALLEY FALLS PHARMACY GIBSON DRUG INC CLELAND PHARMACY LLC WASHINGTON HEALTHMART

NR_0009_10823 10/2017

Provider Phone Number (785) 332-2177 (785) 437-2967 (785) 827-4455 (785) 827-0417 (785) 823-9515 (785) 452-3951 (785) 914-5491 (785) 827-0408 (785) 825-0778 (785) 452-3900 (620) 872-2146 (620) 725-3262 (785) 852-4219 (913) 268-3610 (913) 268-8150 (913) 422-2134 (785) 282-3311 (785) 282-3333 (913) 592-5350 (620) 278-2224 (785) 425-7172 (620) 384-7424 (913) 369-3800 (913) 369-2100 (785) 232-6975 (785) 267-0234 (785) 228-8762 (785) 272-0314 (785) 228-4204 (785) 357-2664 (785) 338-8899 (785) 783-0209 (785) 286-2557 (785) 228-9700 (785) 235-8796 (785) 871-8000 (620) 356-1446 (316) 755-0191 (785) 945-3711 (785) 743-5753 (785) 743-6321 (785) 325-3130

Provider Street 105 W WASHINGTON ST 520 W BERTRAND AVE 601 E IRON AVE 1201 W CRAWFORD ST 2350 PLANET AVE 1235 E CLOUD ST 809 ELMHURST BLVD STE A 901 E CRAWFORD ST 685 LEWIS 651 E PRESCOTT RD 102 ALBERT AVE 129 E MAIN ST 107 W 2ND ST 6440 NIEMAN RD 12010 SHAWNEE MISSION PKWY 22210 W 66TH ST 125 S MAIN ST 317 E US HIGHWAY 36 22350 S HARRISON ST 118 S BROADWAY AVE 402 MAIN ST 302 E AVE A 516 E 4TH ST 760 NORTHSTAR CT 821 SW 6TH AVE 2012 SE 29TH ST 5311 SW 22ND PL 2815 SW 29TH ST 6829 SW 29TH ST 800 NW 25TH ST 325 SW FRAZIER AVE STE 210 330 SW OAKLEY AVE 3405 NW HUNTERS RDG TER #200 2860 SW MISSION WOODS DR 2252 SW 10TH AVE 601 SW CORPORATE VW 219 N MAIN ST 801 S MERIDIAN AVE 320 BROADWAY ST 125 N MAIN ST 202 S 1ST ST 227 C ST

Page 224 of 679

Provider City SAINT FRANCIS SAINT MARYS SALINA SALINA SALINA SALINA SALINA SALINA SALINA SALINA SCOTT CITY SEDAN SHARON SPRINGS SHAWNEE SHAWNEE SHAWNEE SMITH CENTER SMITH CENTER SPRING HILL STERLING STOCKTON SYRACUSE TONGANOXIE TONGANOXIE TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA TOPEKA ULYSSES VALLEY CENTER VALLEY FALLS WA KEENEY WAKEENEY WASHINGTON

State

ZIP code

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

67756-5678 66536-1619 67401-3035 67401-4657 67401-7514 67401 67401-7405 67401-5100 67401 67401-7408 67871 67361-1626 67758 66203-3326 66216-1867 66226-3521 66967-2605 66967-9586 66083-3148 67579-2133 67669-1930 67878-0000 66086-8920 66086-8933 66603-3130 66605-2458 66614-1500 66614-2002 66614-6083 66618-1460 66606-1963 66606-1995 66618-2508 66614-5604 66604-3929 66615-1244 67880-0925 67147-4951 66088-1302 67672-2103 67672-2409 66968-1906

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DILLON PHARMACY WELLINGTON HEALTH MART PHCY AUBURN PHARMACY THE WEST PHARM BARNEY'S PHARMACY, INC BROADWAY PHARMACY CANCER CENTER OF KANSAS CLIFTON FAMILY PHARMACY COMCARE FAMILY PRESCRIPTION SH CONSUMERS PHARMACY CUSTOM RX INC

Provider Name

(316) 326-5981 (620) 326-7455 (785) 883-2462 (785) 457-3611 (316) 945-3388 (316) 260-8880 (316) 262-4467 (316) 689-6100 (316) 295-4721 (316) 263-6233 (316) 721-2626

1111 W 8TH ST 505 E 16TH ST STE 2 601 MAIN ST 402 MAIN ST 3108 W CENTRAL AVE 1610 S BROADWAY ST 818 N EMPORIA STE 403 1515 S CLIFTON AVE 1969 W 21ST ST 1035 N EMPORIA ST 3510 N RIDGE RD STE 900

WELLINGTON WELLINGTON WELLSVILLE WESTMORELAND WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA

KS KS KS KS KS KS KS KS KS KS KS

67152-3424 67152-2810 66092-9201 66549 67203-4912 67211-4119 67214 67218-2900 67203-2106 67214-2944 67205-1225

CUSTOM RX PHCY AND WLLNSS CONCEPTS DANDURAND DRUG DANDURAND DRUG COMPANY INC DANDURAND INC DILLON PHARMACIES DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY DILLON PHARMACY FAMILY PRESCRIPTION SHOP INC GRACEMED PHARMACY

(316) 636-9595 (316) 729-6000 (316) 685-2353 (316) 858-5890 (316) 941-1927 (316) 838-5908 (316) 942-7636 (316) 729-1535 (316) 721-5036 (316) 651-2703 (316) 651-2732 (316) 722-9733 (316) 729-0431 (316) 681-6834 (316) 524-4228 (316) 522-4545 (316) 686-9200 (316) 691-9134 (316) 685-5740 (316) 729-5204 (316) 684-7899 (316) 252-8777

2350 N GREENWICH RD # 1000 2233 N RIDGE RD 7732 E CENTRAL AVE 800 N CARRIAGE PKWY 640 N WEST ST 1910 W 21ST ST N 3932 W 13TH ST N 10222 W 21ST ST N 7107 W 37TH ST N 7707 E CENTRAL AVE 9450 E HARRY ST 8828 W 13TH ST N 10515 W CENTRAL AVE 3020 E DOUGLAS AVE 4747 S BROADWAY ST 3211 S SENECA ST 1607 S GEORGETOWN ST 3707 N WOODLAWN ST 2244 N ROCK RD 13415 MAPLE ST 7111 E 21ST ST N 1122 N TOPEKA ST

WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA

KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS KS

67226-8269 67205-1099 67206-2163 67208-4508 67203-1211 67203-2105 67203-4437 67205-1836 67205-9360 67206-2100 67207-5074 67212-4030 67212-5103 67214-4818 67216-1739 67217-3348 67218-4111 67220-2222 67226-2352 67235-8729 67206-1078 67214-2810

HART PHCY & DURABLE MED EQUIPMENT HPC SPECIALTY RX OF KANSAS INC IDC PHARMACY KANSAS PALLIATIVE PHARMACY LEEKERS FAMILY PHARMACY NEIGHBORHOOD PHARMACY PRESTON SOCORA PHARMACY

(316) 683-5621 (800) 757-9192 (316) 264-3505 (316) 219-1748 (316) 744-3948 (316) 665-4427 (316) 722-4248

6217 E 13TH ST N 7732 E CENTRAL AVE STE 125 1100 N SAINT FRANCIS #150 313 S MARKET 6223 N BROADWAY ST 2251 E 21ST ST N STE 121 8200 W CENTRAL AVE STE 2

WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA WICHITA

KS KS KS KS KS KS KS

67208-2654 67206-2155 67214 67202 67219-1101 67214-2252 67212-3661

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 225 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PROFESSIONAL PHARMACY SENIOR CARE PHARMACY VIA CHRISTI CLINIC PHARMACY VIA CHRISTI OUTPATIENT PHARMACY WICHITA UROLOGY GROUP, PA WINCHESTER PHARMACY DILLON PHARMACY GRAVES DRUGS HEALTH CENTER PHARMACY WINFIELD PHARMACY INC YATES CENTER PHARMACY DYER DRUG FREDS PHARMACY ROBERTS' PHARMACY LLC SHEARER DRUG SHEARER DRUG ALEXANDRIA DRUGS THOMPSON DRUG ANNVILLE

Provider Name

(316) 263-5218 (316) 945-7455 (316) 689-9280 (316) 613-6511 (316) 636-6100 (913) 774-3328 (620) 221-5710 (620) 221-0080 (620) 221-7850 (620) 221-0450 (620) 625-2221 (606) 387-6444 (606) 387-0320 (606) 557-1213 (606) 387-6616 (606) 387-4422 (859) 635-2171 (606) 364-3113

744 N WACO 1402 S RIDGE RD 3311 E MURDOCK ST 929 N SAINT FRANCIS 2626 N WEBB RD 408 DELAWARE ST 2310 MAIN ST 905 MAIN ST 722 WHEAT RD 1708 E 9TH AVE 122 W RUTLEDGE ST 100 CUMBERLAND ST 800 N CROSS ST 190 WESTVIEW SHOPPING CTR 127 FOOTHILLS AVE STE 2 260 BURKESVILLE RD 7857 ALEXANDRIA PIKE 78 HWY 3444 STE 2

WICHITA WICHITA WICHITA WICHITA WICHITA WINCHESTER WINFIELD WINFIELD WINFIELD WINFIELD YATES CENTER ALBANY ALBANY ALBANY ALBANY ALBANY ALEXANDRIA ANNVILLE

KS KS KS KS KS KS KS KS KS KS KS KY KY KY KY KY KY KY

67203-3936 67209-2908 67208-3054 67214 67226-8110 66097-4003 67156-5447 67156-3604 67156-3216 67156-3220 66783-1238 42602 42602-1616 42602-1600 42602-1090 42602-1604 41001-1045 40402-8245

MEDCARE PHARMACY AND HOME MEDICAL ASHLAND BELLEFONTE CANCER CENTER BOYD COUNTY PHARMACY GALLAHERS PHARMACY INC

(270) 655-6151 (606) 836-0202 (606) 929-5301 (606) 329-2122

165 WALNUT ST 122 SAINT CHRISTOPHER DR 12544 US ROUTE 60 2914 BLACKBURN AVE

ARLINGTON ASHLAND ASHLAND ASHLAND

KY KY KY KY

42021-9000 41101-7016 41102-9687 41101-4838

HEALTHY WAY PHARMACY CEDARKNOLL KINGS DAUGHTERS FAMILY PHCY MCMEANS PHARMACY MEDICAL PLAZA PHARMACY OPTION CARE HEARTLAND FAMILY PHARMACY REYNOLDS PHARMACY BOWLING FAMILY PHARMACY HINKLE HOMETOWN DRUG STORE INC KNOX PROFESSIONAL PHARMACY PARKWAY PHARMACY CRUME DRUG STORE HURST DISCOUNT DRUGS MEDICA PHCY & WELLNESS CENTER SCRIPTS PHARMACY BARDWELL PHARMACY DONELLS PHARMACY INC STUFFLEBEAN PHARMACY

(606) 928-1001 (606) 324-0092 (606) 325-8400 (606) 833-3510 (866) 324-4427 (270) 847-4004 (606) 756-2204 (606) 546-2210 (606) 546-8860 (606) 546-5859 (606) 546-3464 (502) 348-3938 (502) 348-9261 (502) 348-6623 (502) 348-8338 (270) 628-5445 (606) 573-4550 (606) 464-3396

1410 EAGLE DR 613 23RD ST STE 110 2920 CARTER AVE 700 SAINT CHRISTOPHER DR 4380 13TH ST 134 SUGAR MAPLE DR STE A 216 MAIN ST 315 HOSPITAL DR STE 6 590 OLD 25E 511 KNOX ST 726 S US HIGHWAY 25E 111 W FLAGET ST 102 N THIRD ST 202 W STEPHEN FOSTER AVE 4181 NEW SHEPHERDSVILLE RD 178 US HIGHWAY 51 N 40 W HIGHWAY 72 STE B 1031 GRAND AVE

ASHLAND ASHLAND ASHLAND ASHLAND ASHLAND AUBURN AUGUSTA BARBOURVILLE BARBOURVILLE BARBOURVILLE BARBOURVILLE BARDSTOWN BARDSTOWN BARDSTOWN BARDSTOWN BARDWELL BAXTER BEATTYVILLE

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

41102-9623 41101-2876 41101-1943 41101-7062 41102-5432 42206-5352 41002-1037 40906-7917 40906 40906-1330 40906-7316 40004 40004 40004-1472 40004-9021 42023 40806-8384 41311-9078

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 226 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

VILLAGE APOTHECARY MIDTOWN PHARMACY EXPRESS LLC RICE DRUGS INC BLUEGRASS DRUG CENTER CLINIC PHARMACY SOUTH TOTAL PHARMACY CARE OF BELFRY BENTON DISCOUNT PHARMACY DRAFFENVILLE PHARMACY J & R PHARMACY BEREA DRUG

Provider Name

(606) 464-3656 (270) 274-9224 (270) 274-3318 (502) 255-3540 (270) 476-3600 (606) 237-0555 (270) 527-1409 (270) 527-1404 (270) 527-9374 (859) 986-4521

110 RIVER ST 500 N MAIN ST 1209 N MAIN ST 325 HIGHWAY 42 E 3959 US HIGHWAY 431 S 20 STATE HIGHWAY 319 2602 MAIN ST 153 US HIGHWAY 68 E 817 MAIN ST 402 RICHMOND RD N

BEATTYVILLE BEAVER DAM BEAVER DAM BEDFORD BEECHMONT BELFRY BENTON BENTON BENTON BEREA

KY KY KY KY KY KY KY KY KY KY

41311-9194 42320-1949 42320-8955 40006-7624 42323-3235 41514-8678 42025-1819 42025-7123 42025-1240 40403-1133

BEREA WHITEHOUSE CLINIC PHARMACY KNIGHTS PHARMACY MED-SAVE BEREA, MEDICINE SHOPPE THOMPSON DRUG KINGSTON BETSY LAYNE PHARMACY INC MIDWAY PHARMACY MEDICA PHARMACY BLOOMFIELD B+H APOTHECARY BOONEVILLE DISCOUNT DRUGS OWSLEY PRESCRIPTION CENTER C.D.S. #10 PHARMACY LLC CLINIC PHARMACY ELY DRUG OF BOWLING GREEN HINES PHARMACY HINES PHARMACY MEDICINE ARTS PHARMACY NORTHGATE PHARMACY RIVERSIDE PHARMACY SHELDONS EXPRESS PHARMACY SHELDONS EXPRESS PHARMACY SHELDON'S EXPRESS PHARMACY #5 SPRINGHILL PHARMACY TRINH PHARMACY BRANDENBURG PHARMACY CARE BRODHEAD PHARMACY DEAN'S PHARMACY ALFORDS PHARMACY EDMONSON DRUG COMPANY INC CAPPS PHARMACY MORGANS MEDICINE LAKESHORE PHARMACY INC

(859) 986-2323 (859) 986-0500 (859) 985-7283 (859) 228-0005 (606) 478-9474 (270) 242-4344 (502) 252-8242 (606) 593-6337 (606) 593-0382 (606) 593-6306 (270) 781-5661 (270) 781-3095 (270) 467-5225 (270) 796-1818 (270) 842-4341 (270) 843-3202 (270) 842-6161 (270) 780-2650 (270) 842-4515 (270) 782-6337 (270) 715-0650 (270) 796-3909 (270) 782-5823 (270) 422-2422 (606) 758-4373 (606) 735-2322 (270) 597-1044 (270) 597-2386 (270) 864-1606 (270) 864-2222 (606) 561-7104

104 LEGACY DR 191 GLADES RD 102 PRINCE ROYAL DR STE 2 2760 BATTLEFIELD MEMORIAL HWY 11105 US HIGHWAY 23 S 9847 ELIZABETHTOWN RD STE 102 114 FAIRFIELD HL 99 KY 11 S 478 KY 11 N 820 KY 11 N 1308 ASHLEY CIRCLE 201 PARK ST 4863 SCOTTSVILLE RD 165 NATCHEZ TRACE AVE STE 101 1340 KY HIGHWAY 185 818 US 31W BYP 3158 LOUISVILLE RD 825 SECOND AVE E STE A1 843 FAIRVIEW AVE 760 CAMPBELL LN STE 121 5575 SCOTTSVILLE RD 2305 RUSSELLVILLE RD 1530 CAMPBELL LANE 455 BYPASS RD STE D 54 W MAIN ST 109 LOCUST STREET 210 S MAIN ST # 100 432 S MAIN ST 331 KEEN STREET 360 KEEN ST STE 100 51 W LAKESHORE DR

BEREA BEREA BEREA BEREA BETSY LAYNE BIG CLIFTY BLOOMFIELD BOONEVILLE BOONEVILLE BOONEVILLE BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BRANDENBURG BRODHEAD BROOKSVILLE BROWNSVILLE BROWNSVILLE BURKESVILLE BURKESVILLE BURNSIDE

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40403-9594 40403-1369 40403-1637 40403-8332 41605-9998 42712-6801 40008-6127 41314-9157 41314-9155 41314-9155 42104 42101-1759 42104-7909 42103 42101-9691 42101-2314 42101 42101 42101-4914 42104-1085 42104-7826 42101-3920 42104 40108-1745 40409 41004-0000 42210-9001 42210-9007 42717-0000 42717-7916 42519-9424

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 227 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CADIZ PHARMACY CALVERT CITY PHARMACY BLUEGRASS DC CAMPBELLSBURG CENTURY MEDICINES EASTRIDGE PHELPS PHARMACY MEDICINE CENTRE PHARMACY TAYLOR RGNL OUTPATIENT PHCY CAMPTON DISCOUNT DRUGS WOLFE FAMILY PHARMACY WOLFE PRESCRIPTION CENTER MIDWAY PHARMACY CANEYVILLE CARLISLE DRUGS SOPER'S FAMILY DRUG BLUEGRASS DRUG CNTR CARROLLTON WEBSTER DRUGS INC CAVE CITY PRESCRIPTION CTR INC PARKLAND DRUGS CENTRAL CITY CLINIC PHARMACY POOLE'S PHARMACY CARE CLARKSON DRUG STORE

Provider Name

(270) 522-3441 (270) 395-4350 (502) 465-4003 (270) 789-4734 (270) 789-0577 (270) 465-3784 (270) 789-5826 (606) 668-3153 (606) 668-2273 (606) 668-3900 (270) 879-6355 (859) 289-2246 (859) 289-8501 (502) 732-4331 (502) 732-4331 (270) 773-2252 (270) 773-3152 (270) 754-4300 (270) 754-1545 (270) 242-3811

435 LAKOTA DR 888 E 5TH AVE 8170 MAIN ST 1608 OLD LEBANON RD 500 N BYPASS RD 325 E BROADWAY ST 1700 OLD LEBANON RD 33 MAIN ST STE 2 797 KY 15 SOUTH 217 MT PARKWAY SPUR 408 E MAPLE ST 126 E MAIN ST 102 S BROADWAY ST 1955 HIGHWAY 227 99 PARKLANE SHOPPING CTR 101 SOUTH DIXIE HWY 209 N DIXIE HWY 203 N 2ND ST 102 W BROAD ST 201 MILLERSTOWN ST

CADIZ CALVERT CITY CAMPBELLSBURG CAMPBELLSVILLE CAMPBELLSVILLE CAMPBELLSVILLE CAMPBELLSVILLE CAMPTON CAMPTON CAMPTON CANEYVILLE CARLISLE CARLISLE CARROLLTON CARROLLTON CAVE CITY CAVE CITY CENTRAL CITY CENTRAL CITY CLARKSON

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

42211 42029-7502 40011 42718-9662 42718-7792 42718-2003 42718-9615 41301-9750 41301-9553 41301-0249 42721-9059 40311-1154 40311-1190 41008-8037 41008 42127 42127-9509 42330-1287 42330-1538 42726-8179

MIDWAY PHARMACY OF CLARKSON, INC. CLAY DRUG STORE INC POWELL PRESCRIPTION CENTER BYASSEE DRUG COMPANY PERKINS PHARMACY ADAIR DRUG CENTURY MEDICINES CERTACARE INC JAMES MEDICAL PHARMACY NORTH CENTURY PHARMACY BAPTIST REGIONAL APOTHECARY BRENTWOOD PHARMACY CORBIN PHARMACY CREECH & GIBBS PHARMACY MORTONS DISCOUNT DRUG PRESCRIPTION SHOPPE SAV-RITE FAMILY PHARMACY STEPHANIE'S DOWN HOME PHCY INC WEST KNOX PHARMACY, LLC L.B. CLINIC PHARMACY BLANKS PHARMACY

(270) 242-2331 (270) 664-2270 (606) 663-3481 (270) 653-2151 (270) 653-5361 (270) 384-9999 (270) 384-5874 (270) 385-9139 (270) 385-9600 (270) 380-1230 (606) 526-8334 (606) 258-9110 (606) 523-5585 (606) 523-1911 (606) 528-2121 (606) 528-9305 (606) 528-7770 (606) 261-7877 (606) 258-1111 (606) 476-2863 (859) 261-1313

627 W MAIN ST 9055 STATE ROUTE 132 W 4644 MAIN ST 107 E CLAY ST 119 E CLAY ST 510 BURKESVILLE ST STE 1 706 JAMESTOWN ST 937 CAMPBELLSVILLE RD 1545 CAMPBELLSVILLE RD STE B 3058 CAMPBELLSVILLE RD 1 TRILLIUM WAY 108 BRENTWOOD PLACE 60 BRYAN BLVD STE 201 13369 N US HIGHWAY 25 E 10 DEMPSEY LN 200 W GORDON ST 1150 MASTER ST 1220 MASTER ST STE 5 14161 N US HIGHWAY 25 E 464 KY HIGHWAY 699 272 PIKE ST

CLARKSON CLAY CLAY CITY CLINTON CLINTON COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA CORBIN CORBIN CORBIN CORBIN CORBIN CORBIN CORBIN CORBIN CORBIN CORNETTSVILLE COVINGTON

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

42726-7044 42404-2173 40312-8801 42031-1222 42031-1222 42728 42728-1116 42728-2265 42728-2262 42728-9511 40701-8426 40701 40701-2781 40701-6129 40701-2765 40701-1550 40701-2563 40701-2517 40701-6183 41731-8749 41011-2343

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FT MITCHELL DRUG SHOPPE RUWE FAMILY PHARMACY COVINGTON

Provider Name

(859) 341-2000 (606) 431-3304

2515 DIXIE HWY 434 SCOTT ST

COVINGTON COVINGTON

KY KY

41017-3009 41011-1528

RUWE FAMILY PHARMACY COVINGTON LTC RUWE FAMILY PHARMACY LATONIA SAVE DISCOUNT DRUGS CRESTVILLE DRUGS GRANT COUNTY DRUGS NORTH TOTAL CARE PHARMACY CROFTON PHARMACY CUMBERLAND DRUG TRI-CITIES CLINIC PHARMACY CLINIC PHARMACY EASTSIDE PHARMACY

(859) 431-3304 (859) 261-0605 (859) 431-2857 (859) 341-1660 (859) 428-3784 (859) 428-0900 (270) 424-8965 (606) 589-0003 (606) 589-0130 (859) 234-2777 (859) 234-6800

434 SCOTT ST 3712 WINSTON AVE 716 MADISON AVE 2446 ANDERSON RD 375 VIOLET RD # A 700 VIOLET ROAD 110 E MAIN ST 1803 E MAIN ST 18880 N US HIGHWAY 119 1210 KY HIGHWAY 36 E STE G6 430 E PLEASANT ST STE 2

COVINGTON COVINGTON COVINGTON CRESCENT SPRINGS CRITTENDEN CRITTENDEN CROFTON CUMBERLAND CUMBERLAND CYNTHIANA CYNTHIANA

KY KY KY KY KY KY KY KY KY KY KY

41011-2342 41015-1469 41011-2412 41017-1400 41030-8535 41030 42217-0000 40823-1840 40823-8106 41031-7493 41031-1614

HOMETOWN PHARMACY OF CYNTHIANA BLUEGRASS DRUG STORE

(859) 234-5600 (859) 236-3535

1134 US HIGHWAY 27 S 104 PONDER CT STE E

CYNTHIANA DANVILLE

KY KY

41031-7570 40422-9000

DANVILLE GOOD NEIGHBOR PHARMACY EPHRAIM MCDOWELL REG MED CTR THE MEDICINE SHOPPE WOODBURN PHARMACY LLC AVENUE PHARMACY DIXON DRUG STORE CARE MORE PHARMACY GRANT CO DRUGS INC TOTAL CARE PHARMACY MIKE'S PHARMACY THOMPSON DRUG EAST BERNSTADT HOWARD FAMILY PHARMACY INC LYON DRUG STORE METCALFE DRUG NUNN DRUG INC APOTHECARE PHARMACY II CARDINAL APOTHECARE PHCY OF ELIZ-TOWN CENTURY MEDICINES DIXIE PHARMACY ETOWN PHARMACY ETOWN VITAL CARE HEARTLAND PRIMARY CARE JEFFS PRESCRIPTION SHOP ELKHORN DRUG

(859) 936-1222 (859) 239-1706 (859) 238-0002 (270) 797-2761 (859) 491-1700 (270) 664-2270 (606) 639-2273 (859) 823-5271 (859) 823-0200 (270) 905-4046 (606) 843-2211 (606) 358-4800 (270) 388-2236 (270) 432-3051 (270) 432-3111 (270) 982-0303 (270) 739-0303 (270) 737-7880 (270) 872-0588 (270) 900-1583 (270) 506-2463 (270) 765-5926 (270) 765-2157 (606) 754-0221

60 CASSIDY WAY # 3 217 S 3RD ST 900 HUSTONVILLE RD 400 E ARCADIA AVE 118 6TH AVE 1335 US HIGHWAY 41A S 151 DORTON JENKINS HWY 24 S MAIN ST 40 BROADWAY ST 126 S LT TODD JR HWY 1088 HIGHWAY 490 327 KY ROUTE 550 201 MAIN ST 115 E STOCKTON ST 1704 W STOCKTON ST 908 WOODLAND DR 1239 WOODLAND DR STE 102 790 N DIXIE AVE STE 1100 1311 RING RD STE 107 914 N DIXIE AVE STE 103 914 N DIXIE AVE STE 101 2412 RING RD 2415 RING RD 105 E ELKHORN ST

DANVILLE DANVILLE DANVILLE DAWSON SPRINGS DAYTON DIXON DORTON DRY RIDGE DRY RIDGE EARLINGTON EAST BERNSTADT EASTERN EDDYVILLE EDMONTON EDMONTON ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELKHORN CITY

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40422-8457 40422-1823 40422-2137 42408-1638 41074-1112 42409-9447 41520 41035-7329 41035-9762 42410-1557 40729-6160 41622-6925 42038-7752 42129 42129-8137 42701-2746 42701-2770 42701-2459 42701-8968 42701-2536 42701-2520 42701-7998 42701-7941 41522-8557

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 229 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NICHOLS APOTHECARY RUSSELL FORK PHARMACY WEATHERS DRUGS EMINENCE APOTHECARY CLOVERFORK CLINIC PHARMACY TOTAL CARE PHARMACY STULTZ PHARMACY INC FLEMINGSBURG FMLY HLTH CTR PHY TOTAL CARE PHARMACY TOTAL CARE PHARMACY RUWE FAMILY PHARMACY RUWE FAMILY PHCY FLORENCE LTC RICE'S PHARMACY FT THOMAS DRUG CENTER

Provider Name

(606) 754-5076 (606) 754-7085 (270) 265-2155 (502) 518-9120 (606) 837-2108 (859) 654-3232 (606) 834-1052 (606) 845-0402 (606) 845-2101 (606) 845-3421 (859) 746-2800 (859) 746-2800 (270) 276-3150 (859) 441-1140

220 ELKHORN ST 10363 REGINA BELCHER HWY 44 PUBLIC SQ 5551 S MAIN ST 101 CHAD STREET 1100 W SHELBY ST 2420 ARGILLITE RD STE A 520 ELIZAVILLE RD 209 S MAIN CROSS ST 118 CLARK ST 7220 BURLINGTON PIKE STE I 7220 BURLINGTON PIKE 44 W MAIN ST 26 N FORT THOMAS AVE

ELKHORN CITY ELKHORN CITY ELKTON EMINENCE EVARTS FALMOUTH FLATWOODS FLEMINGSBURG FLEMINGSBURG FLEMINGSBURG FLORENCE FLORENCE FORDSVILLE FORT THOMAS

KY KY KY KY KY KY KY KY KY KY KY KY KY KY

41522 41522-8510 42220-0000 40019-1126 40828 41040-1046 41139-1972 41041-1141 41041-1203 41041-1207 41042-1586 41042-1586 42343-9761 41075-1565

CAPITAL PHARMACY AND MEDICAL EQUIP CAPITAL PHARMACY LONG TERM CARE HOMETOWN PHARMACY CLINIC PHARMACY FRANKLIN FRANKLIN PHARMACY SHELDONS EXPRESS PHARMACY FRENCHBURG PHARMACY MENIFEE COUNTY PHARMACY PLLC EVANS DRUG COMPANY GAMALIEL DRUG NOBLE'S PHARMACY GEORGETOWN APOTHECARY HOMETOWN PHARMACY J&L PHARMACY ELY DRUGS INC GLASGOW PRESCRIPTION CENTER HIGHLAND PHARMACY MEDICAL ARTS PHARMACY PARK AVENUE PHARMACY PHARMACY EXPRESS TJ PAVILION PHARMACY TJ SAMSON COMM HSP OP PHCY VANN HEALTHCARE SERVICES FRUTH PHARMACY GRAYSON FAMILY DRUG

(502) 223-2827 (502) 223-2827 (502) 699-2440 (270) 482-0130 (270) 813-1101 (270) 586-4471 (606) 768-6610 (606) 768-2161 (270) 472-2421 (270) 457-4100 (606) 757-3535 (502) 370-4336 (502) 863-3784 (502) 863-9823 (270) 651-8359 (270) 651-8889 (270) 629-4300 (270) 651-7030 (270) 651-5156 (270) 651-7948 (270) 651-4334 (270) 651-1866 (270) 651-7627 (606) 475-0033 (606) 475-0232

662 E MAIN ST 664 E MAIN ST 1140 US HIGHWAY 127 S 1112 S MAIN ST 810 N MAIN ST 212 S MAIN ST 732 HIGHWAY 36 70 MAIN ST 212 LAKE STREET 405 W MAIN ST 162 GARRISON LN 1002 S BROADWAY STE 7 1502 OXFORD DR STE 150 705 S BROADWAY ST 415 HAPPY VALLEY RD 615 S L ROGERS WELLS BLVD 301 ROGERS RD 1220 N RACE ST 131 PARK AVE 415 S L ROGERS WELLS BLVD 310 N.L. ROGERS WELLS BLVD 1301 N RACE ST 1220 N RACE ST 630 N CAROLE MALONE BLVD 131 S CAROL MALONE BLVD STE E

FRANKFORT FRANKFORT FRANKFORT FRANKLIN FRANKLIN FRANKLIN FRENCHBURG FRENCHBURG FULTON GAMALIEL GARRISON GEORGETOWN GEORGETOWN GEORGETOWN GLASGOW GLASGOW GLASGOW GLASGOW GLASGOW GLASGOW GLASGOW GLASGOW GLASGOW GRAYS0N GRAYSON

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40601-2338 40601-2338 40601-4360 42134-2371 42134-1334 42134-2116 40322-8123 40322-8318 42041 42140-8906 41141-8437 40324-1463 40324 40324-1164 42141-1537 42141-1074 42141-4110 42141-3462 42141-3226 42141-1191 42141-1300 42141 42141-3462 41143 41143-1810

HORTON BROTHERS AND BROWN PHCY

(606) 474-5655

201 E MAIN ST

GRAYSON

KY

41143-1303

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 230 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MED-SAVE GRAYSON MED SHOPPE

Provider Name

(606) 474-8888

601 N CAROL MALONE BLVD STE A

GRAYSON

KY

41143-1558

EASTRIDGE-PHELPS PHCY GREENSBURG HEALTH FIRST PHARMACY JANE TODD PHARMACY LLC STULTZ PHARMACY INC GREENVILLE PHARMACY GREENVILLE PHARMACY POOLES PHARMACY CARE

(270) 299-2333 (270) 299-2467 (270) 932-2239 (606) 473-7346 (270) 338-3800 (270) 338-3800 (270) 338-6060

1915 CAMPBELLSVILLE RD 111 S MAIN ST 310 INDUSTRIAL PARK RD STE 2 1615 ASHLAND RD 117 N MAIN ST 117 N MAIN ST 159 S MAIN ST

GREENSBURG GREENSBURG GREENSBURG GREENUP GREENVILLE GREENVILLE GREENVILLE

KY KY KY KY KY KY KY

42743-7758 42743-1563 42743 41144-1207 42345-1503 42345-2902 42345-1539

HANSON PHCY AND WELLNESS CNTR LLC TAYLOR PHARMACY TOWNE & COUNTRY PHARMACY INC FOOD CITY PHARMACY HARLAN ARH PHARMACY HARLAN MEDICAL CENTER PHCY HAROLD CLINIC PHARMACY THOMPSON'S PHARMACY KING DRUG AND HOME CARE ARH COMMUNITY PHARMACY COMPLETE CARE PHARMACY EAST MAIN STREET PHARMACY

(270) 322-1234 (270) 756-5222 (270) 756-2151 (606) 573-7200 (606) 573-8196 (606) 573-2004 (606) 478-1600 (859) 734-3004 (270) 298-3278 (606) 487-7380 (606) 487-1910 (606) 487-0107

7455 HANSON RD 109 FAIRGROUNDS RD 517 OLD HIGHWAY 60 2478 US-421 81 BALL PARK RD 132 VILLAGE CENTER RD 24 PINHOOK ROAD 1064 N COLLEGE ST 312 S MAIN ST 210 BLACK GOLD BLVD STE 104 572 MORTON BLVD 279 E MAIN ST

HANSON HARDINSBURG HARDINSBURG HARLAN HARLAN HARLAN HAROLD HARRODSBURG HARTFORD HAZARD HAZARD HAZARD

KY KY KY KY KY KY KY KY KY KY KY KY

42413-9415 40143-2583 40143-2509 40831 40831-1701 40831-1777 41635 40330-2208 42347-1129 41701-2620 41701-9473 41701-1920

HAZARD ARH REG MED CTR CLINIC PHCY KING PHARMACY INC MOUNTAIN COMMUNITY PHARMACY PHARMACY CARE CENTER RX DISCOUNT PHARMACY

(606) 439-6776 (606) 435-1067 (606) 487-0023 (606) 435-0460 (606) 436-2891

200 MEDICAL CENTER DR 900 MORTON BLVD 1908 N MAIN ST STE 108 101 TOWN AND COUNTRY LN STE 10 500 MORTON BLVD

HAZARD HAZARD HAZARD HAZARD HAZARD

KY KY KY KY KY

41701-9466 41701-9476 41701-2505 41701-9524 41701-9473

UK NORTH FORK VALLEY COM HLTH CTR DUNAWAY'S IMPERIAL PHARMACY T & T DRUG STORE

(606) 435-0469 (270) 826-6565 (270) 827-3503

750 MORTON BLVD 110 3RD ST 1331 CLAY ST

HAZARD HENDERSON HENDERSON

KY KY KY

41701-9469 42420-2993 42420-4203

MEDCARE PHARMACY & HOME MEDICAL EAST KENTUCKY PHARMACY, INC. KNOTT PRESCRIPTION CENTER SLONE'S DISCOUNT PHARMACY UK JUNE BUCHANAN PHARMACY LINCOLN PARKWAY PHARMACY SMITH DRUG COMPANY INC CAYCES EAGLE WAY PHARMACY CAYCES PHARMACY

(270) 236-2588 (606) 785-3784 (606) 785-0889 (606) 785-5407 (606) 785-3178 (270) 358-2117 (270) 358-3306 (270) 885-1220 (270) 886-4466

2009 S 7TH ST 588 HIGHWAY 899 59 HIGHWAY 80 E STE 1 674 HIGHWAY 899 59 COWTOWN RD 117 LINCOLN DR 104 N LINCOLN BLVD 211 BURLEY AVE 1112 W 7TH ST

HICKMAN HINDMAN HINDMAN HINDMAN HINDMAN HODGENVILLE HODGENVILLE HOPKINSVILLE HOPKINSVILLE

KY KY KY KY KY KY KY KY KY

42050-1841 41822-8955 41822-8846 41822-8956 41822-9120 42748-9780 42748-1512 42240-8725 42240-1818

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SAVE MORE DRUGS TOMS FAMILY PHARMACY TOWNE & COUNTRY DISCOUNT DRUGS HOME TOWN PHARMACY KING PHARMACY, HYDEN THE MEDICINE SHOPPE CHEROKEE DRUG SHOPPE NIE'S PHARMACY & WELLNESS CNTR HOMETOWN PHARMACY INEZ DRUG STORE MARTIN COUNTY PHARMACY RITE VALUE PHARMACY THE MEDICINE SHOPPE ESTILL CLINIC PHARMACY IRVINE HEALTH CARE PHARMACY IRVINE WHITE HOUSE CLINIC PHCY PLAZA PHARMACY RIVER DRIVE PHARMACY SAVE-RITE DRUGS ISOM COMMUNITY PHARMACY EAST KENTUCKY DRUG FAMILY PHARMACY OF JACKSON HOMETOWN PHARMACY OF JACKSON JACKSON APOTHECARY JAMESTOWN VALURITE BOGGS PHARMACY KIMPER PHARMACY MCCONNELL HEALTH MART PHCY SUTTON DRUGS OF LA CENTER LACKEY FAMILY PHARMACY MED-SAVE LANCASTER SUTTON PHARMACY RUWE FAMILY PHCY LATONIA LTC ANDERSON APOTHECARY ADAMS PHARMACY PAT'S PHARMACY SOUTHALL PHARMACY MIDWAY PHARMACY LEITCHFIELD GOWER DRUG STORE

Provider Name

(270) 885-5515 (270) 885-1524 (270) 885-6131 (606) 672-3084 (606) 672-2210 (606) 672-8705 (859) 356-3121 (859) 356-3931 (606) 298-7283 (606) 298-3800 (606) 298-3412 (606) 298-2080 (606) 298-7774 (606) 723-0044 (606) 723-5446 (606) 723-0665 (606) 723-5315 (606) 723-0265 (270) 547-2855 (606) 633-9238 (606) 478-3784 (606) 666-5519 (606) 666-5500 (606) 666-7060 (270) 343-4443 (606) 832-2121 (606) 631-3327 (270) 388-7371 (270) 665-5192 (606) 358-2661 (859) 792-1697 (859) 792-4611 (859) 261-0605 (502) 839-4584 (270) 692-9115 (270) 692-4950 (270) 692-3111 (270) 259-8400 (270) 755-4831

2208 FT CAMPBELL BLVD 815 COUNTRY CLUB LN 3217 LAFAYETTE RD 130 HIGHWAY 80 22320 MAIN ST 22044 MAIN ST 6439 TAYLOR MILL RD 11745 MADISON PIKE ROUTE 40 EAST 38 OLD MIDDLEFORK 6500 HIGHWAY 645 SUITE 110 94 BOARD WALK 3171 BLACKLOG 275 COURT ST 905 RICHMOND RD 30 STACY LANE RD 1220 RICHMOND RD 223 RIVER DR 14020 E HIGHWAY 60 93 ISOM DR 160 CONN ST STE 2 265 KY HWY 15 S STE 2 95 JACKSON HTS 842 HIGHWAY 15 N 1417 N MAIN ST STE A 9500 HWY 805 9711 ST HIGHWAY 194 E 86 CEDAR ST 234 BROADWAY 77 MILLARD ALLEN DR E 208 STANFORD ST 330 W MAPLE AVE 3712 WINSTON AVE 90 PLAZA DR 125 W MAIN ST 498 W MAIN ST 325 W WALNUT ST STE 500 908 WALLACE AVE STE 105 328 N MAIN ST

HOPKINSVILLE HOPKINSVILLE HOPKINSVILLE HYDEN HYDEN HYDEN INDEPENDENCE INDEPENDENCE INEZ INEZ INEZ INEZ INEZ IRVINE IRVINE IRVINE IRVINE IRVINE IRVINGTON ISOM IVEL JACKSON JACKSON JACKSON JAMESTOWN JENKINS KIMPER KUTTAWA LACENTER LACKEY LANCASTER LANCASTER LATONIA LAWRENCEBURG LEBANON LEBANON LEBANON LEITCHFIELD LEWISBURG

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

42240-4665 42240-1346 42240-3815 41749-8501 41749-8571 41749-8568 41051-9343 41051-8637 41224 41224 41224 41224-7003 41224 40336-1077 40336-7230 40336-7356 40336-7232 40336-1142 40146-7166 41824-9011 41642-9406 41339 41339-6502 41339-8284 42629-2411 41537 41539-6232 42055-6287 42056 41643-9032 40444-1237 40444-1058 41015 40342-9056 40033-1236 40033-1362 40033-1379 42754-1479 42256-9213

BAPTIST HEALTH LEXINGTON RETAIL PHA BLUEGRASS PHCY OF LEXINGTON

(859) 639-3900 (859) 233-0731

1700 NICHOLASVILLE RD # N1210 395 ELAINE DR STE 110

LEXINGTON LEXINGTON

KY KY

40503 40504-2705

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 232 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

C&C PHARMACY CORNER PHARMACY LLC DELANEY PHARMACY LLC GENOA-QOL HEALTHCARE GRASSROOTS PHARMACY HEALTHFIRST BLUEGRASS PHARMACY HEALTHFIRST BLUEGRASS PHCY HUBBARD & CURRY PHARMACY INC

Provider Name

(859) 263-1220 (859) 309-1230 (859) 429-6944 (859) 554-4187 (859) 263-1382 (859) 288-2478 (859) 721-2551 (859) 278-8408

3122 MAPLELEAF DR 1701 ALEXANDRIA DR STE C 2573 RICHMOND RD STE 300 1351 NEWTOWN PIKE BLDG 5 2304 SIR BARTON WAY STE 195 1640 BRYAN STATION RD 496 SOUTHLAND DR 2387 PROFESSIONAL HEIGHTS DR

LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON

KY KY KY KY KY KY KY KY

40509-1240 40504-3149 40509-1710 40511-1282 40509-2284 40505-2144 40503-1827 40503-3004

LEXINGTON COMPOUNDING PHARMACY PASADENA PHARMACY, LLC PROFESSIONAL PHARMACY THE PHARMACY SHOP WHEELER PHARMACY CASEY COUNTY PHARMACY LLC GREEN RIVER PHARMACY POOLES PHARMACY CARE POOLES PHCY CARE HLTH SOLUTION

(859) 276-3905 (859) 260-2469 (859) 278-6449 (859) 278-7282 (859) 266-1131 (606) 787-0119 (606) 787-2100 (270) 278-5537 (270) 278-5252

399 WALLER AVE STE 110 280 PASADENA DR 3050 HARRODSBURG RD 450 SOUTHLAND DR STE A 336 ROMANY RD 430 N WALLACE WILKINSON BLVD 120 LIBERTY SQ 311 HENTON ST 104 E 4TH ST

LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LIBERTY LIBERTY LIVERMORE LIVERMORE

KY KY KY KY KY KY KY KY KY

40504-2910 40503-2925 40503-2747 40503-1831 40502-2404 42539-3018 42539-3392 42352-2126 42352-2154

LAUREL HEIGHTS NURSING HOME PMCY PLAZA DRUG OF LONDON PLAZA DRUG OF LONDON PLAZA DRUG SPECIALTY CARE REED FAMILY PHARMACY, LLC THOMPSON DISCOUNT DRUG THOMPSON DRUG DOWNTOWN THOMPSON DRUG SADDLEBROOK THOMPSON DRUG SOUTH LOUISA DRUG STORE RITE VALUE PHARMACY RIVERVIEW PHARMACY AMERIMED INC API PHARMACY AUDUBON PHARMACY COMPOUND CARE PHARMACY DIXIE PHARMACY EAST BROADWAY PHARMACY EFILL RX EFILLRX LLC ELIPS SCRIPTS FAMILY HEALTH CENTERS BROADWAY GENOA-QOL HEALTHCARE

(606) 878-0761 (606) 657-5245 (606) 657-5245 (606) 864-4445 (606) 330-0302 (606) 878-7713 (606) 877-1008 (606) 862-6261 (606) 864-6324 (606) 638-4155 (606) 638-9627 (606) 638-9218 (502) 585-7677 (866) 409-4419 (502) 371-1002 (502) 244-6500 (502) 812-1920 (502) 589-1828 (502) 259-5050 (502) 568-8830 (502) 200-7246 (502) 772-8625 (502) 694-6623

208 W 12TH ST 731 N LAUREL RD 731 N LAUREL RD 707 N LAUREL RD 272 LONDON MTN VIEW DR STE 2 810 E 4TH ST 803 MEYERS BAKER RD STE 110 575 W LAUREL RD 975 S LAUREL RD STE A 408 N LOCK AVE 2673 HIGHWAY 644 STE 1 201 S WATER ST 5000 COMMERCE CROSSINGS DR STE 645 ROY WILKINS AVE 3503 POPLAR LEVEL RD 12121 SHELBYVILLE RD STE 107 8442 DIXIE HWY STE 100 2304 HURSTBOURNE VILLAGE DR 6400 DUTCHMANS PKWY STE 140 100 E LIBERTY ST STE 700 RM A 4205 SPRINGHURST BLVD STE 101 834 E BROADWAY 708 MAGAZINE ST RM 101

LONDON LONDON LONDON LONDON LONDON LONDON LONDON LONDON LONDON LOUISA LOUISA LOUISA LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40741-1101 40741-6025 40741-6025 40741-6025 40741 40741-1428 40741-3041 40741-8208 40744-7862 41230-1115 41230-5922 41230-1387 40229-3167 40203-2072 40213 40243-1094 40258-1140 40299-1853 40205-3342 40202-1439 40241-6159 40204 40203-2043

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Provider Phone Number

Provider Street

Page 233 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE HUME PHARMACY LIFECARE PHARMACY LIFECARE PHARMACY LOUISVILLE PHARMACY MY PHARMACY NEW VITALIS PHARMACY

Provider Name

(502) 774-8299 (502) 448-2007 (502) 267-7453 (502) 912-8966 (502) 709-5532 (502) 894-4464 (502) 277-1425 (502) 890-2030

2225 W BROADWAY FL 1 2105 CRUMS LN 10101 TAYLORSVILLE RD 1502 S 7TH ST 1169 EASTERN PKWY STE 1110 4014 DUTCHMANS LANE 6470 N PRESTON HWY STE 1 4139 CADILLAC CT STE 201

LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE

KY KY KY KY KY KY KY KY

40211-1003 40216-4231 40299-3662 40208-1711 40217-1462 40207 40229-5407 40213-1578

NORTON HEALTHCARE PHCY BROWNSBORO NORTON HLTCRE PHCY ST MATTHEWS NORTON OUTPATIENT PHARMACY NORTON PHARMACY AUDUBON NORTON SPECIALTY PHARMACY ONCO360 OPTION CARE PCA PHARMACY PHARMACY PLUS PHARMACY PLUS PHARMACY PLUS SPECIALTY RX ADVANTAGE 001 RX ALTERNATIVES RX CROSSROADS ST. MATTHEWS COMMUNITY PHCY THE VILLAGE PHARMACY TPI PHARMACY U OF L HOSP AMBULATORY CARE PH UOFL HOSP FACULTY PRACTICE BL VALUMARKET PHARMACY WISH'S DRUG LUDLOW PHARMACY BLUEGRASS PHARMACY DON PEELER PHARMACY HOMETOWN RX KING DRUG AND HOME CARE MADISONVILLE PHARMACY CLAY COMMUNITY PHARMACY CLAY DISCOUNT PHARMACY FAMILY DRUG CENTER FAMILY DRUG CENTER H & N DRUG INC HOMETOWN PHARMACY

(502) 629-3899 (502) 629-3899 (502) 629-3800 (502) 636-8790 (502) 636-8088 (877) 662-6633 (502) 266-0123 (502) 266-2558 (502) 561-3905 (502) 363-3791 (502) 561-3900 (502) 368-9591 (502) 267-1977 (502) 515-7770 (502) 690-4462 (502) 596-1232 (502) 423-7246 (502) 562-3571 (502) 813-6100 (502) 231-2424 (502) 425-1146 (859) 261-2210 (270) 825-2775 (270) 821-5440 (270) 821-8500 (270) 821-4999 (270) 824-2261 (606) 599-0209 (606) 598-0330 (606) 598-6736 (606) 598-8831 (606) 598-5025 (606) 598-6337

4960 NORTON HEALTHCARE BLVD 4001 DUTCHMANS LN 200 E CHESTNUT STE 200 1 AUDUBON PLAZA DR 4001 DUTCHMANS LN 1901 CAMPUS PL STE 100 11403 BLUEGRASS PKWY STE 400 2701 CHESTNUT STATION CT 220 ABRAHAM FLEXNER WAY 1850 BLUEGRASS AVE 5111 COMMERCE CROSSINGS DR # 1 4402 CHURCHMAN AVE STE 404 9612 TAYLORSVILLE RD STE 1F 4500 PROGRESS BLVD 3922 WILLIS AVE 1100 EAST MARKET STREET 252 WHITTINGTON PKWY 530 S JACKSON ST 401 E CHESTNUT ST STE 180 7519 OUTER LOOP 9615 WHIPPS MILL RD 130 ELM ST 1128 N MAIN ST 127 E NORTH ST 728 S MAIN ST 444 S MAIN ST 200 CLINIC DR STE 101 118 CLAY CO S/C 2734 S HIGHWAY 421 214 BRIDGE ST 110 MANCHESTER SHOPPING CTR 515 MEMORIAL DR STE 2 397 OLD US HIGHWAY 421

LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LOUISVILLE LUDLOW MADISONVILLE MADISONVILLE MADISONVILLE MADISONVILLE MADISONVILLE MANCHESTER MANCHESTER MANCHESTER MANCHESTER MANCHESTER MANCHESTER

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40241-2831 40207-4714 40202-1831 40217-1318 40207 40299-2308 40299-2398 40299 40202-3826 40215-1161 40229-2191 40215-3102 40299-2756 40218-3420 40207-4911 40206 40222-4904 40202-1675 40202-5700 40228-1726 40242-3644 41016 42431-1265 42431-1628 42431-3069 42431-2871 42431 40962 40962-7515 40962-1204 40962-1401 40962-6197 40962-7538

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Provider Phone Number

Provider Street

Page 234 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

MANCHESTER DOWN HOME PHARMACY MORGAN'S PROFESSIONAL PHARMACY THOMPSON DRUG BURNING SPRINGS GLENNS APOTHECARY KB PHARMACY MEDICINE MARKET PHARMACY MED-SAVE MARTIN TOTAL PHARMACY CARE DUNCAN CLINIC PHARMACY DUNCAN PRESCRIPTION CENTER DUNCAN SPECIALTY PHARMACY GIBSON PHARMACY GIBSON'S PHARMACY STONES HEALTH MART PHCY MASON FAMILY DRUG MAYSVILLE OB GYN FAM HLTH CTR PH MCDOWELL PROFESSIONAL PHARMACY WHITE HOUSE CLINIC PHARMACY HOMETOWN PHARMACY FAMILY DISCOUNT DRUGS FOOD CITY PHARMACY FOUNTAIN SQUARE PHARMACY JEFF'S PHARMACY MIDDLESBORO ARH PHARMACY PEOPLES CHOICE PHARMACY RX DISCOUNT

(606) 599-3500 (606) 599-5555 (606) 599-8891 (270) 965-4101 (270) 967-9007 (606) 285-9280 (606) 949-1349 (606) 949-1555 (270) 247-7000 (270) 247-3345 (270) 247-3725 (270) 247-7300 (270) 247-1055 (270) 247-3232 (606) 759-0700 (606) 759-1189 (606) 377-1088 (606) 287-7104 (606) 287-3200 (606) 248-8900 (606) 248-7689 (606) 248-1052 (606) 248-0171 (606) 242-1166 (606) 246-2001 (606) 248-9330

500 RICHMOND RD 280 RICHMOND RD 11901 N HWY 421 520 W GUM STREET 320 S MAIN ST 10870 MAIN ST 45 STEPHENS BRANCH RD 1102 KENTUCKY ROUTE 122 1111 MEDICAL CENTER CIR 315 W BROADWAY ST 317 W BROADWAY 715 E BROADWAY ST 1206 PARIS RD 414 S 9TH ST 912 KENTON STATION DRIVE 927 KENTON STATION DR 9549 KY ROUTE 122 1010 MAIN ST S 581 MAIN ST N 3603 CUMBERLAND AVE 102 N 12TH ST 1928 CUMBERLAND AVE 120 E LOTHBURY AVE 3600 CUMBERLAND AVE 3004 CUMBERLAND AVE STE 101 1841 N 25TH ST

MANCHESTER MANCHESTER MANCHESTER MARION MARION MARTIN MARTIN MARTIN MAYFIELD MAYFIELD MAYFIELD MAYFIELD MAYFIELD MAYFIELD MAYSVILLE MAYSVILLE MC DOWELL MC KEE MCKEE MIDDLESBORO MIDDLESBORO MIDDLESBORO MIDDLESBORO MIDDLESBORO MIDDLESBORO MIDDLESBORO

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40962-1294 40962-1209 40962-4859 42064 42064-1513 41649-7999 41649 41649 42066-1194 42066-2231 42066 42066-2425 42066-4989 42066-2610 41056 41056-9609 41647 40447-7089 40447 40965-2613 40965-1028 40965-1231 40965-2846 40965-2614 40965-2343 40965-1853

RR DRUG & OLD TIME SODA FOUNTAIN PARKVIEW PHARMACY INC F & H DRUGS SILVERS HOMETOWN PHARMACY SOUTH CREEK DRUG SOUTH CREEK DRUG CAVE RUN PHARMACY HOLBROOK DRUG ST CLAIRE MED CNTR INC-RET PHCY TOTAL CARE PHARMACY CLEMENTS PHARMACY FREDS PHARMACY KING DRUG AND HOME CARE CAMARGO PHARMACY

(859) 846-4146 (606) 377-2117 (606) 348-9263 (606) 343-0101 (606) 348-1800 (270) 566-1074 (606) 783-1511 (606) 784-4784 (606) 780-5400 (606) 784-4491 (270) 389-2440 (270) 526-3332 (270) 526-6980 (859) 497-0009

115 E MAIN ST 8274 KY ROUTE 122 70 N MAIN ST 1251 W COLUMBIA AVE 1 S CREEK DR 1 SOUTH CREEK DR 425 CLINIC DR 208 E MAIN ST 222 MEDICAL CIRCLE 206 W MAIN ST 225 N MORGAN ST 211 S MAIN ST 255 W G L SMITH ST 3404 CAMARGO RD

MIDWAY MINNIE MONTICELLO MONTICELLO MONTICELLO MONTICELLO MOREHEAD MOREHEAD MOREHEAD MOREHEAD MORGANFIELD MORGANTOWN MORGANTOWN MOUNT STERLING

KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40347-5024 41651-9008 42633-1495 42633 42633-9472 42633-9472 40351-1077 40351-1620 40351 40351-1769 42437-1411 42261-7270 42261-8602 40353

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CARRINGTON DRUG DIRECT MEDS OF KENTUCKY NORTHVIEW PHARMACY ROSS DRUGS WHITAKER PHARMACY MT VERNON DRUG INC MT VERNON WHITE HOUSE PHCY ROCKCASTLE PROFESSIONAL PHCY VALUMARKET UPPER LEVISA CLINIC PHARMACY INC CLARK DRUGS JANE'S PHARMACY MEDICAL ARTS PHARMACY MURRAY CALLOWAY CO HOSP RX WALTER'S FAMILY PHARMACY FAMILY DRUG OF NEON CLUBB PHARMACY, INC NEWPORT DRUG CENTER THE PRESCRIPTION PAD NORTONVILLE PHARMACY MEDICINE CABINET PHARMACY OWEN DRUG CO MED SHOPPE DANHAUER DRUGS EMORY CENTRE PHARMACY KING DRUG & HOME CARE LINCOLN PHARMACY INC NATION'S MEDICINES NATION'S MEDICINES NATION'S MEDICINES

Provider Name

(859) 498-3464 (859) 520-3220 (859) 498-7700 (859) 498-1004 (859) 498-3141 (606) 256-3447 (606) 256-2143 (606) 256-4613 (502) 538-6649 (606) 835-4991 (270) 524-3669 (615) 525-3142 (270) 753-2011 (270) 762-1394 (270) 753-7688 (606) 855-4428 (502) 845-2345 (859) 291-2578 (859) 887-2841 (270) 676-8268 (606) 286-2035 (606) 286-2225 (270) 684-2341 (270) 684-0649 (270) 683-7010 (270) 684-7278 (270) 685-0557 (270) 926-4080 (270) 685-4931

506 MAYSVILLE RD 146 SKYVIEW DR 638 NORTHVIEW DR 125 FOXGLOVE DR 644 MAYSVILLE RD STE 2 410 RICHMOND ST 116 PROGRESS DR 110 NEWCOMB AVE 205 OAKBROOKE DR 137 N LEVISA RD 232 MAIN ST 950 MAIN ST., SUITE 100 300 S 8TH ST 803 POPLAR ST 604 S 12TH ST 972 HIGHWAY 317 13 N MAIN ST 39 W 10TH ST 465 KEENE CENTRE DR 102 GREENVILLE RD 230 STATE HIGHWAY 2 136 JESSICA LANE STE E 330 FREDERICA ST 527 EMORY DR 1156 CARTER RD 2816 VEACH RD 415 CARTER RD 3000 ALVEY PARK DR W 3030 BURLEW BLVD

MOUNT STERLING MOUNT STERLING MOUNT STERLING MOUNT STERLING MOUNT STERLING MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT WASHINGTON MOUTHCARD MUNFORDVILLE MUNFORDVILLE MURRAY MURRAY MURRAY NEON NEW CASTLE NEWPORT NICHOLASVILLE NORTONVILLE OLIVE HILL OLIVE HILL OWENSBORO OWENSBORO OWENSBORO OWENSBORO OWENSBORO OWENSBORO OWENSBORO

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

40353-9317 40353-1496 40353-9794 40353-9735 40353-9464 40456-2715 40456 40456-2728 40047-7688 41548-8116 42765 42765-9435 42071-2400 42071-2432 42071-2916 41840-9089 40050-2538 41071 40356-1492 42442 41164-8670 41164 42301-3005 42301-6186 42301-2644 42303-6295 42301-0216 42303-4099 42303-6486

OWENSBORO FAMILY PHCY AND WELLNESS

(270) 683-2400

720 W BYERS AVE

OWENSBORO

KY

42303-6330

OWENSBORO HEALTH OUTPATIENT PHCY POOLE'S PHARMACY CARE WILSON FAMILY PHARMACY INC CULL FAMILY PHARMACY BATH HOMETOWN PHARMACY FAMILY DISCOUNT DRUG OWINGSVILLE DRUG STORE DAVIS DRUGS DAVIS DRUGS LONE OAK G & O PHARMACY

(270) 417-6701 (270) 926-6260 (270) 688-0100 (502) 484-3046 (606) 674-2423 (606) 674-6979 (606) 674-6334 (270) 443-1442 (270) 554-5099 (270) 442-3571

1301 PLEASANT VALLY RD STE 104 2200 E PARRISH AVE STE 102 2315 MAYFAIR DR STE 25 965 HIGHWAY 127 N 19 MILLER DR 60 SLATE AVE 53 MILLER DR 250 LONE OAK RD 2855 LONE OAK RD 2338 BROADWAY ST

OWENSBORO OWENSBORO OWENSBORO OWENTON OWINGSVILLE OWINGSVILLE OWINGSVILLE PADUCAH PADUCAH PADUCAH

KY KY KY KY KY KY KY KY KY KY

42303 42303-1450 42301-4557 40359-9302 40360-2212 40360-2201 40360-2212 42001-4400 42003-8041 42001-7114

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Provider Phone Number

Provider Street

Page 236 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name KATTERJOHN DRUG STORE KELLY RAFF ANUNCIATO DO PSC KENTUCKYCARE PHARMACY 62 LAKEVIEW PHARMACY LONE OAK PHARMACY NPS PHARMACY ONCOLOGY ASSOCIATES OF WEST KY OPTION CARE PADUCAH PHARMACY REIDLAND PHARMACY, INC RICKS PHARMACY INC STRAWBERRY HILLS PHARMACY W KY HEMA & ONC GROUP WEST TOWNE PHARMACY BROADWAY CLINIC PHARMACY FOOD CITY PHARMACY HIGHLANDS MEDICAL OFFICE PHCY MED EXPRESS PHARMACY MOUNTAIN APOTHECARY VALUE-MED PHARMACY MEDICINE STOP PHARMACY CITIZENS DRUG COMMONWEALTH PHARMACY ECONOMY DRUG COMPANY INC FAITH PHARMACY FAMILY DRUG CENTER FOOD CITY PHARMACY FOOD CITY PHARMACY JOHNS CREEK DRUG CENTER NOVA PHARMACY PIKEVILLE DISCOUNT DRUG INC PROFESSIONAL PHARMACY TOTAL PHARMACY CARE VALLEY DISCOUNT PHARMACY DAUGHERTYS DRUG STORE INC TAYLOR DRUG STORE TAYLORS DISCOUNT PHARMACY TOTAL CARE PHARMACY MEDICAL CENTER PHARMACY, INC ARCHER CLINIC PHARMACY FOOD CITY PHARMACY MEDICAL CENTER PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (270) 442-2990 (270) 444-6274 (270) 408-1584 (270) 408-3784 (270) 554-7944 (270) 933-1960 (270) 444-3930 (800) 511-0063 (270) 441-4390 (270) 898-7313 (270) 443-7200 (270) 444-7070 (270) 441-4489 (270) 443-0909 (606) 789-9988 (606) 789-7116 (606) 789-3670 (606) 789-1444 (606) 789-6150 (606) 789-5995 (859) 987-4023 (606) 456-3446 (606) 437-0701 (606) 437-7333 (606) 509-6337 (606) 432-5588 (606) 437-9209 (606) 432-2044 (606) 631-9137 (606) 432-2274 (606) 432-0018 (606) 432-0196 (606) 433-0555 (606) 639-2415 (606) 354-2222 (606) 337-8300 (606) 337-1444 (606) 337-4133 (270) 338-9993 (606) 886-1202 (606) 889-9572 (606) 886-7685

Provider Street 1100 CALDWELL ST 2605 KENTUCKY AVE #502 BLDG 3 1901 KENTUCKY AVE 67 LAKEVIEW DR. SUITE 102 3535 LONE OAK RD 619 N 30TH ST 2603 KENTUCKY AVE STE 403 3487 PARK AVE 225 MEDICAL CENTER DR STE 100 5433 REIDLAND RD 3001 SCHNEIDMAN RD 2700 NEW HOLT RD STE D 225 MEDICAL CENTER DR STE 301 2755 W PARK DR 515 BROADWAY ST 330 N MAYO TRL 520 N MAYO TRL 212 S MAYO TRL 834 S MAYO TRL 209B N MAYO TRL 1339 MAIN ST 13380 PHELPS 632 RD 5425 N MAYO TRL STE 102 180 TOWN MOUNTAIN RD STE 115 140 ADAMS LN STE 500 284 TOWN MOUNTAIN RD 215 CASSIDY BLVD 2138 S MAYO TRL 6162 ZEBULON HWY 1330 S MAYO TRL STE 102 994 S MAYO TRL 419 TOWN MOUNTAIN RD STE 101 533 HAMBLEY BLVD 6758 US HIGHWAY 23 S STE 7 4160 S HIGHWAY 27 308 S PINE ST 528 W TENNESSEE AVE 121 VIRGINIA AVE 1010 MEDICAL CENTER DR 400 UNIVERSITY DR STE 100 429 UNIVERSITY DR 5000 KY ROUTE 321

Page 237 of 679

Provider City PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PADUCAH PAINTSVILLE PAINTSVILLE PAINTSVILLE PAINTSVILLE PAINTSVILLE PAINTSVILLE PARIS PHELPS PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PIKEVILLE PINE KNOT PINEVILLE PINEVILLE PINEVILLE POWDERLY PRESTONSBURG PRESTONSBURG PRESTONSBURG

State

ZIP code

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

42003-2080 42003 42003 42001 42003 42001-4047 42003 42001-9150 42003-7914 42003-0954 42003-3541 42001-6524 42003-7915 42001-9058 41240-1391 41240-1804 41240-1811 41240-1330 41240-1384 41240-1803 40361-1715 41553-8603 41501-2904 41501-1607 41501-1480 41501-1611 41501-1426 41501-2296 41501-3529 41501-2321 41501-1534 41501-1632 41501-3709 41501-3724 42635-9227 40977-1735 40977-1437 40977 42367-5463 41653-1080 41653-1071 41653-9113

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MEDZONE PHARMACY TOTAL PHARMACY CARE #3 VALUE MED PHARMACY INC PRINCETON DRUG INC PRINCETON DRUG INCORPORATED PROSPECT PHARMACY THRIFTY PHARMACY APOTHECARE PHARMACY III RADCLIFF RADCLIFF PHARMACY LLC SAVE RITE DRUGS RADCLIFF BAPTIST HLTH RICHMOND PROF PHCY BLUE GRASS FAMILY PHARMACY GENOA-QOL HEALTHCARE MADISON DRUG MCCAYS TOTAL PHARMACY RICHMOND DRUG RICHMOND WHITE HOUSE CLIN PHCY THE MEDICINE SHOPPE LAKE CUMBERLAND PHARMACY #2 LAKE CUMBERLAND PHARMACY, LLC RUSSELL SPRINGS PHARMACY RILEY-WHITE DRUGS WHITLEYS PHARMACY YATES PHARMACY SACRAMENTO PHARMACY CLINIC PHARMACY GLENN'S PRESCRIPTION CENTER CLINIC PHARMACY PARKWAY PHARMACY PRATER DRUG INC TRI-COUNTY PHARMACY HEALTHY WAY PHARMACY SCIENCE HILL DRUG CARPENTER DENT DRUGS PHARMACY ARTS STOVALL'S PRESCRIPTION SHOP VICCO PRESCRIPTION CENTER BELL'S DRUGS STORE ANDREWS PHARMACY SHELBYVILLE PHARMACY B&B PHARMACY SMITHLAND DRUGS

NR_0009_10823 10/2017

Provider Phone Number (606) 889-9003 (606) 889-8570 (606) 886-3030 (270) 365-5585 (270) 365-5585 (502) 785-3000 (270) 667-2049 (270) 352-0303 (270) 351-7400 (270) 351-3784 (859) 626-0076 (859) 624-9797 (859) 353-6277 (859) 624-1565 (859) 623-4216 (859) 972-5000 (859) 626-7700 (859) 623-8900 (270) 866-2686 (270) 858-6400 (270) 866-2778 (270) 726-7626 (270) 726-9592 (270) 726-8451 (270) 736-2999 (270) 988-3230 (270) 988-3226 (606) 349-1700 (606) 349-4400 (606) 349-3136 (606) 349-6135 (606) 738-4041 (606) 423-9959 (270) 237-4446 (270) 618-4444 (270) 237-5402 (606) 476-2333 (270) 835-7544 (502) 633-5573 (502) 437-3008 (502) 543-8200 (270) 928-2552

Provider Street 5291 KENTUCKY ROUTE 321 4845 KY ROUTE 321 334 NORTH LAKE DRIVE 103 W MAIN ST 103 W MAIN ST 9549-B US HIGHWAY 42 127 E MAIN ST 189 E LINCOLN TRAIL BLVD 800 W LINCOLN TRAIL BLVD 990 S DIXIE BLVD STE 6 793 EASTERN BYPASS STE G1 2187 LEXINGTON RD STE 1 415 GIBSON LN STE P 110 BIG HILL AVE 260 BOGGS LN 1071 BEREA RD 401 HIGHLAND PARK DR 238 E MAIN ST 124 DOWELL RD 2431-C LAKEWAY DR 92 JOE T PETTY DR 153 NW PARK SQ 501 N MAIN ST 432 HOPKINSVILLE RD 750 MAIN ST 141 HOSPITAL DR 119 E MAIN 789 PARKWAY DR 100 BRENNA BLVD STE 100 200 CHURCH ST 441 PARKWAY DR 432 S KY 7 5775 N HIGHWAY 27 STE 10 1088 VETERANS MEMORIAL HWY 31 BURNLEY RD 202 S COURT ST 10897 S HIGHWAY 15 7107 STATE ROUTE 56 E 1545 MIDLAND TRL STE 1 182 FRANKFORT RD 1578 HIGHWAY 44 E UNIT 1 203 E ADAIR ST

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Provider City PRESTONSBURG PRESTONSBURG PRESTONSBURG PRINCETON PRINCETON PROSPECT PROVIDENCE RADCLIFF RADCLIFF RADCLIFF RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RUSSELL SPRINGS RUSSELL SPRINGS RUSSELL SPRINGS RUSSELLVILLE RUSSELLVILLE RUSSELLVILLE SACRAMENTO SALEM SALEM SALYERSVILLE SALYERSVILLE SALYERSVILLE SALYERSVILLE SANDY HOOK SCIENCE HILL SCOTTSVILLE SCOTTSVILLE SCOTTSVILLE SCUDDY SEBREE SHELBYVILLE SHELBYVILLE SHEPHERDSVILLE SMITHLAND

State

ZIP code

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

41653 41653-9113 41653 42445-1546 42445-1546 40059 42450-1268 40160-1253 40160 40160-1226 40475 40475-7919 40475-2577 40475 40475-2591 40475-3401 40475-3839 40475-1628 42642 42642-4510 42642-8544 42276-1335 42276-1636 42276 42372-9405 42078-8043 42078-9998 41465-9740 41465 41465-0000 41465-9247 41171-8132 42553-9140 42164 42164-6357 42164-1263 41760-9033 42455-2136 40065-1634 40065-9433 40165-7172 42081

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SMITHS GROVE RX SHOP CENTURY MEDICINES GAP DRUG OAKWOOD PHARMACY OPTION CARE

Provider Name

(270) 563-2180 (606) 677-0073 (606) 425-4234 (606) 677-4068 (888) 568-1316

124 N MAIN STREET 875 S HIGHWAY 27 5410 S HWY 27 2441 S HIGHWAY 27 83 BOGLE OFFICE PARK DR # 400

SMITHS GROVE SOMERSET SOMERSET SOMERSET SOMERSET

KY KY KY KY KY

42171 42501-3512 42501-6063 42501-2935 42503-2810

PROFESSIONAL PHARMACY OF SOMERSET SAV-RITE PHARMACY SOUTH SOMERSET PHARMACY THE MEDICINE SHOPPE WEST SOMERSET PHARMACY INC SOUTH DIXIE PHARMACY MCDONALD PHARMACY

(606) 679-1169 (606) 802-2636 (606) 679-1571 (859) 679-9227 (606) 677-1922 (270) 949-3494 (606) 932-3614

342 BOGLE ST 5418 S HIGHWAY 27 101 S MAIN ST 900 E MOUNT VERNON ST 647 W HIGHWAY 80 12134 S DIXIE HWY 437 JAMES E HANNAH DR

SOMERSET SOMERSET SOMERSET SOMERSET SOMERSET SONORA SOUTH SHORE

KY KY KY KY KY KY KY

42503-2851 42501-6063 42501-2005 42501-1228 42503-2897 42776 41175

SOUTH SHORE FAMILY HLTH CNTR PHCY THE WRIGHT PHARMACY INC FAMILY PHARMACY FOOD CITY PHARMACY PRESCRIPTION DIVISION FREDS PHARMACY MEDICA PHARMACY BAKER'S PHARMACY COLEMANS DRUG STORE STANFORD DRUG BILLINGS DRUG STANTON DRUGS CORNER DRUG STORE OF STURGIS LLC STURGIS PHARMACY WT FROMAN DRUG CO YOUR HOMETOWN PHARMACY TOLLESBORO CLINIC PHARMACY BUSHONG FAMILY PHARMACY HARRISON PHARMACY INC TOMPKINSVILLE DRUG LEWIS COUNTY PRIMARY CARE CENTER OSMAN PHARMACY PROFESSIONAL CARE PHARMACY CORNERSTONE PHARMACY VERSAILLES INDEPENDENT PHCY WOODFORD FAMILY PHARMACY APOTHECARE PHARMACY VINE GROVE WALTON PHARMACY

(606) 932-2138 (606) 932-2202 (606) 237-7430 (606) 237-1175 (606) 237-1735 (859) 336-3078 (859) 481-7100 (502) 535-4466 (606) 365-2164 (606) 365-2100 (606) 663-2848 (606) 663-8990 (270) 333-5341 (270) 333-4672 (502) 477-2267 (502) 477-1973 (606) 798-2072 (270) 407-5045 (270) 487-6408 (270) 487-6155 (606) 796-2686 (606) 796-2932 (606) 796-6100 (859) 873-3007 (859) 879-0199 (859) 879-3784 (270) 877-5111 (859) 485-7733

142 DEPOT DRIVE 82 BIGGS LN 412 CENTRAL AVE 28093 US HIGHWAY 119 306 HOSPITAL DR STE 105A 1117 LINCOLN PARK RD 100 W DEPOT ST 3399 MAIN ST 105 W MAIN ST 107 METKER TRL STE D 163 E COLLEGE AVE # 37 638 E COLLEGE AVE 424 N ADAMS ST 523 N ADAMS ST 847 TAYLORSVILLE RD 913 TAYLORSVILLE RD 17521 W KY 9 709 N MAIN ST 606 N MAIN ST 200 N CRAWFORD ST 211 KY 59 89 SECOND ST 207 PLUMMERS LN 100 S MAIN ST 166 FRANKFORT ST 453 LEXINGTON RD 107 CRUTCHER ST 305 MARY GRUBBS HWY

SOUTH SHORE SOUTH SHORE SOUTH WILLIAMSON SOUTH WILLIAMSON SOUTH WILLIAMSON SPRINGFIELD SPRINGFIELD STAMPING GROUND STANFORD STANFORD STANTON STANTON STURGIS STURGIS TAYLORSVILLE TAYLORSVILLE TOLLESBORO TOMPKINSVILLE TOMPKINSVILLE TOMPKINSVILLE VANCEBURG VANCEBURG VANCEBURG VERSAILLES VERSAILLES VERSAILLES VINE GROVE WALTON

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

41175 41175-7846 41503-4121 41503-3915 41503-4023 40069 40069-1190 40379-9657 40484-1253 40484-1049 40380-2358 40380-2363 42459-1611 42459-1413 40071-9771 40071-8713 41189-8243 42167-1129 42167-1128 42167-1617 41179-7647 41179-5439 41179-7683 40383-1214 40383-1164 40383 40175-1409 41094-7483

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 239 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WARFIELD PRESCRIPTION CENTER BERINGER DRUG CENTER ARH FAMILY HEALTH PHARMACY CLINIC PHARMACY MORGAN COUNTY ARH PHARMACY PEYTONS PHARMACY INC KYVA PHARMACY PARKWAY PHARMACY WHITESBURG ARH PHARMACY WHITESBURG MED CTR PHARMACY WHITESVILLE DRUG STORE BURGESS DRUG STORE INC HOMETOWN PHARMACY WYNN EXPRESS PHARMACY WICKLIFFE PHARMACY INC CORNER PRESCRIPTION SHOPPE KIMS HOMETOWN PHARMACY MAIDEN DRUG COMPANY RICKETTS PHARMACY WHITLEY PHARMACY WINDHAM DRUG

Provider Name

(606) 395-6477 (859) 567-4601 (606) 743-7842 (606) 743-4957 (606) 743-7730 (606) 743-3163 (606) 633-4488 (606) 633-4435 (606) 633-3500 (606) 633-4871 (270) 233-4166 (606) 376-5043 (606) 376-3300 (606) 376-1535 (270) 335-3172 (606) 549-0884 (606) 549-8700 (606) 549-0449 (606) 515-6134 (606) 549-4300 (606) 549-3636

9251 BEAUTY RD 102 W MAIN ST 1084 HIGHWAY 7 STE 3 412 LIBERTY RD 476 LIBERTY RD 414 MAIN ST 109 E MAIN ST 2354 HIGHWAY 15 550 JENKINS RD 226 MEDICAL PLAZA LANE 10053 MAIN ST 19 MEDICAL LOOP STE 2 66 CENTER AVENUE 43 MEDICAL LANE 409 COURT STREET 401 SYCAMORE ST 865 US HIWY 25 W 327 MAIN ST 486 N HIGHWAY 25 W 475 N HIGHWAY 25 W 1605 S HIGHWAY 25 W

WARFIELD WARSAW WEST LIBERTY WEST LIBERTY WEST LIBERTY WEST LIBERTY WHITESBURG WHITESBURG WHITESBURG WHITESBURG WHITESVILLE WHITLEY CITY WHITLEY CITY WHITLEY CITY WICKLIFFE WILLIAMSBURG WILLIAMSBURG WILLIAMSBURG WILLIAMSBURG WILLIAMSBURG WILLIAMSBURG

KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY KY

41267 41095-9300 41472-7146 41472-2049 41472-2049 41472-1014 41858-7351 41858-7413 41858-7606 41858 42378-9741 42653-4129 42653 42653-4216 42087-0000 40769-1136 40769 40769-1123 40769 40769-1576 40769-1610

GRANT COUNTY DRUGS WILLIAMSTOW SIMS DRUG CLARK COUNTY PHARMACY HCA PHARMACY & MED EQUIPMENT CASHWAY PHARMACY OF ABBEVILLE MULA FAMILY PHARMACY & GIFTS

(859) 824-4239 (859) 858-2453 (859) 744-3350 (859) 745-4445 (337) 893-2131 (337) 385-1250

302 BARNES RD 319 E MAIN ST 1520B BOONESBORO RD 1113 W LEXINGTON AVE 2509 CHARITY ST 2619 CHARITY ST

WILLIAMSTOWN WILMORE WINCHESTER WINCHESTER ABBEVILLE ABBEVILLE

KY KY KY KY LA LA

41097-9483 40390-1365 40391-8816 40391-1169 70510-4022 70510

THRIFTY WAY PHARMACY OF ABBEVILLE ALBANY DRUGS JOHNS PHARMACY SOUTHEAST CHS PHARMACY ALBERTSON'S PHARMACY HEMATOLOGY ONCOLOGY LIFE CTR RAYS APOTHECARY PHARMACY RAY'S PHARMACY RHODES PEDIATRIC CLINIC #6764 SENTRY DRUGS SUPER 1 PHARMACY THE PILL BOX THE PILL BOX

(337) 893-6304 (225) 567-7772 (225) 567-1921 (225) 306-2087 (318) 442-5364 (318) 442-2232 (318) 448-6541 (318) 619-7772 (318) 443-9655 (318) 442-4475 (318) 442-5710 (318) 787-2788 (318) 448-2445

2640 NORTH DRIVE 19089 FLORIDA BLVD 29644 S MONTPELIER RD STE A 30575 OLD BATON ROUGE HIGHWAY 2265 S MACARTHUR DR 605 MEDICAL CENTER DR 3311 PRESCOTT RD STE 110 78A VERSAILLES BLVD 37 CALVERT DRIVE 1002 3RD ST 604 MACARTHUR DR 3311 THIRD ST 4740 JACKSON STREET EXT

ABBEVILLE ALBANY ALBANY ALBANY ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA

LA LA LA LA LA LA LA LA LA LA LA LA LA

70510 70711 70711-3903 70711 71301-3052 71301 71301-3917 71303 71303 71301-8343 71303-3111 71302-5704 71303-2505

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 240 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE PILL BOX PHARMACY THRIFT-TOWN PHARMACY C AND C PHARMACY LLC NEW ARCADIA HEALTHMART HARDY'S DRUG STORE INC THRIFTYWAY PHCY OF ARNAUDVILLE FRANCISE PHARMACY BALDWIN DRUGS RAY'S HEALTHMART PHARMACY THRIFTY WAY PHARMACY OF BASILE LEE'S CITY DRUGS SUPER 1 PHARMACY WHIT'S PHARMACY AFFORDABLE PHARMACY 1002 AFFORDABLE PHARMACY LLC AHF PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BOCAGE PHARMACY CENTRE BOLTON HEALTH MART BORDELONS SUPER SAVE PHARMACY BRENT'S PHARMACY BROWN'S PHARMACY CENTRAL DRUG STORE INC FAMILY HLTH MART PHCY & GIFTS GENOA-QOL HEALTHCARE HEMATOLOGY ONCOLOGY CLINIC LAGNIAPPE PHARMACY LG PHARMACY

Provider Name

(318) 528-8765 (985) 748-8191 (504) 279-0446 (318) 263-2919 (337) 754-5231 (337) 754-7481 (225) 774-2795 (337) 923-4682 (318) 640-1174 (337) 432-6642 (318) 281-1344 (318) 283-0082 (318) 281-2305 (225) 655-6337 (225) 284-2825 (225) 231-5737 (225) 216-2309 (225) 924-6094 (225) 769-6084 (225) 768-7775 (225) 926-9604 (225) 753-0805 (225) 751-4415 (225) 364-2847 (225) 343-4869 (225) 356-0253 (225) 332-0511 (225) 650-2077 (225) 262-6200 (225) 636-5229 (225) 362-5342 (225) 761-3916 (225) 367-6488 (225) 927-9972

403 BOLTON AVE 512 N 2ND ST 7540 W JUDGE PEREZ DR 1982 N RAILROAD AVE 123 FUSELIER RD 412 OLIVE STREET 14620 PLANK ROAD 702 MAIN 5822 MONROE HWY 3131 STAGG AVE 123 W MADISON AVE 1714 E MADISON AVE 107 E MADISON AVE 1707 GARDERE STE F 1718 N FOSTER DR STE B 4890 BLUEBONNET BLVD 4857 GOVERNMENT ST 2950 COLLEGE DR 7515 PERKINS RD 9960 BLUEBONNET BLVD 9650 AIRLINE HWY 15232 GEORGE ONEAL RD 15128 AIRLINE HWY 7150 JEFFERSON HWY STE 680 2958 PERKINS RD 6920 PLANK RD 243 N ACADIAN THRUWAY STE 1 3111 FLORIDA BLVD STE B 13565 HOOPER RD 13707 COURSEY BLVD STE B 4615 GOVERNMENT ST 8595 PICARDY AVE STE 400 3490 DRUSILLA LN 9936A FLORIDA BLVD

ALEXANDRIA AMITE ARABI ARCADIA ARNAUDVILLE ARNAUDVILLE BAKER BALDWIN BALL BASILE BASTROP BASTROP BASTROP BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

71301 70422-2123 70032-1915 71001-3422 70512-6134 70512 70714 70514 71405-3367 70515-5572 71220-3702 71220-4032 71220 70820-8144 70806-1076 70809-9644 70806-5908 70808-3203 70808-4330 70810-6457 70815-5505 70817-1507 70817-7307 70806-8171 70808 70811-6041 70806-3752 70806 70818-2912 70817-1306 70806-5922 70809 70809-1866 70815-1402

LOUISIANA HEMATOLOGY ONCOLOGY ASSOC

(225) 767-1311

4950 ESSEN LN

BATON ROUGE

LA

70809-3432

LSU HEALTH BATON ROUGE MIDCITY PHCY MEDICAL PLAZA PHARMACY MESSINAS PHARMACY INC NATIONAL INFUSION SERVICES NATIONAL PHARMACY LTC

(225) 987-9107 (225) 765-8951 (225) 753-2700 (225) 766-7828 (225) 766-7828

1401 N FOSTER DR 7777 HENNESSY BLVD STE 114 15046 MARKET ST 5344 BRITTANY DRIVE STE A 5344 BRITTANY DR

BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE

LA LA LA LA LA

70806-1818 70808-4363 70817-1384 70808 70808

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 241 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NEIGHBORHOOD MARKET

Provider Name

(225) 248-1771

9830 OLD HAMMOND HWY

BATON ROUGE

LA

70816-8251

OCHSNER PHARMACY AND WELLNESS ONEAL OCHSNER PHCY AND WELLNESS BR PRESCRIPTIONS TO GEAUX RALPH'S PHARMACY RX 2 GEAUX

(225) 754-5160 (504) 842-3205 (225) 615-8730 (225) 214-0133 (855) 360-1446

16777 MEDICAL CENTER DR STE 10 9001 SUMMA AVE 313 THIRD ST 6576 JONES CREEK RD 7855 HOWELL BLVD STE 160

BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE BATON ROUGE

LA LA LA LA LA

70816 70809-3726 70801 70817-3023 70807

SURGICAL SPECIALTY CENTER OF BATON THE PHARMACY AT LSU WOMAN'S RETAIL PHARMACY PLAQUEMINES PHARMACY RUSSO'S PHARMACY GRANT FAMILY PHARMACY FREDS PHARMACY C & F PHARMACY INC

(225) 408-6650 (225) 578-5651 (225) 924-8199 (504) 393-1648 (504) 394-4444 (318) 899-5066 (318) 746-0151 (985) 732-2501

8080 BLUEBONNET BLVD STE 2000 STUDENT HEALTH CENTER BUILDING 100 WOMANS WAY 8443 HIGHWAY 23 7902 HIGHWAY 23 19479 HIGHWAY 167 5604 HIGHWAY 3 424 AUSTIN ST

BATON ROUGE BATON ROUGE BATON ROUGE BELLE CHASSE BELLE CHASSE BENTLEY BENTON BOGALUSA

LA LA LA LA LA LA LA LA

70810 70803 70817-5100 70037-2529 70037-2443 71407-3502 71006-3408 70427-3820

OUR LADY OF THE ANGELS OUTPATIENT P ROCKYS MED SHOPPE ALBERTSON'S PHARMACY BENZER PHARMACY

(985) 730-7219 (985) 732-5874 (318) 747-1466 (318) 742-4414

433 PLAZA ST 133 CUMBERLAND ST 3121 E TEXAS ST 2951 E TEXAS ST STE E

BOGALUSA BOGALUSA BOSSIER CITY BOSSIER CITY

LA LA LA LA

70427 70427-3101 71111-3209 71111-3280

DAVID RAINES COMM HLTH CTR BOSSIER SUPER 1 PHARMACY BOONES PHARMACY LIL BOO'S PHARMACY BON AMI PHARMACY CECILIA MEDICINE SHOPPE INC HEBERT'S PHARMACY HOLLIER'S FAMILY PHARMACY SIMONS PHARMACY ALBERTSON'S PHARMACY TOWNE PHARMACY DANIEL PHARMACY NOAHS PHARMACY CITY DRUG STORE FREDS PHARMACY NEW PARRINO DRUG STORE LAKEVIEW PHARMACY GUILBEAUS THRIFTY WAY PHARMACY MELANCON PHARMACY SUPER ONE

(318) 549-2500 (318) 746-8401 (318) 793-2400 (318) 793-2028 (337) 454-6536 (337) 667-6271 (337) 332-5186 (337) 332-5010 (318) 332-2345 (318) 839-0530 (337) 839-8880 (225) 749-2020 (225) 749-8202 (318) 346-6307 (318) 346-1112 (318) 346-7204 (318) 476-4877 (337) 896-3241 (337) 896-8434 (903) 877-6828

1514 DOCTORS DR 1870 AIRLINE DR 513 ULSTER ST 415 ST. CLAIR RD. STE. C 2825 GRAND POINT HWY STE 9 1017 CECILIA BRIDGE HWY 1101 GRAND POINTE AVE 1456 E BRIDGE ST 117 N MAIN ST 1210 ALBERTSON PKWY 103 E MAIN ST 710 E MAIN ST 400 W SAINT FRANCIS ST, #A-4 1010 SHIRLEY RD 109 CHEVY LN STE B 208 SW MAIN ST 3199 HWY 71 208 E SAINT PETER ST 730 VETERANS DR 3916 NE EVANGELINE TRWY

BOSSIER CITY BOSSIER CITY BOYCE BOYCE BREAUX BRIDGE BREAUX BRIDGE BREAUX BRIDGE BREAUX BRIDGE BREAUX BRIDGE BROUSSARD BROUSSARD BRUSLY BRUSLY BUNKIE BUNKIE BUNKIE CAMPTI CARENCRO CARENCRO CARENCRO

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

71111-3379 71112-2702 71409 71409 70517-6949 70517-6801 70517-3917 70517-3406 70517-5033 70518-5087 70518-4616 70719-2213 70719-2283 71322-1543 71322-1561 71322-1781 71411 70520-4009 70520-3619 70520-5972

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 242 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DONS PHARMACY MUMFREY'S PHARMACY WILKINSON FAMILY PHARMACY CHURCH POINT PHARMACY COMMUNITY PHARMACY FREDS PHARMACY WILLARD'S THRIFTY WAY CURRY PHARMACY J & K DRUG COTTONPORT CORNER DRUG LLC PORET'S THRIFTY WAY PHCY INC FREDS PHARMACY BRASWELL DRUG INC LAYTON FAMILY PHARMACY LEE ROAD FAMILY PHARMACY MEDIC SHOP PHARMACY OCHSNER PHARMACY COVINGTON

Provider Name

(504) 516-2706 (504) 279-6312 (504) 309-2202 (337) 684-5475 (337) 684-1911 (337) 684-1444 (337) 684-5401 (225) 683-8188 (318) 649-0825 (318) 876-3665 (318) 876-2104 (318) 932-5194 (985) 892-0818 (985) 888-1170 (985) 400-2595 (985) 875-7515 (504) 842-3205

2201 PARIS RD 1021 W JUDGE PEREZ DR 3001 PARIS RD 300 N MAIN ST 731 S MAIN ST STE B 821 S MAIN ST 209 S MAIN ST 10463 PLANK RD 7190 HIGHWAY 165 206 CHOUPIQUE LN 1007 SYCAMORE ST 1603 RINGGOLD AVE 1107 S TYLER ST 70457 HIGHWAY 21 SUITE 118 19705 HIGHWAY 40 1000 BUSINESS 190 1000 OCHSNER BLVD

CHALMETTE CHALMETTE CHALMETTE CHURCH POINT CHURCH POINT CHURCH POINT CHURCH POINT CLINTON COLUMBIA COTTONPORT COTTONPORT COUSHATTA COVINGTON COVINGTON COVINGTON COVINGTON COVINGTON

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70043-5031 70043-4703 70043-3223 70525 70525-4109 70525-4501 70525-3115 70722-3710 71418-3302 71327-3757 71327-3403 71019 70433-2327 70433 70435 70433-3285 70433

PONTCHARTRAIN HEMATOLOGY ONCOLOGY RX-VIP BIERS PHARMACY INC CARMICHAEL CASHWAY PHARMACY MEDICINE SHOPPE LADY OF THE SEA COMM PHCY WALTER BIRDSALL PHARMACY INC DELCAMBRE PHARMACY INC DELHI HEALTH MART E W THOMPSON DRUG CO INC PHILIP'S FAMILY PHARMACY BERNARDS FAMILY PHARMACY HEALTH MART PHCY & MED SUPPLY JAMES DRUG STORE LIVE OAK PHARMACY NORTHSIDE FAMILY PHARMACY INC FREDS PHARMACY IDEAL HEALTH MART THRIFTY WAY PHARMACY DESTREHAN PHARMACY INC OCHSNER PHCY & WELLNESS-DESTRE MAYEAUX'S FAMILY PHARMACY CASHWAY PHARMACY OF ERATH BELLARD'S FAMILY PHARMACY INC

(985) 875-1202 (985) 605-0265 (337) 783-3023 (337) 783-7200 (337) 783-9084 (985) 325-7950 (985) 632-5003 (337) 685-6851 (318) 878-5104 (318) 878-2261 (318) 878-3671 (225) 667-4286 (225) 271-4995 (225) 665-5186 (225) 664-7125 (225) 664-9520 (337) 786-6111 (337) 463-7210 (337) 463-7442 (985) 764-1181 (985) 240-4610 (337) 584-2256 (337) 937-8333 (337) 546-6386

120 LAKEVIEW CIR 17351 HARD HAT DR STE 13 410 N PARKERSON AVE 1002 N PARKERSON AVE 704 N PARKERSON AVE 144 W 134TH PL 118 W 111TH ST 510 W HIGHWAY 14 414 BROADWAY ST 213 DEPOT ST 203 DEPOT ST 34876 LA HWY 1019 31839 LA HWY 16 STE A 257 FLORIDA AVE SE STE A 34730 LA HIGHWAY 16 850 COCKERHAM RD 129 N PINE ST 610 N PINE ST 601 S PINE ST 12627 AIRLINE HWY 13100 RIVER ROAD SUITE 110 911 MAIN ST # 190 112 E EDWARD ST 621 W MAPLE AVE

COVINGTON COVINGTON CROWLEY CROWLEY CROWLEY CUT OFF CUT OFF DELCAMBRE DELHI DELHI DELHI DENHAM SPRINGS DENHAM SPRINGS DENHAM SPRINGS DENHAM SPRINGS DENHAM SPRINGS DEQUINCY DERIDDER DERIDDER DESTREHAN DESTREHAN ELTON ERATH EUNICE

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70433 70435-5882 70526-5047 70526-3613 70526-4355 70345 70345-3620 70528-2308 71232-2940 71232-2819 71232-2819 70706 70726 70726-3728 70706-0668 70726-2645 70633 70634-3546 70634-4941 70047-2550 70047 70532-3228 70533-4108 70535-5349

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 243 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MAPLE AVE PHARMACY PICOUS DRUG STORE FARMERVILLE DRUG SCOTT'S PHARMACY VAUGHAN'S CITY DRUG FOLSOM FAMILY PHARMACY CASHWAY PHARMACY OF FRANKLIN FREDS PHARMACY TECHE ACTION CLINIC PHARMACY CREEL'S FAMILY PHARMACY FORSHAGS DRUG STORE WILLIAMS FAMILY PHARMACY, L.L.C. DUTCHTOWN PHARMACY CLINIC DRUG STORE LAGNIAPPE PHARMACY LAGNIAPPE PHARMACY LANDRY'S PHARMACY MEDICAP PHARMACY RALPHS PHARMACY RALPH'S PHARMACY THE MEDICINE SHOPPE GEM DRUGS GRAMERCY, INC LLOYD'S REMEDIES GREENSBURG FAMILY PHARMACY PHARMACY CENTRAL CARR DRUGS IV SERVICES LAPALCO DRUGS MEADOWCREST PHARMACY OLD GRETNA PHARMACY PRESCRIPTION PAD DOC YOUR DOSE PHARMACY HEALTH MART PHCY OF GUEYDAN A 1 DISCOUNT PHARMACY ALBERTSON'S PHARMACY CHANNELL DRUGS DON CHAUCER PHARMACY GENOA-QOL HEALTHCARE MANNINO'S FAMILY PRACTICE PHCY MORGANS DISCOUNT PHARMACY SCOTTS HEALTHMART PHARMACY MEDI-THRIFT DRUGS

NR_0009_10823 10/2017

Provider Phone Number (337) 457-5216 (337) 457-2218 (318) 368-9711 (318) 757-3035 (318) 757-4811 (985) 796-3062 (337) 828-0950 (337) 828-3392 (337) 828-2550 (985) 848-5555 (985) 839-4486 (985) 839-7200 (225) 677-5070 (985) 475-7777 (225) 402-4084 (225) 647-0111 (225) 647-3583 (225) 644-1661 (225) 622-0445 (225) 257-1009 (225) 644-3030 (225) 869-3651 (985) 872-4547 (225) 222-4279 (225) 508-4977 (504) 366-1200 (504) 394-9037 (504) 393-7000 (504) 323-2350 (504) 252-9686 (504) 393-7733 (225) 648-2329 (337) 536-9600 (985) 345-5044 (504) 345-4901 (985) 345-4767 (985) 345-7979 (985) 277-1440 (985) 542-8466 (985) 956-7777 (985) 542-7230 (318) 744-5617

Provider Street 1200 W MAPLE AVE 260 N 2ND ST 300 E WATER STREET 114 SERIO BLVD 109 EE WALLACE BLVD N 82150 HIGHWAY 25 1419 HOSPITAL AVE 1524 HOSPITAL AVE 1115 WEBER ST 26496 HIGHWAY 62 1919 MAIN ST 1058 TANGLEWOOD DR 13011 HWY 73 110 S BAYOU DR 14639 AIRLINE HWY STE 114 209 S AIRLINE HWY 416 N BURNSIDE AVE 822 N BURNSIDE AVE 15013 HIGHWAY 44 STE B 6431 HIGHWAY 44 1817 S BURNSIDE AVE 1635 HIGHWAY 3125 3696 W MAIN ST 6166 HWY 10 17070 GREENWELL SPRINGS RD #B 91 WESTBANK EXPY STE 550 1581 CAROL SUE AVE STE E 436 LAPALCO BLVD 151 MEADOWCREST ST # A-1 500 LAFAYETTE ST 120 MEADOWCREST ST STE 150 17275 HIGHWAY 77 200 MAIN ST 1322 W THOMAS ST 1711 W THOMAS ST 1812 W THOMAS ST 15794 MEDICAL ARTS DR 835 PRIDE DR STE B-75 113 W CHARLES ST 47411 N MORRISON BLVD 42242 VETERANS AVE 302 BUSHLEY STREET

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Provider City EUNICE EUNICE FARMERVILLE FERRIDAY FERRIDAY FOLSOM FRANKLIN FRANKLIN FRANKLIN FRANKLINTON FRANKLINTON FRANKLINTON GEISMAR GOLDEN MEADOW GONZALES GONZALES GONZALES GONZALES GONZALES GONZALES GONZALES GRAMERCY GRAY GREENSBURG GREENWELL SPRINGS GRETNA GRETNA GRETNA GRETNA GRETNA GRETNA GROSSE TETE GUEYDAN HAMMOND HAMMOND HAMMOND HAMMOND HAMMOND HAMMOND HAMMOND HAMMOND HARRISONBURG

State

ZIP code

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70535-4320 70535-3338 71241 71334-2013 71334-2819 70437 70538-3722 70538 70538-4124 70438-7968 70438-3689 70438-5673 70734 70357-2728 70737 70737 70737-2828 70737-2836 70737-6744 70737-8158 70737-4429 70052-3554 70359 70441 70739 70053-3688 70056 70056 70056 70053-5936 70056-5278 70740-3008 70542 70401-3046 70401-2942 70401-2945 70403-1446 70401-9527 70401-3232 70401-7333 70403-1423 71340

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WESTBANK PHARMACY KILLGORE'S PHARMACY TEDS PHARMACY BOYER'S THRIFT PHARMACY INC CLAIBORNE PHARMACY FREDS PHARMACY BROADMOOR DRUG CENTER HAYDELS DRUG STORE HAYDEL'S DRUG STORE PEOPLES DRUG STORE INC TECHE ACTION CLINIC PHARMACY VITAL CARE OF HOUMA WILLOW BARK PHARMACY CANNONS DISCOUNT PHARMACY LLC PETES FAMILY PHARMACY MILLER'S FAMILY PHARMACY FREDS PHARMACY MCDONALD PHARMACY CASHWAY PHARMACY INC CITY PHARMACY LARROQUE PHARMACY HONEYCUTT DRUG STORE JENA PHARMACY TRIANGLE PHARMACY LLC CASSIDYS PHARMACY INC FAMILY DRUG STORE JALH OUTPATIENT PHARMACY FAMILY PHARMACY MITCHELL'S PHARMACY BROOKS DRUGS MORGANS PHARMACY INC

Provider Name

(504) 340-0777 (318) 624-1122 (318) 624-1053 (337) 228-2064 (318) 927-3523 (318) 927-3534 (985) 876-2584 (985) 872-5201 (985) 853-1242 (985) 873-8526 (985) 851-1717 (985) 262-8214 (985) 876-5502 (985) 878-5555 (985) 878-6321 (337) 779-2214 (337) 582-3585 (225) 634-2470 (337) 276-6006 (337) 276-4249 (337) 276-5001 (318) 992-4574 (318) 992-5565 (318) 992-4447 (337) 824-1648 (337) 824-2800 (337) 616-7371 (318) 259-7334 (318) 259-7466 (318) 339-7913 (318) 339-8532

3709 WESTBANK EXPWAY STE 1C 1909 MAIN ST 1866 MAIN ST 1423 HENDERSON HWY 820 WEST MAIN STREET 902 W MAIN ST 6096 W PARK AVE 4752 HIGHWAY 311 STE 100 831 GRAND CAILLOU RD 7869 MAIN ST 1014 W TUNNEL BLVD 304 CORPORATE DR STE A 2138 BAYOU BLUE RD 13351 E ALESSI RD 539 W RAILROAD AVE 119 S 5TH ST 214 S THOMSON AVE 1701 CHARTER ST 1801 MAIN ST 1411 MAIN ST 1305 MAIN ST 2835 E OAK STREET 2951 E OAK ST 3148 WEST OAK ST 710 N MAIN ST 1710 JOHNSON ST 1634 ELTON RD 500 ALEXANDER ST 202 E MAIN ST 104 MOUND ST 1806 FOURTH ST

HARVEY HAYNESVILLE HAYNESVILLE HENDERSON HOMER HOMER HOUMA HOUMA HOUMA HOUMA HOUMA HOUMA HOUMA INDEPENDENCE INDEPENDENCE IOTA IOWA JACKSON JEANERETTE JEANERETTE JEANERETTE JENA JENA JENA JENNINGS JENNINGS JENNINGS JONESBORO JONESBORO JONESVILLE JONESVILLE

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70058 71038-4907 71038-4904 70517-7812 71040 71040-3328 70364-1808 70360-2810 70363 70360-4461 70360-4050 70360-2458 70364-3909 70443 70443-2761 70543-6044 70647 70748-5927 70544-3423 70544-3505 70544-3640 71342 71342 71342 70546-5312 70546 70546-3614 71251-2002 71251-3202 71343-2319 71343-2002

HEALTH MART PHARMACY OF KAPLAN, INC THRIFTY WAY PHARMACY ALL SAINTS PHARMACY KENNER DISCOUNT PHARMACY OCHSNER PHCY & WELLNESS-KENNER SCHILLING PHARMACY COUSHETTA FAMILY PHARMACY FREDS XPRESS KINDER FAMILY PHARMACY AXUM MEDICAL

(337) 643-8883 (337) 643-6440 (504) 443-1294 (504) 464-4421 (504) 842-8623 (985) 229-2501 (337) 738-4170 (337) 738-2614 (337) 738-2531 (985) 359-5251

818 N CUSHING AVE 100 N CUSHING AVE 2124 38TH ST 3108 LOYOLA DR 200 WEST ESPLANADE AVE STE 106 210 AVENUE G 287 PANTHER TRAIL 832 4TH AVE 904 4TH AVE 721 W 5TH ST

KAPLAN KAPLAN KENNER KENNER KENNER KENTWOOD KINDER KINDER KINDER LA PLACE

LA LA LA LA LA LA LA LA LA LA

70548-2615 70548-4908 70065 70065-4139 70065 70444-2804 70648 70648-3211 70648-0430 70068-5504

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 245 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE MEDICINE SHOPPE BAYOU LACOMBE PHARMACY LACOMBE FAMILY PHARMACY LLC ACADIANA PRESCRIPT SHOP SOUTH ACADIANA SAFEWAY PRES SHOP ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY APC PHARMACEUTICALS CARMICHAELS PHARMACY D & L FAMILY PHARMACY, INC. DRUG EMPORUIM FALCON PHARMACY, LLC HEALTH MART PHCY OF LAFAYETTE ICARE COMM PHARMACY & GIFTS JEFFERSON DRUG STORE

Provider Name

(985) 652-1245 (985) 882-2828 (985) 882-5999 (337) 504-7395 (337) 233-4017 (337) 233-2265 (337) 406-8806 (318) 984-5133 (337) 988-4824 (337) 234-5834 (337) 981-8844 (337) 261-0337 (337) 210-1248 (337) 235-3523 (337) 889-3170 (337) 234-1428

932 CARROLLWOOD DR 27431 HIGHWAY 190 28079 US HWY 190 5000 AMB CAFFERY PKWY BLDG 3B 454 HEYMANN BLVD 2678 JOHNSTON ST 2863 AMBASSADOR CAFFERY PKWY 4400 AMBASSADOR CAFFERY PKWY 1103 KALISTE SALOOM RD STE 304 1472 S COLLEGE RD STE 102A 108 REPUBLIC AVE STE B 505 BERTRAND DR 1103 KALISTE SALOOM RD STE 103 600 JOHNSTON ST 2807 KALISTE SALOOM RD 620 JEFFERSON BLVD

LA PLACE LACOMBE LACOMBE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70068-3304 70445 70445 70508 70503-2617 70503-3240 70506-5905 70508-6760 70508-5705 70503-2921 70508-6843 70506-5542 70508-5783 70501-8060 70508 70501-7206

KENS THRIFTY WAY PHCY HOME MED-LAF LEMAIRES PHARMACY MEDICINE BIN PLUS LLC NEIGHBORS PHARMACY NORTHSIDE PHARMACY PALLIATIVE PHARMACY SOLUTIONS PARK PHARMACY PROFESSIONAL ARTS PHARMACY SUPER 1 PHARMACY SUPER 1 PHARMACY TECHE DRUGS INC

(337) 266-4621 (337) 233-4782 (337) 408-8800 (337) 706-7706 (337) 232-2666 (337) 262-9777 (337) 806-9000 (337) 991-0101 (318) 988-1940 (337) 988-1940 (337) 235-4578

333 HEYMANN BLVD 2039 JOHNSTON ST 1105 W WILLOW ST 6770 JOHNSTON ST 2930 MOSS ST STE A 620 GUILBEAU RD STE D 4811 AMBASSADOR CAFFERY #101 128 CURRAN LANE 1455 NW EVANGELINE TRWY 3747 AMBASSADOR CAFFERY PKWY 509 JEFFERSON ST

LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE LAFAYETTE

LA LA LA LA LA LA LA LA LA LA LA

70503-2415 70503-2784 70501-1780 70503-6202 70501-1274 70506-8709 70508-6917 70506-7222 70501-2829 70503-5233 70501-6905

THE COMPOUNDING CENTER PHARMACY

(337) 981-8844

3810 AMB CAFFERY PKWY STE 200

LAFAYETTE

LA

70503

THRIFTY WAY PHARMACY NORTHSIDE, INC THRIFTY WAY PHCY LAKE ARTHUR ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BEYOND RX BOUDREAUXS NEW DRUG STORE CHILDREN'S PHARMACY INC CHILDREN'S PHARMACY INC FREDS PHARMACY GENOA-QOL HEALTHCARE GORDON DRUG STORE INC

(337) 234-5228 (337) 774-2246 (337) 478-9197 (337) 480-4132 (337) 990-5575 (337) 436-7216 (337) 502-4873 (337) 474-5492 (337) 855-4031 (337) 426-0906 (318) 477-6773

1419 MOSS ST 202 ARTHUR AVE 4060 RYAN ST 2750 COUNTRY CLUB RD 1409 KIRKMAN ST 404 E PRIEN LAKE RD 4111 LAKE ST. 2903 1ST AVE 899 N HIGHWAY 171 4105 KIRKMAN ST 2716 LAKE ST

LAFAYETTE LAKE ARTHUR LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE CHARLES

LA LA LA LA LA LA LA LA LA LA LA

70501-3654 70549-4614 70605-2820 70605-5914 70601-5344 70601 70605 70601-8809 70611-5034 70607-4603 70601-8216

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 246 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HOBGOOD PHARMACY LANINGHAM'S THRIFTY WAY, INC. MEDICAL PLAZA PHARMACY PRESCRIPTION SPECIALTIES LLC MINSKY'S DRUG STORE LADY OF THE SEA COMMUNITY PHCY PITRE'S PHARMACY THRIFTY WAY PHARMACY THRIFT TOWN DRUGS INC LIVONIA THRIFT-T-WAY PHARMACY ROBICHAUXS PHARMACY ROUSE DISCOUNT PHARMACY HEADRICK'S DRUG STORE LOREAUVILLE PHARMACY THRIFT VILLAGE DRUGS TOMPKINS PHARMACY LYDIA PHARMACY SCRIPT SPECIALISTS THE MEDICINE CABINET DES HOTELS DRUGS POINCIANA PHARMACY LLC REEDS FAMILY PHARMACY SAVOY DRUG STORE INC THRIFTY WAY PHCY OF MAMOU INC C & C DRUGS MANDEVILLE PHARMACY CLINIC PHARMACY OF MANGHAM LLC MANGHAM RX MANSFIELD DRUG MANSURA DRUG STORE MANY PROFESSIONAL PHARMACY ELLIOTT PHARMACY MATTE'S PHARMACY INC DON'S PHARMASAVE INC DAVE'S PHARMACY INC FOLSE PHARMACY GENOA-QOL HEALTHCARE H & W DRUG STORE HEALTH FIRST PHARMACY MAJORIA DRUGS PELICAN DELIVERY PHARMACY PRIORITY HEALTH CARE

NR_0009_10823 10/2017

Provider Phone Number (337) 602-6024 (337) 477-7733 (337) 494-2990 (337) 562-7979 (318) 559-2400 (985) 693-9260 (985) 693-7496 (337) 239-3474 (225) 686-7241 (225) 637-2356 (985) 532-9140 (504) 532-2545 (318) 697-4381 (337) 229-4968 (985) 785-6213 (225) 869-3535 (337) 369-6156 (985) 792-4377 (985) 206-9425 (318) 468-5402 (337) 468-5001 (318) 468-5207 (337) 468-3666 (337) 468-7111 (985) 626-0234 (985) 778-2306 (318) 248-3338 (318) 248-2345 (318) 872-1933 (318) 964-2104 (318) 256-3426 (225) 625-2353 (318) 292-4570 (318) 253-8747 (504) 340-7516 (504) 341-2711 (504) 218-2278 (504) 349-3300 (504) 252-4571 (504) 340-3592 (504) 341-0800 (504) 309-9135

Provider Street 2640 COUNTRY CLUB RD STE 150 1505 W MCNEESE ST 1717 OAK PARK BLVD STE 110 4070 NELSON RD STE 200 405 LAKE ST 13086 HIGHWAY 3235 13087 W MAIN ST 1019 FERTITTA BLVD 29680 S FROST RD 3066 HWY 78 616 CRESCENT AVE 1428 CRESCENT AVE 204 MAIN STREET 100 N MAIN ST 737 PAUL MAILLARD RD STE C 2064 W MAIN ST 3917 DARNELL RD 1922 HWY 22 WEST SUITE B 211 COVINGTON ST 900 6TH ST 1508 CAJUN DR STE A 1009 6TH ST 813 POINCIANA AVE 704 POINCIANA AVE 2803 HIGHWAY 59 1655 HIGHWAY 190 252 HIGHWAY 132 104 LOUISIANA STREET 132 JEFFERSON ST 2043 LEGLISE ST 220 HIGHLAND DR 77395 LANDRY DR 314 MAIN ST 134 RUE MEDECINE 1220 BARATARIA BLVD 4000 4TH ST 5001 WESTBANK EXPY 5969 LAPALCO BLVD 7521-I WESTBANK EXPWY 2564 BARATARIA BLVD 4700 WICHERS DR STE 104 4700 WICHERS DR SUITE 303

Page 247 of 679

Provider City LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE CHARLES LAKE PROVIDENCE LAROSE LAROSE LEESVILLE LIVINGSTON LIVONIA LOCKPORT LOCKPORT LOGANSPORT LOREAUVILLE LULING LUTCHER LYDIA MADISONVILLE MADISONVILLE MAMOU MAMOU MAMOU MAMOU MAMOU MANDEVILLE MANDEVILLE MANGHAM MANGHAM MANSFIELD MANSURA MANY MARINGOUIN MARION MARKSVILLE MARRERO MARRERO MARRERO MARRERO MARRERO MARRERO MARRERO MARRERO

State

ZIP code

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70605-6079 70605-4241 70601 70605-2444 71254-2631 70373 70373 71446-4646 70754-1904 70755-0000 70374-2735 70374-3106 71049 70552-2048 70070-4343 70071-0000 70569 70447 70447-9683 70554-3122 70554-2400 70554-3123 70554-2201 70554-2208 70471-1936 70448 71259-5268 71259-0000 71052-2602 71350-4501 71449-3718 70757-3208 71260-5252 71351-0000 70072-3702 70072-2240 70072-2954 70072-4833 70072 70072-5304 70072-3054 70072

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CHRIS PHARMACY AND GIFTS LLC LANDRY'S PHARMACY MELVILLE PHARMACY A-1 PHARMACY METAIRIE ADVANTAGE RX B&B DISCOUNT PHARMACY C & S FAMILY PHARMACY CHATEAU DRUGS, INC. DCS NO PHARMACY FAST ACCESS SPCLTY THERAPEUTIC GENOA-QOL HEALTHCARE GULF SOUTH PHARMACY MAJORIA DRUGS NOLA DISCOUNT PHARMACY NOLA DISCOUNT PHARMACY PATIO DRUGS PATIO DRUGS EXTENDED CARE PHCY FREDS PHARMACY HIGHLAND CLINIC APMC REAGENS RX & HOME CARE LLC ARONS PHARMACY COMMUNITY HEALTH PHARMACY COMMUNITY PHARMACY LLC MELS PHARMACY OF MONROE LLC S & S PHARMACY SAINT JOHN PHARMACY ST FRANCIS MEDICAL CENTER PHCY SUPER 1 PHARMACY THE MEDICINE SHOPPE UNIV HLTH CONWAY OP PHCY LAKESIDE PHARMACY & GIFTS MONTGOMERY PHARMACY LLC CLINIC PHARMACY HPC BIOLOGICALS INC

Provider Name

(225) 698-6000 (337) 898-1015 (337) 623-9992 (504) 875-2330 (504) 832-0614 (504) 325-5613 (504) 833-0195 (504) 889-2300 (504) 488-3007 (877) 327-8881 (504) 641-4140 (504) 336-2400 (504) 835-7211 (504) 835-6060 (504) 888-9411 (504) 889-7070 (504) 456-7808 (318) 371-1292 (318) 798-4616 (318) 382-7948 (318) 323-2242 (318) 966-6290 (318) 398-2100 (318) 387-6725 (318) 387-9608 (318) 807-1083 (318) 327-7242 (318) 323-8698 (318) 323-2883 (318) 330-7819 (318) 386-2344 (318) 646-6877 (985) 384-7940 (800) 757-9192

18525 HWY 22 106 MILTON RD 320 CHURCH ST 3501 SEVERN AVE STE 3A 3202 W METAIRIE AVE S 612 VETERANS BLVD 1300 VETERANS MEMORIAL BLVD 3544 W ESPLANADE AVE S 111 N CAUSEWAY BLVD 3131 N I-10 SERVICE RD E #202 3616 S I 10 SERVICE RD W 111 VETERANS MEM BLVD #406A 1805 METAIRIE AVE 1107 VETERANS BLVD STE 3 4305-B CLEARVIEW PKWY 5208 VETERANS MEMORIAL BLVD 5208 VETERANS MEMORIAL BLVD 1208 HOMER RD 10600 INDUSTRIAL DR 1118 HOMER RD STE G 1209 N 18TH ST 2600 TOWER DR STE 102 2123 FORSYTHE AVE 1734 S 9TH ST 2951 RENWICK ST 110 ST JOHN STREET 309 JACKSON ST 2810 LOUISVILLE AVE 1510 S 2ND ST 4864 JACKSON ST 6280 HIGHWAY 129 1101 CADDO ST 1234 DAVID DR 1234 DAVID DR STE A

MAUREPAS MAURICE MELVILLE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE METAIRIE MINDEN MINDEN MINDEN MONROE MONROE MONROE MONROE MONROE MONROE MONROE MONROE MONROE MONROE MONTEREY MONTGOMERY MORGAN CITY MORGAN CITY

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70449 70555-4426 71353 70002-3459 70001-5235 70005 70005 70002-7130 70001-5450 70002-6054 70001-1874 70005-3028 70005-3860 70005 70006-2762 70006-5123 70006-5123 71055-3082 71055 71055-3028 71201-5429 71201-5783 71201-3610 71202-3526 71201-8146 71201 71201-7407 71201-6658 71202 71202-6400 71354 71454-0000 70380-1300 70380-1365

PRESCRIPTION CENTER OF MORGAN CITY SPITALE DRUGS ST. MARY PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE RAWLS PHARMACY ASSUMPTION PHARMACY LLC

(504) 385-1866 (985) 255-4789 (985) 384-1234 (985) 384-3071 (985) 395-2694 (985) 877-4700 (985) 369-6375

832 MARGUERITE ST 1200 N. VICTOR II BLVD 1124 SEVENTH ST 926 7TH ST 1275 BELLEVIEW ST 36009 HIGHWAY 38 120 WASHINGTON ST

MORGAN CITY MORGAN CITY MORGAN CITY MORGAN CITY MORGAN CITY MOUNT HERMON NAPOLEONVILLE

LA LA LA LA LA LA LA

70380-1837 70380 70380 70380-1904 70380-5351 70450-6534 70390-8512

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 248 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CADE'S PHARMACY,LLC CAUSEY'S PHARMACY, INC. M&M PHARMACY

Provider Name

(318) 354-0501 (318) 352-3141 (318) 354-1554

1053 PARKWAY DR 407 BIENVILLE ST 311 DIXIE PLZ

NATCHITOCHES NATCHITOCHES NATCHITOCHES

LA LA LA

71457 71457-5702 71457-5880

DELAUNE'S PHARMACY & HOME MEDICAL L & M PHARMACY INC SOILEAUS PHARMACY SUPER 1 PHARMACY ALGIERS PHARMACY ASPEN PHARMACY AVITA PHARMACY BENZER PHARMACY BEST LIFE PHCY & RESTAURANT BROAD AVENUE PHARMACY CARR'S DRUGS CASTELLON PHARMACY CHARBONNET FAMILY PHARMACY CLAIBORNE DISCOUNT PHARMACY LLC COLISTICS PHARMACY COMMUNITY CHOICE PHARMACY CRESCENT CITY PHARMACY DCSNO PHARMACY CARROLLTON DCSNO PHARMACY GENTILLY DCSNO PHARMACY ST CECILIA DCSNO PHARMACY-NOE EPIC SPECIALTY PHARMACY GENERAL MEYER PHARMACY GENOA-QOL HEALTHCARE H S REMEDIES PHARMACY H&W DRUG STORE INC MED-PRO PHARMACY OCHSNER MAIN CAMPUS ATRIUM

(337) 364-7671 (337) 365-1411 (337) 365-6721 (318) 364-1368 (504) 957-6784 (504) 734-0333 (504) 309-2557 (813) 304-2221 (504) 264-5100 (504) 309-4388 (504) 367-5724 (504) 866-3784 (504) 309-2449 (504) 942-8700 (504) 361-5650 (504) 957-2336 (504) 267-4100 (504) 207-3019 (504) 667-4300 (504) 207-6287 (504) 539-3860 (504) 324-4343 (504) 872-9882 (540) 571-9120 (504) 324-6270 (504) 244-3784 (504) 309-9223 (504) 842-3205

308 N LEWIS ST 1033 ANDRE ST 805 CENTER ST 939 S LEWIS ST 3648 GENERAL DEGAULLE DR 5745 PLAUCHE CT 3308 TULANE AVE SUITE 102 2525 CANAL ST 2657 TULANE AVE 1400 N BROAD ST 3500 HOLIDAY DRIVE 8232 OAK ST 7211 REGENT ST 1522 SAINT BERNARD AVE 3361 GENERAL DEGAULLE DR STE A 9970 LAKE FOREST BLVD 2240 SIMON BOLIVAR AVE STE A 3201 S CARROLLTON AVE 100 WARRINGTON DR 1030 LESSEPS ST 5630 READ BLVD 8138 OAK ST 3201 GENERAL MEYER AVE STE A 2221 PHILIP ST STE Q 3600 GEN MEYER AVE STE C 8454 MORRISON RD 2600 S CLAIBORNE AVE 1514 JEFFERSON HWY

NEW IBERIA NEW IBERIA NEW IBERIA NEW IBERIA NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70563 70563-2161 70560-5505 70560-6303 70114 70123-4119 70119 70119-6407 70119 70119-2332 70114 70118 70124 70116-1419 70114-6701 70127-2609 70113-1480 70118 70122-3000 70117 70127 70118-2040 70114-3201 70113-2525 70114 70127-1913 70125-3921 70121-2429

OCHSNER PHARMACY AND WELLNESS-BAPTI OCHSNER PHCY & WELLNESS OCHSNER SPECIALTY PHARMACY ST. BERNARD DRUGS TULANE SHC PHARMACY UPTOWN DELIVERY PHARMACY ELLIOTT PHARMACY POINTE COUPEE PHARMACY RAYMOND'S FAMILY PHARMACY

(504) 842-8623 (504) 842-8310 (855) 312-4193 (504) 242-1100 (504) 865-5255 (504) 897-0141 (225) 638-7186 (225) 638-6321 (225) 638-7550

2802 NAPOLEAN AVE SUITE 220 1401 JEFFERSON HWY 1405 JEFFERSON HWY STE A 10200 CHEF MENTEUR HWY 6823 ST. CHARLES AVE BLDG 92 741 NASHVILLE AVE 169 E MAIN ST 222 HOSPITAL RD 303 E MAIN ST

NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ORLEANS NEW ROADS NEW ROADS NEW ROADS

LA LA LA LA LA LA LA LA LA

70115 70121-2426 70121-2426 70127-4212 70118 70115-3226 70760-3505 70760-2619 70760-3635

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 249 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BRITT'S PHARMACY MEDICINE SHOPPE PERKINS FAMILY PHARMACY WEST CARROLL HOSPITAL PHARMACY OAKDALE DRUG COMPANY INC PHILS PHARMACY R & K DRUGS ACADIANA PHARMACY GLENN'S FAMILY PHARMACY KEN'S THRIFTY WAY PHARMACY MILLER DRUGS INC PLAZA PHARMACY SHUTES PHARMACY SUPER ONE PHARMACY THE MEDICINE SHOPPE THRIFT CLINIC PHCY ON UNION LLC THRIFTY WAY AT THE COTTAGE THRIFTY WAY PHARMACY PAINCOURTVILLE PHARMACY INC MILLS CASHWAY PHARMACY FAMILY DRUG MART PEARL RIVER PHARMACY RICHARD'S PHARMACY FUSELIERS PHARMACY CROSSROADS PHARMACY FRIENDS & FAMILY PHARMACY HOLLOWAY PHARMACY SUPER 1 PHARMACY KELLY PHARMACY INC GOUDEAU'S HEALTHMART SCALLANS PHARMACY FLOYD'S FAMILY PHARMACY MEDITHRIFT PHARMACY PONCHATOULA FAMILY PHARMACY BOURGS DRUG STORE STEVENS PHARMACY THRIFTY WAY PHARMACY DELTA DRUGS OF PORT SULPHUR CHRIS' PHARMACY-PORT VINCENT GALVEZ TOWN PHARMACY PRAIRIEVILLE PHARMACY THE WELLNESS CORNER

NR_0009_10823 10/2017

Provider Phone Number (318) 467-5225 (318) 428-4205 (318) 428-4344 (318) 428-6155 (318) 335-1360 (337) 639-4367 (318) 495-5155 (318) 942-1400 (337) 948-9827 (337) 942-7551 (337) 942-2631 (337) 948-6507 (337) 942-2611 (337) 942-3674 (337) 948-7703 (337) 948-4441 (337) 942-2653 (337) 948-7900 (985) 369-3578 (337) 845-5199 (985) 863-3737 (985) 863-6444 (985) 252-6661 (337) 599-2147 (318) 443-3100 (318) 787-2817 (318) 466-3113 (318) 640-0145 (318) 326-4229 (225) 687-4349 (318) 922-3134 (985) 386-2232 (985) 386-8543 (985) 386-6556 (225) 344-1077 (225) 336-4456 (337) 585-2382 (504) 564-3141 (225) 698-6888 (225) 622-4817 (225) 677-7979 (225) 677-8200

Provider Street 100 N MAIN ST 411 E MAIN ST 803 E MAIN ST 706 ROSS ST 149 HOSPITAL DR 128 W 6TH AVE 2832 FRONT ST 507 N MARKET ST 1615 N MAIN ST 517 E PRUDHOMME ST 209 N MARKET ST 1200 HOSPITAL DR 205 N MAIN ST 2418 S UNION ST 1717 S UNION ST STE 2 825 N UNION ST 1406 W LANDRY 2961 S UNION ST 112 HWY 403 1027 MARTIN 61461 HIGHWAY 1090 64060 HWY 41 3610 HIGHWAY 70 S 10600 VETERANS MEMORIAL HWY 3592 HWY 28 EAST 3003A HIGHWAY 28 E 12805 HIGHWAY 28 E STE A 2951 COTTINGHAM EXPY 302 E PALMETTO 57930 LABAUVE AVE 115 HWY 1181 1625 HIGHWAY 51 STE K 240 W PINE ST 19008 HIGHWAY 22 484 LOUISIANA AVE 1000 COURT ST STE A 17695 HIGHWAY 190 27136 HIGHWAY 23 18590 LA HIGHWAY 16 STE 2 40017 HIGHWAY 42 STE D 16270 AIRLINE HWY STE A-100 17733 OLD JEFFERSON HWY

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Provider City NEWELLTON OAK GROVE OAK GROVE OAK GROVE OAKDALE OBERLIN OLLA OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS OPELOUSAS PAINCOURTVILLE PARKS PEARL RIVER PEARL RIVER PIERRE PART PINE PRAIRIE PINEVILLE PINEVILLE PINEVILLE PINEVILLE PLAIN DEALING PLAQUEMINE PLAUCHEVILLE PONCHATOULA PONCHATOULA PONCHATOULA PORT ALLEN PORT ALLEN PORT BARRE PORT SULPHUR PORT VINCENT PRAIRIEVILLE PRAIRIEVILLE PRAIRIEVILLE

State

ZIP code

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

71357-9656 71263-1003 71263-2534 71263 71463-3034 70655 71465 70570-5241 70570-6618 70570-6499 70570-5263 70570-6552 70570-6256 70570-5735 70570-5703 70570 70570 70570-5740 70391 70582 70452-4146 70452 70339-4454 70576 71360 71360-5718 71360 71360-4389 71064-4200 70764-3338 71362-0000 70454-6376 70454 70454-6780 70767-2141 70767-2524 70577-5136 70083 70726 70769-5240 70769-4589 70769-3934

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

OCHSNER PHCY AND WELLNESS-ST ANNE SAVOIE'S PHARMACY MECHE'S FAMILY DRUGS MOUTON PHARMACY RAYNE PHARMACY RAYVILLE FAMILY PHARMACY LLC YANCEYS HEALTHMART PHARMACY GEM DRUGS, INC. C & G PHARMACY ROBERT PHARMACY ROSEPINE FAMILY PHARMACY INC FREDS PHARMACY GREEN CLINIC PHARMACY PRESCRIPTION SHOPPE PHARMACY RUSTON APOTHECARE RUSTON WELLNESS & COMPOUNDING SUPER 1 PHARMACY ST. AMANT PHARMACY BRADLEY'S PHARMACY ELLIOTT PHARMACY FREDS PHARMACY PAT MARTIN RPH, INC. ROBICHAUX'S PHARMACY INC

(504) 842-8623 (985) 532-5943 (337) 334-3399 (337) 334-2117 (318) 334-5105 (318) 728-2430 (318) 728-4195 (985) 536-3957 (504) 738-2277 (985) 448-3978 (337) 462-0177 (318) 255-3044 (318) 251-6337 (318) 255-7363 (318) 255-3223 (318) 255-8106 (318) 254-8256 (225) 644-7288 (504) 682-5236 (225) 635-3878 (337) 394-1311 (337) 394-7100 (337) 394-8087

108 ACADIA PARK DR 4912 HIGHWAY 1 913 THE BOULEVARD 301 S ADAMS AVE 713 CURTIS DR 1821 LOUISA STREET 103 CHRISTIAN DR 139 CENTRAL AVE 9311 JEFFERSON HWY 44354 HIGHWAY 445 STE B 18507 CENTRAL AVE 2019 FARMERVILLE HWY 1200 S FARMERVILLE ST 104 W LINE AVE 1680 E KENTUCKY AVE 109 N TRENTON ST STE 2 1500 N TRENTON ST 12502 HIGHWAY 431 8115 E SAINT BERNARD HWY 7189 U S HIGHWAY 61 1114 S MAIN ST 1117 N MAIN ST 201 E BRIDGE ST

RACELAND RACELAND RAYNE RAYNE RAYNE RAYVILLE RAYVILLE RESERVE RIVER RIDGE ROBERT ROSEPINE RUSTON RUSTON RUSTON RUSTON RUSTON RUSTON SAINT AMANT SAINT BERNARD SAINT FRANCISVILLE SAINT MARTINVILLE SAINT MARTINVILLE SAINT MARTINVILLE

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

70394 70394-2559 70578 70578-5837 70578-8311 71269 71269-3658 70084-6001 70123-2114 70455-1992 70659 71270-3009 71270-5941 71270 71270-6615 71270 71270-2328 70774-3418 70085 70775-4522 70582-4430 70582-3513 70582-4005

THRIFTY WAY PHCY OF ST MARTINVILLE CASHWAY PHARMACY OF SCOTT INC INSTITUTIONAL PHARMACIES OF LA SCOTT PHARMACY SUPER 1 PHARMACY ALBERTSON'S PHARMACY BOUDREAUXS COMPOUNDING PHCY DAVID RAINES CHC PHARMACY DRUG EMPORIUM HEALTHCARE PHARMACY LLC MEDIC PHARMACY MEDIC SPECIALTY PHARMACY

(337) 394-9772 (337) 233-3382 (337) 268-4023 (337) 235-5216 (337) 210-2001 (318) 861-2431 (318) 631-2005 (318) 227-3355 (318) 861-7898 (318) 671-9603 (318) 221-0691 (318) 212-0614

1620 S MAIN ST 5900 CAMERON ST STE 100 106 ABIGAYLE ROW 1000 ST MARY ST 200 DESTINATION POINTE LN 105 SOUTHFIELD RD 2551 GREENWOOD RD STE 110 1625 DAVID RAINES RD 5819 E KINGS HWY 8720 QUIMPER PLACE SUITE 300 1849 LINE AVE 745 OLIVE ST STE 201

SAINT MARTINVILLE SCOTT SCOTT SCOTT SCOTT SHREVEPORT SHREVEPORT SHREVEPORT SHREVEPORT SHREVEPORT SHREVEPORT SHREVEPORT

LA LA LA LA LA LA LA LA LA LA LA LA

70582 70583-5182 70583-8909 70583 70583 71105-3702 71103-3984 71107-5899 71105-4303 71105 71101-4611 71104-2246

PMO PHCY MANAGEMENT SHREVEPORT RITE CARE PHARMACY SPECIALISTS PHARMACY SUPER 1 PHARMACY

(318) 429-0161 (318) 635-8159 (318) 213-3350 (318) 631-2065

2255 WOODWARD AVE 3102 LINWOOD AVE 1500 LINE AVE STE 104B 2640 WAGGONER AVE

SHREVEPORT SHREVEPORT SHREVEPORT SHREVEPORT

LA LA LA LA

71103-3547 71103-4231 71101 71108-3859

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SUPER ONE PHARMACY UNIVERSITY HEALTH SHREVEPORT VITAL CARE RX II ISLAND PHARMACY DAVIS DRUGS LACOURS PHARMACY CURRY PHARMACY SLAUGHTER ACARIAHEALTH PHARMACY, INC. FAMILY DRUG MART FAMILY DRUG MART FINNAN'S FAMILY PHARMACY MEDICINE SHOPPE TRINITY SPECIALTY PHARMACY DBA SPRINGFIELD DRUG STORE HOMETOWN PHARMACY LLC MALL PHARMACY THE CORNER DRUG STORE NORTH DESOTO DRUG BRINKHAUS THRIFTY WAY PHARMACY SUNSET PHARMACY INC BEENE'S HEALTH MART DRUG CITY PHARMACY OF TALLULAH INC S & B DRUGS MAJORIA DRUGS BAYOU DRUG STORE D & M DRUG STORE SOUTHLAND DRUGS INC WILLOW BARK PHARMACY URANIA DRUG STORE WEST ST JAMES PHARMACY BOOK'S PHARMACY REEVES DRUG STORE BLAKE'S SOUTHSIDE PHARMACY EASTINS PHARMACY EVANGELINE DRUG STORE MEDICINE CHEST PHARMACY PINE PRAIRIE PHARMACY, INC. THRIFTY WAY PHCY OF VLE PLATTE VILLE PLATTE CLINIC PHCY INC FREDS PHARMACY RX CARE PHARMACY OLOL LIVINGSTON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (318) 861-3985 (318) 813-1804 (318) 673-8360 (318) 389-5807 (318) 941-2296 (318) 941-2423 (225) 286-7773 (800) 511-5144 (985) 781-7541 (985) 641-7557 (985) 288-5899 (985) 643-7894 (985) 641-4252 (225) 294-5045 (225) 294-6021 (318) 539-3622 (318) 539-3199 (318) 775-4371 (337) 662-5236 (337) 662-5298 (318) 574-1351 (318) 574-1655 (318) 574-6363 (504) 392-1551 (985) 492-9200 (985) 447-3746 (985) 447-6599 (985) 633-2275 (318) 495-5407 (225) 265-2191 (318) 414-2616 (318) 336-5112 (337) 363-7497 (337) 363-6668 (337) 363-3456 (337) 363-8065 (337) 599-2050 (337) 363-6685 (337) 363-0941 (337) 589-3011 (318) 375-3784 (225) 271-6098

Provider Street 745 SHREVEPORT BARKSDALE HWY 1606 KINGS HWY RM 2263 2015 FAIRFIELD AVE STE E 311 CHISUM ST 116 JJJ LN 16237 HIGHWAY 1 1169 HWY 19 STE A 1736 GAUSE BLVD E STE 24 2230 E GAUSE 140 GAUSE BLVD 3044 GAUSE BLVD E 999 ROBERT BLVD 2800 E GAUSE BLVD STE F 31696 HWY 22 27118 HIGHWAY 42 531 S MAIN ST 27 REYNOLDS ST 4974 HIGHWAY 3276 STE B 127 ACORN DR 919 NAPOLEON AVE 402 E DARROW ST 1009 JOHNSON ST 501 N CHESTNUT ST 888 TERRY PKWY 1615 SAINT MARY ST STE F 1772 CANAL BLVD 1117 AUDUBON AVE 606 HIGHWAY 20 2164 E HARDTNER DR 21430 LA HWY 20 1158 LOGAN SEWELL DR 307 CARTER ST 808 S CHATAIGNIER ST 1535 W MAIN STE 2 10 W MAIN ST 409 E LINCOLN RD 10711 VETERAN MEMORIAL HWY 1011 W LINCOLN RD 505 JACK MILLER RD 1301 HORRIDGE ST 202 SOUTH AVE STE A 5000 ODONOVAN BLVD STE 104

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Provider City SHREVEPORT SHREVEPORT SHREVEPORT SICILY ISLAND SIMMESPORT SIMMESPORT SLAUGHTER SLIDELL SLIDELL SLIDELL SLIDELL SLIDELL SLIDELL SPRINGFIELD SPRINGFIELD SPRINGHILL SPRINGHILL STONEWALL SUNSET SUNSET TALLULAH TALLULAH TALLULAH TERRYTOWN THIBODAUX THIBODAUX THIBODAUX THIBODAUX URANIA VACHERIE VIDALIA VIDALIA VILLE PLATTE VILLE PLATTE VILLE PLATTE VILLE PLATTE VILLE PLATTE VILLE PLATTE VILLE PLATTE VINTON VIVIAN WALKER

State

ZIP code

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA

71105-2201 71103-4128 71104-2066 71368-4807 71369-2180 71369-2157 70777 70461-5521 70461 70458-2030 70461-4155 70458-2009 70461-4247 70462-0000 70462-7979 71075-4027 71075-3241 71078-9335 70584-6134 70584-6100 71282-3512 71282-5215 71282-3507 70056-5270 70301 70301-5225 70301-4940 70301-6255 71480-5000 70090 71373 71373-3305 70586-5934 70586-2868 70586-4566 70586-3431 70586-8232 70586-3045 70586-5627 70668 71082-3220 70785

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WALKER PHARMACY OUR LADY OF GUADALUPE PHARMACY WASHINGTON THRIF-T-WAY PHCY OSBORN'S CRESCENT DRUG STORE WELSH PHARMACY DRENNAN'S PHARMACY LLC HARDIN'S COMPOUNDING PHCY, LLC HEALTHCARE WAREHOUSE PHARMACY LEGENDS PHARMACY SUPER 1 PHARMACY HEALTH WISE PHARMACY VIALLON DRUG CO. PHARMACY SERVICES OF WINNFIELD THE MEDICINE SHOPPE K & S DRUGS WINNSBORO DRUG STORE VANMOL FAMILY PHARMACY LLC ACKALS COMMUNITY PHARMACY FARMERS DRUGS & GIFTS DRYS PHARMACY MEDICAL PHARMACY MEDICAL PHARMACY WEST HENDERSON PHARMACY BEMIS DRUG COMPANY STOP & SHOP PHARMACY ACTON PHARMACY INC GENOA-QOL HEALTHCARE BIG Y PHARMACY CENTRAL PHARMACY JOSEPH M SMITH COMM HEALTH CTR STOP & SHOP PHARMACY AMHERST PHARMACY NORTH AMHERST PHARMACY LETOURNEAUS PHARMACY MAIDA PHARMACY INC STOP & SHOP PHARMACY ATHOL PHARMACY COUNTY SQUARE PHARMACY INC PHARMBLUE MASSACHUSETTS LLC STOP & SHOP PHARMACY SHAWS PHARMACY KEYES DRUG INC

NR_0009_10823 10/2017

Provider Phone Number (225) 243-4852 (337) 826-9810 (337) 826-3677 (337) 734-3374 (337) 734-3374 (318) 397-9979 (318) 388-5592 (318) 651-0320 (318) 998-3018 (318) 325-3142 (337) 439-7067 (225) 545-2402 (318) 628-3575 (318) 628-2136 (318) 435-7858 (318) 435-4311 (318) 443-7073 (337) 857-5082 (337) 856-5761 (225) 654-1175 (225) 654-6883 (225) 658-8101 (318) 645-6116 (781) 878-0893 (781) 871-9228 (978) 263-3901 (978) 631-2186 (413) 743-5702 (617) 254-5900 (617) 783-0500 (978) 388-9755 (413) 253-0387 (413) 992-2145 (978) 475-7779 (781) 643-7840 (781) 643-3267 (978) 830-0427 (508) 222-7620 (800) 295-9564 (508) 226-5888 (508) 643-0312 (617) 244-2794

Provider Street 29811 WALKER RD S 904 HIGHWAY 363 310 N MAIN ST 110 W SOUTH ST 514 E RUSSELL AVE 2601 N 7TH ST SUITE 500 100 WESTLAND PL STE C 209 EXPO CIRCLE STE B 222 BELL LN STE 5A 2907 CYPRESS ST 916A SAMPSON ST 32555 BOWIE STREET 100 W MAIN ST 419 W COURT ST 802 ADAMS ST 1213 COMMON ST 9374 HIGHWAY 165 S 814 FORTUNE RD STE 109 601 LAFAYETTE ST 4344 CHURCH ST 6400 MAIN ST 2250 CHURCH ST 1169 NORTH MAIN 6 BRIGHTON ST 323 CENTRE AVE 563 MASSACHUSETTS AVE 289 GREAT RD STE G1 1 MYRTLE ST 1349 COMMONWEALTH AVE 287 WESTERN AVE 58 MACY ST 381 COLLEGE STREET 19 MONTAGUE RD 349 N MAIN ST 121 MASSACHUSETTS AVE 905 MASSACHUSETTS AVE 290 MAIN ST 289 COUNTY ST 163 PLEASANT ST PERRY & PLEASANT ST 11 ROBERT TONER BLVD 2090 COMMONWEALTH AVE

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Provider City WALKER WASHINGTON WASHINGTON WELSH WELSH WEST MONROE WEST MONROE WEST MONROE WEST MONROE WEST MONROE WESTLAKE WHITE CASTLE WINNFIELD WINNFIELD WINNSBORO WINNSBORO WOODWORTH YOUNGSVILLE YOUNGSVILLE ZACHARY ZACHARY ZACHARY ZWOLLE ABINGTON ABINGTON ACTON ACTON ADAMS ALLSTON ALLSTON AMESBURY AMHERST AMHERST ANDOVER ARLINGTON ARLINGTON ATHOL ATTLEBORO ATTLEBORO ATTLEBORO ATTLEBORO FALLS AUBURNDALE

State

ZIP code

LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA LA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

70785-7909 70589-4141 70589 70591-4246 70591-4848 71291 71291-5400 71292 71291-6303 71291-5337 70669-5311 70788-2503 71483-3239 71483-2743 71295-2602 71295-2609 71485-9786 70592-5542 70592-5410 70791-3102 70791-4039 70791-2707 71486 02351-1738 02351-2275 01720-2903 01720-4766 01220-1726 2134 02134-1010 01913-3736 1002 01002-1027 01810-2687 02474-8615 02476-4706 01331-2226 02703-3512 02703-2457 02703-0000 02763-1174 02466-1911

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE MEDICINE SHOPPE BARRE FAMILY PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY BELMONT PHARMACY SHAWS PHARMACY 610 TREMONT DRUG COMPANY BOSTON MED CNTR PHCY @ SHAPIRO BOSTON MED CTR O/P PHCY BOSTON MED CTR O/P PHCY-ENC DANA FARBER CANCER INST INC FENWAY PHARMACY FENWAY PHARMACY SEA GALAXY PHARMACY GARY DRUG COMPANY INC GREEN CROSS PHARMACY HEALTH FIRST PHARMACY MASS GENERAL HOSP O/P PHCY MCINNIS HOUSE PHARMACY

Provider Name

(978) 772-7325 (978) 355-2359 (781) 271-9403 (413) 323-9096 (617) 489-1616 (617) 489-6542 (617) 262-3389 (617) 414-4880 (617) 414-5377 (617) 638-8130 (617) 632-3338 (617) 927-6330 (617) 927-6163 (617) 268-0800 (617) 227-0023 (617) 227-3728 (617) 206-3233 (617) 724-3100 (857) 654-1150

50 MAIN ST 547 SUMMER ST 337 GREAT RD 9 GEORGE HANNUM RD 246 TRAPELO RD 535 TRAPELO RD 610 TREMONT ST 725 ALBANY ST 818 HARRISON AVE 88 E NEWTON ST # DOB-1 44 BINNEY ST 1340 BOYLSTON ST 142 BERKELEY ST 534 DORCHESTER AVE 59 CHARLES ST 393 HANOVER ST 1670-1678 COMMONWEALTH AVE 32 FRUIT ST 780 ALBANY ST

AYER BARRE BEDFORD BELCHERTOWN BELMONT BELMONT BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON BOSTON

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

01432-1339 01005-9561 01730-2802 01007-9158 02478-1849 02478-1403 02118-1600 02118-2526 02118-2905 02118-2308 02115-6013 02215-4302 02116-5100 02127-2762 02114-4605 02113-1308 02135-5601 02114-2620 02118-2524

NORTH END WATERFRONT HEALTH PHCY SHAWS PHARMACY TAI-TUNG PHARMACY INC STOP & SHOP PHARMACY BLUE HILLS PHARMACY STOP & SHOP PHARMACY BRIGHTON PHARMACY CHARLES RIVER COMMUNITY HEALTH MELVIN PHARMACY SHAWS PHARMACY APOTHECARE SOUTH SHORE EATON APOTHECARY SHAWS PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY LAHEY CLINIC MEDICAL CTR PHCY SHAWS PHARMACY CAMBRIDGE HEALTH ALLIANCE CAMBRIDGE HEALTH ALLIANCE PHCY HARVARD UNIV HLTH SRVCES PHCY INMAN PHARMACY INC SKENDERIAN APOTHECARY

(617) 643-8085 (617) 782-4585 (617) 482-7419 (508) 743-9563 (781) 843-8500 (781) 356-8596 (617) 322-0077 (617) 870-7448 (617) 566-2281 (617) 782-1628 (508) 588-6800 (508) 580-3000 (508) 584-8520 (508) 427-6582 (508) 427-1777 (781) 744-8658 (781) 221-0144 (617) 806-8509 (617) 806-8505 (617) 496-6661 (617) 876-4868 (617) 354-5600

332 HANOVER ST 1065 COMMONWEALTH AVE 256 HARRISON AVE 1 TOWERBRIDGE PLACE 340 WOOD RD STE 205 316 GROVE ST 388 WASHINGTON ST 495 WESTERN AVE 1558 COMMONWEALTH AVE 370 WESTERN AVE 720 CENTRE ST 63 MAIN ST 641 BELMONT ST 932 N MONTELLO ST 683 BELMONT ST 41 MALL RD 180 CAMBRIDGE ST # A 163 GORE ST 1493 CAMBRIDGE ST 75 MOUNT AUBURN ST 1414 CAMBRIDGE ST 1613 CAMBRIDGE ST

BOSTON BOSTON BOSTON BOURNE BRAINTREE BRAINTREE BRIGHTON BRIGHTON BRIGHTON BRIGHTON BROCKTON BROCKTON BROCKTON BROCKTON BROCKTON BURLINGTON BURLINGTON CAMBRIDGE CAMBRIDGE CAMBRIDGE CAMBRIDGE CAMBRIDGE

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

2113 02215-1031 02111-1835 2532 02184-2404 02184-7224 02135-2726 02135-1007 02135-5033 02135-1011 02302-3366 02301-4042 02301-4928 02301-1671 02301-5632 01805-0999 01803-2919 2141 02139-1047 02138-4960 02139-1108 02138-4315

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 254 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STAR PHARMACY EATON APOTHECARY OSCO PHARMACY SOLEO HEALTH INC MARGOLIS PHARMACY CHICOPEE HEALTH CENTER PHCY STOP & SHOP PHARMACY STOP & SHOP PHARMACY WEST CONCORD PHARMACY STOP & SHOP PHARMACY BOSTON HOME INFUSION

Provider Name

(617) 661-9337 (781) 575-9500 (781) 298-4400 (781) 298-3427 (617) 884-3524 (413) 420-6222 (413) 593-3999 (781) 383-6614 (978) 369-3100 (508) 999-7300 (781) 326-1986

699 MT AUBURN ST 427 TURNPIKE ST STE 5 95 WASHINGTON ST 5 SHAWMUT ROAD SUITE 103 447 BROADWAY 505 FRONT ST 672 MEMORIAL DR 400 CHIEF JUSTICE CUSHING HWY 1212 MAIN ST 25 FAUNCE CORNER RD 110 STERGIS WAY

CAMBRIDGE CANTON CANTON CANTON CHELSEA CHICOPEE CHICOPEE COHASSET CONCORD DARTMOUTH DEDHAM

MA MA MA MA MA MA MA MA MA MA MA

02138-4520 02021-2709 2021 2021 02150-2809 01013-3140 01020-5069 02025-1608 01742-3008 02747-4202 02026-2637

DEDHAM PHARMACY & MEDICAL SUPPLY BLUE HILL PHARMACY COMMUNITY CARE PHARMACY CRAWFORD DRUG LLC DORCHESTER HOUSE MULTI SVC CTR HARVARD NEIGHBORHOOD PHCY INC KIMMY PHARMACY MAXIM PHARMACY NEPONSET HEALTH CENTER PHCY PRIME PHARMACY SHAWS PHARMACY STOP & SHOP PHARMACY UPHAM'S CORNER H. C. PHARMACY CARING PHARMACY EATON APOTHECARY ALEXANDERS PHARMACY HEALTH CARE FAMILY PHARMACY

(781) 326-7007 (617) 652-7546 (617) 322-9265 (617) 436-3400 (617) 740-2544 (617) 265-0171 (617) 288-8199 (617) 282-9800 (617) 282-3200 (617) 427-2222 (617) 265-7911 (617) 541-4300 (617) 265-1310 (617) 322-1933 (617) 265-7400 (978) 957-0330 (978) 455-0570

596 PROVIDENCE HWY 320 BLUE HILL AVE 2100 DORCHESTER AVE 1735 DORCHESTER AVE 1353 DORCHESTER AVE 632 BLUE HILL AVE 1435 DORCHESTER AVE 1377 DORCHESTER AVE 398 NEPONSET AVE 201 HUMBOLDT AVE 45 MORRISSEY BLVD 8 STE B ALLSTATE RD 415 COLUMBIA RD 2288 DORCHESTER AVE 637 WASHINGTON ST FL G 505 NASHUA RD 14 LOON HILL RD

DEDHAM DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER DORCHESTER CENTER DORCHESTER CENTER DRACUT DRACUT

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

02026-6804 02121-1951 02124-5615 02124-2535 02122-2932 02121-3213 02122-2915 02122-2950 02122-3134 02121-1727 02125-3326 2125 02125-2424 02124-5622 02124-3510 01826-1929 01826-4015

E BOSTON NEIGHBORHOOD HEALTH CENTER EATON APOTHECARY BIG Y PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY SOUTHCOAST PHARMACY SOUTHCOAST SPECIALTY PHARMACY STOP & SHOP PHARMACY DEVILLERS PHARMACY SOUTHCOAST PHARMACY STANDARD PHARMACY

(617) 568-4000 (617) 568-4781 (413) 525-6346 (413) 525-6929 (508) 627-5107 (508) 973-2420 (508) 973-3320 (508) 990-4700 (508) 679-1944 (508) 973-7375 (508) 672-6911

10 GOVE ST 20 MAVERICK SQ 441 N MAIN ST 470 N MAIN ST 245 VINYARD HAVEN RD 208 MILL RD 206 MILL RD 221 HUTTLESTON AVE 1392 RODMAN ST 363 HIGHLAND AVE 246 E MAIN ST

EAST BOSTON EAST BOSTON EAST LONGMEADOW EAST LONGMEADOW EDGARTOWN FAIRHAVEN FAIRHAVEN FAIRHAVEN FALL RIVER FALL RIVER FALL RIVER

MA MA MA MA MA MA MA MA MA MA MA

02128-1920 02128-2335 01028-1804 01028-1805 2539 02719-5208 02719-5208 02719-1956 02721-3845 02720-3703 02724-3232

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 255 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

STANDARD PHARMACY @ HEALTHFIRST STOP & SHOP PHARMACY STOP & SHOP PHARMACY TRUESDALE CLNC HEALTH CARE PHCY

(774) 322-1335 (508) 675-0887 (508) 672-2366 (508) 675-5858

387 QUARRY ST 333 MARIANO BISHOP BLVD 501 RODMAN ST 1030 PRESIDENT AVE

FALL RIVER FALL RIVER FALL RIVER FALL RIVER

MA MA MA MA

02723-1007 02721-2349 02721-4217 02720-5923

WALSH PHARMACY OF ROCK STREET, INC. CAPE COD HEALTHCARE PHARMACY STOP & SHOP PHARMACY FITCHBURG FAMILY PHARMACY INC STOP & SHOP PHARMACY EATON APOTHECARY METROWEST PHARMACY OPTION CARE STOP & SHOP PHARMACY V-CARE PHARMACY & SURGICAL SUP SHAWS PHARMACY STOP & SHOP PHARMACY GARDNER FAMILY PHARMACY INC PRICE CHOPPER PHARMACY CENTRAL STREET PHARMACY CENTER PHARMACY BIG Y PHARMACY PRICE CHOPPER PHARMACY BIG Y PHARMACY GENOA-QOL HEALTHCARE STOP & SHOP PHARMACY SHAWS OSCO PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY SHAWS PHARMACY CAPE COD HHC PHY @ FONTAINE OP STAR PHARMACY STOP & SHOP PHARMACY HINGHAM CENTRE PHARMACY STOP & SHOP PHARMACY HOLYOKE HEALTH CENTER PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY NANTASKET PHARMACY APOTHECARE

(508) 679-1300 (508) 495-7520 (413) 789-2226 (978) 878-8461 (508) 543-6174 (508) 626-2800 (508) 405-0609 (580) 624-8555 (508) 820-0903 (508) 202-9993 (508) 520-7017 (508) 520-4106 (978) 730-8393 (978) 730-1041 (351) 207-5132 (413) 467-7022 (413) 528-5460 (413) 528-2408 (413) 774-3858 (413) 376-5430 (413) 774-6006 (978) 448-2605 (413) 256-4167 (781) 293-5786 (781) 293-0561 (508) 430-3311 (508) 432-0895 (508) 432-5001 (781) 749-1277 (781) 749-5856 (413) 533-7323 (413) 536-5483 (413) 536-9101 (781) 925-1270 (508) 775-9254

202 ROCK ST 100 TER HEUN DRIVE 1282 SPRINGFIELD ST 326 NICHOLS RD 141 MAIN ST 266 WAVERLY ST 214 UNION AVE 1291 WORCHESTER BLVD 235 OLD CONNECTICUT PATH 151 COCHITUATE RD 255 E CENTRAL ST 40 FRANKLIN VILLAGE DR 175 CONNORS ST 560 MAIN ST 50 CENTRAL STREET 242 STATE ST 700 MAIN ST STE 2 300 STOCKBRIDGE RD 237 MOHAWK TRL # 2 55 FEDERAL ST STE 105 89 FRENCH KING HWY 760A BOSTON RD 456 RUSSELL ST 275 PLYMOUTH ST 476 LIBERTY ST 525 LONG POND DR 18 SISSON ROAD 111 CHATHAM RD 294 MAIN ST 400 LINCOLN ST 230 MAPLE ST 28 LINCOLN ST 2217 NORTHAMPTON ST 480 NANTASKET AVE 145 BARNSTABLE RD

FALL RIVER FALMOUTH FEEDING HILLS FITCHBURG FOXBORO FRAMINGHAM FRAMINGHAM FRAMINGHAM FRAMINGHAM FRAMINGHAM FRANKLIN FRANKLIN GARDNER GARDNER GEORGETOWN GRANBY GREAT BARRINGTON GREAT BARRINGTON GREENFIELD GREENFIELD GREENFIELD GROTON HADLEY HALIFAX HANSON HARWICH HARWICH HARWICH HINGHAM HINGHAM HOLYOKE HOLYOKE HOLYOKE HULL HYANNIS

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

02720-3212 2540 01030-2119 01420-1914 02035-1359 01702-7031 01702-8285 01701-8921 01701-4575 01701-7821 02038-1317 02038-4000 01440-2637 01440-3044 01833-2407 01033-9417 01230-2016 01230-1235 01301-9621 01301-2546 01301-1312 01450-2058 01035-9591 02338-1435 02341-1163 02645-1227 2645 02645-3151 02043-2842 02043-1505 01040-5124 01040-3325 01040-3447 02045-2521 02601-2901

NR_0009_10823 10/2017

Page 256 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

CAPE COD HLTH PHY AT CAPE COD HOSP HARBOR COMMTY HLTH CTR HYANNIS STOP & SHOP PHARMACY WHOLE HEALTH PHARMACY QUALITY RX PHARMACY INC SHAWS PHARMACY CONLEY'S DRUG STORE BRAVO PHARMACY STOP & SHOP PHARMACY BIG Y PHARMACY STOP & SHOP PHARMACY AZEE PHCY & MEDICAL SOLUTIONS CURE-AID PHARMACY

(508) 862-5900 (508) 778-5424 (508) 790-2182 (508) 778-5928 (617) 361-3030 (617) 364-3161 (978) 356-2121 (617) 553-2501 (617) 524-2419 (781) 585-1326 (781) 582-3703 (978) 975-1575 (978) 984-5285

27 PARK ST 735 ATTUCKS LN 65 INDEPENDENCE DR 596 W MAIN ST 1260 RIVER ST 1377 HYDE PARK AVE 146 HIGH ST 3158 WASHINGTON ST 301 CENTRE ST 182 SUMMER ST 160 SUMMER ST 25 MARSTON ST 203 ESSEX ST

HYANNIS HYANNIS HYANNIS HYANNIS HYDE PARK HYDE PARK IPSWICH JAMAICA PLAIN JAMAICA PLAIN KINGSTON KINGSTON LAWRENCE LAWRENCE

MA MA MA MA MA MA MA MA MA MA MA MA MA

2601 02601-1867 02601-1851 02601-3465 02136-2833 02136-2752 01938-1212 02130-4514 02130-1637 2364 02364-1226 01841-2310 01840-1510

GREATER LAWRENCE FAMILY HEALTH CTR

(978) 689-6790

73D WINTHROP AVE

LAWRENCE

MA

1843

GREATER LAWRENCE FAMILY HLTH CNTR GREATER LAWRENCE FAMILY HLTH CTR

(978) 688-1567 (978) 686-4453

34 HAVERHILL ST FL 1 150 PARK ST

LAWRENCE LAWRENCE

MA MA

01841-2884 01841-2517

GREATER LAWRENCE FMLY HLTH CNT PHCY PACKARD PHARMACY PERROTTA'S SUPER DRUG BIG Y PHARMACY LENOX VILLAGE PHARMACY LEOMINSTER FAMILY PHARMACY INC THEATRE PHARMACY INC BIG Y PHARMACY CENTURY PHARMACY, LLC K PHARMACY

(978) 691-6248 (978) 682-5122 (978) 682-2557 (413) 243-1007 (413) 637-4700 (978) 728-4429 (781) 862-4480 (413) 567-0679 (978) 455-6554 (978) 455-8375

700 ESSEX ST 128 PARKER ST 292 PROSPECT ST 10 PLEASANT ST 5 WALKER ST STE 1 843 CENTRAL ST 1784 MASSACHUSETTS AVE 802 WILLIAMS ST 937 GORHAM ST 280 WESTFORD ST

LAWRENCE LAWRENCE LAWRENCE LEE LENOX LEOMINSTER LEXINGTON LONGMEADOW LOWELL LOWELL

MA MA MA MA MA MA MA MA MA MA

01841-4396 01843-1537 01841-2825 01238-1317 01240-2723 01453-4813 02420-5302 01106-2054 01852-4635 01851-2525

LONG TERM PHARMACY SOLUTIONS INC.

(978) 458-4000

225 STEDMAN ST STE 27

LOWELL

MA

01851-2792

LOWELL COMMUNITY HEALTH CENTER PHCY ONEWORLD RX HEALTHMART TRUE CARE PHARMACY BIG Y PHARMACY EATON APOTHECARY EATON APOTHECARY FLAG PHARMACY RICHMOND PHARMACY SHAWS PHARMACY

(978) 459-9500 (978) 455-4066 (978) 452-6666 (413) 583-7910 (781) 593-4805 (781) 598-3535 (781) 599-5900 (781) 592-4172 (781) 596-9625

161 JACKSON ST 138 HIGHLAND AVE #5 1275 PAWTUCKET BLVD #3 433 CENTER STREET, SUITE 3 270 UNION ST 12 MARKET SQ 7 WILLOW ST 499 EASTERN AVE # 503 43 STATE ST

LOWELL LOWELL LOWELL LUDLOW LYNN LYNN LYNN LYNN LYNN

MA MA MA MA MA MA MA MA MA

1852 1851 1854 1056 01901-1348 01905-2422 01901-1206 01902-1570 01901-1504

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STATE STREET PHARMACY STOP & SHOP PHARMACY VILLAGE PHARMACY

Provider Name

(781) 599-0900 (781) 596-3277 (781) 334-3133

22 STATE ST 35 WASHINGTON ST 590 MAIN ST

LYNN LYNN LYNNFIELD

MA MA MA

01901-1505 01904-3305 01940-1712

CAMBRIDGE HEALTH ALLIANCE MALDEN STOP & SHOP PHARMACY ALLENS PHARMACY STOP & SHOP PHARMACY VILLAGE PHARMACY OF MARBLEHEAD BOUVIER PHARMACY GENOA-QOL HEALTHCARE ST GEORGE PHARMACY STAR PHARMACY

(781) 338-8990 (781) 397-0050 (978) 526-1321 (508) 337-9455 (781) 631-8100 (508) 485-0432 (508) 970-9009 (774) 451-7911 (781) 837-5163

195 CANAL ST STE 104 99 CHARLES ST 40 BEACH ST 377 CHAUNCY ST 1 VILLAGE PLZ 515 LINCOLN ST 340 MAPLE ST STE 450 435 FURNACE ST 16 WEBSTER SQUARE

MALDEN MALDEN MANCHESTER MANSFIELD MARBLEHEAD MARLBOROUGH MARLBOROUGH MARSHFIELD MARSHFIELD

MA MA MA MA MA MA MA MA MA

02148-6701 02148-6700 01944-1468 02048-1169 01945-2373 01752-2088 01752-3200 02050-2328 2050

COMMUNITY HLTH CTR OF CAPE COD PHCY STOP & SHOP PHARMACY SHAWS PHARMACY STOP & SHOP PHARMACY GREEN STREET PHARMACY CONLIN'S PHARMACY GREATER LAWRENCE FAM HLTH CNTR GREATER LAWRENCE FAMILY HC INC NEIGHBORHOOD HEALTHMART PHCY STOP & SHOP PHARMACY EATON APOTHECARY STOP & SHOP PHARMACY DAN'S PHARMACY ISLAND PHARMACY NANTUCKET PHARMACY JONES DRUG INC NATICK FAMILY PHARMACY INC STOP & SHOP PHARMACY BIRDS HILL PHARMACY INC MEDMINDER PHARMACY ST LUKES RETAIL PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY DANIEL L LYNCH PHARMACY ACC APOTHECARY FOX'S DRUGSTORE

(508) 477-0004 (508) 539-1803 (508) 359-6855 (781) 396-2940 (781) 665-0022 (978) 552-1750 (978) 655-5731 (978) 682-3850 (978) 794-1111 (978) 837-6644 (774) 462-3200 (508) 478-5748 (508) 825-9100 (508) 228-6400 (508) 228-0180 (508) 653-1820 (508) 720-4971 (508) 653-3504 (781) 449-0550 (888) 633-6463 (508) 961-5449 (508) 996-5090 (508) 998-0999 (978) 462-2232 (617) 527-1563 (617) 244-3535

107 COMMERCIAL ST 39 NATHAN ELLIS HWY 230 MAIN ST 760 FELLSWAY 35 GREEN ST 30 LAWRENCE ST 147 PELHAM ST 70 EAST ST 7-9 CROSS STREET 90 PLEASANT VALLEY ST 23 MAPLE ST 196 E MAIN ST 110 PLEASANT ST 122 PLEASANT ST 45 MAIN ST 7 MAIN ST 67 UNION ST UNIT 1-1 829 WORCESTER ST 401 GREAT PLAIN AVE 30 WEXFORD ST 101 PAGE ST 438 DARTMOUTH ST 1001 KINGS HWY 173 HIGH ST 153 CALIFORNIA ST 416 WATERTOWN ST

MASHPEE MASHPEE MEDFIELD MEDFORD MELROSE METHUEN METHUEN METHUEN METHUEN METHUEN MILFORD MILFORD NANTUCKET NANTUCKET NANTUCKET NATICK NATICK NATICK NEEDHAM NEEDHAM NEW BEDFORD NEW BEDFORD NEW BEDFORD NEWBURYPORT NEWTON NEWTON

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

02649-6507 02649-3267 02052-1400 02155-4926 02176-2811 01844-4449 01844-2060 1844 1844 01844-7212 01757-3650 01757-2822 02554-4004 02554-4003 02554-3542 01760-4505 01760-7700 01760-2076 02492-3735 02494-2912 02740-3464 02740-1115 02745-4902 01950-3961 2458 02458-1121

BERKSHIRE COMMUNITY PHARMACY OF NOR

(413) 664-5333

71 HOSPITAL AVE

NORTH ADAMS

MA

1247

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 258 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LITTLES PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY MEDICAL CENTER PHARMACY MEDICAL CENTER PHARMACY INC REMEDIUM PHARMACY PHARMAHEALTH HAWTHORN NORTH FALMOUTH PHARMACY BIG Y PHARMACY SERIOS PHARMACY STOP & SHOP PHARMACY ALLCARE PLUS PHARMACY SHATTUCK PHARMACY INC ROCHE BROS PHARMACY BIG Y PHARMACY STOP & SHOP PHARMACY CONROY APOTHECARY OB STOP & SHOP PHARMACY BIG Y PHARMACY BIG Y PHARMACY EATON APOTHECARY HOME CARE PHARMACY LAHEY CLINIC NORTH PHARMACY STOP & SHOP PHARMACY ARXCARE,LLC STOP & SHOP PHARMACY PEPPERELL FAMILY PHARMACY BERKSHIRE COMMUNITY PHARMACY BIG Y PHARMACY PRICE CHOPPER PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY T.C. FLYNN PHARMACY PLAINVILLE PRESCRIPTION CENTER BALBONIS DRUG STORE INC SHAWS PHARMACY STOP & SHOP PHARMACY THE MEDICINE SHOPPE PROVINCETOWN OUTER CAPE PHCY BAXTER PHARMACY GALAXY PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (413) 663-6450 (413) 664-8550 (978) 683-4925 (508) 695-6111 (978) 663-6583 (978) 663-6583 (978) 251-7070 (508) 998-7888 (508) 564-4459 (413) 586-5145 (413) 584-8980 (413) 584-9700 (508) 459-3535 (508) 393-2670 (508) 285-5293 (781) 878-7063 (781) 982-2946 (508) 696-0700 (508) 255-3851 (413) 283-4827 (978) 536-3222 (978) 977-7744 (978) 535-3893 (978) 538-4150 (978) 977-3946 (781) 924-5471 (781) 826-7329 (978) 433-6130 (413) 395-7610 (413) 447-9844 (413) 496-9332 (413) 443-0064 (413) 442-8898 (413) 445-5567 (508) 695-5091 (508) 746-1251 (508) 833-8819 (508) 746-7114 (508) 747-1247 (774) 538-3333 (617) 773-7733 (617) 302-3599

Provider Street 109 EAGLE ST 876 STATE RD 757 TURNPIKE ST 260 E WASHINGTON ST 221 BOSTON RD 221 BOSTON RD 2 VINAL SQUARE 535 FAUNCE CORNER RD 111 COUNTY RD 136 N KING ST 63 STATE ST 288 KING ST 50 BEARFOOT RD 17 W MAIN ST 175 MANSFIELD AVE 10 WASHINGTON ST 468 WASHINGTON ST 82 PENNACOOK AVE 24 RT 6A 1180 THORNDIKE ST 637 LOWELL ST 2 CENTENNIAL DR STE 1A 104 NEWBURY ST 1 ESSEX CENTER DR 19 HOWLEY ST 42 WINTER STREET UNIT 1 125 CHURCH ST 74 MAIN ST 725 NORTH ST 200 WEST ST 555 HUBBARD AVE 660 MERRILL RD 1 DAN FOX DR 173 ELM ST 122 SOUTH ST 289 COURT ST 2260 STATE RD 127 SAMOSET ST 235 SANDWICH ST 49 HARRY KEMP WAY 464 WASHINGTON ST 343 NEWPORT AVE

Page 259 of 679

Provider City NORTH ADAMS NORTH ADAMS NORTH ANDOVER NORTH ATTLEBORO NORTH BILLERICA NORTH BILLERICA NORTH CHELMSFORD NORTH DARTMOUTH NORTH FALMOUTH NORTHAMPTON NORTHAMPTON NORTHAMPTON NORTHBOROUGH NORTHBOROUGH NORTON NORWELL NORWELL OAK BLUFFS ORLEANS PALMER PEABODY PEABODY PEABODY PEABODY PEABODY PEMBROKE PEMBROKE PEPPERELL PITTSFIELD PITTSFIELD PITTSFIELD PITTSFIELD PITTSFIELD PITTSFIELD PLAINVILLE PLYMOUTH PLYMOUTH PLYMOUTH PLYMOUTH PROVINCETOWN QUINCY QUINCY

State

ZIP code

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

01247-2696 01247-3027 01845-6120 02760-2313 01862-2321 01862-2321 01863-1312 02747-1242 2556 01060-1120 01060-3011 01060-2332 01532-1514 01532-1909 02766-1333 2061 02061-2006 2557 02653-2412 01069-1511 1960 01960-7936 01960-3806 01960-2901 01960-5617 2359 02359-1929 01463-1560 01201-4109 01201-5735 01201-3876 01201-3710 01201-8234 01201-6530 02762-2004 02360-4341 02360-5177 02360-4801 02360-2434 02657-1618 02169-5716 02170-3376

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name S. COVE COMM HLTH CNTR,INC STOP & SHOP PHARMACY STOP & SHOP PHARMACY RANDOLPH PHARMACY STOP & SHOP PHARMACY ANAWAN PHARMACY REVERE HEALTHCARE CTR PHCY SEASIDE PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY ROSLINDALE PHARMACY LIMITED SULLIVANS PHARMACY INC ROWLEY PHARMACY INC DIMOCK CENTER PHARMACY KORNFIELD DRUG WHITTIER HEALTH PHARMACY II WHITTIER HEALTH PHARMACY RUTLAND PHARMACY EATON APOTHECARY CAPE COD HLTH PHCY AT STONEMAN STOP & SHOP PHARMACY STOP & SHOP PHARMACY SCITUATE PHARMACY STOP & SHOP PHARMACY THE BAKER PHARMACY KABAFUSION, INC. PRICE CHOPPER PHARMACY SHAWS PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY EATON APOTHECARY MAXIM PHARMACY DEERFIELD PHARMACY, LLC BIG Y PHARMACY BIG Y PHARMACY CONNOLLYS PHARMACY INC OLDENS PHARMACY INC STOP & SHOP PHARMACY PROCARE LTC OF MA, LLC BIG Y PHARMACY SOUTHWICK PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (617) 318-3310 (617) 471-6707 (617) 328-6622 (781) 885-1181 (508) 824-2845 (774) 901-2445 (781) 485-6015 (781) 284-6525 (781) 289-6879 (781) 284-5155 (617) 325-0300 (617) 323-6544 (978) 948-2208 (617) 427-9800 (617) 427-8950 (617) 652-7679 (617) 536-1890 (508) 886-6262 (978) 744-0300 (774) 338-5010 (508) 833-3288 (781) 231-5775 (781) 545-1020 (508) 336-4453 (413) 625-6324 (508) 845-2168 (774) 214-4255 (508) 363-0057 (508) 842-2771 (508) 324-9693 (617) 666-1404 (617) 268-9500 (617) 268-4500 (413) 665-8143 (508) 238-4067 (413) 538-6178 (978) 468-3711 (781) 337-0187 (508) 394-8909 (508) 481-5800 (413) 569-9174 (413) 998-3446

Provider Street 435 HANCOCK ST 495 SOUTHERN ARTERY # 017 65 NEWPORT AVE 1187 N MAIN ST 36 NEW STATE HWY 224 WINTHROP ST 300 OCEAN AVE 169 SHIRLEY AVE 540 SQUIRE RD # 043 40 FURLONG DR 452 HYDE PARK AVE 1 CORINTH ST 169 MAIN ST 45-55 DIMOCK ST 2121 WASHINGTON ST 278 BLUE HILL AVE 1290 TREMONT ST 18 MAPLE AVE 47 CONGRESS ST 2 JAN SEBASTIAN DR 6A MERCHANTS WAY # & 164 MAIN ST 384 GANNETT RD 35 HIGHLAND AVE 52 BRIDGE ST 159 MEMORIAL DR UNIT E 731 BOSTON TPKE 50 BOSTON TPKE 539 BOSTON TPKE # 571 815 GRAND ARMY HWY 274 MYSTIC AVE 409 W BROADWAY 267 OLD COLONY AVE 45 N MAIN ST 25 ROBERT DRIVE 44 WILLIMANSETT ST 44 BAY RD 101 PLEASANT ST 55 LONG POND DR 155 NORTHBORO RD 195 COLLEGE HWY 549 COLLEGE HWY UNIT B

Page 260 of 679

Provider City QUINCY QUINCY QUINCY RANDOLPH RAYNHAM REHOBOTH REVERE REVERE REVERE REVERE ROSLINDALE ROSLINDALE ROWLEY ROXBURY ROXBURY ROXBURY ROXBURY CROSSING RUTLAND SALEM SANDWICH SANDWICH SAUGUS SCITUATE SEEKONK SHELBURNE FALLS SHREWSBURY SHREWSBURY SHREWSBURY SHREWSBURY SOMERSET SOMERVILLE SOUTH BOSTON SOUTH BOSTON SOUTH DEERFIELD SOUTH EASTON SOUTH HADLEY SOUTH HAMILTON SOUTH WEYMOUTH SOUTH YARMOUTH SOUTHBOROUGH SOUTHWICK SOUTHWICK

State

ZIP code

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

02171-2428 02169-4610 02171-2643 02368-2135 02767-5423 02769-2650 02151-3675 02151-3256 02151-1863 02151-4006 02131-3131 02131-3014 01969-1841 2119 02119-2086 02119-2158 02120-3432 01543-1529 01970-7308 2563 02563-5305 01906-3271 02066-1220 02771-5805 01370-1131 01545-6202 01545-3201 01545-3540 01545-5969 02726-1204 2145 02127-2245 02127-3520 01373-1012 2375 01075-3062 01982-2202 02190-2400 02664-4161 01772-1033 01077-9438 01077-9821

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BIG Y PHARMACY BAYSTATE PHARMACY BAYSTATE PHARMACY BAYSTATE PHARMACY BAYSTATE SPECIALTY PHARMACY BIG Y PHARMACY CARING HEALTH CENTER PHARMACY CARING PHARMACY COMMUNITY PHCY MERCY MED CTR LOUIS & CLARK DRUG LOUIS & CLARK DRUG QUALITY ZONE PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY THE APOTHECARY CENTER INC SHAWS PHARMACY SUDBURY PHARMACY MARKET 32 #244 STOP & SHOP PHARMACY SHAWS PHARMACY STOP & SHOP PHARMACY MCNABB PHARMACY TYNGSBORO FAMILY PHARMACY CONROY APOTHECARY LESLIES PHARMACY VINEYARD SCRIPTS SMITH DRUG THE MEDICINE STORE BETRO PHARMACY BIG Y PHARMACY CHARLES RIVER COMMUNITY HEALTH

Provider Name

(508) 885-9073 (413) 794-7016 (413) 794-9009 (413) 794-3291 (855) 865-5432 (413) 783-0105 (413) 693-1005 (413) 342-4238 (413) 452-6337 (413) 781-2996 (413) 736-5649 (413) 739-3900 (413) 732-7040 (413) 543-5428 (413) 734-2080 (978) 897-1736 (978) 443-6311 (508) 865-2513 (781) 596-0224 (508) 457-1185 (508) 540-4711 (978) 597-2392 (978) 226-5679 (508) 693-7070 (508) 693-1010 (508) 693-7979 (781) 245-0380 (781) 246-3527 (508) 668-0018 (508) 660-9713 (617) 208-1654

62 W MAIN ST 3300 MAIN ST 50 WASON AVE 759 CHESTNUT ST 298 CAREW ST 300 COOLEY ST 1049 MAIN ST 377 BELMONT AVE 299 CAREW ST 490 PAGE BLVD 300 BIRNIE AVE 355 BELMONT AVE 1277 LIBERTY ST 1600 BOSTON RD 1985 MAIN ST 115 GREAT ROAD 447 BOSTON POST RD 21 GALAXY PASS 450 PARADISE RD 137 TEATICKET HWY 20 TEATICKET HWY 233 MAIN ST 138 MIDDLESEX RD 459 STATE RD 65-12 MAIN ST 117 BEACH RD 390 MAIN ST 409 LOWELL ST 965 MAIN ST 999 PROVIDENCE HWY 564 MAIN ST

SPENCER SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD STOW SUDBURY SUTTON SWAMPSCOTT TEATICKET TEATICKET TOWNSEND TYNGSBORO VINEYARD HAVEN VINEYARD HAVEN VINEYARD HAVEN WAKEFIELD WAKEFIELD WALPOLE WALPOLE WALTHAM

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

01562-2644 01107-1112 01107-1132 01199-0001 01104-2316 01128-1801 01103-2143 01108-2064 01104-2301 01104-3026 01107-1107 1108 01104-1165 01129-1141 01103-1095 1775 01776-3011 1590 01907-1300 02536-5659 02536-5615 1469 01879-2711 02568-7213 02568-0417 02568-5524 01880-5015 01880-1962 02081-2965 02081-4232 02452-5516

JOHNSON COMPOUNDING & WELLNESS CTR MASS GENERAL WEST PHARMACY ONCOMED PELHAM COMMUNITY PHARMACY ROGERS PHARMACY INC SPECIAL CARE PHARMACY STAR OSCO PHARMACY VILLAGE FERTILITY PHARMACY PRICE CHOPPER PHARMACY ANDREWS PHARMACY

(781) 893-3870 (781) 487-4390 (877) 662-6033 (781) 966-2700 (781) 894-1800 (877) 334-1610 (781) 899-3332 (877) 334-1610 (508) 949-8804 (781) 235-1250

577 MAIN ST 40 2ND AVE STE 400 150 BEAR HILL ROAD 196 BEAR HILL RD 923 MAIN ST 335 BEAR HILL RD STE B 1070 LEXINGTON ST 335 BEAR HILL ROAD 118 E MAIN ST STE 1 324 WESTON RD

WALTHAM WALTHAM WALTHAM WALTHAM WALTHAM WALTHAM WALTHAM WALTHAM WEBSTER WELLESLEY

MA MA MA MA MA MA MA MA MA MA

02452-5527 02451-1137 2451 02451-1004 02451-7416 02451-1006 02452-7206 2451 01570-1710 02482-4509

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 261 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

OUTER CAPE HEALTH SVS PHCY GREATER BOSTON LONG TERM CARE SHAWS PHARMACY WEST ROXBURY PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY ARROW PRESCRIPTION CTR STOP & SHOP PHARMACY WESTMINSTER PHARMACY INC WESTPORT APOTHECARY INC STOP & SHOP PHARMACY MBS PHARMA CARE DUVALS PHARMACY INC BIG Y PHARMACY WILLIAMSBURG PHARMACY ACARIAHEALTH PHARMACY, INC WINCHESTER PHARMACY INC BROWN'S PHARMACY STOP & SHOP PHARMACY ALLCARE PHARMACY BEACON PHARMACY INC BIG Y PHARMACY BOULEVARD PHRM CMPD CTR COMPARE QUALITY PHARMACY PRESCOTT PHARMACY LTC PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY SAINT VINCENT PHARMACY SHAWS/OSCO PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY UMASS MEM MED CTR SPEC PHCY UMASS MEM MED CTR SPEC PHCY

Provider Name

(508) 214-0187 (617) 325-0017 (617) 327-9360 (617) 325-0017 (413) 733-8511 (508) 366-0849 (413) 568-8911 (413) 568-9660 (978) 874-5812 (508) 636-5957 (781) 331-1902 (508) 372-0627 (781) 447-0606 (413) 543-9912 (413) 268-3387 (800) 511-5144 (781) 570-2320 (617) 846-1500 (781) 932-8660 (508) 754-8800 (508) 754-4075 (508) 890-8589 (508) 754-1791 (508) 755-3000 (508) 683-0260 (508) 854-8318 (508) 363-4570 (508) 363-6602 (508) 852-5344 (508) 791-2166 (508) 852-2202 (508) 421-1990 (888) 639-3988

2700 STATE HWY RT 6 STE 3 1864 CENTRE ST 75 SPRING ST 1868 CENTRE ST 935 RIVERDALE ST 32 LYMAN ST 427 N ELM ST 57 MAIN ST 128 MAIN ST 784 MAIN RD 700 MIDDLE ST 1035 PROVIDENCE RD 571 WASHINGTON ST 2035 BOSTON RD 49 MAIN ST 260 E FORDHAM RD. 568 MAIN ST 214 WINTHROP ST 2 ELM ST 12 PLYMOUTH ST STE 100 810 MAIN ST 100 MAYFIELD ST 149 SHREWSBURY ST 664 MAIN ST 100 GROVE ST STE B12 72 PULLMAN ST 50 S CAMBRIDGE ST 123 SUMMER ST STE 365 14 W BOYLSTON ST 949 GRAFTON ST 940 W BOYLSTON ST 119 BELMONT ST 55 LAKE AVE N BLDG ACC

WELLFLEET WEST ROXBURY WEST ROXBURY WEST ROXBURY WEST SPRINGFIELD WESTBOROUGH WESTFIELD WESTFIELD WESTMINSTER WESTPORT WEYMOUTH WHITINSVILLE WHITMAN WILBRAHAM WILLIAMSBURG WILMINGTON WINCHESTER WINTHROP WOBURN WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER WORCESTER

MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA MA

2667 02132-1919 02132-4335 02132-1902 01089-4656 01581-1419 01085-1616 01085-3170 01473-1542 02790-4341 02188-4006 01588-2121 02382-1337 01095-1103 01096-9404 1887 01890-1953 02152-2605 01801-1802 01608-2121 01610-2422 01602-3453 01604-4637 01610-3124 01605-2627 01606-3311 01610-2303 01608-1216 01605-1228 01604-2003 01606-1141 01605-2903 01655-0002

UMASS UNIVERSITY PRESCRIPTION CENTE WORCESTER FAMILY PHARMACY JOHNSON FAMILY PHARMACY LLC KLEINS PHARMACY OF ABERDEEN GIANT PHARMACY

(508) 421-1900 (508) 791-1100 (410) 297-9400 (410) 272-3101 (410) 420-3161

55 LAKE AVE N 108 GROVE ST STE 12 119 W BEL AIR AVE 949 BEARDS HILL RD 3229 EMMORTON ROAD

WORCESTER WORCESTER ABERDEEN ABERDEEN ABINGDON

MA MA MD MD MD

01655-0002 01605-2651 21001-3221 21001-1734 21009

ACCOKEEK DRUG AND HEALTHCARE, INC GIANT PHARMACY

(301) 203-7205 (301) 893-3101

15789 LIVINGSTON RD UNIT 108 7025 BERRY RD

ACCOKEEK ACCOKEEK

MD MD

20607-3345 20607-3419

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 262 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ANNAPOLIS PROFESSIONAL PHARMACY ANNE ARUNDEL MEDICAL CTR PHCY ANNE ARUNDEL UROLOGY, PA GIANT PHARMACY GIANT PHARMACY MED PARK PHARMACY PATIENT CARE PHARMACY SHOPPERS PHARMACY ARNOLD PROFESSIONAL PHARMACY BROADNECK PHARMACY ABH MEDICAL SUPPLIES ABSOLUTECARE, INC ALPHA HEALTHCARE GROUP, INC ALPHA PHARMACY AUSTIN'S PHARMACY BALT MED SYS PHCY @ ST AGNES BALTIMORE HIGHLANDS PHARMACY BALTIMORE MEDICAL SYSTEM INC BALTIMORE MEDICAL SYSTEM INC BALTIMORE MEDICAL SYSTEM INC BAYVIEW PHARMACY BELAIR PHARMACY BELVEDERE PHARMACY BELVEDERE PHARMACY LLC BESTCARE PHARMACY, INC BREATHE4SURE, LLC CAMPUS PHARMACY CARE ONE PHARMACY CARE ONE PHARMACY CAREMAX PHARMACY CATONSVILLE PHARMACY CENTRAL AVENUE PHARMACY CHARLESMEAD PHARMACY CHASE BREXTON CLINIC PHARMACY CITICARE PHARMACY COMFORT PHARMACY INC CONNET PHARMACY LLC DIVINE CARE PHARMACY DRUG CITY PHARMACY EASTERN AVENUE PHARMACY EDMONDSON PHARMACY EXTRACARE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (410) 263-7440 (443) 481-4175 (410) 266-8049 (410) 224-2850 (410) 268-4020 (410) 573-6900 (443) 949-9005 (410) 224-3794 (443) 949-8373 (410) 544-3733 (410) 644-4002 (443) 738-0300 (410) 889-0727 (443) 453-9383 (410) 377-5300 (443) 703-3185 (410) 636-1035 (443) 703-3683 (443) 703-3687 (443) 703-3680 (410) 633-5050 (410) 601-3136 (410) 323-1515 (410) 367-5628 (410) 383-0300 (443) 529-9988 (410) 433-9434 (410) 523-7500 (410) 669-3744 (443) 251-2718 (410) 744-5959 (410) 276-3530 (410) 435-0210 (410) 234-0327 (410) 261-5551 (410) 342-0616 (410) 522-0009 (443) 873-8294 (410) 284-2424 (410) 929-8455 (410) 566-5565 (410) 332-4666

Provider Street 703 GIDDINGS AVENUE STE L 1 2003 MEDICAL PARKWAY 600 RIDGELY AVE STE 222 2323 FOREST DR 948 BAY RIDGE RD 2002 MEDICAL PKWY STE 170 2047 WEST STREET SUITE A 2371 SOLOMONS ISLAND RD 1460 RITCHIE HWY STE 103 269 PENINSULA FARM RD 219 COLLINS AVE 1040 PARK AVE STE 200 418 E 30TH ST 3061 FREDERICK AVE STE C 6729 YORK RD 900 S CATON AVE 4109 ANNAPOLIS ROAD 3120 ERDMAN AVE 2323 ORLEANS ST 3700 FLEET ST STE 100 6510 ODONNELL ST 5309 BELAIR RD 517 E BELVEDERE AVE 3716 1/2 W BELVEDERE AVE # C 1133 PENNSYLVANIA AVE 643 N CAREY ST 200 W COLD SPRINGS LN 2277 REISTERSTOWN RD 1835 PENNSYLVANIA AVE 5411 OLD FREDERICK RD STE 12 6350 FREDERICK RD 1235 E MONUMENT ST 6242 BELLONA AVE 1001 CATHEDRAL ST 3332 GREENMOUNT AVE 3240 BELAIR RD 1ST FLOOR 529 S BROADWAY 1631 W. NORTH AVENUE 2805 NORTH POINT ROAD 5901 EASTERN AVE STE D 4556 EDMONDSON AVE 883 N HOWARD ST

Page 263 of 679

Provider City ANNAPOLIS ANNAPOLIS ANNAPOLIS ANNAPOLIS ANNAPOLIS ANNAPOLIS ANNAPOLIS ANNAPOLIS ARNOLD ARNOLD BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE

State

ZIP code

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21401 21401 21401-1045 21401-3833 21403-3958 21401-3276 21401-3006 21401-3707 21012-2704 21012 21229-3612 21201-5634 21218 21223-2715 21212-1806 21229-5201 21227 21213-1720 21224-1020 21224-4230 21224-4643 21206-5109 21212-3745 21215-5708 21201-2005 21217-2410 21210 21217-1950 21217-3214 21229-2126 21228-2305 21202-5327 21212-2408 21201-5403 21218-2840 21213 21231-2913 21217 21222 21224-2731 21229 21201-4605

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FEMKOL PHARMACY FRANKFORD FAMILY PHARMACY FRANKLIN CARE PHARMACY

Provider Name

(410) 617-8641 (410) 485-7500 (410) 362-3838

526 ST PAUL PLACE 5422 SINCLAIR LN 520N N FRANKLINTOWN RD

BALTIMORE BALTIMORE BALTIMORE

MD MD MD

21202 21206-4645 21223-1052

FRANKLIN SQUARE HOSPITAL OUTPATIENT FULLER MEDICAL CENTER PHARMACY GARWYN PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GOVANS PROFESSIONAL PHARMACY GRACE CARE PHARMACY GWYNN OAK PHARMACY HALETHORPE PHARMACY HARFORD ROAD PHARMACY HEALTHGATES PHCY & MED SUPPLY HIGHLANDTOWN PHARMACY INC HOWARD PHARMACY INDEPENDENT DRUG JAMES PHARMACY JHHCG/PHARMAQUIP JHHCG/PHARMAQUIP AT BAYVIEW

(443) 777-7400 (410) 574-1440 (667) 205-1134 (410) 485-2772 (410) 602-7661 (410) 377-4400 (410) 649-8181 (410) 649-4181 (410) 362-1375 (410) 247-5802 (410) 532-9796 (410) 563-2000 (443) 426-1601 (410) 247-3344 (410) 882-4012 (443) 708-3302 (667) 212-3621 (443) 961-3578 (410) 687-1115 (410) 752-5810 (410) 955-3733 (410) 550-0961

9000 FRANKLIN SQUARE DR 6918 RIDGE ROAD 2300 GARRISON BLVD SUITE 200 5150 SINCLAIR LN 3757 OLD COURT RD 6340 YORK RD 6620 REISTERSTOWN RD 601 E 33RD ST 4624 EDMONDSON AVE 4622 WILKENS AVE 5010 YORK RD 919 N CAROLINE ST 4909 LIBERTY HEIGHT AVE 1307 FRANCIS AVE 9501 HARFORD RD 9 S HIGHLAND AVE 3911 EASTERN AVE 405 N PACA ST 2ND FLOOR 28 KINGSTON RD 1119 LIGHT ST 601 N CAROLINE ST STE 1006 4940 EASTERN AVE

BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21237-3901 21237-3854 21216-2309 21206-5939 21208-3902 21212-2361 21215-2305 21218-3505 21229-1407 21229-4842 21212-4437 21205-1000 21207 21227-3913 21234-3112 21224-2326 21224-4224 21201-1815 21220-4814 21230-4104 21287-0006 21224-2735

JOHN HOPKINS OUTPT PHCY WEINBERG JOHNS HOPKINS OP PHCY AT BARTL

(410) 955-5747 (410) 614-5611

401 S BROADWAY STE 1001 1717 E MONUMENT ST RM G-105

BALTIMORE BALTIMORE

MD MD

21231-2410 21287

JOHNS HOPKINS OP PHCY MONUMENT ST JOHNS HOPKINS OUTPATIENT PHCY JOHNS HOPKINS OUTPATIENT PHCY AT JOHNS HOPKINS PHCY AT HOLABIRD JOPPA ROAD PHARMACY KAYE'S PHARMACY KERNAN OUTPATIENT PHARMACY KEYSTONE PHARMACY INC LEXINGTON PHARMACY LIBERTY PHARMACY LLC LIFE CARE PHARMACY LIFELINE BALTIMORE PHARMACY

(410) 502-5735 (443) 287-9200 (410) 550-5180 (410) 288-8000 (410) 665-5050 (410) 665-5192 (410) 448-6337 (410) 669-1900 (410) 962-0277 (443) 948-5400 (443) 869-6787 (410) 764-6500

1810 E MONUMENT ST 1800 ORLEANS ST 4940 E AVE BMO BLDG RM 01-1343 5901 HOLABIRD AVE STE A-2 1907A E JOPPA RD 6913 BELAIR RD 2200 KERNAN DR 1358 W NORTH AVE 220 W BALTIMORE ST 108 N EUTAW ST. 5417 REISTERSTOWN RD STE B 6821 REISTERSTOWN RD STE 207

BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE

MD MD MD MD MD MD MD MD MD MD MD MD

21205-2107 21287-0010 21224 21224-6015 21234-2729 21206-1123 21207-6665 21217-3536 21201-2502 21201-1707 21215-4440 21215-1482

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 264 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LIFEWAY PHARMACY LLC

Provider Name

(443) 530-3731

1107 NORTH POINT BLVD STE 225

BALTIMORE

MD

21224-3401

MEDSTAR PHARMACY @ HARBOR HOSP MEDSTAR PHARMACY AT GSH MEDSTAR PHARMACY AT UMH MERRITT STAR PHARMACY MIDAS RX PHARMACY MIDTOWN DISCOUNT PHARMACY MIMIKAY PHARMACY MT VERNON PHARMACY MT. VERNON PHARMACY AT FALLSWAY NORTHERN PHARMACY & MED EQUIP NORTHERN PHARMACY AT OVERLEA NUWORLD PHARMACY LLC OLD TOWNE PHARMACY ORCHARD PHARMACY PARK AVENUE PHARMACY PARK LANE PHARMACY PATTERSON PARK PHARMACY POPLAR GROVE PHARMACY INC. PREMIER CARE PHARMACY PRIME CARE PHARMACY PROHEALTH PHARMACY QUALITY CARE PHARMACY

(410) 350-3878 (443) 444-4760 (410) 554-2557 (410) 284-7979 (410) 727-4400 (410) 528-6010 (410) 469-9206 (410) 539-8030 (410) 962-1100 (410) 254-2055 (410) 661-1655 (410) 659-5000 (410) 276-3383 (410) 646-0547 (410) 225-0800 (410) 466-8001 (410) 675-6046 (410) 945-5555 (410) 466-0322 (443) 453-9963 (410) 488-5091 (410) 800-4886

3001 S HANOVER ST 5601 LOCH RAVEN BLVD 201 E UNIVERSITY PKWY 1576 MERRITT BLVD STE 12 700 WASHINGTON BLVD STE A 2014 MARYLAND AVE 1027 W. 36TH ST 900 CATHEDRAL ST 421 FALLSWAY 6701 HARFORD RD 7618 BELAIR RD 1800 N CHARLES ST 576 OLD TOWN MALL 3350 WILKENS AVE STE 200 1535 PARK AVE 4259 PARK HEIGHTS AVE 2245 EASTERN AVE 705-709 POPLAR GROVE ST 3539 DOLFIELD AVE 5500 SINCLAIR LN SUITE C 4532 ERDMAN AVE 1403 E COLD SPRING LN STE B

BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21225-1233 21239-2905 21218-2829 21222-2114 21230 21218-5902 21211 21201-5311 21202-4800 21234-7707 21236-4088 21201-5920 21202-4190 21229-4617 21217-4238 21215-6740 21231-3113 21216-4625 21215-6125 21206-4645 21213-2606 21239

REFUA PHARMACY AND MEDICAL SUPPLY RITCHIE PHARMACY LLC RUXTON PHARMACY SANTA MONICA PHCY MEDICAL SUPPLY SHOPPERS PHARMACY SHOPPERS PHARMACY SHOPPERS PHARMACY SHOPPERS PHARMACY SHOPPERS PHARMACY SOUTH BALTIMORE PHARMACY SUNRISE PHARMACY THE LIFEBRIDGE PHCY AT SINAI HOSP THE PHARMACIA AT MT WA MILL TOTAL HEALTH CARE PHARMACY TOTAL HEALTH CARE PHARMACY TOTAL HEALTH CARE PHARMACY TOTAL HEALTH CARE PHARMACY

(410) 585-0055 (410) 355-3610 (410) 823-1453 (410) 617-0116 (443) 627-2292 (410) 918-0219 (410) 282-7622 (410) 869-0223 (410) 665-5120 (410) 355-8500 (410) 433-8150 (410) 601-7100 (443) 388-8710 (410) 735-5378 (410) 735-5382 (410) 735-5390 (410) 735-5397

6404 REISTERSTOWN RD 5507 RITCHIE HWY STE B 7621 BELLONA AVE 4300 BELAIR RD STE E 2000 GWYNNS FALLS PARKWAY 1200 EASTERN BLVD 6500 EASTERN AVE 5457 BALTIMORE NATIONAL PIKE 1955 E JOPPA RD 631 CHERRY HILL RD 1900 E NORTHERN PKWY STE 100 2401 W BELVEDERE AVE 1340 SMITH AVE STE A 1515 W NORTH AVE 2401 LIBERTY HEIGHTS AVE 1501 DIVISION ST 2400 KIRK AVE

BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21215-2308 21225-3472 21204-6610 21206 21216 21221-3421 21224-2900 21229-2102 21234-2733 21225-1228 21239-2113 21215 21209-3736 21217 21215-8019 21217-3121 21218-5507

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 265 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TOTAL HEALTH CARE PHARMACY TOTAL HEALTH CARE PHARMACY TRINITY CARE PHARMACY LLC TRUCARE PHARMACY & MED EQUIP TRUE CARE PHARMACY TUXEDO PHARMACY INC UMMC MIDTOWN CAMPUS PHARMACY VOSHELL'S PHARMACY WAVERLY PROFESSIONAL PHARMACY WEIS PHARMACY WELLCARE PHARMACY WESTSIDE PHARMACY WELLNESS CTR WOODMOOR PHARMACY BEL AIR MEDICINES BOYD & FULFORD PHARMACY GIANT PHARMACY HARFORD PHARMACY KLEINS PHARMACY AT FESTIVAL KLEINS PHARMACY OD BEL AIR MACPHAIL PHARMACY

Provider Name

(410) 735-5392 (410) 735-5401 (410) 366-0054 (410) 617-8742 (410) 254-0100 (410) 323-3000 (410) 856-3650 (410) 644-8400 (410) 467-4471 (410) 529-3045 (410) 662-6000 (410) 566-1360 (410) 448-4200 (410) 877-0611 (410) 838-6500 (410) 420-2961 (410) 838-0990 (443) 512-8373 (410) 515-9602 (410) 638-7367

1501 W SARATOGA ST 700 WASHINGTON BLVD 2222 HARFORD RD 2124 E MONUMENT ST 5950 BELAIR RD 5115 ROLAND AVE 821 N EUTAW ST 3455 WILKENS AVE 453 E 28TH ST 4126 E JOPPA RD 2203 N CHARLES ST BSMT 2021 W PRATT ST 7027 LIBERTY RD 1327 BALTIMORE PIKE 23 S MAIN ST 1401 ROCK SPRING RD 1510 CONOWINGO RD 5 BEL AIR SOUTH PKWY STE 301 223 N MAIN ST 615 W MACPHAIL RD

BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BALTIMORE BEL AIR BEL AIR BEL AIR BEL AIR BEL AIR BEL AIR BEL AIR

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21223-1749 21230-2350 21218-5538 21205 21206-2615 21210-2141 21201-4648 21229-5213 21218-4426 21236-2223 21218-5742 21223-2242 21207-5802 21014-5108 21014-3702 21014-1920 21014-1812 21015-6087 21014-3501 21014-4309

MACPHAIL PHCY AT UPPER CHESAPEAKE MEDICAP PHARMACY PLUMTREE PHARMACY REDNERS PHARMACY WEIS PHARMACY KLEINS PHARMACY AT RIVERSIDE BELTSVILLE PHARMACY FIRMUS PHARMACY AGH REDISCRIPTS PHARMACY APPLE DISCOUNT DRUGS COASTAL DRUG PRMC HOME SCRIPTS OCEAN PINES BRADLEY DRUGS

(443) 643-3190 (410) 638-2730 (410) 670-3719 (410) 838-7694 (410) 638-5804 (410) 272-1810 (301) 595-5939 (844) 347-6871 (410) 641-9241 (410) 641-3130 (410) 629-0089 (410) 543-4769 (301) 654-6776

510 UPPER CHESAPEAKE DR #414 602 S ATWOOD RD STE 101 208 PLUMTREE RD STE A 2126 N FOUNTAIN GREEN RD 550 W MACPHAIL RD 1321 RIVERSIDE PKWY 10820-F RHODE ISLAND AVE 10000 VIRGINIA MANOR RD STE 35 9733 HEALTHWAY DR # 42 314 FRANKLIN AVE STE 600 11307 MANKLIN CREEK RD UNIT 1 11101 CATHAGE RD 6900 ARLINGTON RD

BEL AIR BEL AIR BEL AIR BEL AIR BEL AIR BELCAMP BELTSVILLE BELTSVILLE BERLIN BERLIN BERLIN BERLIN BETHESDA

MD MD MD MD MD MD MD MD MD MD MD MD MD

21014 21014-4198 21015-6056 21015-1414 21014-4320 21017-1388 20705 20705-4205 21811-1155 21811-1230 21811-4014 21811 20814-5206

CENTER FOR CANCER & BLOOD DISORDERS FOERS PHARMACY FOER'S PHARMACY GIANT PHARMACY GIANT PHARMACY GLEN ECHO PHARMACY INC PATIENT PHARMACY, LLC

(301) 571-0019 (301) 657-3500 (301) 493-4422 (301) 530-3271 (301) 492-5161 (301) 229-5656 (301) 571-0850

6420 ROCKLEDGE DR STE 4100 8218 WISCONSIN AVE 6420 ROCKLEDGE DR 10400 OLD GEORGETOWN RD 7142 ARLINGTON RD 7311 MACARTHUR BLVD 10401 OLD GEORGETOWN RD #205

BETHESDA BETHESDA BETHESDA BETHESDA BETHESDA BETHESDA BETHESDA

MD MD MD MD MD MD MD

20817-7847 20814-3107 20817-7837 20814-1914 20814-2915 20816-1036 20814

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 266 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

VILLAGE GREEN APOTHECARY PADEK HEALTHCARE PHARMACY BOONSBORO PHARMACY WEIS PHARMACY ACHOR CARE PHARMACY COMCARE PHARMACY GIANT PHARMACY GIANT PHARMACY SHOPPERS PHARMACY MEDMERICA DISCOUNT PHARMACY SHOPPERS PHARMACY BRUNSWICK PHARMACY GIANT PHARMACY GIANT PHARMACY CLAYTON'S PHARMACY CRAIGS DRUG STORE INC CRAIG'S INSTITUTIONAL PHARMACY DAPO PHARMACY INC.

Provider Name

(301) 530-0800 (301) 277-7107 (301) 432-5488 (301) 432-3953 (301) 383-1502 (301) 262-2877 (301) 262-2008 (301) 352-2364 (240) 544-0187 (443) 283-8400 (410) 636-9779 (301) 834-9715 (301) 421-4493 (240) 725-5199 (410) 221-6400 (410) 228-3322 (410) 228-1012 (410) 228-8855

5415 W CEDAR LN STE 102B 5403A ANNAPOLIS RD 7628 OLD NATIONAL PIKE 700 CHASE SIX BLVD 12130 CENTRAL AVE 15431 EXCELSIOR DR 15520 ANNAPOLIS RD 3500 CRAIN HWY 10501 MARTIN LUTHER KING JR HW 5003 RITCHIE HWY 5722 RITCHIE HWY 610 9TH AVE 15618 OLD COLUMBIA PIKE 45101 FIRST COLONY WAY 404B WASHINGTON ST 406 RACE ST 3 WASHINGTON ST 300 WASHINGTON ST

BETHESDA BLADENSBURG BOONSBORO BOONSBORO BOWIE BOWIE BOWIE BOWIE BOWIE BROOKLYN BROOKLYN PARK BRUNSWICK BURTONSVILLE CALIFORNIA CAMBRIDGE CAMBRIDGE CAMBRIDGE CAMBRIDGE

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

20814-1515 20710-2201 21713-2002 21713 20721-1916 20716-2208 20715-3002 20716-1303 20720 21225-3048 21225-3641 21716-1828 20866-1630 20619-2416 21613 21613-1836 21613-2801 21613-2808

ONSITE 340B DISPENSARY FASSETT MAGE SHORE DISCOUNT PHARMACY MECMO PHARMACY MENDEL PHARMACY INC NEW ERA PHCY & VARIETY OUTLET KLEINS PHARMACY OF CARDIFF AME PHARMACY GIANT PHARMACY NATURECARE PHARMACY PARADISE PROFESSIONAL PHARMACY REHYA PHARMACY EDWARDS PHARMACY MCKAY'S PHARMACY BROOKVILLE PHARMACY BROOKVILLE PHCY AND WELLNESS CTR CHEVY CHASE CARE PHARMACY FRIENDSHIP PHARMACY GIANT PHARMACY CLARKSBURG PHARMACY GIANT PHARMACY CLEAR SPRING PHARMACY PHYS RX PHARM OF CLINTON, INC. SHALOM PHARMACY

(855) 355-3402 (410) 228-0900 (301) 909-0664 (301) 735-2221 (301) 808-4361 (410) 452-9799 (410) 719-2020 (410) 788-6220 (410) 869-9833 (410) 744-5959 (410) 869-0099 (410) 758-1715 (301) 884-3561 (301) 652-0600 (301) 718-0900 (301) 986-5354 (301) 657-3050 (240) 497-6101 (301) 428-4400 (410) 531-7837 (301) 842-2774 (240) 348-7157 (301) 856-5663

503 MUIR ST STE A 909 WASHINGTON ST 5831 ALLENTOWN RD #6 1264 BENNING ROAD 1436 ADDISON RD S 1606 DOOLEY RD 731 FREDERICK RD 6223 BALTIMORE NATIONAL PIKE 6483 BALTIMORE NATIONAL PIKE 6350 FREDERICK RD 4 W ROLLING CROSSROADS 102 S COMMERCE ST 37670 MOHAWK DR 7025 BROOKVILLE RD 5454 WISCONSIN AVE STE 400 8531 CONNECTICUT AVE 5530 WISCONSIN AVE STE 100 5463 WISCONSIN AVE 23213 STRINGTOWN RD 6050 DAYBREAK CIR 34 MULBERRY ST 9131 PISCATAWAY RD STE 670 9131 PISCATAWAY RD STE 260

CAMBRIDGE CAMBRIDGE CAMP SPRINGS CAPITOL HEIGHTS CAPITOL HEIGHTS CARDIFF CATONSVILLE CATONSVILLE CATONSVILLE CATONSVILLE CATONSVILLE CENTREVILLE CHARLOTTE HALL CHEVY CHASE CHEVY CHASE CHEVY CHASE CHEVY CHASE CHEVY CHASE CLARKSBURG CLARKSVILLE CLEAR SPRING CLINTON CLINTON

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21613-1848 21613-2627 20746-4570 20743 20743-4413 21160-1130 21228-4503 21228-2910 21228 21228-2305 21228-6280 21617-1116 20622-3123 20815-3263 20815-6911 20815-6826 20815-4423 20815-3532 20871-9363 21029-1641 21722-1070 20735-2579 20735-2511

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 267 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SHALOM PHCY AND MED SUPPLIES SHOPPERS PHARMACY AUSTIN PHCY & MEDICAL SUPPLIES GIANT PHARMACY HUNT VALLEY PHARMACY COLLEGE PARK PHARMACY HOLLYWOOD PHARMACY SHOPPERS PHARMACY COLORA PHARMACY ASPCARES CENTRE PARK PHARMACY

Provider Name

(301) 868-4094 (301) 868-0157 (410) 773-0300 (410) 785-1065 (410) 667-6246 (301) 474-0500 (301) 345-3400 (301) 345-7738 (410) 658-2237 (410) 964-5500 (410) 740-7000

8981 WOODYARD RD 6300 COVENTRY WAY 10757 YORK RD 11399 YORK RD 10 WARREN RD 4701 MELBOURNE PL 9901 RHODE ISLAND AVE 4720 CHERRY HILL RD 2527 JACOB TOME HIGHWAY 5500 KNOLL NORTH DR STE 140 8885 CENTRE PARK DR STE 2C

CLINTON CLINTON COCKEYSVILLE COCKEYSVILLE COCKEYSVILLE COLLEGE PARK COLLEGE PARK COLLEGE PARK COLORA COLUMBIA COLUMBIA

MD MD MD MD MD MD MD MD MD MD MD

20735-4203 20735-2256 21030-2114 21030-1909 21030-2506 20740-2540 20740-1424 20740-1330 21917 21045-2360 21045-2199

CHASE BREXTON PHARMACY COLUMBIA COLUMBIA HICKORY PHARMACY COLUMBIA PHARMACY CONTINUARX DYNAMIC CARE PHARMACY FELDMANS MEDICAL CENTER PHCY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY HOWARD PHARMACY

(443) 810-2001 (410) 964-6409 (410) 995-1111 (724) 809-9412 (410) 290-3903 (410) 964-8444 (410) 531-1111 (443) 364-5181 (410) 290-7013 (410) 740-1600

5500 KNOLL NORTH DR STE 370 10805 HICKORY RIDGE RD 9650 SANTIAGO RD STE 11 7085 SAMUEL MORSE DR STE 110 7120 MINSTREL WAY 11055 LITTLE PATUXENT PKWY 6480 FREETOWN RD 8805 CENTRE PARK DR 7200 CRADLEROCK WAY 8900 COLUMBIA 100 PKWY STE H

COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA

MD MD MD MD MD MD MD MD MD MD

21045-2393 21044-3626 21045-3960 21046-3411 21045-5248 21044-2896 21044-4050 21045-2117 21045-5067 21045-2336

JOHNS HOPKINS OP PHCY AT HOWARD CN OPTION CARE SPECIALTY RX LLC CECIL COMMUNITY PHARMACY CRISFIELD DISCOUNT PHARMACY MARION PHARMACY INC SHOPPERS PHARMACY BECKMAN'S GREENE STREET PHCY LA VALE PHARMACY INC MARTINS PHARMACY MARTINS PHARMACY MEDICINE SHOPPE MEDICINE SHOPPE MEDICINE SHOPPE MEDICINE SHOPPE POTOMAC VALLEY PHARMACY STEVES PHARMACY WALSH MCCAGH KELLOUGH PHCY INC WEIS PHARMACY

(443) 546-1000 (410) 309-9601 (410) 715-6785 (877) 622-8484 (410) 968-1660 (410) 968-2300 (410) 793-0325 (301) 777-7336 (301) 729-3535 (301) 777-7670 (301) 729-9740 (301) 777-1771 (301) 722-5100 (301) 777-1771 (301) 777-1771 (301) 722-2342 (301) 729-2600 (301) 724-3646 (301) 253-9418

10710 CHARTER DR STE 150 9730 PATUXENT WOODS DR STE 600 9650 SANTIAGO RD STE 8 49 ROCK SPRING RD 390 W MAIN ST 26427 BURTON AVE 1649 CROFTON CTR 686 GREENE ST 1221C NATIONAL HWY 739 PARK ST 12101 WINCHESTER RD 64 GREENE ST 1100 W INDUSTRIAL BLVD 12502 WILLOWBROOK RD STE 203 11306 BEDFORD RD NE 501 N CENTER ST 16103 MCMULLEN HWY SW 101 N CENTRE ST 26075 RIDGE RD

COLUMBIA COLUMBIA COLUMBIA CONOWINGO CRISFIELD CRISFIELD CROFTON CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND CUMBERLAND DAMASCUS

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21044 21046-1668 21045-3960 21918-1352 21817-1329 21817-1248 21114-1330 21502-2734 21502-7602 21502-3172 21502-7688 21502-2998 21502-4412 21502-6393 21502-6802 21502 21502-6207 21502-2307 20872-1831

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 268 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DARLINGTON PHARMACY DEALE PHARMACY FRIENDLY PHARMACY DENTON PHARMACY LLC ONSITE 340B DISPENSARY DENTON CHESAPEAKE BAY PHARMACY GIANT PHARMACY PARKLAND PHARMACY DRUGSTORE PHCY & SURGICALS DUNDALK PHARMACY GIANT PHARMACY MINGOCARE PHARMACY WEIS PHARMACY WEIS PHARMACY WISE DISCOUNT PHARMACY GIANT PHARMACY BAY HEMATOLOGY ONCOLOGY, PA GIANT PHARMACY HILLS DRUG STORE HILLS DRUG STORE, INC. GIANT PHARMACY WOODBRIDGE PHARMACY FELDMANS PHARMACY AT CHARTWELL GIANT PHARMACY MIDAS RX CITY PHARMACY OF ELKTON, INC ELKTON FRIENDLY PHARMACY HILLCREST PHCY & COMPOUNDING LYONS PHARMACY NORTHSIDE PHARMACY

Provider Name

(410) 457-5521 (410) 867-2455 (410) 867-2500 (410) 479-1100 (855) 355-3402 (301) 456-7349 (301) 817-3181 (240) 788-7097 (410) 288-0007 (410) 282-8388 (410) 631-1280 (410) 691-3912 (410) 288-1823 (410) 282-1725 (410) 285-8500 (410) 286-2901 (410) 820-5945 (410) 819-3215 (410) 822-3700 (410) 822-2666 (410) 956-4150 (410) 612-0019 (443) 620-9990 (410) 379-6607 (410) 799-7227 (410) 398-4383 (410) 398-6100 (443) 485-1944 (410) 398-2820 (410) 398-3784

1115 MAIN ST 5809 DEALE-CHURCHTON RD 5720 DEALE CHURCHTON RD 508 S 5TH AVE 609 DAFFIN LANE 5686 SILVERHILL RD 5500 SILVER HILL RD 6104 OLD SILVER HILL RD 209 WISE AVE 40 S DUNDALK AVE 1400 MERRITT BLVD 7444 HOLABIRD AVE STE 2 7200 HOLABIRD AVE 7848 WISE AVE 7836 WISE AVE # A 10790 TOWN CENTER BLVD 8221 TEAL DR STE 301 8223 ELLIOTT RD 503 CYNWOOD DR 30 E DOVER ST 13 LEE AIRPORT ROAD 1711 PULASKI HWY STE D 8186 LARK BROWN RD STE 101 6020 MARSHALEE DR 6020 MEADOWRIDGE CTR DR 723 N BRIDGE ST 228 S BRIDGE ST 120 E PULASKI HWY, UNIT 120 107 E MAIN ST 707 N BRIDGE ST UNIT B

DARLINGTON DEALE DEALE DENTON DENTON DISTRICT HEIGHTS DISTRICT HEIGHTS DISTRICT HEIGHTS DUNDALK DUNDALK DUNDALK DUNDALK DUNDALK DUNDALK DUNDALK DUNKIRK EASTON EASTON EASTON EASTON EDGEWATER EDGEWOOD ELKRIDGE ELKRIDGE ELKRIDGE ELKTON ELKTON ELKTON ELKTON ELKTON

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21034-1405 20751 20751-9756 21629-1368 21629 20747 20747-2041 20747-2111 21222 21222-4267 21222-2107 21222-1848 21222-1809 21222-3338 21222-3338 20754-2736 21601 21601-2956 21601-3869 21601-3048 21037 21040 21075-6437 21075-5935 21075-6528 21921-5309 21921-5915 21921 21921-5906 21921-5314

NORTHSIDE PHARMACY LONG TERM CARE WELCARE PHARMACY CROSSROADS PHARMACY ELLICOTT CITY PHARMACY GIANT PHARMACY GIANT PHARMACY HANA PHARMACY EMMITSBURG PHARMACY ESSEX PHARMACY & SURGICALS RIVERVIEW PHCY & SURGICALS WEIS PHARMACY

(443) 207-8048 (443) 207-5105 (410) 772-7912 (410) 750-1951 (410) 465-5683 (410) 992-3797 (410) 461-1333 (301) 447-6226 (410) 686-0373 (443) 231-5177 (410) 238-1064

707 N BRIDGE ST UNIT C 300 E PULASKI HWY STE 103 4801 DORSEY HALL DR STE 120 9338 BALTIMORE NATL PIKE #11 9200 BALTIMORE NATIONAL PIKE 4715 DORSEY HALL DR 3301 NORTH RIDGE RD 101 SILO HILL RD 1550 COUNTRY RIDGE LN 408-410 EASTERN BLVD 165 ORVILLE RD

ELKTON ELKTON ELLICOTT CITY ELLICOTT CITY ELLICOTT CITY ELLICOTT CITY ELLICOTT CITY EMMITSBURG ESSEX ESSEX ESSEX

MD MD MD MD MD MD MD MD MD MD MD

21921-5314 21921-6435 21042-7703 21042-2805 21042-2613 21042-5975 21043 21727-8702 21221-3906 21221 21221-1309

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 269 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FALLSTON PHARMACY CANTNERS DRUG STORE

Provider Name

(410) 879-9000 (410) 754-5200

2112 BEL AIR RD STE 11 323 BLOOMINGDALE AVE

FALLSTON FEDERALSBURG

MD MD

21047-2786 21632-1727

ONSITE 340B DISPENSARY FEDERALSBURG FINKSBURG PHARMACY KLEINS PHARMACY OF FOREST HILL SHOPPERS PHARMACY GIANT PHARMACY HEALTH POINTE PHARMACY CARE MEDICA PHARMACY FREDERICK COMMUNITY PHARMACY GIANT PHARMACY GIANT PHARMACY

(855) 355-3402 (410) 526-1055 (410) 420-8224 (240) 492-0189 (301) 248-1333 (240) 204-8371 (301) 360-5930 (240) 422-8433 (301) 815-2201 (301) 698-9430

215 BLOOMINGDALE AVE 2027 SUFFOLK RD 2101 ROCK SPRING RD 2950 DONNELL DR 9580 LIVINGSTON RD 9203 OXON HILL RD 110 BAUGHMANS LN 190 THOMAS JOHNSON DR STE 3 1700 KINGFISHER DR 5316 NEW DESIGN RD

FEDERALSBURG FINKSBURG FOREST HILL FORESTVILLE FORT WASHINGTON FORT WASHINGTON FREDERICK FREDERICK FREDERICK FREDERICK

MD MD MD MD MD MD MD MD MD MD

21632 21048-1634 21050-2617 20747-3200 20744-4918 20744-4834 21702-4059 21702-4879 21701-4775 21703-7102

HILLCREST PHARMACY & COMPOUNDING MASTERS SPECIALTY PHARMACY THOMAS JOHNSON PHARMACY WEIS PHARMACY WEIS PHARMACY WEIS PHARMACY WEIS PHARMACY WHITESELL & BOWEN PHARMACY GIANT PHARMACY FRIENDSVILLE PHARMACY MEDICINE SHOPPE BEST CARE EXPRESS PHARMACY DIAMOND DRUG EXPRESS PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY VASHAN COMPOUNDING PHARMACY GALENA PHARMACY GIANT PHARMACY GERMANTOWN PROF PHCY AND COMP GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY SHOPPERS PHARMACY THE BLUE DOOR PHARMACY

(240) 608-2006 (240) 651-5966 (301) 682-3220 (301) 631-8160 (301) 663-9111 (301) 473-4201 (301) 662-3830 (301) 662-4848 (301) 874-1202 (301) 746-5881 (301) 463-5757 (301) 869-1900 (301) 926-1000 (301) 977-4210 (301) 840-0815 (301) 926-2044 (301) 208-8204 (301) 990-0627 (301) 948-1198 (301) 947-4747 (410) 648-5662 (410) 721-1771 (240) 780-7412 (301) 428-9115 (301) 528-2764 (301) 515-9498 (301) 528-0133 (301) 515-1915

1080 W. PATRICK STREET UNIT 10 1100 W PATRICK ST STE A 177 THOMAS JOHNSON DR STE B 6093 SPRING RIDGE PKWY 448 PROSPECT BLVD 2 OLD CAMP RD 199 THOMAS JOHNSON DR 236 N MARKET ST 3530 SUGAR LOAF PKWY 248 MAPLE STREET 10601 NEW GEORGES CREEK RD SW 481 N FREDERICK AVE STE 103 226 E DIAMOND AVE 16220 FREDERICK RD STE 100 46 BUREAU DR 842 MUDDY BRANCH RD 229 KENTLANDS BLVD 20044 GOSHEN RD 18250 FLOWER HILL WAY 9005 SHADY GROVE CT 104 W CROSS ST 1161 STATE ROUTE 3 N 19735 GERMANTOWN RD STE 175 13060 MIDDLEBROOK RD 18331 LEAMAN FARM RD 20944 FREDERICK RD 18066 MATENY RD 19851 OBSERVATION DR #145

FREDERICK FREDERICK FREDERICK FREDERICK FREDERICK FREDERICK FREDERICK FREDERICK FREDRICK FRIENDSVILLE FROSTBURG GAITHERSBURG GAITHERSBURG GAITHERSBURG GAITHERSBURG GAITHERSBURG GAITHERSBURG GAITHERSBURG GAITHERSBURG GAITHERSBURG GALENA GAMBRILLS GERMANTOWN GERMANTOWN GERMANTOWN GERMANTOWN GERMANTOWN GERMANTOWN

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21703 21703-3903 21702-5104 21701-5898 21701-6400 21702-3740 21702-4877 21701-5335 21704 21531-0127 21532-1453 20877-2470 20877-3014 20877 20878-1402 20878-2780 20878-5446 20879-1604 20879-5300 20877-1301 21635-1558 21054-1714 20874 20874-2617 20874-2904 20876-4101 20874-2112 20876

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 270 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ULTRA CARE PHARMACY ARUNDEL PHARMACY CAREMED PHARMACY CHASE BREXTON-GLEN BURNIE CRAIN TOWERS PHARMACY EMPIRE PROFESSIONAL PHARMACY GIANT PHARMACY GIANT PHARMACY LIFELINE PHARMACY QUARTERFIELD PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE

Provider Name

(301) 569-6464 (410) 761-3443 (410) 768-1212 (410) 837-2050 (410) 760-1570 (410) 787-0030 (410) 760-4588 (410) 969-3030 (410) 553-6100 (410) 590-9100 (410) 760-2290 (410) 760-2290

12619A WISTERIA DR 7571 RITCHIE HWY 325 HOSPITAL DR STE 203 200 HOSPITAL DR SUITE 300 1600 CRAIN HWY S STE 110 200 HOSPITAL DR STE 107 7383 BALTIMORE ANNAPOLIS BLVD 7940 CRAIN HWY S 85 KINDRED WAY 7671 QUARTERFIELD RD STE 103 103B CRAIN HWY N 103 CRAIN HWY N STE B2

GERMANTOWN GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE GLEN BURNIE

MD MD MD MD MD MD MD MD MD MD MD MD

20874-5259 21061-3716 21061-5807 21061-5884 21061-6439 21061-5861 21061-3266 21061-4932 21061 21061 21061-3002 21061-3096

SUPREME PHARMACY & MEDICAL SUPPLIES TEN OAKS PHARMACY AVALON PROFESSIONAL PHARMACY THE MEDICINE SHOPPE CO-OP PHARMACY DEMMY'S PHARMACY GIANT PHARMACY HANOVER PARK PHARMACY PHYSICIANS RX PHARMACY, LLC GREENSBORO PHARMACY EXPRESS PHARMACY EXPRESS PHARMACY EXPRESS PHARMACY #5 MARTINS PHARMACY MARTINS PHARMACY MARTINS PHARMACY OPTIMAL HLTH CARE HLTHMRTPHCY SCHINDELS PHARMACY WEIS PHARMACY WEIS PHARMACY WYE OAK PHARMACY FAMILY PHARMACY OF HAMPSTEAD WEIS PHARMACY WEIS PHARMACY REEDS PHARMACY THE HOME CENTER PHARMACY ARUNDEL MILLS PHARMACY CORRECT RX PHARMACY SERVICES INC. CITIZENS PHARMACY SERVICES

(301) 322-8082 (410) 531-9699 (301) 383-0142 (301) 895-5177 (301) 474-4400 (301) 220-3124 (301) 982-2359 (301) 345-1124 (301) 477-3367 (410) 482-6256 (301) 791-5220 (301) 790-1233 (240) 513-6991 (301) 766-9148 (301) 745-4904 (240) 420-0665 (301) 393-9221 (301) 739-2780 (240) 420-0553 (301) 665-9568 (410) 536-0555 (410) 239-3100 (410) 374-1422 (410) 374-4019 (301) 678-2930 (301) 678-5421 (443) 755-0060 (410) 636-9500 (410) 939-4404

7936 JOHNSON AVE 3900 10 OAKS RD STE 11 12100 ANNAPOLIS RD UNIT 2 149 MAIN ST 121 CENTERWAY 5510 CHERRYWOOD LN STE B 6000 GREENBELT RD 7217 HANOVER PKWY STE A 7525 GREENWAY CNTR DR #202 102 S MAIN ST 25 N CANNON AVE 11236 ROBINWOOD DR STE 104 201 S CLEVELAND AVE STE 101 1650C WESEL BLVD 1729 DUAL HWY 18726 N POINTE DR 18368 COLLEGE RD 642 OAK HILL AVE 31 EASTERN BLVD N 12817 SHANK FARM WAY 1935 LANSDOWNE RD 907 S MAIN ST STE A 720 HANOVER PIKE 2205 HANOVER PIKE 343 N PENNSYLVANIA AVE 154 W MAIN ST 7556 TEAGUE RD STE 220 1352 CHARWOOD RD STE C 415 MARKET ST

GLENARDEN GLENELG GLENN DALE GRANTSVILLE GREENBELT GREENBELT GREENBELT GREENBELT GREENBELT GREENSBORO HAGERSTOWN HAGERSTOWN HAGERSTOWN HAGERSTOWN HAGERSTOWN HAGERSTOWN HAGERSTOWN HAGERSTOWN HAGERSTOWN HAGERSTOWN HALETHORPE HAMPSTEAD HAMPSTEAD HAMPSTEAD HANCOCK HANCOCK HANOVER HANOVER HAVRE DE GRACE

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

20706-1772 21737-9747 20769 21536-1258 20770-1802 20770-1045 20770-1018 20770 20770 21639 21740-4918 21742-6704 21740-5758 21740-5387 21740-6653 21742-2418 21740-1768 21740-3870 21740-5812 21742-2781 21227-1707 21074-2273 21074 21074 21750-1046 21750-1432 21076-1200 21076-3125 21078-3301

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 271 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LYONS PHARMACY WEIS PHARMACY THE PHARMACY AT PJ BEAN THE DRUG STORE GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY LAWSON'S PHARMACY INDIAN HEAD CARE PHARMACY JARRETTSVILLE PHARMACY JESSUP CARE PHARMACY MISSION PLACE PHARMACY REDNER'S PHARMACY KENSINGTON PHARMACY KNOWLES APOTHECARY SHOPPERS PHARMACY GIANT PHARMACY LAPLATA PHARMACY GIANT PHARMACY GREENBELT PHARMACY LLC KAY CEE LTC PHARMACY GIANT PHARMACY GLOBAL HEALTH PHARMACY LAUREL PHARMACY LORVEN PHARMACY MAIN STREET PHARMACY PAX PHARMACY LLC SHOPPERS PHARMACY SHOPPERS PHARMACY WEIS PHARMACY WEIS PHARMACY MCKAY'S PHARMACY MEDSTAR PHARMACY ST MARYS PHARMACY FAMILY CARE PHARMACY GLOBAL COMMUNITY PHARMACY

Provider Name

(410) 939-4545 (410) 939-4282 (240) 309-4062 (410) 943-4959 (301) 853-3701 (301) 559-8721 (301) 577-6128 (301) 864-4043 (301) 684-2580 (410) 557-7717 (301) 483-0795 (443) 296-7478 (410) 679-3804 (301) 933-6165 (301) 942-7979 (301) 881-0646 (301) 392-5485 (301) 934-4050 (301) 666-1181 (301) 552-8755 (410) 789-8454 (301) 498-9337 (240) 786-6045 (301) 604-8500 (301) 490-8311 (301) 317-3838 (301) 490-1170 (301) 776-6058 (301) 575-0270 (301) 362-7304 (301) 725-5008 (301) 866-5711 (240) 434-7351 (301) 475-2025 (301) 862-3945 (301) 862-1800

328 SAINT JOHN ST 943 PULASKI HWY 24035 THREE NOTCH RD 103 POPLAR ST 3521 E WEST HWY 5815 EASTERN AVE 7546 ANNAPOLIS RD 3415 HAMILTON ST 4115 INDIAN HEAD HIGHWAY 3714 NORRISVILLE RD 8610 WASHINGTON BLVD #110 8160 WASHINGTON BLVD SUITE 102 1002 JOPPA FARM RD 3737 UNIVERSITY BLVD W 10400 CONNECTICUT AVE STE 100 5110 NICHOLSON LN 200 ROSEWICK RD 6501 CRAIN HWY 10515 GREENBELT RD 9801 GREENBELT RD STE 207 4611 ASSEMBLY DR STE H 1009 FAIRLAWN AVE 7500 MONTPELIER RD STE 106 7350 VAN DUSEN RD STE 120 13929 BALTIMORE AVE STE 4 667 MAIN ST 9900 WASHINGTON BLVD N 3441 FORT MEADE RD 13600 BALTIMORE AVE STE 100 9250 WASHINGTON BLVD N 9270 ALL SAINTS RD 40845 MERCHANTS LN 25500 POINT LOOKOUT RD 25482 POINT LOOKOUT RD BLDG 2 46300 LEXINGTON VILLAGE WAY ST 21728 GREAT MILLS ROAD

HAVRE DE GRACE HAVRE DE GRACE HOLLYWOOD HURLOCK HYATTSVILLE HYATTSVILLE HYATTSVILLE HYATTSVILLE INDIAN HEAD JARRETTSVILLE JESSUP JESSUP JOPPA KENSINGTON KENSINGTON KENSINGTON LA PLATA LA PLATA LANHAM LANHAM LANHAM LAUREL LAUREL LAUREL LAUREL LAUREL LAUREL LAUREL LAUREL LAUREL LAUREL LEONARDTOWN LEONARDTOWN LEONARDTOWN LEXINGTON PARK LEXINGTON PARK

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21078-2817 21078-2601 20636 21643-3407 20782-1918 20782-2201 20784-1702 20782-3953 20640 21084-1419 20794-9499 20794 21085-3604 20895-2123 20895-3993 20895-1046 20646-4216 20646-4268 20706-2213 20706-6227 20706-4841 20707-4807 20723-6012 20707-5267 20707-5045 20707-4067 20723-1972 20724 20707-9494 20723-1317 20723-1702 20650-3767 20650-2015 20650-3895 20653-5561 20653

UNIVERSITY OF MARYLAND MEDICAL SOL MEDICINE SHOPPE OF GEORGES CREEK GIANT PHARMACY GIANT PHARMACY JOHNS HOPKINS OUTPATIENT PHCY

(443) 462-5850 (301) 463-5757 (410) 394-2171 (410) 252-4217 (410) 583-2600

825 N HAMMONDS FERRY RD #C 19 MAIN ST 11740 ROUSBY HALL RD 2145 YORK RD 10755 FALLS ROAD

LINTHICUM HEIGHTS LONACONING LUSBY LUTHERVILLE LUTHERVILLE

MD MD MD MD MD

21090 21539-1122 20657 21093 21093-4506

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 272 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Street

Provider City

State

ZIP code

LUTHERVILLE PHARMACY HARVARD DISCOUNT PHARMACY CARROLL DRUGS OF MANCHESTER MANCHESTER PHARMACY EAGLE PHARMACY DEEP CREEK PHARMACY NEW MARKET PHARMACY LLC TIDEWATER PHARMACY MIDDLETOWN PHARMACY MILLINGTON PHARMACY COMMUNITY CARE RX THE VILLAGE PHARMACY AVNI APOTHECARY WEIS PHARMACY MT. AIRY PHARMACY FAMILY CHOICE PHARMACY INC SHOPPERS PHARMACY NEW MARKET PHARMACY NORTH EAST PHARMACY INC POTOMAC CARE PHARMACY INC GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY WHITE MARSH PHARMACY

Provider Name

(410) 252-5247 (410) 560-6906 (410) 374-1414 (410) 239-2300 (410) 442-2050 (301) 387-5300 (301) 472-1987 (301) 884-4646 (301) 371-8145 (410) 928-5333 (301) 882-7370 (240) 912-7784 (301) 703-8836 (301) 829-1499 (301) 831-7111 (301) 577-1212 (301) 577-5701 (301) 865-5920 (443) 674-8226 (301) 337-6430 (410) 256-9870 (410) 882-6220 (410) 931-7533 (443) 384-2500

1776 YORK RD 1813A YORK RD 3128 WESTMINSTER ST 3321 MAIN ST 2470 LONGSTONE LN STE G 24465 GARRETT HWY 29015 THREE NOTCH RD UNIT 7 28948 THREE NOTCH RD 4317 OLD NATIONAL PIKE 200 SASSAFRAS ST 11801 FINGERBOARD RD STE 6 9999 STEDWICK RD 2702 BACK ACRE CIR STE 190-B 1001 TWIN ARCH RD 1 N MAIN STREET 8313 ANNAPOLIS RD 7790 RIVERDALE RD 11717 OLD NATIONAL PIKE 2316 PULASKI HWY STE A 12103 DARNESTOWN RD 8905 BELAIR RD 7920 BELAIR RD 7944 HONEYGO BLVD 4924 CAMPBELL BLVD

LUTHERVILLE LUTHERVILLE TIMONIUM MANCHESTER MANCHESTER MARRIOTTSVILLE MC HENRY MECHANICSVILLE MECHANICSVILLE MIDDLETOWN MILLINGTON MONROVIA MONTGOMERY VILLAGE MOUNT AIRY MOUNT AIRY MT AIRY NEW CARROLLTON NEW CARROLLTON NEW MARKET NORTH EAST NORTH POTOMAC NOTTINGHAM NOTTINGHAM NOTTINGHAM NOTTINGHAM

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21093-5606 21093-5119 21102-1893 21102-1708 21104-1512 21541-1311 20659-3228 20659-9998 21769-7700 21651-2007 21770-9030 20886 21771-7769 21771-4138 21771-5652 20784-3001 20784-3957 21774-6154 21901-3730 20878-2205 21236-2406 21236-3706 21236-4919 21236-5908

GREGG'S PHARMACY, MEDICINE SHOPPE MOUNTAIN LAUREL COMMUNITY PHARMACY GIANT PHARMACY GLOBAL HEALTH PHARMACY II WEIS PHARMACY GIANT PHARMACY MEDSTAR PHARMACY OLNEY PROFESSIONAL PHARMACY SHOPPERS PHARMACY CALVERT-ARUNDEL PHARMACY CARE PHARMACY CHOICE PHARMACY GIANT PHARMACY GIANT PHARMACY OWINGS MILLS PHARMACY WELLCARE PHARMACY INC

(301) 334-2197

20 N 3RD ST

OAKLAND

MD

21550-1322

(301) 245-7002 (410) 305-1291 (410) 874-3477 (410) 672-1418 (301) 774-6304 (301) 774-8682 (301) 774-9812 (301) 924-5692 (410) 257-3700 (410) 363-9900 (410) 363-8222 (410) 363-2390 (410) 654-1160 (443) 352-3818 (410) 654-4441

1027 MEMORIAL DRIVE SUITE 100 1115 ANNAPOLIS RD 1114 TOWN CENTER BLVD STE F 2294 BLUE WATER BLVD 17821 GEORGIA AVE 18101 PRINCE PHILIP DR 18111 PRINCE PHILIP DR STE 100 18140 VILLAGE CENTER DR 15 CHESAPEAKE BEACH RD E #160 23 CROSSROADS DR STE 110 9151 REISTERSTOWN RD 9934 REISTERSTOWN RD 9730 GROFFS MILL DR 10085 RED RUN BLVD STE 104 9213 LAKESIDE BLVD

OAKLAND ODENTON ODENTON ODENTON OLNEY OLNEY OLNEY OLNEY OWINGS OWINGS MILLS OWINGS MILLS OWINGS MILLS OWINGS MILLS OWINGS MILLS OWINGS MILLS

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21550 21113-1633 21113-1224 21113-3300 20832-2233 20832-1514 20832-1513 20832-1413 20736 21117-5476 21117-4503 21117-3945 21117-6341 21117-4811 21117-3859

NR_0009_10823 10/2017

Provider Phone Number

Page 273 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ALLCARE PHARMACY GIANT PHARMACY HEALING TOUCH PHARMACY SHOPPERS PHARMACY HEREFORD PHARMACY INC MT CARMEL PHARMACY FAITH PHARMACY LLC NORTHERN SPECIAL CARE PHARMACY PARKVILLE PHARMACY PHARMACY 4 LESS GIANT PHARMACY MIKE'S PHARMACY MIKE'S PHARMACY II PASADENA PHARMACY SHOPPERS PHARMACY WEIS PHARMACY WEIS PHARMACY KLEINS PHARMACY OF JACKSONVILLE

Provider Name

(301) 485-0000 (301) 839-8181 (844) 943-2546 (301) 749-9323 (410) 357-4211 (410) 343-0110 (443) 290-4553 (410) 951-1636 (443) 290-4867 (410) 513-7357 (410) 439-2104 (410) 255-1800 (410) 255-0099 (410) 255-6000 (410) 760-5850 (410) 421-9304 (410) 529-3980 (410) 666-1700

6196 OXON HILL RD SUITE #130 20 AUDREY LN 5210 INDIAN HEAD HWY UNIT 1RR 6111 LIVINGSTON RD 216 MOUNT CARMEL RD 111 MOUNT CARMEL RD 7915 HARFORD RD 7816 HARFORD RD 8118 HARFORD RD STE B 7112 DARLINGTON DR 4315 MOUNTAIN RD 8541 FORT SMALLWOOD RD UNIT G 3820 MOUNTAIN RD UNIT G 2932 MOUNTAIN RD 8048 RITCHIE HWY 8115 RITCHIE HWY 9400 SCOTT MOORE WAY 14330 JARRETTSVILLE PIKE

OXON HILL OXON HILL OXON HILL OXON HILL PARKTON PARKTON PARKVILLE PARKVILLE PARKVILLE PARKVILLE PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PERRY HALL PHOENIX

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

20745 20745-1301 20745-2048 20745-3035 21120-9725 21120-9706 21234-5815 21234-5850 21234-5725 21234-7013 21122-4560 21122-2676 21122-2027 21122-2014 21122-1084 21122-6917 21128-8932 21131-1743

PAPER MILL PHARMACY AND GIFT SHOP PROFESSIONAL CARE PHARMACY SINU RX PHARMACY INC WELLCARE PHARMACY PITTSVILLE PHARMACY CITY DISCOUNT PHARMACY POCOMOKE DISCOUNT PHARMACY GIANT PHARMACY GENOA-QOL HEALTHCARE GIANT PHARMACY KARE MORE PHARMACY TLC PHARMACY CHASE BREXTON PHARMACY RANDALLSTOWN FAMILI-CARE PHARMACY INC OLD COURT PHARMACY

(410) 667-4600 (410) 484-4801 (410) 486-7468 (410) 484-2105 (410) 835-8585 (410) 957-1447 (410) 957-9030 (301) 983-4211 (443) 486-7173 (410) 535-5974 (410) 651-3980 (410) 651-5555

3320 PAPER MILL RD 806 REISTERSTOWN RD UNIT 3 306 REISTERSTOWN RD 4000 OLD COURT RD STE 101 34205-E OLD OCEAN CITY RD 440 LINDEN AVE 305 10TH ST STE 103 9812 FALLS RD 975 SOLOMONS ISLAND RD N STE 1 655 SOLOMONS ISLAND RD N 12085 SOMERSET AVE UNIT 5 12145 ELM ST

PHOENIX PIKESVILLE PIKESVILLE PIKESVILLE PITTSVILLE POCOMOKE CITY POCOMOKE CITY POTOMAC PRINCE FREDERICK PRINCE FREDERICK PRINCESS ANNE PRINCESS ANNE

MD MD MD MD MD MD MD MD MD MD MD MD

21131-1419 21208-4214 21208-5312 21208-2828 21850-2083 21851-1132 21851-1607 20854-3976 20678-3917 20678-3915 21853-1314 21853-1358

(410) 496-6441 (443) 272-6424 (410) 521-9520

8507 LIBERTY RD 11100 LIBERTY RD STE D 8607 LIBERTY RD

RANDALLSTOWN RANDALLSTOWN RANDALLSTOWN

MD MD MD

21133-4833 21133-1054 21133-4713

THE LIFEBRIDGE PHCY @ NW HOSPITAL FAMILY FIRST PHARMACY GIANT PHARMACY NATURECARE PHARMACY RIDGELY PHARMACY MARTINS PHARMACY

(410) 701-4455 (410) 363-0500 (410) 526-1661 (410) 833-9844 (410) 634-9800 (410) 658-8253

5401 OLD COURT RD 718 MAIN ST 11604 REISTERSTOWN RD 40 MAIN STREET 7 W BELLE ST 24 RISING SUN TOWN CTR

RANDALLSTOWN REISTERSTOWN REISTERSTOWN REISTERSTOWN RIDGELY RISING SUN

MD MD MD MD MD MD

21133 21136-2502 21136-3702 21136 21660-2009 21911-1902

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 274 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SUN PHARMACY EAST PINES PHARMACY LLC ALLIED PHARMACEUTICAL SVCS AMBULATORY CARE PHARMACY FOER'S LTC PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY IBEX PHARMACY PATIENT PHARMACY, LLC ROLLINS CARE PHARMACY SHADY GROVE PHARMACY WELLBEING CARE PHARMACY WHITE FLINT PHARMACY GIANT PHARMACY MEDSTAR PHARMACY @ FS WEINBERG PROFESSIONAL PHARMACY PEMBERTON PHCY/GIFT ST MICHAEL REESER'S PHARMACY APPLE DISCOUNT DRUGS APPLE DISCOUNT DRUGS COMMUNITY PHARMACY DELMARVA PHARMACY KAREMORE PHARMACY LOWER SHORE PHARMACY MED PLUS PHARMACY MILFORD STREET PHARMACY MT HERMON DISCOUNT PHARMACY PEMBERTON PHARMACY & GIFT PRMC HOME SCRIPTS RIVERSIDE PHARMACY SHAYONA PHARMACY SHAYONA PHARMACY II APPLE INFUSION SHOPPERS PHARMACY GIANT DISCOUNT DRUG PARK PHARMACY INC SHARPSBURG PHARMACY CORNER MARKET & PHARMACY GIANT PHARMACY GIANT PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (410) 658-6444 (301) 459-6211 (301) 309-0999 (301) 545-0193 (301) 216-1190 (240) 314-5161 (301) 315-1461 (301) 881-2225 (301) 840-1777 (301) 881-1555 (301) 527-0370 (301) 816-2801 (301) 948-4222 (301) 424-1411 (310) 881-3828 (410) 574-4766 (443) 777-6201 (410) 687-8113 (410) 745-8382 (410) 745-2207 (410) 543-8401 (410) 749-8401 (410) 749-1899 (410) 677-0561 (410) 341-7474 (410) 341-4710 (443) 736-3109 (410) 742-0869 (410) 749-5900 (410) 677-0707 (410) 543-4798 (410) 742-1188 (410) 736-4662 (443) 978-7777 (410) 860-1669 (410) 969-4809 (410) 647-8331 (410) 544-7275 (301) 432-7223 (301) 200-8472 (301) 585-2777 (301) 692-4181

Provider Street ONE NORTH QUEEN STREET 6003 66TH AVE 1201 SEVEN LOCKS RD 15001 SHADY GROVE RD 1300 PICCARD DR STE LL-16 625 HUNGERFORD DR 9719 TRAVILLE GATEWAY DR 12051 ROCKVILLE PIKE 16837 CRABBS BRANCH WAY 11520 ROCKVILLE PIKE 15200 SHADY GROVE RD STE 101 184 ROLLINS AVE 15225 SHADY GROVE RD STE 101 9715 MEDICAL CENTER DR #100 11125 ROCKVILLE PIKE 8665 PHILADELPHIA RD 9103 FRANKLIN SQUARE DR STE 18 9106 PHILADELPHIA RD STE 100 204 S TALBOT ST 1013 # F TALBOT ST 1500A PEMBERTON DR 404 N FRUITLAND BLVD 725 S SALISBURY BLVD 1615 TREE SAP CT 817 SNOW HILL RD UNIT 2 505 E MAIN ST 1411-B SOUTH SALISBURY BLVD 106 MILFORD ST 337 CIVIC AVE STE 20 1147 PEMBERTON DR 100 E CARROLL ST 540 RIVERSIDE DR 910 WEST RD 811 PRISCILLA ST 404B N FRUITLAND BLVD 7858 QUARTERFIELD RD 573 RITCHIE HWY 580 RITCHIE HWY 17316 SHEPHERDSTOWN PIKE 8309 GRUBB RD 8750 ARLISS ST 2900 UNIVERSITY BLVD W

Page 275 of 679

Provider City RISING SUN RIVERDALE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROCKVILLE ROSEDALE ROSEDALE ROSEDALE SAINT MICHAELS SAINT MICHAELS SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBUSRY SEVERN SEVERNA PARK SEVERNA PARK SHARPSBURG SILVER SPRING SILVER SPRING SILVER SPRING

State

ZIP code

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21911-0000 20737-1780 20854-2931 20850-6352 20850-4303 20850-1721 20850-7408 20852-1642 20855-2215 20852-2750 20850-3218 20852 20850-3234 20850-3323 20852-3142 21237-3020 21237-3938 21237 21663 21663 21801-2475 21801-7261 21801-5812 21804-9403 21804-1900 21804-5020 21801-7126 21804-6953 21804-5231 21801-2529 21801-5422 21801-5352 21801-3030 21804-3843 21801 21144-1320 21146-2923 21146-3924 21782-1626 20910-2539 20901-3905 20902-1971

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY LITTLE ACORN PHARMACY MAXIM PHARMACY MEDICINE SHOPPE MEDSTAR PHARMACY (STORE # 7) MIDTOWN PHARMACY THE MEDICINE SHOPPE SMITHSBURG PHARMACY SNOW HILL PHARMACY INC FREEDOM DRUGS

Provider Name

(301) 384-2228 (301) 681-8310 (301) 598-3208 (301) 603-7501 (301) 565-0575 (301) 592-0060 (301) 439-6878 (301) 681-5353 (301) 598-1005 (240) 833-3937 (301) 622-0744 (301) 824-1111 (410) 632-3500 (410) 477-5130

13490 NEW HAMPSHIRE AVE 11221 NEW HAMPSHIRE AVE 3860 INTERNATIONAL DR 13781 CONNECTICUT AVE 1280 E WEST HWY 11161 NEW HAMPSHIRE AVE #110 636 UNIVERSITY BLVD E 10313 GEORGIA AVE 3305 N LEISURE WORLD BLVD 13117 BROADMORE RD 12838 NEW HAMPSHIRE AVE 22030 JEFFERSON BLVD 5610 MARKET ST UNIT 2 7568 N POINT RD

SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SILVER SPRING SMITHSBURG SNOW HILL SPARROWS POINT

MD MD MD MD MD MD MD MD MD MD MD MD MD MD

20904-1224 20904-2631 20906-1548 20906-2916 20910-3242 20904-2606 20901-3768 20902-5006 20906 20904-3267 20904-3352 21783-2057 21863-2426 21219-1412

ONSITE 340B DISPENSARY BAY HUNDRED SUITLAND PHARMACY MARTINS PHARMACY MCDOUGALL'S DRUG CENTER SHOPPERS PHARMACY WAH OUTPT PHARMACY OU KENNIE'S PHARMACY TANEYTOWN PHARMACY GIANT PHARMACY GIANT PHARMACY GIG PHARMACY ST. BARNABAS PHARMACY THURMONT PHARMACY WEIS PHARMACY BLAIR PHARMACY LYKOS PHARMACY AUSTIN SPECIALTY PHARMACY CHESAPEAKE UROLOGY ASSOCIATES DULANEY VALLEY HEALTHMART GIANT PHARMACY HILLENDALE PHARMACY OSLER MEDICAL PHARMACY TOWSON PHARMACY WEIS PHARMACY UNION BRIDGE PHARMACY GIANT PHARMACY GIANT PHARMACY

(855) 355-3402 (301) 736-3270 (410) 552-5749 (410) 795-2662 (301) 270-2638 (301) 891-6207 (410) 756-6166 (410) 756-5240 (301) 630-7810 (301) 449-7483 (301) 423-8070 (301) 456-2471 (301) 271-2223 (301) 271-2548 (410) 252-2060 (410) 252-4225 (410) 982-0800 (410) 825-5454 (410) 296-4900 (410) 821-6611 (410) 825-0101 (410) 821-0110 (410) 823-1818 (410) 339-5703 (410) 775-7272 (301) 952-7539 (301) 336-9428

933 SOUTH TALBOT ST UNIT 4 4731 SILVER HILL RD 1320 LONDONTOWN BLVD 1645 LIBERTY RD 6881 NEW HAMPSHIRE AVE 7600 CARROLL AVE 11 GRAND DR 417 E BALTIMORE ST 4119 BRANCH AVE 7074 ALLENTOWN RD 3611 BRANCH AVE STE 103 4311 ST. BARNABAS RD 58 WATER ST 2 THURMONT BLVD 1818 POT SPRING RD STE 12 2101 YORK RD 901 DULANEY VALLEY RD STE 300 6535 N CHARLES ST STE 650 716 DULANEY VALLEY RD 8100 LOCH RAVEN BLVD 6875 LOCH RAVEN BLVD 7600 OSLER DR STE 110 32 WEST RD STE 100 1238 PUTTY HILL AVE 5 N MAIN ST 5700 CRAIN HWY 10480 CAMPUS WAY S

ST. MICHAELS SUITLAND SYKESVILLE SYKESVILLE TAKOMA PARK TAKOMA PARK TANEYTOWN TANEYTOWN TEMPLE HILLS TEMPLE HILLS TEMPLE HILLS TEMPLE HILLS THURMONT THURMONT TIMONIUM TIMONIUM TOWSON TOWSON TOWSON TOWSON TOWSON TOWSON TOWSON TOWSON UNION BRIDGE UPPER MARLBORO UPPER MARLBORO

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD

21663 20746-2404 21784-6409 21784-6521 20912-4816 20912 21787-2422 21787-2300 20748-1713 20748-5333 20748-1200 20748-1833 21788-1912 21788-2000 21093 21093-3109 21204-0620 21204-5835 21204-5109 21286-8305 21286-8302 21204-7705 21204-2302 21286-5844 21791-9100 20772-4102 20774-1304

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 276 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FAMILY MEDS INC GIANT PHARMACY HANSON PHARMACY HIGH STREET DISCOUNT PHARMACY NORTHGATE CARE PHARMACY INC PEMBROOKE PHARMACY S MD COMPOUNDING CNTR WALKERSVILLE PHARMACY TRI-TOWNS PHARMACY ANCHOR PHARMACY ANCHOR PHARMACY GIANT PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY SHOPPERS PHARMACY MY EXPRESS CARE PHARMACY LLC SAUBELS PHARMACY WHITEFORD WHITEFORD PHARMACY EXPRESS PHARMACY WILLIAMSPORT PHARMACY CATONSVILLE P.A. PHARMACY INC GIANT PHARMACY ROLLING ROAD PHARMACY WEIS PHARMACY KINGS PHARMACY WOODBINE PHARMACY WEIS PHARMACY CENTRAL MAINE PHARMACY BEDARD PHARMACY INC SHAWS PHARMACY KENNEBEC PHARMACY & HOME CARE

Provider Name

(301) 396-9277 (301) 542-4200 (301) 233-4542 (240) 448-3301 (301) 932-7977 (301) 932-7900 (301) 645-2400 (301) 845-4401 (301) 359-3778 (410) 848-8900 (410) 848-1618 (410) 857-6320 (410) 848-7426 (410) 848-5085 (240) 514-1009 (240) 448-3679 (410) 452-0339 (410) 452-5221 (301) 223-8185 (301) 223-4101 (443) 200-1200 (410) 922-2400 (410) 788-8149 (410) 298-4759 (410) 549-1900 (410) 489-2708 (410) 461-7547 (207) 437-7777 (207) 783-1410 (207) 783-8951 (207) 626-9066

12114 OLD LINE CENTER 3297 CRAIN HWY 2110 CRAIN HWY 30 HIGH ST 3973 SAINT CHARLES PKWY 11355 PEMBROOKE SQ STE 109 3643 LEONARDTOWN RD 19 E FREDERICK ST 22 MAIN ST 205 WASHINGTON HEIGHTS MED CTR 205 SAINT MARK WAY 405 N CENTER ST 288 E GREEN ST 630 BALTIMORE BLVD 2201 RANDOLPH RD 4453 CRAIN HWY 2902 WHITEFORD RD 2338 WHITEFORD RD 307 E POTOMAC ST STE A 34 N CONOCOCHEAGUE ST 2015 LORD BALTIMORE DR 3602 MILFORD MILL RD 7001 JOHNNYCAKE RD STE 100 7005 SECURITY BLVD 7627 WOODBINE RD 710 LISBON CTR DR STE D 10825 BIRMINGHAM WAY 18 CHINA RD 359 MINOT AVE STE B 600 CENTER ST 11 MEDICAL CENTER PKWY STE A

WALDORF WALDORF WALDORF WALDORF WALDORF WALDORF WALDORF WALKERSVILLE WESTERNPORT WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WESTMINSTER WHEATON WHITE PLAINS WHITEFORD WHITEFORD WILLIAMSPORT WILLIAMSPORT WINDSOR MILL WINDSOR MILL WINDSOR MILL WINDSOR MILL WOODBINE WOODBINE WOODSTOCK ALBION AUBURN AUBURN AUGUSTA

MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD ME ME ME ME

20602 20603-4848 20601-3146 20602-1846 20602-2683 20603-4805 20601 21793-8234 21562-1408 21157-5632 21158-4103 21157-5119 21157-5410 21157-6104 20902-1307 20695 21160-1113 21160-1207 21795-1203 21795 21244-2558 21244-3328 21244-2419 21244-2533 21797-8903 21797 21163-1427 04910-6445 04210-4329 04210-6311 04330-8158

KENNEBRA PHARMACY AND HOME CARE SHAWS PHARMACY GENOA-QOL HEALTHCARE MILLER DRUG RIVERSIDE MILLER DRUG STATE STREET MILLER DRUG WESTGATE

(207) 626-2726 (207) 626-0364 (207) 404-2536 (207) 973-8888 (207) 947-8369 (207) 973-6788

43 LEIGHTON RD 150 WESTERN AVE 42 CEDAR ST STE A 431 STATE ST 210 STATE ST 915 UNION ST STE 7

AUGUSTA AUGUSTA BANGOR BANGOR BANGOR BANGOR

ME ME ME ME ME ME

04330-7705 04330-7241 04401-6433 04401-6615 04401-5411 04401-3010

PENOBSCOT COMMUNITY HEALTH CTR INC SHAWS PHARMACY WEST END DRUG COMPANY

(207) 992-4100 (207) 945-6550 (207) 288-3318

1012 UNION ST STE 1 353 MAIN ST 105 MAIN ST

BANGOR BANGOR BAR HARBOR

ME ME ME

04401-3058 04401-6211 04609-1844

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 277 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WILSONS DRUG STORE

Provider Name

(207) 442-8786

114 FRONT ST

BATH

ME

04530-2607

SEAPORT COMMUNITY HLTH CENTER PHCY YORK HOSPITAL BERWICK PHARMACY E.W.MOORE & SON PHARMACY COMMUNITY PHARMACY-BLUE HILL MILLER DRUG WHITING HILL KENNEBEC SENIOR CARE MEDICAL CENTER PHARMACY SHAWS/OSCO PHARMACY WALTZ LONG TERM CARE PHARMACY COMMUNITY PHARMACY-BUCKSPORT FRONTIER PHARMACY PARADIS SHOP N SAVE DIRIGO DRUG COMMUNITY PHARMACY-CORINTH COMMUNITY PHARMACY-CORNISH FOXCROFT PHARMACY SHAWS OSCO PHARMACY DAVIS PHARMACY GOOD FOR ALL PHARMACY EASTPORT FAMILY PHARMACY SHAWS/OSCO PHARMACY FAIRFIELD PHARMACY MT. BLUE DRUG I CARE PHARMACY PARADIS PHARMACY ST JOHN VALLEY PHARMACY SHAWS PHARMACY GARDINER APOTHECARY COMMUNITY PHARMACY-GORHAM GREENE VILLAGE PHARMACY INC HARRIS DRUG STORE COMMUNITY PHARMACY OF HERMON KVHC PHARMACY PARADIS SHOP N SAVE SPRUCE MOUNTAIN PHARMACY KENNEBUNK VILLAGE PHARMACY COLONIAL PHARMACY WESTERN MAINE PHARMACY, INC. BEDARD DIRECT BEDARD PHARMACY INC

(207) 992-4100 (207) 698-6740 (207) 672-3312 (207) 621-0698 (207) 973-9444 (207) 729-3642 (207) 729-3642 (207) 721-0900 (207) 373-9077 (207) 621-0698 (207) 493-7771 (207) 498-3545 (207) 426-6005 (207) 621-0698 (207) 621-0698 (207) 564-6900 (207) 564-2857 (207) 746-3721 (207) 247-4000 (207) 853-9200 (207) 669-3005 (207) 453-6611 (207) 778-5419 (888) 422-7319 (207) 834-4204 (207) 834-2880 (207) 865-0205 (207) 588-7202 (207) 621-0698 (207) 946-2425 (207) 695-2921 (207) 848-5020 (207) 521-0620 (207) 532-2500 (207) 897-9080 (207) 985-1755 (207) 967-4442 (207) 265-8020 (207) 440-2200 (207) 786-0138

53 SCHOODIC DR 4 DANA DRIVE 337 MAIN ST 15 SOUTH ST 33 WHITING HILL RD STE 4 121 MEDICAL CENTER DR STE G500 121 MEDICAL CENTER DR STE G500 147 BATH RD 3 BUSINESS PKWY STE 2 75 MAIN ST 153 BENNETT DR 114 HIGH ST 1144 MAIN ST 689 MAIN ST 200 MAPLE ST UNIT 3 1207 W MAIN ST 1073 W MAIN ST STE 9 59 MAIN ST 10 GOODALL WAY STE 800 60 WATER ST 175 HIGH ST 66 WESTERN AVE 624 WILTON RD 227 MAIN ST 62 WEST MAIN ST STE 101 182 MARKET ST 200 LOWER MAIN ST 35 BRIDGE ST 365 MAIN ST 19B PATTEN ROAD 10 PRITHAM AVE 2402 ROUTE 2 UNIT 1 59 BANGOR ST 33 LUDLOW RD 3 TWEEDIE ST 18 BLUE WAVE PROFESSIONAL CTR 40 DOCK SQ 238 MAIN ST 5 HORTON ST 61 COLLEGE ST

BELFAST BERWICK BINGHAM BLUE HILL BREWER BRUNSWICK BRUNSWICK BRUNSWICK BRUNSWICK BUCKSPORT CARIBOU CARIBOU CLINTON CORINTH CORNISH DOVER FOXCROFT DOVER FOXCROFT EAST MILLINOCKET EAST WATERBORO EASTPORT ELLSWORTH FAIRFIELD FARMINGTON FORT FAIRFIELD FORT KENT FORT KENT FREEPORT GARDINER GORHAM GREENE GREENVILLE HERMON HOULTON HOULTON JAY KENNEBUNK KENNEBUNKPORT KINGFIELD LEWISTON LEWISTON

ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME

04915-7246 03901-2767 04920-4021 04614-6109 04412-1022 04011-2653 04011-2660 04011-2647 04011-7390 04416-4025 04736-2024 04736-2709 4927 4427 4020 04426-3747 04426-3742 04430-1126 4030 04631-1329 04605-1730 04937-1337 04938-6138 04742-1122 4743 04743-1514 04032-1000 04345-1848 04038-1309 4236 4441 04401-0665 04730-1740 04730-3524 04239-5078 04043-7050 04046-6011 04947-4243 04240-6828 04240-6805

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 278 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CMMC PHARMACY SHAWS PHARMACY THE MEDICINE SHOPPE MADAWASKA PHARMACY TAYLOR'S DRUG STORE MARS HILL PHARMACY INC MACHIAS FRIENDLY PHARMACY MILBRIDGE PHARMACY OAKLAND PHARMACY

Provider Name

(207) 795-7177 (207) 784-6666 (207) 783-3539 (207) 728-7200 (207) 696-3935 (207) 425-4431 (207) 255-6400 (207) 546-2304 (207) 465-4440

12 HIGH ST 27 EAST AVE 373 SABATTUS ST 104 MAIN ST 2 OLD POINT AVE 106 MAIN ST 8 OLD COUNTY RD 11 MAIN ST 907 KENNEDY MEMORIAL DR

LEWISTON LEWISTON LEWISTON MADAWASKA MADISON MARS HILL MARSHFIELD MILBRIDGE OAKLAND

ME ME ME ME ME ME ME ME ME

04240-7676 04240-6645 04240-5429 04756-1437 04950-1115 04758-3403 04654-5215 04658-3500 04963-4821

HELEN HUNT HEALTH CENTER PHARMACY ORONO PHARMACY KVHC PHARMACY PATTEN PATTEN DRUG COMPANY APOTHECARY BY DESIGN COASTAL PHARMACY & WELLNESS

(207) 992-4100 (207) 866-3800 (207) 447-4949 (207) 528-2244 (877) 814-8447 (207) 899-0886

242 BRUNSWICK ST 16 MILL ST 30 HOULTON ST 20 MAIN ST 141 PREBLE ST 84 MARGINAL WAY

OLD TOWN ORONO PATTEN PATTEN PORTLAND PORTLAND

ME ME ME ME ME ME

04468-1613 04473-4039 04765-3035 04765-3151 4101 4101

MARTINS PT HLTHCARE PORTLAND PHCY 1

(888) 408-8281

331 VERANDA ST

PORTLAND

ME

04103-5545

MARTINS PT HLTHCARE PORTLAND PHCY 2 SHAWS PHARMACY THE PHARMACY AT MAINE MED CTR CITY DRUG STORE PRESQUE ISLE PHARMACY COMMUNITY PHARMACY-RANDOLPH JENSEN'S PHARMACY SHAWS PHARMACY KENNEBEC PHARMACY & HOME CARE COMMUNITY PHARMACY-SACO SHAWS OSCO PHARMACY SHAWS PHARMACY MAINE CTR FOR CANCER MEDICINE SHAWS OSCO PHARMACY VARIETY DRUG S BERWICK PHCY SEACOAST COMP MOBY RX CARROLL DRUG STORE SEASIDE PHARMACY UNITY PHARMACY HEBERT REXALL PHARMACY COMMUNITY PHARMACY-WALDOBORO SHAWS PHARMACY

(800) 707-9853 (207) 797-0536 (207) 662-2626 (207) 764-4424 (207) 760-9100 (207) 621-0698 (207) 593-7922 (207) 594-8070 (207) 594-0888 (207) 283-2792 (207) 284-9955 (207) 490-3562 (207) 885-7600 (207) 510-3005 (207) 474-3393 (207) 384-2772 (207) 899-4600 (207) 244-5588 (207) 367-2575 (207) 948-3950 (207) 868-2242 (207) 790-2220 (207) 680-3001

901 WASHINGTON AVE 91 AUBURN ST 22 BRAMHALL STREET 172 ACADEMY ST 797 MAIN ST 268 WATER ST 91 CAMDEN ST STE 105 235 CAMDEN ST 839 COMMERCIAL ST 244 MAIN ST 4 SCAMMON ST STE 12 1364 MAIN ST 100 CAMPUS DR UNIT 108 417 PAYNE RD 12 HIGH ST 289 MAIN ST 225 WATERMAN DR 3 VILLAGE GREEN WAY 59 SCHOOL ST 33 PLAZA DR 74 MAIN ST 5 FRIENDSHIP ST 251 KENNEDY MEMORIAL DR

PORTLAND PORTLAND PORTLAND PRESQUE ISLE PRESQUE ISLE RANDOLPH ROCKLAND ROCKLAND ROCKPORT SACO SACO SANFORD SCARBOROUGH SCARBOROUGH SKOWHEGAN SOUTH BERWICK SOUTH PORTLAND SOUTHWEST HARBOR STONINGTON UNITY VAN BUREN WALDOBORO WATERVILLE

ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME ME

04103-2737 04103-2103 4102 04769-3165 04769-2201 04346-5217 04841-2421 04841-2563 04856-4243 04072-1509 04072-5122 04073-3660 04074-7172 04074-9594 04976-1815 03908-1543 4106 04679-4227 04681-3610 04988-3917 4785 04572-6287 04901-4534

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 279 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SHAWS PHARMACY WINSLOW PHARMACY YORK HOSPITAL APOTHECARY YORK HOSPITAL PHARMACY HOMETOWN PHARMACY #52 - ADA ADDISON PHARMACY ADRIAN PHARMACY COUNTRY MARKET PHARMACY FAMILY FARE PHARMACY PARKS DRUG STORE INC YOUNGS PHARMACY ALLEGAN COMMUNITY PHARMACY ALLEGAN MEDICAL CENTER PHARMACY VALUE DRUGS ALL CARE PHARMACY ALLEN PARK DISCOUNT PHARMACY CHAMPAIGN FAMILY PHARMACY MED RX PHARMOR PHCY ALLEN PARK UPTOWN DRUGS PHARMACY FAMILY FARE PHARMACY ALMA FAMILY PHARMACY MIDMICHIGAN MED CENTER-GRATIOT

Provider Name

(207) 857-9298 (207) 872-7979 (207) 351-2150 (207) 361-3875 (616) 682-9100 (517) 547-6686 (517) 759-3500 (517) 265-9162 (517) 629-2286 (517) 629-9481 (517) 629-2900 (616) 673-4188 (269) 673-4700 (269) 673-6749 (313) 386-2273 (313) 928-2222 (313) 382-0000 (313) 928-4922 (313) 388-9560 (313) 383-8300 (616) 895-7426 (989) 968-4003 (989) 466-3252

47 MAIN ST 20 GARLAND RD 15 HOSPITAL DR 343 US ROUTE 1 6745 E FULTON AVE 100 W MAIN ST 1325 N MAIN ST STE D 1535 W MAUMEE ST 1406 N EATON ST 318 S SUPERIOR ST 120 S CLARK ST 115 LOCUST ST 551 LINN ST STE 120 100 MONROE ST 7125 ALLEN RD 6811 ALLEN RD 14726 CHAMPAIGN RD 15101 SOUTHFIELD RD STE 101 8221 ALLEN ROAD 14737 CHAMPAIGN RD 6370 LAKE MICHIGAN DR STE 100 1686 WRIGHT AVE STE C 300 E WARWICK DR

WESTBROOK WINSLOW YORK YORK ADA ADDISON ADRIAN ADRIAN ALBION ALBION ALBION ALLEGAN ALLEGAN ALLEGAN ALLEN PARK ALLEN PARK ALLEN PARK ALLEN PARK ALLEN PARK ALLEN PARK ALLENDALE ALMA ALMA

ME ME ME ME MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

04092-4737 04901-0600 03909-1011 03909-1636 49301 49220-9807 49221-1721 49221-1805 49224-9470 49224-1753 49224-1915 49010-1301 49010-1595 49010-1363 48101-2009 48101-2007 48101 48101-2664 48101-2034 48101-1616 49401-8068 48801-1090 48801-1014

ALCONA HEALTH CENTER PHARMACY SVCS LEFAVE PHARMACY

(989) 358-3950 (989) 354-3189

1185 US HIGHWAY 23 N 1202 W CHISHOLM ST

ALPENA ALPENA

MI MI

49707-8018 49707-1620

MIDMICHIGAN MEDICAL CENTER - ALPENA NEIMAN'S FAMILY PHARMACY THE DRUG STORE BIG HOUSE PHARMACY CLARK PROFESSIONAL PHARMACY DIX BORO VILLAGE PHARMACY GENOA-QOL HEALTHCARE

(989) 356-8079 (989) 356-2191 (989) 354-2171 (734) 929-2425 (734) 369-8782 (734) 214-1234 (734) 418-0448

1501 W CHISHOLM ST 2205 US HIGHWAY 23 S STE 144 2236 US HIGHWAY 23 S 1000 E STADIUM BLVD STE B 3280 WASHTENAW AVE 5770 PLYMOUTH RD 110 N 4TH AVE STE 1100

ALPENA ALPENA ALPENA ANN ARBOR ANN ARBOR ANN ARBOR ANN ARBOR

MI MI MI MI MI MI MI

49707-1401 49707-4517 49707-4544 48104-4616 48104-4250 48105-9312 48104-5503

HEALTHPLUS PHARMACY OF ANN ARBOR HOMEMED INFUSION PHARMACY SER HOMETOWN PHARMACY OPTION CARE PACKARD DISCOUNT PHARMACY PHARMACY SOLUTIONS INC STADIUM PHARMACY

(734) 929-5668 (734) 975-3006 (734) 747-8080 (734) 677-3800 (734) 929-5504 (734) 821-8000 (734) 913-4752

4350 JACKSON RD STE 250 2850 S INDUSTRIAL HWY STE 50 2355 E STADIUM BLVD 1350 HIGHLAND DR STE C 3152 PACKARD RD 5204 JACKSON RD STE C 1930 W STADIUM BLVD

ANN ARBOR ANN ARBOR ANN ARBOR ANN ARBOR ANN ARBOR ANN ARBOR ANN ARBOR

MI MI MI MI MI MI MI

48103-1832 48104-6792 48104-4800 48108-2263 48108 48103-1866 48103-4504

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 280 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ARMADA PHARMACY INC LARMOURS VILLAGE DRUG THUNDER BAY PHARMACY AUGRES PHARMACY WACKERLY PHARMACY AUBURN HILLS PHARMACY ULTIMATE MEDICAL PHARMACY ASKLERS AUGUSTA PHCY N MORE NORTHGATE PHARMACY INC FAMILY HEALTH CARE PHARMACY PATTIE DRUG OF BALDWIN SWANSTRA PHARMACY BORGESS HEALTH PARK PHARMACY

Provider Name

(586) 784-9222 (269) 729-5161 (989) 785-5535 (989) 876-8899 (989) 832-8177 (248) 309-3333 (248) 370-8070 (269) 731-2400 (989) 269-8061 (231) 745-5024 (231) 745-4697 (269) 427-7706 (269) 565-9200

23032 E MAIN ST 106 S CAPITAL AVENUE 11899 M 32 212 E SAGINAW ST 310 E MIDLAND RD 3089 E WALTON BLVD 2049 N OPDYKE RD 108 S WEBSTER ST 721 N VAN DYKE RD STE 1 1615 MICHIGAN AVE 868 MICHIGAN AVE 3 W MONROE 3035 CAPITAL AVE SW

ARMADA ATHENS ATLANTA AU GRES AUBURN AUBURN HILLS AUBURN HILLS AUGUSTA BAD AXE BALDWIN BALDWIN BANGOR BATTLE CREEK

MI MI MI MI MI MI MI MI MI MI MI MI MI

48005-4705 49011 49709-9374 48703 48611-9751 48326 48326 49012-9776 48413-9188 49304 49304-7123 49013-1330 49015-4334

BRONSON BATTLE CREEK OUTPT PHARM FAMILY FARE PHARMACY FAMILY FARE PHARMACY GENOA-QOL HEALTHCARE LARMOURS PHARMACY TWIN VALLEY PHARMACY ANDERSON PHARMACY INC COUNTRY DRUGS KESSEL PHARMACY LAYERERS PHARMACY INC MAPLEWOOD PHARMACY MCLAREN DRUG SHOP - AMB MCLAREN DRUG SHOP - WSMM MCLAREN DRUG SHOP- BRMC SOUTHSIDE PHARMACY RICHMOND DRUG BEAVERTON PHARMACY LEPPINKS PHARMACY BELDING BELLAIRE FAMILY HEALTH CENTER BELLAIRE PHARMACY GLENS PHARMACY BELLEVILLE PHARMACY HEALTH SMART PHARMACY INC ORCHARD PHARMACY CENTER SAV ON 7 ANDREWS BELLEVILLE VAN BUREN PHARMACY HOME TOWN PHCY (FRUIN PHCY) BENTON HARBOR COMMUNITY PHCY

(269) 966-8646 (616) 878-2761 (269) 962-1456 (269) 979-7822 (269) 965-1258 (269) 964-9467 (989) 684-8905 (989) 684-8251 (517) 686-3592 (989) 893-7579 (989) 892-4531 (989) 892-2561 (989) 667-2940 (989) 894-3744 (989) 891-9999 (231) 864-3114 (989) 435-7778 (616) 794-4053 (231) 533-6655 (231) 533-8014 (231) 533-5534 (734) 325-7658 (734) 699-2228 (734) 391-8284 (734) 699-2075 (734) 325-6318 (269) 763-9407 (269) 849-8251

363 FREMONT ST STE 111 45 COLUMBIA AVE E 1603 CAPITAL AVE NE 3630 CAPITAL AVE SW 1478 MICHIGAN AVE W 1250 COLUMBIA AVE E 1108 MARQUETTE AVE 362 STATE PARK DR 945 N EUCLID AVE 1100 COLUMBUS AVE 920 N JOHNSON ST 200 S WENONA ST 4175 N EUCLID AVE 1900 COLUMBUS AVE 1002 LAFAYETTE AVE 7717 LAKE ST 127 W BROWN ST 301 W MAIN ST 4955 S M 88 HWY 115 N BRIDGE ST 211 S DIVISION ST 25 OWEN ST 10824 BELLEVILLE RD 19731 SUMPTER RD 444 MAIN STREET 11650 BELLEVILLE RD STE 103 117 N MAIN ST 800 M 139

BATTLE CREEK BATTLE CREEK BATTLE CREEK BATTLE CREEK BATTLE CREEK BATTLE CREEK BAY CITY BAY CITY BAY CITY BAY CITY BAY CITY BAY CITY BAY CITY BAY CITY BAY CITY BEAR LAKE BEAVERTON BELDING BELLAIRE BELLAIRE BELLAIRE BELLEVILLE BELLEVILLE BELLEVILLE BELLEVILLE BELLEVILLE BELLEVUE BENTON HARBOR

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49017-3395 49015-3703 49017-5381 49015-7375 49037-1926 49014-5159 48706 48706-1340 48706-2400 48708-6644 48708 48706-8820 48706-2483 48708-6831 48708-7975 49614-5110 48612-8119 48809-1675 49615-9082 49615-9509 49615-9550 48111-2921 48111-5304 48111-8919 48111 48111 49021-1231 49022-3881

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 281 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE SHOP N SAVE PHARMACY DAVOB PHARMACY INC MED CART PHARMACY MARTZ & SHAPLEY PHARMACY WEST MICHIGAN PHARMACY BIRCH RUN DRUGS MILLS PHCY & APOTHECARY SAV-ON 17 BIRMINGHAM DRUGS SCHMIDT & SONS PHCY BLISSFIELD SAV-ON 1 BLOOMFIELD FOX HILLS MEDI-MART, LTD MEDICAL PARK PHARMACY STAR DRUGS

Provider Name

(269) 934-0119 (231) 882-0254 (248) 439-2150 (248) 542-2300 (231) 796-7621 (231) 305-4095 (989) 624-9231 (248) 644-5060 (248) 644-3214 (517) 486-2145 (248) 626-2525 (248) 858-2225 (248) 454-6500 (248) 333-0222

1485 M 139 1747 BENZIE HWY 4148 WEST 12 MILE RD 1964 11 MILE RD STE C 101 MAPLE ST 20095 GILBERT RD 8501 MAIN ST 1744 W MAPLE RD STE A 33877 WOODWARD AVE 177 W BROOKE LN 6510 TELEGRAPH RD 1539 S OPDYKE RD 799 DENISON CT FL 1 1525 OPDYKE

BENTON HARBOR BENZONIA BERKLEY BERKLEY BIG RAPIDS BIG RAPIDS BIRCH RUN BIRMINGHAM BIRMINGHAM BLISSFIELD BLOOMFIELD BLOOMFIELD HILLS BLOOMFIELD HILLS BLOOMFIELD HILLS

MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49022-5711 49616-8600 48072 48072-3046 49307-1803 49307-2365 48415-9700 48009-1545 48009-0915 49228-8601 48301-3011 48304 48302-0301 48304

THE VILLAGE PHCY AND COMPOUNDING WOODWARD PHARMACY GLENS PHARMACY HUFF PHARMACY

(248) 644-6337 (248) 499-7840 (231) 582-2101 (231) 582-6514

3592 W MAPLE RD 42557 WOODWARD AVE STE 230 430 N LAKE ST 121 WATER ST

BLOOMFIELD HILLS BLOOMFIELD HILLS BOYNE CITY BOYNE CITY

MI MI MI MI

48301-3371 48304-5038 49712-1104 49712-1242

BRIDGEPORT HEALTH-MART PHARMACY MEDPLEX PHARMACY

(989) 777-2900 (989) 746-9500

6224 DIXIE HIGHWAY 6318 DIXIE HWY

BRIDGEPORT BRIDGEPORT

MI MI

48722 48722-9566

HEALTHPLUS PHARMACY OF BRIGHTON INNOVATIVE PHARMACEUTICAL BAY MILLS PHARMACY COUNTRY MARKET PHARMACY

(810) 229-4420 (810) 229-4000 (906) 248-2031 (517) 592-2475

2305 GENOA BUSINESS PARK DR ST 2250 GENOA BUSINESS PARK DR ST 12124 W LAKESHORE DR 11301 BROOKLYN RD

BRIGHTON BRIGHTON BRIMLEY BROOKLYN

MI MI MI MI

48114-7004 48114-7372 49715-9319 49230-8485

WEATHERWAX FAMILY PHARMACIES INC EHARDT'S PHARMACY DISCOUNT DRUGS HENRY FORD HEALTH CENTER ABC DISCOUNT PHARMACY CENTER ROAD PHARMACY HAMILTON BURTON PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY SAINT MARYS SOUTHWEST PHARMACY CADILLAC FAMILY PHARMACY LLC CADILLAC HOSPITAL PHARMACY COBBS STREET PHARMACY GLENS PHARMACY

(517) 591-8505 (810) 346-2637 (734) 224-6400 (734) 671-1499 (810) 877-6446 (810) 309-3209 (810) 406-4001 (616) 281-7605 (616) 878-6047 (616) 685-3950 (231) 775-8200 (231) 876-7841 (231) 876-6740 (231) 775-6383

105 N MAIN STREET 4436 MAIN ST 19145 ALLEN RD STE 105 23050 WEST RD 6009 EAST LAPEER RD 1513 S CENTER RD G-3375 S SAGINAW ST 701 68TH ST SW STE 115 2245 84TH ST SW 2373 64TH ST SW STE 1100 108 N MITCHELL ST 400 HOBART ST 520 COBB ST 602 MITCHELL

BROOKLYN BROWN CITY BROWNSTOWN TWP BROWNSTOWN TWP BURTON BURTON BURTON BYRON CENTER BYRON CENTER BYRON CENTER CADILLAC CADILLAC CADILLAC CADILLAC

MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49230 48416-9701 48183-6812 48183-1468 48509-2214 48509-1728 48529-1277 49315-8372 49315-8666 49315-7975 49601-2713 49601-2331 49601-2588 49601

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 282 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

D AND W PHARMACY PROFESSIONAL PHARMACY CANTON SPECIALTY PHARMACY DEVZ PHARMACY II HAGGERTY DRUGS AND MED SUPPLIES HAGGERTY PHARMACY HEALTHPLUS SPECIALTY PHARMACY OAKWOOD PHARMACY-CANTON SAV-ON 22 RICHARDSONS PHARMACY CAPAC PHARMACY INC ROGERS PHARMACY OF CAPAC CARLETON PHARMACY CARO DRUGS

Provider Name

(616) 891-7898 (616) 891-1116 (313) 467-0404 (734) 335-6312 (734) 981-7340 (734) 667-2000 (734) 769-1300 (734) 454-8070 (734) 981-3900 (810) 395-2336 (810) 395-1880 (734) 654-6252 (989) 672-1080

9375 CHERRY VALLEY AVE SE 9175 CHERRY VALLEY RD 305 N LILLEY RD 6624 N CANTON CENTER RD 2050 N HAGGERTY RD STE 160 6200 N HAGGERTY RD STE 300 45300 HANFORD RD 7330 N CANTON CENTER RD STE 11 42433 FORD RD 136 N MAIN 3433 CAPAC RD STE 3 201 MEDICAL CENTER DRIVE 1525 W CARO RD

CALEDONIA CALEDONIA CANTON CANTON CANTON CANTON CANTON CANTON CANTON CAPAC CAPAC CARLETON CARO

MI MI MI MI MI MI MI MI MI MI MI MI MI

49316-9506 49316-9521 48187-3908 48187-1651 48187-3796 48187-3605 48187-2695 48187-1538 48187-3303 48014-3142 48014-4306 48117 48723-9686

STATE STREET PHCY & WELLNESS CENTER VG'S PHARMACY CARSON APOTHECARY SHOPPE SCHEURER FAMILY PHARMACY COACHLIGHT PHARMACY HOSPITAL DRIVE PHARMACY CASSOPOLIS FAMILY CLINIC ARFSTROM PHARMACY ASSURASCRIPT BINSONS PHARMACY CENTERLINE CITY PHARMACY LLC CENTRAL LAKE PHARMACY CENTRAL DRUG STORE CENTRAL PHARMACY - CHARLOTTE GLENS PHARMACY MODERN PHARMACY CHELSEA CARE PHARMACY CHELSEA PHARMACY COUNTRY MARKET PHARMACY BROAD STREET PHARMACY CENTRAL PHARMACY-CHESANING LLC KNIGHT DRUGS - CHESANING HENRY FORD MACOMB PHARMACY GATEWAY PHARMACY CLARKSTON PHARMACY MEDCENTER PHARMACY PINE KNOB PHARMACY PINE KNOB SAV MOR PHARMACY

(989) 672-3500 (989) 673-7020 (989) 584-3272 (989) 856-2900 (989) 872-3613 (989) 912-6061 (269) 228-8505 (906) 484-3355 (586) 692-7779 (586) 757-2755 (586) 427-5344 (231) 544-2929 (231) 547-2424 (517) 541-4148 (231) 627-5371 (231) 627-9949 (734) 593-5900 (734) 475-1188 (734) 433-0129 (989) 845-9355 (810) 845-3609 (989) 845-2050 (586) 421-3020 (989) 386-2900 (248) 625-8030 (248) 625-3885 (248) 620-3588 (248) 384-8050

192 N STATE ST 1520 W CARO RD 245 S SECOND ST 6568 MAIN ST 6480 MAIN ST 6190 HOSPITAL DR 261 M 62 4 EAST M 134 26330 LAWRENCE STE A 26834 LAWRENCE 8033 E 10 MILE RD STE 103 2424 N MAIN ST 301 BRIDGE ST 354 S COCHRAN AVE STE 3 992 S MAIN ST 127 N MAIN ST 14650 OLD US 12 STE 103 1125 S MAIN ST 1255 S MAIN ST 1115 W BROAD ST 126 W BROAD ST 129-133 W BROAD ST. 30795 23 MILE RD 1048 N MCEWAN ST 5838 S MAIN ST 7210 N MAIN ST STE 102 6770 DIXIE HWY 5701 BOW POINTE DR STE 130

CARO CARO CARSON CITY CASEVILLE CASS CITY CASS CITY CASSOPOLIS CEDARVILLE CENTER LINE CENTER LINE CENTER LINE CENTRAL LAKE CHARLEVOIX CHARLOTTE CHEBOYGAN CHEBOYGAN CHELSEA CHELSEA CHELSEA CHESANING CHESANING CHESANING CHESTERFIELD CLARE CLARKSTON CLARKSTON CLARKSTON CLARKSTON

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48723-1550 48723-9260 48811 48725-9457 48726-1143 48726 49031-1034 49719-0000 48015-1268 48015-1262 48015-1454 49622-9271 49720-1414 48813-1569 49721-2265 49721-1637 48118 48118-1426 48118-1418 48616-1068 48616-1203 48616 48047-5720 48617-1154 48346-2963 48346-1575 48346-2087 48346

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 283 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CLAWSON CARE PHARMACY

Provider Name

(248) 439-2400

117 W 14 MILE RD

CLAWSON

MI

48017-1965

SCHMIDT & SONS PHCY OF CLINTON INC CAREWELL PHARMACY FRANKS PHARMACY ADVANCED CARE GARFIELD DRUG MART

(517) 456-4150 (586) 221-2829 (586) 464-2000 (586) 554-2745

140 W MICHIGAN AVE 41940 HAYES RD 39023 HARPER AVE 42086 GARFIELD RD

CLINTON CLINTON TOWNSHIP CLINTON TOWNSHIP CLINTON TOWNSHIP

MI MI MI MI

49236-9577 48038-5841 48036-3226 48038-1643

HENRY FORD MACOMB AMBULATORY PHCY LAKEWOOD FAMILY PHARMACY LLC NORTHEAST PHARMACY PREMIER PHARMACY LLC SOMERSET FAMILY PHARMACY ST GEORGE PHARMACY VALUE CENTER PHARMACY HEARTLAND DRUGS OUR FAMILY PHARMACY VG'S PHARMACY FELPAUSCH COLDWATER PHARMACY VCARE PHARMACY #1 COLEMAN FAMILY PHARMACY HARDING'S PHARMACY DMC PHARMACY HURON VALLEY SENIOR HOME HEALTH CARE INC OPTION CARE TASKER'S DRUG STORE EHARDT'S PHARMACY CRYSTAL FALLS PHARMACY CURTIS FAMILY PHARMACY MEDICAP PHARMACY VG'S PHARMACY A & S PHARMACY AL AMIR PHARMACY LLC AMERICO PHARMACY BLOSSOM CARE PHARMACY CHASE HEALTH PHARMACY CHASE MEDICAL PHARMACY LLC CHERRY HILL PROFESSIONAL PHCY CLINIC RX DEARBORN COMMUNITY CARE PHCY DEARBORN FAMILY PHARMACY LLC DEARBORN FRESH PHARMACY DEARBORN HILLS PHARMACY

(586) 263-2677 (586) 533-2007 (586) 263-6400 (586) 741-4850 (248) 712-6909 (586) 213-1386 (586) 954-9100 (586) 228-1551 (810) 547-1278 (810) 686-0004 (517) 279-1230 (517) 924-1400 (989) 465-6661 (269) 468-6207 (248) 937-5710 (248) 363-7575 (616) 997-2611 (616) 837-6394 (810) 679-3900 (906) 875-3601 (906) 586-3333 (810) 658-2646 (810) 658-9710 (313) 582-1350 (313) 436-1785 (313) 563-7777 (313) 436-5513 (313) 769-6817 (313) 791-7390 (313) 274-5990 (313) 429-3433 (313) 558-2121 (313) 523-5334 (313) 581-8801 (313) 915-5455

16151 19 MILE RD 33720 HARPER AVE, STE B 43900 GARFIELD RD # STE102 34025 HARPER AVE 33495 HARPER AVE 42621 GARFIELD RD STE 101A 37155 HARPER AVE 43614 GARFIELD RD 415 W VIENNA ST 710 S MILL ST 410 MARSHALL ST 360 E CHICAGO ST 211 E RAILWAY ST 6577 PAW PAW AVE 1 WILLIAM CARLS DR 4204 MARTIN RD STE E 50 64TH AVE S 281 MAIN STREET 57 N HOWARD AVE 1340 W US 2 W17220 MAIN ST 9070 DAVISON RD 8503 DAVISON RD 14716 W WARREN AVE 15210 W WARREN AVE 24355 FORD RD 5250 AUTO CLUB DR STE 160 6200 CHASE RD 5901 CHASE RD STE 100 23100 CHERRY HILL ST 21759 TENNY ST 15120 MICHIGAN AVE 17000 EXECUTIVE PLAZA DR 13661 COLSON ST STE A 24755 FORD RD

CLINTON TOWNSHIP CLINTON TOWNSHIP CLINTON TOWNSHIP CLINTON TOWNSHIP CLINTON TOWNSHIP CLINTON TOWNSHIP CLINTON TOWNSHIP CLINTON TWP CLIO CLIO COLDWATER COLDWATER COLEMAN COLOMA COMMERCE COMMERCE TOWNSHIP COOPERSVILLE COOPERSVILLE CROSWELL CRYSTAL FALLS CURTIS DAVISON DAVISON DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48038-1158 48035-4255 48038-1128 48035-3737 48035-4253 48038-5031 48036-3013 48038 48420-1307 48420-1491 49036-1139 49036-2074 48618-9799 49038-8805 48382 48390-4135 49404-1391 49404 48422-1222 49920 49820 48423-1037 48423-2116 48126-1347 48126-1356 48128-1129 48126-2619 48126 48126-2103 48124-1493 48124-2929 48126-2916 48126 48126-3232 48128

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 284 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DEARBORN RX PHARMACY DIX DRUG STORE CORP DIX FAMILY CARE PHARMACY DRUG MAX EASTBORN RX PHARMACY ELITE ACCESS PHARMACY EXECUTIVE INFUSION SERVICE EXECUTIVE INFUSION SERVICES GREENFIELD PHARMACY INC HAMZEH PHARMACY HEALTH CARE PHARMACY HEALTHSOURCE PHARMACY INSTACARE PHARMACY JULIAS PHARMACY KINGS PHARMACY LIFE PHARMACY LLC MAYA PHARMACY MEDEX PHARMACY MEDINA PHARMACY MONROE PHARMACY NADIA'S PHARMACY NEW SCHAEFER PHARMACY NOUR PHARMACY LLC OAKMAN MEDICAL PHARMACY OAKWOOD PHARMACY DEARBORN PALM PHARMACY PATIENT CARE PHARMACY PELHAM PHARMACY PHARMCITY PREMIER HOME PHARMACY OF MI PREMIUM PHARMACY LLC RIGHT MEDICINE SAADS HEALTHY LIVING PHARMACY SCHAEFER MEDICAL PHARMACY SHEBA DISCOUNT PHARMACY SOUTH DEARBORN PHARMACY TLC PHARMACY TRUDELL PHARMACY UNITED SPECIALTY PHARMACY WELL CARE PHARMACY WEST VILLAGE PHARMACY WESTBORN PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (313) 633-0683 (313) 843-2400 (313) 914-5556 (313) 584-4600 (313) 491-1010 (313) 216-2213 (313) 382-3220 (313) 982-3220 (313) 846-9090 (313) 582-1670 (313) 357-3712 (313) 633-1668 (313) 800-1111 (313) 406-3363 (313) 584-7800 (313) 846-2000 (313) 945-8000 (313) 846-3339 (313) 397-6919 (313) 274-9141 (313) 584-7272 (313) 582-1800 (313) 581-6500 (313) 846-1941 (313) 593-7273 (313) 436-0156 (313) 584-2400 (313) 565-2745 (313) 914-7224 (313) 887-9111 (313) 209-3339 (313) 278-0500 (313) 846-7700 (313) 749-7967 (313) 841-8820 (313) 841-2272 (313) 274-0800 (313) 581-2424 (313) 558-9448 (313) 846-8040 (313) 561-9700 (313) 438-6476

Provider Street 10633 W WARREN AVE STE A 10066 DIX 10035 W VERNOR HWY 5472 SCHAEFER RD 7526 WYOMING STE 1 6450 MAPLE RD 17000 EXECUTIVE PLAZA DR #201 17000 EXECUTIVE PLAZA DR S 201 6050 GREENFIELD RD 10437 W WARREN AVE 10801 W WARREN 15044 MICHIGAN AVE STE B 14300 MICHIGAN AVE 5220 OAKMAN BLVD 4700 SCHAEFER RD STE 162 4025 MAPLE ST 15400 MICHIGAN AVE STE 2 13530 MICHIGAN AVE STE 180 8744 W WARREN AVE 2507 MONROE ST 12818 W WARREN AVE 6635 SCHAEFER RD 6500 SCHAEFER RD 5280 OAKMAN BLVD 18181 OAKWOOD BLVD STE 108 6650 GREENFIELD RD 15301 TIREMAN AVE 3815 PELHAM RD STE 3 3735 MONROE ST STE B 23874 KEAN ST SUITE 120 3808 MONROE ST 1338 N TELEGRAPH RD 13734 W WARREN AVE 7738 SCHAEFER RD 10136 VERNOR HWY 9925 DIX AVE SUITE 106 2959 S TELEGRAPH RD 5711 SCHAEFER RD 25205 TROWBRIDGE ST 5237 OAKMAN BLVD 2040 MONROE ST STE 201 1800 GRINDLEY PARK ST STE 1

Page 285 of 679

Provider City DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN DEARBORN

State

ZIP code

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48126-8010 48120-1551 48120-1513 48126-3223 48126-1690 48126 48126-2610 48126 48126-6004 48126-1660 48126-1191 48126-2914 48126-3417 48126 48126-3698 48126-3532 48126-3491 48126-3574 48126 48124-3013 48126-1533 48126-1812 48126-1813 48126 48124-4082 48126-1701 48126-1045 48124 48124-3788 48124 48124 48128 48126-1423 48126 48120-1515 48120 48124-3241 48126-2252 48124-2414 48126-4045 48124 48124

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

WOODHAVEN MEDICAL CENTER PHARMACY DEARBORN HEIGHTS PHARMACY FAMILY DRUGS PHARMACY III INC FORD TEL PHARMACY HIBBARD PHARMACY MALEK PHARMACY MARSHALL FAMILY PHARMACY SAVERX DISCOUNT PHARMACY SAV-ON DRUGS 4 DEARBORN HTS TODD'S PHARMACY TOTAL COMMUNITY PHARM TRUHEALTH PHARMACY SAV ON 9 RIVER OAKS DBN HGTS DECATUR VILLAGE PHARMACY HARBOR DRUG DELTON FAMILY PHARMACY 7 VAN DRUGS A & M PHARMACY ACTION DRUGS ANDY'S PHARMACY ON GRAND BLVD ARK PHARMACY ASHTON DRUGS A-V PHARMACY II BENSTAR PHARMACY PLLC BLUE PHARMACY BRITAM PHARMACY BUCKLEY'S PHARMACY BUCKLEY'S PHARMACY BUENAVIDA PHARMACY CARE-MOR PHARMACY CITY PHARMACY COMPREHENSIVE MEDS PHARMACY CONANT PLAZA PHARMACY LLC CONNER PHARMACY DAVIS CUT RATE DRUG DAVISON PHARMACY

(313) 581-8200 (313) 724-1111 (313) 336-9333 (313) 274-4647 (313) 406-4466 (313) 334-7742 (313) 789-5577 (866) 844-4142 (313) 565-9357 (313) 406-5279 (313) 277-4546 (313) 769-5551 (313) 271-3770 (269) 423-6770 (810) 376-8070 (269) 623-5250 (313) 733-8587 (313) 875-9010 (313) 894-4300 (313) 871-3285 (313) 469-8112 (313) 340-1900 (313) 651-5290 (313) 334-5859 (313) 899-4120 (313) 862-8888 (313) 245-0300 (313) 272-0202 (313) 297-3550 (313) 838-2500 (313) 544-7144 (313) 307-7367 (313) 366-1221 (313) 458-7529 (313) 861-9300 (313) 868-2020

4700 GREENFIELD RD 25524 FORD RD 20217 ANN ARBOR TRL STE A 23800 FORD RD 23850 VAN BORN 27015 W WARREN ST STE 2 25022 W WARREN ST 3915 PELHAM ST 5688 N TELEGRAPH RD 25871 FORD RD 25605 JOY RD 25302 W WARREN ST 20145 ANN ARBOR TRAIL 108B E DELAWARE ST 2046 BLACK RIVER ST STE 2 338 N GROVE ST 7701 E 7 MILE RD STE A 8282 WOODWARD AVE 5412 W WARREN AVE 2676 W GRAND BLVD 11250 E JEFFERSON AVE 20500 GREENFIELD RD 13535 PURITAN ST 2510 E. NEVADA STREET 6240 MICHIGAN AVE 10832 PURITAN ST STE #2 15014 E 8 MILE RD 14313 GREENFIELD RD 8040 W VERNOR HWY 17256 WEST 7 MILE RD 15617 W MCNICHOLS RD 14825 W MCNICHOLS RD STE B 3611 CARPENTER ST STE 3 4673 CONNER ST 14039 W MCNICHOLS RD 2645 W DAVISON

DETROIT COMMUNITY HLT CONNECT PHCY DETROIT MEDICAL PHARMACY DISCOUNT RX PHARMACY DLS DISCOUNT PHARMACY

(313) 924-9798 (313) 831-2400 (313) 923-1000 (313) 397-2575

7900 KERCHEVAL ST 500 E WARREN AVE 7011 GRATIOT AVE 6508 WOODWARD AVE

NR_0009_10823 10/2017

Provider Street

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Provider City

State

ZIP code

DEARBORN DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HEIGHTS DEARBORN HGTS DECATUR DECKERVILLE DELTON DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48126-4124 48127-3022 48127-2692 48127-3200 48125-2325 48127-1901 48127-2145 48125-3118 48127-3219 48127-2934 48127-1259 48127-2102 48127 49045 48427-9426 49046-9601 48234-3149 48202-2532 48210-1217 48208-1237 48214-3301 48235-1854 48227-3355 48234 48210 48238-1025 48205 48227 48209-1522 48235 48235 48235-3939 48212-2784 48215-2028 48235-3929 48238-3443

DETROIT DETROIT DETROIT DETROIT

MI MI MI MI

48214-2439 48201-1436 48207-1973 48202-3240

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DMC PHARMACY - HARPER CVI DMC PHARMACY CHILDREN'S DMC PHARMACY HARPER DMC PHARMACY SINAI GRACE DMC PHARMACY SINAI LOBBY DMC PHCY DETROIT RECEIVING ELUX PHARMACY EVERGREEN PHARMACY EXPRESS MEDS PHARMACY EXTRA CARE PHARMACY INC FAMILY DRUGS PHARMACY FARMACITY PHARMACY FIDMARC EXPRESS PHARMACY FRASER DRUGS FRIENDZ PHARMACY GATEWAY PHARMACY INC GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GIANT PHARMACY GRACE MEDICAL PHARMACY GRAND RIVER PHARMACY GRAND VALUE PHARMACY GREENCARE PHARMACY GRISWOLD PHARMACY HEALTHY CHOICE PHARMACY HEYDEN PHARMACY INDIAN VILLAGE PHARMACY JEFFERSON PHARMACY JOE'S DISCOUNT PHARMACY KARMANOS CANCER HOSPITAL PHCY KELLY MORANG PHARMACY KING PHARMACY KNIGHT DRUGS - DMC KNIGHT DRUGS - JEFFERSON KNIGHT DRUGS - MCNICHOLS KNIGHT DRUGS E DAVISON KNIGHT DRUGS GREENFIELD

NR_0009_10823 10/2017

Provider Phone Number (313) 832-0180 (313) 745-0436 (313) 966-3148 (313) 966-2979 (313) 966-9134 (313) 966-8230 (313) 534-1900 (313) 336-3500 (313) 308-4500 (313) 387-1700 (313) 441-6666 (313) 789-8934 (313) 766-7432 (313) 895-0357 (313) 397-1103 (313) 835-9999 (313) 879-2057 (313) 309-1084 (412) 931-3131 (313) 989-0536 (313) 347-2025 (313) 989-0249 (313) 723-3419 (313) 272-7777 (313) 837-4722 (313) 766-5959 (313) 931-0010 (313) 558-3000 (313) 237-9000 (313) 579-5700 (313) 533-8200 (313) 331-2000 (313) 331-1200 (313) 397-6466 (313) 576-9350 (313) 526-1200 (313) 331-8484 (313) 832-5800 (313) 822-2260 (313) 369-4399 (313) 891-7500 (313) 836-5400

Provider Street 311 MACK AVE. STE 21013 3901 BEAUBIEN RM 108 3990 JOHN R STE 1460 6001 W OUTER DR STE 110 6071 W OUTER DR STE M110 4201 ST ANTOINE 20805 GRAND RIVER AVE 20010 W WARREN AVE 17731 E WARREN AVE 22341 W 8 MILE RD 18611 W WARREN AVE 3456 W VERNOR HWY SUITE B 21737 W 8 MILE RD STE A 7350 GRAND RIVER AVE 13848 W MCNICHOLS RD 15690 JOY RD 2925 RUSSELL ST STE 100 2051 W GRAND BLVD 1700 WATERMAN ST 5716 MICHIGAN AVE 12800 E WARREN AVE 24424 W MCNICHOLS RD 15400 W MCNICHOLS RD STE 500 14040 GREENFIELD RD 20161 GREENFIELD RD 20270 GRAND RIVER AVE 10920 GRAND RIVER AVE 8014 GREENFIELD RD 1411 WASHINGTON BLVD 7811 GRATIOT AVE 20201 W 7 MILE RD 8415 E JEFFERSON AVE 8656 WYOMING AVE 18647 LIVERNOIS AVE 4100 JOHN R STE HP00RX 18085 KELLY RD 12871 E JEFFERSON AVE 4501 WOODWARD AVE STE 104A 9149 E JEFFERSON 4321 E MCNICHOLS 4420 E DAVISON ST 19141 GREENFIELD RD

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Provider City DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT

State

ZIP code

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48201 48201 48201 48235-2626 48235 48201 48219 48228-3250 48224 48219 48228-3599 48216-1551 48219-4430 48204-2210 48235-3926 48228-2118 48207-4825 48208-1105 48209-2022 48210-3039 48215-2061 48219-3653 48235-3724 48227 48235-1872 48219-3341 48204-2052 48228-2221 48226-1745 48213-2823 48219-3406 48214 48204 48221-2256 48201 48224 48215-2754 48201-1890 48214-2907 48212 48212-1744 48235

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LAFAYETTE SAV-MOR DRUGS LIBERTY PHARMACY LIVERNOIS EXPRESS PHARMACY M & D PHARMACY M & M DISCOUNT DRUGS MCNICHOLS DRUGSTORE MEDEC PHARMACY MEDPLUS CARE PHARMACY LLC MEDSTOP PHARMACY METRO MEDICAL PHARMACY MIDTOWN RX PHARMACY MOTOR CITY PHARMACY CORP NEW GRATIOT PHARMACY NEW HOPE PHARMACY NEW MO-TOWN PHARMACY NEW SAMARITAN PHARMACY NEW SEVEN MILE PHARMACY LLC NEXT DOOR PHARMACY LLC NEZAK PHCY & MED SUPPLIES LLC OBAMA PHARMACY OBI MEDICAL PHARMACY PARK MEDICAL RX PARTNERSHIP RX PHARMACY PAUL PRESCRIPTIONS PHARMACY LC PEOPLE MEDICAL PHARMACY PEOPLE PHARMACY PEOPLES MEDICAL PHARMACY PHARMACY 4 LESS II PHARMACY 4 LESS V PHARMOR PHARMACY DOCTORS PHARMOR PHARMACY FORD CAMPUS PHARMOR PHARMACY- GRAND LAHSER PHARMOR PHARMACY- LAFAYETTE PHARMOR PHARMACY- SCHOOLCRAFT

Provider Name

(313) 259-0090 (313) 841-1990 (313) 659-1622 (313) 881-2890 (313) 749-7621 (313) 340-4242 (313) 414-7771 (313) 371-9000 (313) 933-0630 (313) 894-2888 (313) 832-5900 (313) 838-2555 (313) 922-0700 (313) 334-5203 (313) 891-2253 (313) 571-3095 (313) 245-9920 (313) 818-1810 (313) 272-3333 (313) 837-2000 (313) 341-6123 (313) 651-5887 (313) 782-4818 (313) 297-2908 (313) 933-2300 (313) 341-0606 (313) 925-8000 (313) 372-4100 (313) 891-2335 (313) 832-4810 (313) 875-9000 (313) 533-0500 (313) 396-5555 (313) 270-3333

670 CHENE 4802 W VERNOR HWY 15530 PURITAN ST 14525 MACK AVE 6835 MICHIGAN AVE 10123 W MCNICHOLS RD 3260 W DAVISON AVE 14071 E 7 MILE RD 10041 FENKELL ST 6461 W WARREN AVE 4100 WOODWARD AVE 20526 PLYMOUTH RD STE D 3745 GRATIOT AVE 19940 CONANT ST STE D 3040 E 7 MILE RD 5575 CONNER ST STE 103 14400 GRATIOT AVE 18250 W WARREN AVE 15201 W 7 MILE RD 18400 PLYMOUTH RD 13701 W 7 MILE RD 20720 PLYMOUTH RD 3011 W GRAND BLVD STE 226 6915 MICHIGAN AVE 8706 SCHAEFER HWY 17126 SCHAEFER HWY 7608 GRATIOT AVE 13233 E 7 MILE RD 8139 E 7 MILE RD 3169 WOODWARD AVE 2699 W GRAND BLVD 21673 GRAND RIVER AVE 1565 E LAFAYETTE 15537 SCHOOLCRAFT RD

DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48207 48209-2122 48227-2342 48215-2520 48210-3097 48221-2454 48238-3344 48205 48238-1643 48210-1176 48201-2173 48228-1273 48207 48234-1335 48234-1662 48213-6400 48205-2307 48228 48235-2821 48228 48235-1714 48228-1240 48202-3042 48210-2869 48228 48235 48213-2822 48205-2221 48234-3626 48201 48208-1233 48219 48207-2958 48227

PHARMOR PHARMACY-CARSON CENTER PHARMOR PHARMACY-EVERGREEN PHYSICIANS PHCY AND MED SUPPLY PLATINUM CARE PHARMACY QUICK-SERVE PHARMACY REDFORD INC RIGLEY'S PHARMACY

(313) 693-4695 (313) 535-9755 (313) 832-2050 (313) 894-0451 (313) 341-8948 (313) 532-5920 (313) 372-6661

8000 W OUTER DR STE B 20250 W 7 MILE RD 40 E ALEXANDRINE ST 8500 14TH ST 13433 W 8 MILE RD 17364 LAHSER RD 12266 GRATIOT AVE

DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT

MI MI MI MI MI MI MI

48235 48219-3469 48201-2012 48206-2425 48235-1043 48219-2348 48205

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 288 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RITE HEALTH PHARMACY RITE HEALTH PHARMACY - VERNOR ROSA PARKS MEDICAL PHCY ROSEDALE COMMUNITY PHARMACY RUSSELL'S PHARMACY RX CARE PHARMACY SAFARI DRUGS PHARMACY SAIF PHARMACY, LLC SAM'S PHARMACY SAV MAX PHARMACY MAZEN SAVE-MART PHARMACY SAVON MEDICAL PHARMACY SCHAEFER SEVEN DRUGS SMART CHOICE PHARMACY SOUTHWEST DISCOUNT PHARMACY SPRINGWELLS CLINICAL PHARMACY ST PAUL PHARMACY SUPER MART PHARMACY SUTTON'S DRUG INC TONYS PHARMACY TOWN PHARMACY UNITED CARE PHARMACY UNITED RX UNIVERSITY PHARMACY WATSON PHARMACY

Provider Name

(313) 209-6066 (313) 442-7100 (313) 361-8800 (313) 531-0100 (313) 875-5384 (313) 838-1100 (313) 855-6385 (313) 635-5244 (313) 340-7777 (313) 371-3300 (313) 635-5103 (313) 862-8800 (313) 340-1300 (313) 491-7450 (313) 841-9350 (313) 841-8000 (313) 921-3537 (313) 371-7865 (313) 822-4085 (313) 272-3744 (313) 297-6617 (313) 362-1862 (313) 836-2222 (313) 831-2008 (313) 922-2900

4835 MICHIGAN AVE STE 1 5700 W VERNOR HWY 8665 ROSA PARKS BLVD 19220 GRAND RIVER AVE 3011 W GRAND BLVD STE 107 16311 GRAND RIVER AVE 17100 W 7 MILE RD 18254 LIVERNOIS AVE 14470 LIVERNOIS AVE 12740 GRATIOT AVE 18330 W CHICAGO ST 18000 LIVERNOISE AVE 13403 W 7 MILE RD 14379 LIVERNOIS AVE 5851 W VERNOR HWY 2117 SPRINGWELLS ST 9934 HARPER AVE 12230 E 8 MILE RD 13336 E JEFFERSON AVE 18360 FENKELL 6170 W VERNOR HWY 22046 W 7 MILE RD 15808 PLYMOUTH RD 5254 ANTHONY WAYNE DR 9731 HARPER AVE

DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT DETROIT

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48210-3249 48209-2158 48206-2201 48223-1707 48202-3068 48227-1825 48235-3023 48221-4214 48238 48205-3944 48228-1839 48221 48235-1387 48238-2507 48209-2159 48209-1507 48213-3110 48205-1048 48215-2719 48223-2314 48209-2062 48219-1811 48227-1636 48202-3924 48213

WAYNE CAMPUS HEALTHMART PHARMACY WESTSIDE PHCY OF DETROIT INC WOODWARD RX PHARMACY WYOMING DISCOUNT PHARMACY LLC HOMETOWN PHARMACY DEXTER PHARMACY WILCOX PHARMACY DORR COMMUNITY PHARMACY FAMILY FARE PHARMACY SHAWS PHARMACY EAST JORDAN FAMILY PHARMACY CENTRAL PHARMACY EAST LANSING OLIN HEALTH CENTER PHARMACY FAIRWAY SAV MOR DRUGS HEALTH CHOICE PHARMACY KELLY'S PHARMACY

(313) 833-6000 (313) 342-1555 (313) 656-4956 (313) 341-8888 (517) 668-9299 (734) 426-1600 (517) 646-9274 (616) 681-9947 (269) 782-4511 (989) 288-6886 (231) 536-2207 (517) 580-4216 (517) 353-9165 (586) 771-0030 (586) 778-2026 (586) 872-2525

1131 W WARREN AVE 10600 W MCNICHOLS RD 9300 WOODWARD AVE 18200 WYOMING ST 128 S BRIDGE ST 2820 BAKER RD 140 EAST RD 1730 142ND AVE 56151 M-51 221 N SAGINAW ST 601 BRIDGE ST 3340 E LAKE LANSING RD STE 1 463 E CIRCLE DR ROOM 103 19332 E 10 MILE ROAD 18801 E 9 MILE RD 21321 KELLY RD STE 120

DETROIT DETROIT DETROIT DETROIT DEWITT DEXTER DIMONDALE DORR DOWAGIAC DURAND EAST JORDAN EAST LANSING EAST LANSING EASTPOINTE EASTPOINTE EASTPOINTE

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48201 48221-2366 48202-1633 48221 48820-8908 48130 48821-8705 49323-9434 49047 48429 49727-9383 48823-6224 48824-1037 48021 48021-2051 48021

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Provider Phone Number

Provider Street

Page 289 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDPOINTE PHARMACY PAY LESS DRUGS PAY LESS RX PHARMACY FAMILY FARE PHARMACY ROTTENBUCHER PHARMACY COUNTRYSIDE PHARMACY HANSENS PHARMACY & VARIETY EDWARDSBURG DRUGS CORNER DRUG RIVER PHARMACY SCHEURER FAMILY PHARMACY HARVEST PHARMACY INC EMPIRE PHARMACY ELMER'S COUNTY MARKET PHARMACY LA BRENZ PHARMACY MCLAREN DRUG SHOP - MME MCLAREN LONG-TERM CARE PHCY EVART PHARMACY HOLIHANS DRUG STORE JILL'S GENUINE CARE TAYLER PRESCRIPTIONS BOTSFORD OUTPATIENT PHARMACY

Provider Name

(586) 757-9100 (586) 222-2224 (586) 222-2224 (517) 663-8331 (517) 663-6811 (989) 427-5141 (989) 427-5275 (269) 414-4554 (231) 264-8033 (231) 264-8165 (989) 375-2121 (989) 862-4858 (231) 935-7265 (906) 789-9200 (989) 892-5491 (989) 895-4570 (989) 316-4280 (231) 734-5581 (231) 734-2551 (800) 238-7911 (248) 474-8290 (248) 471-8700

16546 E 9 MILE RD 20804 GRATIOT AVE 14993 E 9 MILE RD 1411 S MAIN ST 122 S MAIN ST # 124 503 E MAIN ST 326 E MAIN ST 69045 M 62 STE G 154 RIVER ST 124 AMES ST 4970 RAILROAD ST 313 S OVID ST 9975 W OTTAWA AVE 412 N LINCOLN RD 1606 WOODSIDE AVE 1454 W CENTER RD STE 1 1454 W CENTER RD STE 2 107 N MAIN ST. 128 N MAIN ST 23354 FARMINGTON 32316 GRAND RIVER AVE 28100 GRAND RIVER AVE STE 101

EASTPOINTE EASTPOINTE EASTPOINTE EATON RAPIDS EATON RAPIDS EDMORE EDMORE EDWARDSBURG ELK RAPIDS ELK RAPIDS ELKTON ELSIE EMPIRE ESCANABA ESSEXVILLE ESSEXVILLE ESSEXVILLE EVART EVART FARMINGTON FARMINGTON FARMINGTON HILLS

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48021 48021 48021-2147 48827-1953 48827-1230 48829 48829 49112-9152 49629-9614 49629-9449 48731-5155 48831-8750 49630-9618 49829-1365 48732-1459 48732 48732 49631 49631-9416 48336-3102 48336-3201 48336-5968

FARMINGTON HILLS MEDICAL PHARMACY HEALTH DIMENSIONS INC KENDALLWOOD FAMILY PHARMACY LIFECARE PHARMACY OF MICHIGAN NIDHALS SAV MOR PHARMACY EAGLE PHARMACY ALEXANDER'S DRUGS B&C PHARMACY RX CARE PHARMACY VG'S PHARMACY VG'S PHARMACY FERNDALE FAMILY PHARMACY HEALTH CHOICE PHARMACY PREMIER CARE PHARMACY ROYALS PHARMACY FLATROCK CITY PHARMACY LLC ALL AMERICAN PHARMACY LLC BEECHER RD FAMILY PHARMACY BENZER PHARMACY

(248) 538-0010 (248) 489-1573 (248) 987-7200 (734) 261-4400 (248) 477-2131 (989) 588-2900 (269) 561-4411 (810) 629-4002 (810) 354-8500 (810) 750-1572 (810) 629-6074 (248) 565-8031 (248) 965-3962 (248) 544-4500 (248) 566-0116 (734) 789-8950 (810) 234-0480 (810) 337-1121 (810) 230-9900

27970 ORCHARD LAKE RD 39303 COUNTRY CLUB DR STE A26 33100 W 12 MILE RD STE 1 23580 ORCHARD LAKE RD 23800 ORCHARD LAKE RD 109 W MAIN ST 211 EAST MAIN 223 W SILVER LAKE RD 305 N LEROY ST STE A 18005 SILVER PKWY 1390 N LEROY ST 753 W 9 MILE RD 600 W 9 MILE RD 23131 WOODWARD AVE 20727 WYOMING ST 25620 GIBRALTAR RD 3104 FLUSHING RD # 3106 3169 BEECHER RD G3333 BEECHER RD STE B

FARMINGTON HILLS FARMINGTON HILLS FARMINGTON HILLS FARMINGTON HILLS FARMINGTON HILLS FARWELL FENNVILLE FENTON FENTON FENTON FENTON FERNDALE FERNDALE FERNDALE FERNDALE FLAT ROCK FLINT FLINT FLINT

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48334-3767 48331-3482 48334-3307 48336-3241 48336-2561 48622-9553 49408-0000 48430-2605 48430-2729 48430-3421 48430-5310 48220-1217 48220-1720 48220 48220-2141 48134-1243 48504-4337 48503 48532-3619

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Provider Phone Number

Provider Street

Page 290 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BROTHERS PHARMACY CENTRAL PHARMACY EAST CLIO ROAD PHARMACY DIPLOMAT PHARMACY INC. DIPLOMAT SPECIALTY PHARMACY DISCOUNT RX DORT LONGWAY PHARMACY LLC FAMILY PHARMACY FLINT PHARMACY GENOA-QOL HEALTHCARE HAMILTON MAIN PHARMACY H-CARE PHARMACY H-CARE PHARMACY 3 KESSEL PHARMACY LAPEER RD FAMILY PHARMACY MCLAREN DRUG SHOP - MRMC NORTH SAGINAW PHARMACY POINTE PHARMACY PLLC TOWN CENTER PHARMACY VALLEY MEDICAL PHARMACY VILLA LINDE PHARMACY LLC FLUSHING DISCOUNT PHARMACY KESSEL PHARMACY DISCOUNT RX-PORT HURON FOWLERVILLE PHARMACY COMMUNITY DRUG OF FRANKFORT FREELAND PHARMACY BAARS PHARMACY INC VILLAGE PHARMACY OF FRUITPORT GALESBURG PHARMACY LLC GARDEN DRUGS JOY PHARMACY PRO MED PHARMACY QUALITY CURE PHARMACY SAV ON 3 ANDREWS GARDEN CITY GLENS PHARMACY VG'S PHARMACY GIBRALTAR SAV MOR PHARMACY GLADSTONE SQUARE PHARMACY FAMILY FARE PHARMACY THE MEDICINE SHOPPE GOBLES PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (810) 785-7770 (810) 744-9101 (810) 789-7085 (810) 768-9000 (810) 732-8720 (810) 239-2667 (810) 235-2800 (810) 235-7995 (810) 820-4108 (810) 496-4876 (810) 787-5092 (810) 733-0280 (810) 262-6370 (810) 732-2005 (810) 715-0996 (810) 342-3400 (810) 234-5500 (810) 866-4520 (810) 232-9100 (810) 230-8252 (810) 820-9855 (810) 309-0786 (734) 432-1851 (810) 216-3302 (517) 223-9832 (231) 352-4471 (989) 695-6500 (231) 924-2720 (231) 865-3345 (269) 665-9727 (734) 266-0600 (734) 266-9018 (734) 466-5001 (734) 743-3450 (734) 421-1900 (989) 732-4114 (810) 640-1424 (734) 675-0000 (906) 428-1000 (989) 426-8608 (989) 426-4595 (269) 628-2650

Provider Street 118 W PIERSON RD 3097 N GENESEE RD 4902 CLIO RD 4100 S SAGINAW STREET STE D G3320 BEECHER RD 4400 S SAGINAW ST STE 1335 2700 ROBERT T LONGWAY BLVD #B G4444 FENTON RD 3605 CORUNNA RD 420 W 5TH AVE 2900 N SAGINAW ST 4433 MILLER RD 1 HURLEY PLZ STE 100 5249 CORUNNA RD 3441 LAPEER RD 401 S BALLENGER HWY 2918 N SAGINAW ST 5494 S DORT HWY 1201 FLUSHING RD STE 2 5142 MILLER RD 5031 VILLA LINDE PKWY #21 6390 W PIERSON RD 1542 E PIERSON RD 4190 24TH AVE STE 100 119 E GRAND RIVER 401 MAIN ST 212 N MAIN ST 6 W MAIN ST 10 S THIRD AVE 9880 E MICHIGAN AVE 30615 FORD RD 27543 WARREN RD 29866 FORD RD 6204 MIDDLEBELT RD 29436 FORD ROAD 829 W MAIN ST 7461 N GENESEE RD 29255 W JEFFERSON 911 DELTA AVE 1204 N STATE ST 663 E CEDAR AVE 212 S STATE ST

Page 291 of 679

Provider City FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLINT FLUSHING FLUSHING FORT GRATIOT FOWLERVILLE FRANKFORT FREELAND FREMONT FRUITPORT GALESBURG GARDEN CITY GARDEN CITY GARDEN CITY GARDEN CITY GARDEN CITY GAYLORD GENESEE GIBRALTAR GLADSTONE GLADWIN GLADWIN GOBLES

State

ZIP code

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48505-3348 48506-2151 48504-1898 48507 48532-3614 48507-2645 48503-2190 48507-3784 48532-3830 48503-2445 48505-4452 48507-1123 48503-5902 48532-4109 48503-4482 48532-3638 48505-4452 48507-4483 48504-4730 48507-1042 48532-3447 48433-2300 48433-1817 48059-3882 48836-0000 49635-9142 48623-9001 49412-1136 49415-9630 49053-9756 48135-1871 48135-2253 48135-2365 48135-2409 48135 49735-1998 48437-9800 48173 49837-1648 48624-1246 48624-2215 49055-9410

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GOBLES VILLAGE MARKET PHARMACY PHARMD CO. PHARMACY KESSEL PHARMACY KNIGHT DRUGS GRAND BLANC D AND W PHARMACY DUNEWOOD PHARMACY

Provider Name

(269) 628-0035 (810) 636-2979 (810) 953-9156 (810) 603-0918 (616) 846-7180 (616) 842-5193

407 S STATE ST 8191 S STATE RD 12731 S SAGINAW ST 8483 HOLLY RD STE 202 1116 ROBBINS RD 1445 SHELDON RD STE 104

GOBLES GOODRICH GRAND BLANC GRAND BLANC GRAND HAVEN GRAND HAVEN

MI MI MI MI MI MI

49055-9724 48438-9723 48439-1830 48439 49417-2740 49417-2479

HOMETOWN PHARMACY GRAND HAVEN APOTHECARY SHOP AT GRAND LEDGE PHARMACY PLUS #4 ADVANCED SPECIALTY RX WEST CANCER & HEMATOLOGY CTR OF W MI CHCWM - ST MARYS D & W PHARMACY D AND W PHARMACY D&W PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY FAMILY FARE-FOREST HILLS PHCY GRAND RAPIDS HOME FOR VETERANS HEART OF THE CITY PHARMACY

(616) 842-4360 (517) 622-4000 (517) 627-1670 (810) 874-6752 (616) 977-4840 (616) 685-5257 (616) 949-0340 (616) 451-3404 (616) 361-3676 (616) 774-9422 (616) 791-4777 (616) 459-6203 (616) 698-8234 (616) 281-5442 (616) 447-2788 (616) 949-0170 (616) 364-5260 (616) 965-8278

1125 WASHINGTON AVE 820 CHARLEVOIX DRIVE UNIT 1H 508 S CLINTON ST 1010 FRONT AVE NW, STE 1 145 MICHIGAN ST STE 3100 250 CHERRY ST SE 6425 28TH ST SE 2181 WEALTHY ST SE 2022 APPLE ORCHARD AVE 1415 FULTON ST E 2755 LAKE MICHIGAN DR NW 1225 LEONARD AVE NE 6127 KALAMAZOO AVE SE 4325 BRETON RD SE 5241 NORTHLAND DR NE 4668 CASCADE RD 3000 MONROE AVE NE 100 CHERRY ST

GRAND HAVEN GRAND LEDGE GRAND LEDGE GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49417 48837 48837-2296 49504-4272 49503-2563 49503 49546-6917 49506-3033 49525 49503-3853 49504-5872 49505-5510 49508-7019 49512-3859 49525-1041 49546 49505-3397 49503-4526

HOMETOWN PHARMACY GRAND RAPIDS KAY PHARMACY INC KEYSTONE PHARMACY MERCY HEALTH PHARMACY SOLUTIONS SAINT MARYS FAMILY PHCY LTC SPECTRUM HLTH O/P PHARMACY ST MARY FAMILY PHARMACY ECS ST. MARYS FAMILY PHARMACY THE CHEMIST SHOPPE TRUCARE LTC PHARMACY WALKER STREET PHARMACY WOODPOINTE PHARMACY ZUAH PHARMACY D AND W PHARMACY FAMILY HEALTH CARE PHCY GRASS LAKE COMMUNITY PHARMACY

(616) 281-1323 (616) 361-7319 (616) 974-9792 (616) 685-1080 (616) 685-1070 (616) 391-1638 (616) 685-1147 (616) 685-6105 (616) 774-7799 (616) 965-7480 (616) 458-9640 (616) 949-4499 (616) 259-9314 (616) 530-4590 (231) 834-1567 (517) 522-4100

4252 KALAMAZOO AVE SE 2178 PLAINFIELD AVE NE 4021 CASCADE RD SE 360 DIVISION AVE S STE 1E 360 DIVISION AVE S 100 MICHIGAN ST NE 360 DIVISION AVE S 300 LAFAYETTE AVE SE 1900 WEALTHY ST SE STE 105 6140 28TH ST SE STE 105 1181 WALKER AVE NW 2500 E BELTLINE AVE SE 4301 KALAMAZOO AVE SE STE 13 3960 44TH ST SW 11 N MAPLE 112 E MICHIGAN AVE

GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS GRANDVILLE GRANT GRASS LAKE

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49508-3607 49505-4204 49546-2149 49503-4501 49503-4501 49503-2560 49503-4539 49503-4650 49506-2969 49546-6938 49504-7404 49546-5987 49508-3673 49418-2420 49327 49240-9680

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GLENS PHARMACY MUNSON HTHCARE GRAYLING THE MEDICINE SHOPPE SAV ON DRUGS 6 GROSSE ILE MACKS DISCOUNT PHARMACY BEAUMONT HOSPITAL GROSSE POINTE NOTRE DAME PHARMACY BEACON PT PHCY & SURGICAL PARK PHARMACY MERIT WOODS PHARMACY PHARMOR PHARMACY MACK-MOROSS SNYDER PHARMACY HOMETOWN PHCY #39 (HALE DRUG) HAMILTON FAMILY PHARMACY AZAAL DISCOUNT PHARMACY BETTER CARE NEIGHBORHOOD PHARM CAMPAU PHARMACY CARE MAX PHARMACY CARPENTER PHARMACY DESH PHARMACY FRD SAV-MOR PHARMACY HAMTRAMCK DRUGS HAMTRAMCK PHARMACY LLC HOOVER PHARMACY LLC ICARE PHARMACY INFINITY DRUGS MINAL PHARMACY PHARMOR PHARMACY-HAMTRAMCK PRIME RX PHARMACY THERA SCRIPT PHARMACY COPPER COUNTRY APOTHECARY THE APOTHECARY-HANCOCK HARBOR DRUG KELBEL PHARMACY INC HARPER PHARMACY HARPER WOODS MEDICAL PHARMACY

Provider Name

(989) 348-5335 (989) 348-0800 (989) 348-2000 (734) 676-6000 (313) 640-9766 (313) 343-1857 (313) 885-2154 (313) 822-5474 (313) 822-0100 (313) 882-0922 (313) 642-1800 (906) 346-0104 (989) 728-9711 (269) 751-8482 (313) 872-0021 (313) 892-2300 (313) 365-2400 (313) 874-1234 (313) 893-3000 (313) 366-3800 (313) 871-1115 (313) 873-2366 (313) 996-5555 (313) 870-9703 (313) 645-0215 (313) 733-6098 (313) 893-3339 (313) 871-1010 (313) 739-0330 (313) 875-7979 (906) 483-1901 (906) 483-1919 (989) 479-3241 (231) 526-5971 (313) 882-2600 (313) 521-7000

2470 S I-75 BUSINESS LOOP 1100 E MICHIGAN AVE 500 N JAMES ST 8900 MACOMB 20746 MACK AVE 468 CADIEUX RD 16926 KERCHEVAL ST 15200 E JEFFERSON AVE 15126 KERCHEVAL AVE 19325 MACK AVE 19251 MACK AVE STE M-155 130 E M-35 3270 M 65 3416 LINCOLN RD 9834 CONANT ST 12111 CONANT ST 12169 JOSEPH CAMPAU ST STE 101 9222 JOSEPH CAMPAU ST STE B 3120 CARPENTER ST STE 101 12170 CONANT ST 9811 CONANT 10300 JOSEPH CAMPAU ST 9318 CONANT ST 2930 HOLBROOK 9607 CONANT ST 11527 JOSEPH CAMPAU ST STE B 13031 CONANT ST 3301 HOLBROOK ST STE B 3001 CANIFF ST 9740 CONANT ST STE 3 500 CAMPUS DR 500 CAMPUS DR 114 S HURON AVE 205 E MAIN ST 19230 HARPER AVE 19959 VERNIER RD STE 100

GRAYLING GRAYLING GRAYLING GROSSE ILE GROSSE POINT WOODS GROSSE POINTE GROSSE POINTE GROSSE POINTE PARK GROSSE POINTE PARK GROSSE POINTE WOODS GROSSE POINTE WOODS GWINN HALE HAMILTON HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HAMTRAMCK HANCOCK HANCOCK HARBOR BEACH HARBOR SPRINGS HARPER WOODS HARPER WOODS

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49738-2008 49738-1312 49738-1714 48138 48236-1436 48230-1507 48230-1533 48230-1304 48230-1360 48236 48236-2893 49841 48739-8509 49419-9512 48212-3309 48212-2718 48212-2693 48212-3731 48212-2771 48212-4137 48212-3308 48212-3260 48212 48212 48212-3304 48212 48212-2361 48212-3519 48212 48212-3307 49930-1569 49930-1569 48441-1201 49740-1511 48225-2211 48225-1471

PHARMOR PHARMACY HARPER WOODS SAV-ON 18 HUNTER PHARMACY GLENS PHARMACY HARRISON FAMILY PHARMACY ALCONA HEALTH PHARMACY

(313) 245-9000 (313) 884-5400 (989) 539-0584 (989) 539-2900 (989) 736-9888

19700 KELLY RD 20352 HARPER AVE 1570 N CLARE AVE 182 N 2ND ST 177 N BARLOW RD

HARPER WOODS HARPER WOODS HARRISON HARRISON HARRISVILLE

MI MI MI MI MI

48225-1916 48225-1643 48625-8216 48625-8234 48740-9607

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 293 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

OCEANA PHARMACY WEST SHORE PHARMACY HASLETT PHARMACY FAMILY FARE PHARMACY HASTINGS PHARMACY PENNOCK PHARMACY VENUS PHARMACY ADVANCE CARE PHARMACY PC BUCKLEY'S PHARMACY DYNAMIC PHCY & HEALTH SOLUTIONS HAZEL PARK PHARMACY LIVE WELL PHARMACY MARINCO DRUG MEDPARK PHARMACY HEMLOCK PHARMACY WRIGHTS PHARMACY BOB'S DRUGS KNIGHT DRUGS-HIGHLAND PARK

Provider Name

(231) 873-2540 (231) 873-3609 (517) 339-0300 (269) 945-2466 (269) 945-3777 (269) 948-3136 (269) 948-2080 (248) 545-5515 (248) 808-6505 (248) 397-8635 (248) 268-4504 (248) 381-4000 (248) 546-0494 (248) 808-6929 (989) 301-0250 (989) 642-5411 (231) 854-6605 (313) 868-5800

819 S STATE ST 18 S STATE ST 1641 HASLETT RD 902 W STATE ST 400 W STATE ST 1009 W GREEN ST 200 S BOLTWOOD ST STE D 24822 JOHN R RD 20721 DEQUINDRE RD STE B 624 E 9 MILE RD 116 W 8 MILE RD 23411 JOHN R RD 21936 VASSAR AVE 1059 E 9 MILE RD 132 HEMLOCK PLAZA DR 147 W SAGINAW ST 194 N DIVISION AVE 13820 WOODWARD AVE

HART HART HASLETT HASTINGS HASTINGS HASTINGS HASTINGS HAZEL PARK HAZEL PARK HAZEL PARK HAZEL PARK HAZEL PARK HAZEL PARK HAZEL PARK HEMLOCK HEMLOCK HESPERIA HIGHLAND PARK

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49420-1236 49420-1123 48840-8438 49058-1661 49058-1640 49058-1710 49058-1993 48030 48030-2633 48030-1842 48030-2433 48030 48030-1828 48030-1855 48626-9544 48626-0319 49421-7500 48203

PHARMOR PHARMACY WOODWARD PLACE PRO CARE PHARMACY WRIGLEY'S PHARMACY LLC HILLMAN PHARMACY INC HILLSDALE MARKET PHARMACY NASH DRUGS INC D & W PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY PAUL'S PHARMACY INC SKIPS PHARMACY OF MICHIGAN HOLT PHARMACY HOPPS COLONIAL PHARMACY HOMETOWN PHARMACY HONOR APOTHECARY - HOUGHTON ASPIRUS HOUGHTON PHARMACY

(313) 957-0099 (313) 865-9900 (313) 867-5000 (989) 742-3527 (517) 439-9325 (517) 437-4497 (616) 392-9735 (616) 392-7504 (616) 399-4100 (616) 396-5233 (616) 392-8507 (517) 699-1544 (517) 568-3400 (231) 325-2735 (906) 483-1818 (906) 231-8009

15131 WOODWARD AVE 13111 WOODWARD AVE 14100 WOODWARD AVE 601 STATE ST 208 W CARLETON RD 30 N HOWELL ST 50 DOUGLAS AVE 1185 S WASHINGTON AVE 993 BUTTERNUT DR 803 LINCOLN AVE 700 MICHIGAN AVE 2291 CEDAR ST 126 W MAIN ST 10587 MAIN ST 600 MACINNES DR 1000 CEDAR STREET

HIGHLAND PARK HIGHLAND PARK HIGHLAND PARK HILLMAN HILLSDALE HILLSDALE HOLLAND HOLLAND HOLLAND HOLLAND HOLLAND HOLT HOMER HONOR HOUGHTON HOUGHTON

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48203-2907 48203-3607 48203-2936 49746-9511 49242-1050 49242-1621 49424-2198 49423-7729 49424-1552 49423-5306 49423-6944 48842-1202 49245-1046 49640-9761 49931-1144 49931

MIDMICHIGAN COMMUNITY HLTH SRVC LEPPINKS PHARMACY INC GENOA-QOL HEALTHCARE ST JOSEPH MERCY PHARMACY - HO VG'S PHARMACY HUDSON PHARMACY

(989) 202-4605 (231) 937-5282 (517) 258-0002 (517) 545-6666 (517) 548-7070 (517) 448-3111

9249 W LAKE CITY RD 730 W SHAW ST 2280 E GRAND RIVER AVE RM 122 620 BYRON RD 2400 W GRAND RIVER AVE 325 RAILROAD ST

HOUGHTON LAKE HOWARD CITY HOWELL HOWELL HOWELL HUDSON

MI MI MI MI MI MI

48629 49329-9453 48843-8503 48843-1002 48843-8585 49247-1031

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Provider Phone Number

Provider Street

Page 294 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FAMILY FARE PHARMACY FAMILY FARE PHARMACY SAV-ON DRUGS 8 IMLAY CITY INDIAN RIVER VILLAGE PHARMACY HEIGHTS INKSTER PHARMACY HOLLYWOOD PHARMACY NEW MILLENNIUM DRUGS WESTERN WAYNE PHARMACY LIFECARE PHARMACY II LTC THE DRUG STORE OF IRON MOUNTAIN SNYDER DRUG THE CORNER DRUG STORE MORRISONS DRUGSTORE SNYDER PHARMACY SNYDER RX EXPRESS KENDALL PHARMACY LLC ADVANCED CARE PHARMACY SERVICES CENTER FOR FAMILY HEALTH GENOA-QOL HEALTHCARE HENRY FORD ALLEGIANCE HLTH PHC HENRY FORD ALLEGIANCE PHCY RED CAP PHARMACY ROSE CITY PHARMACY

Provider Name

(616) 669-1960 (616) 669-8518 (810) 724-7692 (231) 238-8911 (313) 551-3062 (313) 451-8016 (734) 721-2100 (313) 914-3434 (616) 200-8300 (906) 774-3654 (906) 265-5149 (906) 265-2312 (906) 486-4443 (906) 485-5592 (906) 486-4405 (989) 875-6100 (517) 750-2180 (517) 748-5400 (517) 789-8579 (517) 205-7843 (517) 205-7843 (517) 917-4877 (517) 784-3430

5221 CHERRY AVE 6480 28TH AVE 2040 S CEDAR 6433 BARBARA AVE 349 INKSTER RD 26831 MICHIGAN AVE 30141 CHERRY HILL RD 2700 HAMLIN BLVD STE C 910 E LINCOLN AVE STE C 1112 S STEPHENSON AVE 933 RIVERSIDE PLZ 128 W GENESEE ST 901 LAKESHORE DR STE 202 1330 US HIGHWAY 41 W 110 S MAIN ST 117 S PINE RIVER ST. 2136 ROBINSON RD STE 2 505 N JACKSON ST 1200 N WEST AVE STE 500 205 N EAST AVE 2200 SPRINGPORT RD 214 N W AVE ST A 300 W WASHINGTON AVE STE 110

HUDSONVILLE HUDSONVILLE IMLAY CITY INDIAN RIVER INKSTER INKSTER INKSTER INKSTER IONIA IRON MOUNTAIN IRON RIVER IRON RIVER ISHPEMING ISHPEMING ISHPEMING ITHACA JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49426-1432 49426-8800 48444-9606 49749-9351 48141 48141 48141-4019 48141-2206 48846 49801-4038 49935-1529 49935-1437 49849-1367 49849-3152 49849-1820 48847 49203-3558 49201-1266 49202-2182 49201 49202-1432 49201 49201-2175

WEATHERWAX FAMILY PHARMACIES INC WELCOME PHARMACY SOUTH FAMILY FARE PHARMACY NASH DRUGS INC JONESVILLE ARCADIA PHARMACY BORGESS OUTPATIENT PHARMACY D & W PHARMACY FAMILY HEALTH CENTER PHARMACY GULL POINTE PHARMACY HARDINGS PHARMACY KMED PHARMACY MSU KALAMAZOO CTR PHCY OPTIMED SPECIALTY PHARMACY OSHTEMO PHARMACY PARK STREET PHARMACY QD PHARMACY SANUS SPECIALTY PHARMACY SINDECUSE PHARMACY

(517) 784-3184 (517) 787-2132 (616) 457-9630 (517) 849-9804 (269) 553-6000 (269) 226-8336 (269) 344-2513 (269) 488-0835 (269) 553-5000 (269) 381-0270 (269) 888-4488 (269) 337-6330 (269) 250-8003 (269) 459-8653 (269) 381-1888 (269) 459-9648 (269) 775-7450 (269) 387-3301

210 HINCKLEY BLVD 303 W PROSPECT ST 1965 BALDWIN ST 237 E CHICAGO ST 615 E CROSSTOWN PKWY STE 100 1521 GULL RD 2103 PARKVIEW AVE 117 W PATERSON ST 5585 GULL RD STE 120 5165 W MAIN ST 316 N DRAKE RD 1000 OAKLAND DR # MSU 6480 TEHCNOLOGY DR STE A 635 N 9TH ST STE E 512 N PARK ST 1710 W MAIN ST 2401 GULL RD 1903 W MICHIGAN AVE

JACKSON JACKSON JENISON JONESVILLE KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO KALAMAZOO

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49203 49203-4191 49428-8915 49250-1002 49001-2501 49048-1640 49008-3925 49007-2557 49048-6704 49009-1003 49009-1106 49008-1282 49009-8116 49009-5897 49007-3370 49006 49048-1491 49008-5200

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 295 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name W MICH CANCER CTR RETAIL PHCY WESTSIDE MEDICAL PHARMACY GLENS PHARMACY KALKASKA MEMORIAL HLTH CTR NORTHLAND FOOD & FAMILY CTR SABOURINS PHARMACY GRICE'S PHARMACY WADHAM'S SAV-MOR PHARMACY KINGSLEY PHARMACY NORTHLAND FOOD CENTER INC L'ANSE PHARMACY, INC CENTRAL PHARMACY LAINGSBURG JERRY'S PHARMACY LC FAMILY PHARMACY WALKER PHARMACY FALCON MEDICAL PHARMACY LS SAV-MOR PHARMACY WE CARE PHARMACY PLUS COUNTRYSIDE PHARMACY THE MEDICINE SHOPPE ATLAS MEDS PHARMACY BIOMED PHARMACY LAKE LANSING CEDAR PHARMACY CENTRAL PHARMACY - MT. HOPE CENTRAL PHARMACY - WESTSIDE CENTRAL PHARMACY MLK CENTRAL PHARMACY PATIENT CARE GENOA-QOL HEALTHCARE KNIGHT DRUGS-LANSING LANSING SPECIALTY PHARMACY MCLAREN DRUG SHOP - IRMCG MCLAREN DRUG SHOP - IRMCP PHARMACY PLUS PHARMACY PLUS PHARMACY PLUS #1 QUALITY MEDRX SAV ON 20 WESTSIDE PHARMACY SPARROW HOSP PHCY-OUTPAT THE APOTHECARY SHOP YOUR PHARMACY BALDWIN RD PHARMACY GENOA-QOL HEALTHCARE

NR_0009_10823 10/2017

Provider Phone Number (269) 384-8626 (269) 375-1700 (231) 258-8681 (231) 258-7790 (231) 258-9114 (989) 667-4877 (616) 678-5380 (810) 984-8200 (231) 263-7701 (231) 258-9114 (906) 524-6202 (517) 651-1777 (231) 839-5800 (231) 559-0005 (616) 374-3190 (248) 929-8182 (248) 693-6219 (248) 690-9686 (989) 352-8168 (734) 856-9123 (517) 580-0991 (517) 371-3300 (517) 575-6446 (517) 316-0711 (517) 505-2990 (517) 574-5015 (517) 393-1000 (517) 887-3539 (517) 485-9633 (517) 371-1912 (517) 975-6675 (517) 975-2290 (517) 364-3079 (517) 364-5380 (517) 364-7474 (517) 899-1680 (517) 323-2382 (517) 364-2405 (517) 482-0882 (517) 253-7512 (810) 245-9600 (810) 245-4950

Provider Street 200 N PARK ST 6565 W MAIN ST 784 S CEDAR ST 419 S CORAL ST 2101 US HIGHWAY 131 N 1461 S HURON RD 6 SOUTH MAIN ST 5277 LAPEER RD 114 SOUTH BROWNSON AVE 2377 E M 113 18341 US HWY 41 7404 WOODBURY RD 5760 W HOUGHTON LAKE RD 57 N MOREY RD 838 4TH AVE 1375 S LAPEER RD STE 103 1455 S LAPEER RD STE 101 1412 S LAPEER RD 9695 N GREENVILLE RD 7473 SECOR RD STE C 5016 MARTIN LUTHER KING JR 1515 LAKE LANSING RD 2513 S CEDAR ST 1003 E MOUNT HOPE AVE 4801 W SAGINAW HWY 1122 W HOLMES RD STE 23 3955 PATIENT CARE WAY 6250 S CEDAR ST STE 2 1540 LAKE LANSING RD 2501 S CEDAR ST 401 W. GREENLAWN 2727 S PENNSYLVANIA AVE 915 E MICHIGAN AVE 1200 E MICHIGAN AVE STE 310 1100 W SAGINAW ST 1601 E MICHIGAN AVE 632 NORTH DIBBLE BLVD 1215 E MICHIGAN AVE 737 N GRAND AVE 713 N WAVERLY RD 944 BALDWIN RD STE B 1570 SUNCREST DR STE 300

Page 296 of 679

Provider City KALAMAZOO KALAMAZOO KALKASKA KALKASKA KALKASKA KAWKAWLIN KENT CITY KIMBALL KINGSLEY KINGSLEY L ANSE LAINGSBURG LAKE CITY LAKE CITY LAKE ODESSA LAKE ORION LAKE ORION LAKE ORION LAKEVIEW LAMBERTVILLE LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LANSING LAPEER LAPEER

State

ZIP code

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49007 49009-6114 49646-9460 49646-2503 49646-8821 48631-9410 49330 48074 49649 49649-9370 49946-1026 48848 49651-9703 49651-8585 48849 48360-1421 48360-1468 48360 48850-9107 48144-8686 48910 48912-3753 48910-3137 48910-1822 48917-2623 48910-0333 48911-4299 48911-5700 48912 48910-3137 48910 48910-3488 48912-1417 48912-1800 48915-2033 48912-2894 48917 48912-1811 48906-5160 48917-2242 48446 48446-1154

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MCLAREN DRUG SHOP - LRMC ROGERS PHARMACY EXCEL RX PHARMACY LATHRUP PHARMACY MED CARE PHARMACY SOUTHFIELD PHARMACY

Provider Name

(810) 667-5970 (810) 664-0600 (248) 559-8888 (248) 331-1112 (248) 559-9901 (248) 728-4960

1375 N MAIN ST 316 W NEPESSING ST 18161 W 12 MILE RD SUITE 4 27241 SOUTHFIELD RD 28500 SOUTHFIELD RD STE 300 26237 SOUTHFIELD

LAPEER LAPEER LATHRUP VILLAGE LATHRUP VILLAGE LATHRUP VILLAGE LATHRUP VILLAGE

MI MI MI MI MI MI

48446-1350 48446-2149 48076-2662 48076 48076-2722 48076-4812

KEWEENA MEDICAL CENTER PHARMACY LAWTON PHARMACY LESLIE WELCOME PHARMACY EHARDT'S PHARMACY INC SNYDER'S LINCOLN PHARMACY INC ADAMS PHARMACY CREDO PHARMACY DOWNRIVER PHARMACY DOWNRIVER RX PHARMACY FAMILY CARE PHARMACY GENOA-QOL HEALTHCARE INDEX PARK PHARMACY JANA DRUGS PHARMOR PHARMACY- LINCOLN PARK PRINCES PHARMACY BLOOMS PHARMACY

(906) 337-6575 (269) 624-2231 (517) 589-8291 (810) 359-5322 (989) 736-8138 (313) 381-0070 (313) 436-4501 (734) 578-1189 (313) 406-2561 (313) 381-9200 (734) 333-7027 (313) 357-7500 (313) 383-5700 (313) 382-3802 (313) 887-7443 (734) 469-4657

205 OSCEOLA ST 350 N MAIN ST 826 W BELLEVUE ST 7275 HURON AVE 301 SECOND ST 1373 DIX HWY 752 SOUTHFIELD RD 4045 DIX HWY 2017 FORT ST 3782 FORT ST 26184 OUTER DR 2255 FORT ST 1684 FORT ST 4150 DIX HWY 26190 OUTER DR STE 120 16347 MIDDLEBELT RD

LAURIUM LAWTON LESLIE LEXINGTON LINCOLN LINCOLN PARK LINCOLN PARK LINCOLN PARK LINCOLN PARK LINCOLN PARK LINCOLN PARK LINCOLN PARK LINCOLN PARK LINCOLN PARK LINCOLN PARK LIVONIA

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49913-2134 49065-9249 49251-9744 48450-8324 48742-0000 48146-1346 48146 48146-3934 48146 48146-4117 48146-2084 48146 48146-1909 48146-4030 48146-2084 48154-3360

FARMINGTON DRUGS & MED SUPPLIES LLC IPHARMACY LIVONIA CARE PHARMACY LIVONIA FAMILY PHARMACY LIVONIA PHARMACY MED CART SPECIALTY PHARMACY MEDPRO PHARMACY MERRIMAN DRUGS PEAK PHARMACY PHARMACY SPECIALIST PROFESSIONAL VILLAGE PHARMACY QUALICARE RX RAYS DRUGS SMART PHARMACY SOLARA MEDICAL SUPPLIES INC ST. MARY MERCY OUTPATIENT PHCY TOP CARE PHARMACY LAKESIDE PHARMACY

(248) 478-3922 (734) 743-5055 (734) 437-1956 (734) 744-7636 (734) 744-8110 (734) 762-6600 (734) 855-4700 (734) 427-3430 (248) 530-0930 (734) 744-4844 (734) 427-2400 (734) 469-2930 (734) 432-2015 (734) 427-0354 (888) 568-8145 (734) 655-2325 (734) 762-1500 (586) 532-4141

20434 FARMINGTON RD 31193 PLYMOUTH RD 16989 FARMINGTON RD 15983 MIDDLEBELT RD 17888 FARMINGTON RD 32131 INDUSTRIAL RD 15580 MIDDLEBELT ROAD 31320 5 MILE RD 20008 FARMINGTON RD 14155 FARMINGTON RD 11589 FARMINGTON RD 28370 JOY RD 37672 PROFESSIONAL CENTER DR 8996 MIDDLEBELT RD 35275 PLYMOUTH RD 36475 5 MILE RD RM 21520 27493 6 MILE RD 15959 HALL RD STE 101

LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA LIVONIA MACOMB

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48152-1416 48150-2103 48154-2946 48154-3311 48152 48150 48154-3808 48154-3680 48152-1416 48154 48150-5729 48150-4133 48154-1154 48150-4052 48150 48154-1971 48152-3834 48044-5363

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 297 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CITY PHARMACY HEALTHY LIVING PHARMACY JOHN R EXPRESS PHARMACY PC MADISON PHARMACY INC SELECT CARE PHARMACY, LLC SONA PHARMACY THE PHARMACY SHOP INC VALUE CENTER PHARMACY II GLENS PHARMACY MANCHESTER PHARMACY GLENS PHARMACY

Provider Name

(248) 268-1102 (248) 577-9903 (248) 268-3302 (248) 336-8900 (248) 246-7997 (248) 808-6082 (248) 591-5555 (248) 583-1854 (231) 587-8491 (734) 428-8393 (231) 398-3202

26795 JOHN R RD # B 30755 BARRINGTON ST 26100 JOHN R RD 1385 E 12 MILE RD STE 105 28003 JOHN R RD 27745 DEQUINDRE RD 28411 DEQUINDRE RD 1485 W 14 MILE RD 617 N WILLIAMS ST 128 E MAIN ST 1057 US HIGHWAY 31 S

MADISON HEIGHTS MADISON HEIGHTS MADISON HEIGHTS MADISON HEIGHTS MADISON HEIGHTS MADISON HEIGHTS MADISON HEIGHTS MADISON HEIGHTS MANCELONA MANCHESTER MANISTEE

MI MI MI MI MI MI MI MI MI MI MI

48071-3615 48071-1833 48071 48071-2618 48071-2809 48071 48071-3055 48071-1055 49659-9766 48158-8748 49660-2266

MANISTIQUE TRIBAL HLTH CLINIC-PHCY PUTVIN DRUG STORE BOSTICKS DRUG STORE VG'S PHARMACY MAINSTREET PHARMACY CAMPUS PHARMACY PENINSULA PHARMACY PENINSULA PHARMACY PLUS SNYDER DRUG UNIVERSITY HEALTH CENTER HEMMINGSEN DRUG STORE WARE'S PHARMACY LAKEVIEW PHARMACY MEDICINE TREE PHARMACY WINGERTS PHARMACY MCBAIN FAMILY PHARMACY GOG PHARMACY MELVINDALE PHARMACY MEMPHIS DRUGS MESICK PHARMACY COMMET WELCOME PHARMACY PHARMACY CARE GLOVERS REXALL PHARMACY GREAT LAKES PHARMACY OF MIDLAND MIDLAND SABOURIN'S PHARMACY LITTLE PHARMACY OF MILAN MILFORD SAVMOR PHARMACY MILLINGTON PHARMACY PIONEER FAMILY PHARMACY FOOD TOWN DRUGS

(906) 341-8469 (906) 341-5494 (231) 824-6465 (810) 765-3585 (517) 635-7777 (906) 225-5911 (906) 225-3902 (906) 225-1450 (906) 249-1441 (906) 227-1165 (269) 781-3411 (517) 676-5518 (269) 668-6205 (269) 668-6801 (989) 843-5440 (231) 825-8175 (313) 382-3996 (313) 386-0830 (810) 392-2424 (231) 885-1751 (517) 764-0400 (269) 795-7936 (989) 839-9975 (989) 835-7911 (989) 839-2402 (734) 439-3900 (248) 685-8363 (989) 871-2820 (989) 826-8989 (734) 241-2046

5698 W US-2 211 S CEDAR ST 117 W MAIN ST 6764 RIVER RD 6541 PLAZA DR 1015 NORTH THIRD ST. 1414 W FAIR AVE STE 133 300 N MCCLELLAN AVE 5091 US 41 SOUTH 1401 PRESQUE ISLE AVE 132 W MICHIGAN AVE 304 S JEFFERSON ST 52375 N MAIN ST 56109 VILLAGE CENTER CIRCLE 315 E MAIN ST 119 N ROLAND ST 3600 OAKWOOD BLVD 18287 ALLEN RD 80850 MAIN ST 112 MESICK AVE 4646 PAGE AVE 4652 N M37 HWY 4000 JEFFERSON AVE 1120 EASTMAN AVE 314 W WACKERLY ST STE L 34 DEXTER ST 1191 N MILFORD ROAD 8542 STATE RD 114 S MORENCI ST 211 N TELEGRAPH RD

MANISTIQUE MANISTIQUE MANTON MARINE CITY MARLETTE MARQUETTE MARQUETTE MARQUETTE MARQUETTE MARQUETTE MARSHALL MASON MATTAWAN MATTAWAN MAYVILLE MC BAIN MELVINDALE MELVINDALE MEMPHIS MESICK MICHIGAN CENTER MIDDLEVILLE MIDLAND MIDLAND MIDLAND MILAN MILFORD MILLINGTON MIO MONROE

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49854 49854-1425 49663 48039-2252 48453-1299 49855 49855-5408 49855 49855-0000 49855-2818 49068-1581 48854-1652 49071-9332 49071 48744-9105 49657 48122-1150 48122-1513 48041 49668-9555 49254-1042 49333 48640-3528 48640-4215 48640-2766 48160-1518 48381 48746 48647-0000 48162-3231

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 298 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE HOMETOWN PHARMACY HOMETOWN PHARMACY HOMETOWN PHARMACY HOMETOWN PHARMACY MONROE MED RX PHARMACY YINGER PHARMACY SHOPPE YINGER PHARMACY SHOPPE MIKES FAMILY PHARMACY SAV ON 16 MONTROSE PHARMACY MIKE'S PHARMACY MCLAREN DRUG SHOP-MCRMC SAV ON PHIL'S DRUGS KESSEL PHARMACY UNION PRESCRIPTION CENTER INC AMBULATORY INFUSION CARE INC CARDINAL PHARMACY DOWNTOWN DRUGS MISSION PHARMACY PUTVIN DRUG STORE SNYDER PHARMACY BENSON SAV-MOR PHARMACY CHCWM MUSEKEGON HACKLEY HLTHCR EQUIP AND PHCY HACKLEY PHARMACY GLENSIDE HACKLEY PROFESSIONAL PHARMACY HOMETOWN PHARMACY

Provider Name

(734) 636-1486 (734) 243-5656 (734) 242-9011 (734) 242-2966 (734) 243-6301 (734) 240-3466 (734) 243-5451 (734) 384-7044 (231) 894-8633 (810) 639-2071 (517) 458-2261 (586) 493-2800 (586) 468-0597 (810) 687-6263 (810) 686-2900 (989) 773-4879 (989) 317-3700 (989) 773-5544 (989) 773-8200 (906) 387-2248 (906) 387-4855 (231) 722-2861 (231) 332-5875 (231) 727-7968 (231) 755-2443 (231) 728-5888 (231) 744-4718

1003 S RAISINVILLE RD 15483 S DIXIE HWY 811 N MACOMB ST 1144 N MONROE ST 1397 N MONROE ST 337 STEWART RD STE 1 1704 S CUSTER RD 1036 N MONROE ST 8718 WATER ST STE A 225 E STATE ST 213 W MAIN ST 1000 HARRINGTON ST 35 N WALNUT ST 7188 N SAGINAW RD 11830 N SAGINAW ST 920 INDUSTRIAL AVE 2410 S LEATON RD STE 8 121 E BROADWAY ST 926 S MISSION ST 119 ELM AVE 415 E M28 961 SPRING ST 1440 E SHERMAN BLVD STE 200 6401 PRAIRIE ST STE 1100 1663 W SHERMAN BLVD 1675 LEAHY ST STE 111 1900 RUDDIMAN DR

MONROE MONROE MONROE MONROE MONROE MONROE MONROE MONROE MONTAGUE MONTROSE MORENCI MOUNT CLEMENS MOUNT CLEMENS MOUNT MORRIS MOUNT MORRIS MOUNT PLEASANT MOUNT PLEASANT MOUNT PLEASANT MOUNT PLEASANT MUNISING MUNISING MUSKEGON MUSKEGON MUSKEGON MUSKEGON MUSKEGON MUSKEGON

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48161-9754 48161-3953 48162-2929 48162-3190 48162-5360 48162 48161-1622 48162-3113 49437-1204 48457 49256-1420 48043-2920 48043 48458-2128 48458-1504 48858-4648 48858-8640 48858-2360 48858-3548 49862-1105 49862 49442-3278 49444-1878 49444-7839 49441-3564 49442-5538 49445-3148

HOMETOWN PHARMACY #53 - MUSKEGON MERCY HEALTH MUSKEGON CMH PHAR MERCY HLTH PTRS - PHCY INC. PATTERSON'S PHARMACY WATKINS PHCY & SURGICAL SUPPLY WEST SHORE PROFESSIONAL PHCY COMMUNITY CARE PHARMACY MAPLE VALLEY PHARMACY NEGAUNEE SNYDER DRUG NEW BOSTON RX PHARMACY HOMETOWN PHCY #50-NEW BUFFALO NEW HUDSON DISCOUNT PHARMACY HOMETOWN PHARMACY NEWBERRY HOMETOWN PHARMACY

(231) 563-6237 (231) 722-4632 (231) 672-7835 (231) 722-2564 (231) 739-7158 (231) 739-7566 (231) 737-9510 (517) 852-0845 (906) 475-9967 (734) 753-2000 (269) 469-3636 (248) 486-0720 (231) 652-6914 (906) 293-9900

5866 HARVEY ST 376 APPLE AVE E 1500 E SHERMAN BLVD GL P-200 2144 HOYT ST 1391 E SHERMAN 1150 E SHERMAN BLVD STE 1400 2700 BAKER ST 1ST FLR STE 1 219 N MAIN ST 390 US 41 EAST 19162 HURON RIVER DR 1 N WHITTAKER ST 56270 GRAND RIVER AVE 226 W RIVER VALLEY DR 2013 NEWBERRY AVE

MUSKEGON MUSKEGON MUSKEGON MUSKEGON MUSKEGON MUSKEGON MUSKEGON HEIGHTS NASHVILLE NEGAUNEE NEW BOSTON NEW BUFFALO NEW HUDSON NEWAYGO NEWBERRY

MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49444-6720 49442 49444 49444-1121 49444-1802 49444-1870 49444-2157 49073-9577 49866-0000 48164 49117-1135 48165-9727 49337-8972 49868-1338

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 299 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SNYDER PHARMACY FRENCHTOWN PHARMACY NEWPORT PHARMACY MARTIN'S PHARMACY NILES WELLCARE PHARMACY EHARDT'S PHARMACY INC NORWAY PHARMACY ADVICARE PHARMACY ARBOR LANE PHARMACY AT FOX RUN CHECKER SPECIALTY PHARMACY CREAMS N CAPS MICHIGAN SAV ON 12 NOVI DRUGS SAV ON 13 LTC PHARMACY SOLEO HEALTH INC GOOD HEALTH PHARMACY LINCOLN DRUGS INC MEDSOURCE PHARMACY MERCURY DRUGS OAK PARK PHARMACY ULTIMATE CARE PHARMACY PGPA PHARMACY INC THUNDER BAY PHARMACY ONAWAY TOMS FAMILY MARKET PHARMACY THE MEDICINE SHOPPE HARBOR TOWN PHARMACY, INC OAK FAMILY PHARMACY GILBERTS DRUG STORE INC OSSINEKE PHARMACY HARDINGS PHARMACY CENTRAL PHARMACY - OWOSSO LLC HEALTHFIRST PHARMACY THE MEMORIAL HOSPITAL VG'S PHARMACY HOMETOWN PHARMACY #54 - OXFORD MEDICINE ROOM FAMILY FARE PHARMACY PAW PAW VILLAGE PHARMACY CENTRAL PHARMACY-PERRY LLC R & R PRESCRIPTION SERVICES SCHEURER FAMILY PHARMACY PINNY PHARMACY CAMPBELL PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (906) 293-8571 (734) 872-2100 (734) 872-1490 (269) 684-1418 (269) 262-4343 (810) 793-5006 (906) 563-5151 (248) 344-0877 (248) 668-8778 (248) 305-7240 (844) 232-9098 (248) 478-3000 (888) 722-5579 (248) 513-8687 (243) 541-0600 (248) 543-7847 (248) 850-8594 (248) 545-3600 (248) 582-8807 (248) 206-7603 (517) 381-7472 (989) 733-7037 (989) 733-8229 (517) 456-7225 (906) 884-4229 (248) 831-1222 (989) 739-7585 (989) 471-2339 (269) 692-6011 (989) 725-1344 (517) 729-9355 (989) 729-4793 (989) 725-5141 (248) 628-2538 (248) 628-7990 (269) 657-1778 (269) 657-6073 (517) 625-8640 (231) 487-2147 (989) 453-2535 (989) 879-7705 (269) 685-6808

Provider Street 7293 M-123 7505 GRAFTON RD STE 2 7825 N DIXIE HWY STE 105 720 S 11TH ST 70 E MAIN ST 6002 N LAPEER RD 514 MAIN ST 46325 W 12 MILE RD STE 160 41100 FOX RUN 43155 W 9 MILE RD STE 300 25875 NOVI RD SUITE 130 24100 MEADOWBROOK STE A 24100 MEADOWBROOKD STE B 26800 MEADOWBROOK RD STE 119 13821 W 9 MILE RD 25901 COOLIDGE HWY 15300 W 9 MILE RD UNIT 2 22150 COOLIDGE HWY 21675 COOLIDGE HWY 15075 LINCOLN ST APT 110 3520 OKEMOS RD STE 5 21258 WEST M-68 HWY 20597 STATE ST 400 N MAIN ST STE C 850 GREENLAND RD 320 N ORTONVILLE RD 212 S STATE ST 11745 US HIGHWAY 23 S 114 S FARMER ST 110 W EXCHANGE ST 111 N WASHINGTON ST 721 N SHIAWASSEE ST 1341 N M 52 1 S WASHINGTON ST 72 S WASHINGTON ST STE 207 847 S KALAMAZOO ST 322 E MICHIGAN AVE 520 N MAIN ST 560 W MITCHELL ST STE 200 168 N CASEVILLE RD 704 S MABLE ST 102 S MAIN ST

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Provider City NEWBERRY NEWPORT NEWPORT NILES NILES NORTH BRANCH NORWAY NOVI NOVI NOVI NOVI NOVI NOVI NOVI OAK PARK OAK PARK OAK PARK OAK PARK OAK PARK OAK PARK OKEMOS ONAWAY ONAWAY ONSTED ONTONAGON ORTONVILLE OSCODA OSSINEKE OTSEGO OWOSSO OWOSSO OWOSSO OWOSSO OXFORD OXFORD PAW PAW PAW PAW PERRY PETOSKEY PIGEON PINCONNING PLAINWELL

State

ZIP code

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49868-0000 48166-8939 48166 49120-3313 49120-2200 48461-8150 49870-1238 48377 48377-4804 48375 48375-1678 48375 48375-3457 48377-3540 48237-2775 48237-1108 48237-5200 48237-2813 48237-3171 48237-1289 48864-5943 49765 49765-8665 49265-9204 49953-1452 48462-8653 48750-1635 49766 49078-1152 48867-2816 48867-2819 48867-1632 48867-1232 48371-4978 48371 49079-9230 49079-1408 48872 49770-2276 48755-9704 48650-9348 49080-1635

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name COMMUNITY PHARMACY OF PLAINWEL WILTSES PHARMACY A1 PHARMACY INC BLOOMFIELD PHARMACY NORTH PC GLOBAL HEALTH PHARMACY INDEX MEDS MCLAREN DRUG SHOP PDHRMC MEDLIFE RX NEAU ERA PHARMACY OMEGA PHARMACY PINE KNOB SAVMOR PHARMACY #6 PONTIAC DISCOUNT PHARMACY SAV-PLUS PHARMACY ST JOSEPH MERCY PRO PHCY ST JOSEPH MERCY PROF PHARMACY THRIFTY DRUGS BLUE WATER PHARMACY GENOA-QOL HEALTHCARE LAKE HURON COMMUNITY PHARMACY MCLAREN PHARMACY - PORT HURON PORT HURON PHARMACY ADVANCED HEALTHMART PHARMACY D AND W PHARMACY HARDINGS PHARMACY HARDINGS PHARMACY PORTAGE PHARMACY WESTLAKE DRUG & GIFTSHOP TOMS PHARMACY LLC POTTERVILLE PHARMACY INC ROOS PHARMACY NORTH INC KRONNER PHARMACY HOMETOWN PHARMACY ARBOR LANE PHARMACY #3 COMPASSIONATE PHARMACY CROWN PHARMACY FAMILY DRUG PHARMACY V GENOA-QOL HEALTHCARE IDM PHARMACY METROPOLITAN PHARMACY PRECARE PHARMACY LLC REDFORD DISCOUNT PHARMACY TEL CRAFT PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (269) 685-5847 (734) 453-4848 (248) 221-7730 (248) 334-7700 (248) 451-1590 (248) 340-0886 (248) 338-5016 (248) 791-7566 (248) 975-9300 (248) 481-9004 (248) 253-0521 (248) 377-9700 (248) 481-9299 (248) 858-6725 (248) 858-3059 (248) 334-1549 (810) 982-3100 (810) 824-5120 (810) 216-3140 (810) 989-3455 (810) 989-9550 (269) 324-1100 (269) 329-3205 (269) 327-4508 (269) 323-7380 (269) 327-0033 (269) 327-3049 (517) 647-7373 (517) 645-9800 (989) 873-1478 (989) 366-7611 (231) 853-2261 (313) 532-4000 (313) 937-3000 (313) 532-3784 (313) 531-9200 (313) 486-2579 (313) 543-3414 (313) 937-1100 (313) 255-4420 (313) 533-7920 (313) 246-6301

Provider Street 533 ALLEGAN ST 330 S MAIN ST 461 W HURON ST STE 111 44200 WOODWARD AVE STE 107 135 S TELEGRAPH RD 989 UNIVERSITY DR STE 107 50 N PERRY ST 35 S JOHNSON ST STE 1E 506 N TELEGRAPH RD 420 W HURON ST 1701 BALDWIN AVE SUITE 100 1430 JOSLYN 775 BALDWIN AVE 44405 WOODWARD AVE 44405 WOODWARD AVE 140 N SAGINAW ST 1524 10TH ST 3111 ELECTRIC AVE 2601 ELECTRIC AVE 1221 PINE GROVE AVENUE 515 10TH ST 7916 OAKLAND DR 525 ROMENCE RD 6330 S WESTNEDGE AVE 3750 W CENTRE AVE 7966 LOVERS LN 8822 PORTAGE RD 1462 E GRAND RIVER AVE 127 W PEARL ST 2370 GREENWOOD RD 778 W HOUGHTON LAKE DR 12441 STAFFORD ST 24224 JOY RD STE 103 27144 JOY RD 24401 PLYMOUTH RD 25241 GRAND RIVER AVE 9327 TELEGRAPH RD 26541 PLYMOUTH RD 26380 PLYMOUTH RD 25045 GRAND RIVER AVE 25850 GRAND RIVER AVE 14110 TELEGRAPH RD

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Provider City PLAINWELL PLYMOUTH PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PONTIAC PORT HURON PORT HURON PORT HURON PORT HURON PORT HURON PORTAGE PORTAGE PORTAGE PORTAGE PORTAGE PORTAGE PORTLAND POTTERVILLE PRESCOTT PRUDENVILLE RAVENNA REDFORD REDFORD REDFORD REDFORD REDFORD REDFORD REDFORD REDFORD REDFORD REDFORD

State

ZIP code

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49080-1276 48170-1604 48341-1601 48341 48341-1934 48342-1885 48342-2217 48341-1660 48341-1038 48341-1425 48340 48340 48340-2576 48341-5023 48341-5023 48342-2112 48060-5815 48060-8127 48060 48060 48060-4404 49024-4936 49024-3444 49002-3572 49024-4630 49002-4446 49002-6416 48875-1632 48876-5156 48756-4033 48651-8425 49451-5103 48239-1215 48239-2368 48239 48240-1404 48239-1260 48239-2214 48239-2211 48240 48240-1433 48239

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CET PHARMACY SERVICE HOMETOWN PHARMACY REMUS PHARMACY RICHLAND VILLAGE DRUG RIVER ROUGE PHARMACY GALLERIA PHARMACY AUBURN PHARMACY CRITTENTON MEDICAL PHARMACY LYTLE PHARMACY INC BARCLAY PHARMACY PHARMACARE PHARMACY PURE HEALTH PHARMACY LLC ROCHESTER HILLS PHARMACY SOMERSET SPECIALTY PHARMACY THERA SCRIPT ROCHESTER TRI-STAR PHARMACY WELLPOINTE PHARMACY D & W PHARMACY MERCY HEALTH PHARMACY ROCKFORD ROCKWOOD PHARMACY MCLEAN PHARMACY SAV-0N 10 FAMILY PHARMACY PIONEER FAMILY PHARMACY ROSE CITY DRUG DOCTORS PHCY & HEALTH CARE CTR PARK FAMILY PHARMACY ROSEVILLE PHARMACY CUSTOM CARE PHARMACY DYNAMIC CARE PHARMACY

Provider Name

(231) 832-7890 (231) 832-5521 (989) 967-8411 (269) 629-9550 (313) 438-6825 (734) 675-7900 (248) 289-6637 (248) 650-2155 (248) 651-8511 (248) 852-4600 (248) 601-7000 (248) 923-2699 (248) 601-1178 (248) 841-5106 (313) 727-6602 (313) 674-9800 (248) 852-9355 (616) 863-9376 (616) 685-7990 (734) 379-6815 (989) 734-4701 (734) 941-0755 (989) 275-5600 (517) 685-2141 (586) 777-2190 (734) 626-7125 (586) 415-4844 (248) 551-8290 (248) 850-1802

204 N PATTERSON ROAD 130 W UPTON AVE 144 W WHEATLAND 8900 GULL RD 10550 W JEFFERSON AVE 14720 KING RD STE C 2855 CRANBROOK RIDGE CT 1135 W UNIVERSITY DR 340 S MAIN ST 75 BARCLAY CIR STE 114 1460 WALTON BLVD STE 90 441 S LIVERNOIS RD STE 160 6700 N ROCHESTER RD STE 101 2708 S ROCHESTER RD 204 455 BARCLAY CIR #C-2 2840 CROOKS RD 1701 SOUTH BLVD E 201 MARCELL DR NE 6050 NORTHLAND DR NE STE 1107 32825 FORT ST 229 N THIRD ST 36567 GODDARD RD 412 N 5TH ST 2640 S M 33 18801 E 10 MILE RD 28350 GRATIOT AVE 20733 E 13 MILE RD 3535 W 13 MILE RD STE 124 4119 W 13 MILE RD

REED CITY REED CITY REMUS RICHLAND RIVER ROUGE RIVERVIEW ROCHESTER ROCHESTER ROCHESTER ROCHESTER HILLS ROCHESTER HILLS ROCHESTER HILLS ROCHESTER HILLS ROCHESTER HILLS ROCHESTER HILLS ROCHESTER HILLS ROCHESTER HILLS ROCKFORD ROCKFORD ROCKWOOD ROGERS CITY ROMULUS ROSCOMMON ROSE CITY ROSEVILLE ROSEVILLE ROSEVILLE ROYAL OAK ROYAL OAK

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49677-8096 49677-1130 49340 49083-9310 48218 48193-7973 48306 48307-1871 48307-2030 48307-4508 48309 48307-2596 48306 48307 48307-4774 48309 48307-6122 49341-1364 49341-9256 48173-1157 49779-1610 48174-1232 48653-9329 48654-9702 48066-3931 48066-4208 48066 48073-6770 48073-6655

WILLIAM BEAUMONT HOSPITAL OP PHCY ZMC PHARMACY AROGYA PHARMACY BRADY DRUGS CARE PHARMACY

(248) 898-4097 (248) 280-6401 (989) 607-3379 (989) 781-2370 (989) 755-7890

3601 W 13 MILE RD 1041 S MAIN ST 5470 GRATIOT RD 7835 GRATIOT RD 1320 N MICHIGAN AVE STE 8

ROYAL OAK ROYAL OAK SAGINAW SAGINAW SAGINAW

MI MI MI MI MI

48073-6712 48067-3274 48638-6038 48609-5020 48602-4751

COVENANT HEALTHCARE O/P PHARMACY DOWNS PHARMACY FALER DRUGS GENOA-QOL HEALTHCARE KESSEL PHARMACY MEDWINS PHARMACY

(989) 583-6484 (989) 758-6000 (989) 793-2445 (989) 793-3130 (517) 791-7110 (989) 755-7998

700 COOPER AVE 316 S 4TH AVE 1806 COURT ST 500 HANCOCK ST STE 100 5025 GRATIOT RD 301 E GENESEE ST STE 100

SAGINAW SAGINAW SAGINAW SAGINAW SAGINAW SAGINAW

MI MI MI MI MI MI

48602-5383 48607-1602 48602-4040 48602-4224 48638 48607

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 302 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PHARMACY 4 LESS IV PRINCING'S PHARMACY UNIVERSAL PHARMACY OF SAGINAW HEALTHWAY PHARMACY INC NEIMANS FAMILY PHARMACY ST CLAIR COLLIE DRUG INC MADHAV PHARMACY LLC RX CARE PHARMACY SHORES PHARMACY PIONEER FAMILY PHARMACY BAY PHARMACY

Provider Name

(989) 401-8455 (989) 793-8640 (989) 792-6000 (989) 865-9971 (810) 329-4613 (586) 776-6122 (586) 359-2326 (586) 359-6517 (586) 859-5657 (989) 389-7252 (906) 643-7725

3581 DIXIE HWY 333 S MICHIGAN AVENUE 3077 BAY PLAZA DR 1008 N SAGINAW ST 1167 S CARNEY DR 21728 HARPER AVE 24800 HARPER AVE SUITE 2 25014 LITTLEMACK AVE 29306 HARPER AVE 2100 N SAINT HELEN RD 112 S STATE ST

SAGINAW SAGINAW SAGINAW SAINT CHARLES SAINT CLAIR SAINT CLAIR SHORES SAINT CLAIR SHORES SAINT CLAIR SHORES SAINT CLAIR SHORES SAINT HELEN SAINT IGNACE

MI MI MI MI MI MI MI MI MI MI MI

48601-4204 48602-2024 48604-2534 48655-1022 48079-5569 48080-2216 48080 48080-1118 48081-2712 48656-9209 49781-1618

LAMBERT TRIBAL HLTH CLINIC PHARMACY CLINTON MEMORIAL HOSPITAL PHCY MARTIN'S PHARMACY RICHARD GILLESPIE PHARMACY ROGER'S PHARMACY VANS PHARMACY INC V CARE PHARMACY JENSEN'S COMMUNITY PHARMACY SALINE PHARMACY SANILAC PHARMACY SANFORD FAMILY PHARMACY SAUGATUCK DRUG COMPANY ARFSTROM PHARMACY SAULT COMMUNITY PHARMACY SAULT STE MARIE TRIBAL HLTH PHCY HARDINGS PHARMACY SCHEURER FAMILY PHARMACY SHELBY PHARMACY ADVANCED CARE INFUSION SHELBY GENOA-QOL HEALTHCARE JOHNS LTC PHARMACY SHELBY FAMILY PHARMACY STONEBRIDGE RETAIL PHARMACY PHARMASCRIPT OF SHELBY INC WEICKS PHARMACY SHORELINE PHARMACY VALUE DRUGS CENTER PHARMACY BIOMED HEALTH SOLUTIONS LLC CADILA PHARMACY

(906) 643-8689 (989) 224-8155 (269) 983-5847 (269) 983-6881 (269) 408-1348 (269) 983-4802 (989) 681-8285 (734) 429-9053 (734) 312-2162 (810) 648-2265 (989) 687-2612 (616) 857-2300 (906) 632-9661 (906) 632-2122 (906) 632-5236 (269) 679-2008 (989) 883-3850 (231) 861-4341 (586) 323-8280 (586) 323-8270 (586) 279-3333 (586) 461-2900 (586) 690-4303 (586) 803-0800 (616) 672-7774 (269) 637-9476 (269) 637-3222 (248) 486-1444 (248) 663-3390 (248) 557-9333

1140 N STATE ST STE 2805 901 S OAKLAND ST 2121 S CLEVELAND AVE 2020 WASHINGTON AVE 4039 HOLLYWOOD RD 807 NAPIER AVE 135 W WASHINGTON ST 968 E MICHIGAN AVE 75 E BENNETT 78 S ELK ST 28 W SAGINAW RD 201 BUTLER STREET 415 ASHMUN ST 560 OSBORN BLVD 2864 ASHMUN ST 139 N GRAND ST 8866 UNIONVILLE RD 178 N MICHIGAN AVE 50680 CORPORATE DR 50680 CORPORATE DR STE 2 48887 HAYES RD STE B 48887 HAYES RD 13350 24 MILE RD STE 300 50505 SCHOENHERR RD STE 130 71 124TH AVE 950 BLUE STAR HWY 08337 M 140 UNIT NUMBER-2 12660 10 MILE RD SUITE B 23815 NORTHWESTERN HWY STE 100 23832 SOUTHFIELD RD

SAINT IGNACE SAINT JOHNS SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT LOUIS SALINE SALINE SANDUSKY SANFORD SAUGATUCK SAULT SAINTE MARIE SAULT SAINTE MARIE SAULT SAINTE MARIE SCHOOLCRAFT SEBEWAING SHELBY SHELBY TOWNSHIP SHELBY TOWNSHIP SHELBY TOWNSHIP SHELBY TOWNSHIP SHELBY TOWNSHIP SHELBY TWP SHELBYVILLE SOUTH HAVEN SOUTH HAVEN SOUTH LYON SOUTHFIELD SOUTHFIELD

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49781-1013 48879-2200 49085-2601 49085-2431 49085-9156 49085-2003 48880-1534 48176-1586 48176-1204 48471-1354 48657 49453-0000 49783-1905 49783-1822 49783-3740 49087-5111 48759-9569 49455-1028 48315-3107 48315-3107 48315-4405 48315-4405 48315-1814 48315 49344-9772 49090-7759 49090-1990 48178-9141 48075-7738 48075-8017

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 303 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CHEMVILLE PHARMACY DARING DRUGS ADVANCE FARMBROOK MEDICAL PHARMACY FRANKLIN DISCOUNT PHARMACY GENOA-QOL HEALTHCARE GRANT PHARMACY GREENPOINT PHARMACY HUNTER MAPLE HEALTH SERVICES LAHSER MEDICAL CAMPUS PHARMACY MAJESTIC PHARMACY NORTHLAND MEDICAL BLDG PHCY PHARMOR PHARMACY - GREENFIELD

Provider Name

(248) 356-2000 (248) 559-8555 (248) 354-5600 (248) 355-1910 (248) 799-8125 (248) 799-3900 (248) 557-2200 (248) 569-9551 (248) 262-7679 (248) 948-8800 (248) 569-0450 (248) 809-6024

22100 W 10 MILE RD 23077 GREENFIELD RD 29877 TELEGRAPH RD 29113 NORTHWESTERN HWY 22170 W 9 MILE RD 29355 NORTHWESTERN HWY STE 220 23303 GREENFIELD RD 17090 W 12 MILE RD 27207 LAHSER RD SUITE 102 25861 LAHSER RD 20905 GREENFIELD RD STE 104 15627 W 9 MILE RD

SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD

MI MI MI MI MI MI MI MI MI MI MI MI

48033-3232 48075-3709 48034-1332 48034 48033-6007 48034-1051 48075-3758 48076-2144 48034-8470 48033 48075 48075-3718

PHARMOR PHARMACY HIGHLAND PARK PREMIER HOME PHARMACY PRIMEMART PHARMACY LLC SOUTHFIELD SCRIPTS SPECIALTY MEDS THE MEDICINE CABINET TOP SERVICE SAV-MOR PHARMACY TRI-UNITY PHARMACY 200 LLC VICTORIA PHARMACY BELAVISTA DRUGS BIO SCRIPT PHARMACY BYRON DRUGS DOWNRIVER FAMILY PHARMACY EAGLE DRUGS PHARMACY EAST RIVER SAV-MOR FALCON HEALTH-MART DRUGS FAMILY HEALTH PHARMACY LIBERTY DRUGS MD ROYAL PHARMACY NORTHLINE DRUGS OAKWOOD PHARMACY SOUTHGATE PRIME CARE PHARMACY THE RITE PHARMACY FAMILY FARE PHARMACY MOMBER PHARMACY

(248) 996-8441 (248) 223-9734 (248) 352-3400 (248) 621-9149 (248) 281-3636 (248) 557-8840 (248) 569-7578 (248) 304-7659 (248) 595-8609 (734) 282-1940 (734) 324-4000 (734) 283-0100 (734) 285-0003 (734) 281-9200 (734) 374-2335 (734) 250-8168 (734) 720-7480 (734) 785-8026 (734) 288-3588 (734) 285-9496 (734) 324-9606 (734) 324-1290 (734) 589-3185 (616) 887-8861 (616) 887-7323

23815 NORTHWESTERN HWY STE 120 27762 FRANKLIN RD 27177 LAHSER RD STE 102 17330 NORTHLAND PARK CT #101 22972 LAHSER RD 27159 GREENFIELD RD 15600 W 10 MILE RD UNIT 1B 22255 GREENFIELD RD STE 120 29963 NORTHWEST HWY 15830 FORT ST STE 5 15348 FORT ST 13355 DIX TOLEDO RD 14156 EUREKA RD 14167 DIX TOLEDO RD 13101 ALLEN ROAD STE 511 15600 NORTHLINE RD 15450 NORTHLINE RD STE 102 14799 DIX TOLEDO RD 12866 FORT ST 13894 NORTHLINE 15777 NORTHLINE RD STE 100A 3 HERITAGE DR # 3 15150 FORT ST 565 S STATE ST 11 S STATE ST

SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHFIELD SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SOUTHGATE SPARTA SPARTA

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48075-7738 48034-2300 48034-8467 48075 48033-4408 48076 48075-2148 48075-3710 48034-1020 48195-1348 48195-1304 48195-1849 48195 48195-2505 48195 48195-2350 48195-2490 48195-2507 48195-1060 48195 48195-2300 48195-3000 48195 49345-1568 49345-1718

WEATHERWAX SAV-MOR SPRING ARBOR LEPPINKS PHARMACY FERRYSBURG STANDISH PHARMACY

(517) 750-2550 (616) 842-4706 (989) 846-0411

8012 SPRING ARBOR ROAD 17717 174TH AVE 533 S MAIN ST

SPRING ARBOR SPRING LAKE STANDISH

MI MI MI

49283 49456-8879 48658-9531

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 304 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

COUNTRYSIDE PHARMACY ATLANTIC MEDICAL PHARMACY BROOKSIDE DRUGS CANAL PHARMACY CANAL PHARMACY CAREMONT PHARMACY DALCOMA SPECIALTY PHARMACY FRANKLIN DISCOUNT PHARMACY HEALTH CHOICE PHARMACY HOLIDAY PHARMACY PLLC KASHAT SAV-MOR PHARMACY MEDICINE SHOPPE PHARM E-Z INC PHARMACARXE PLUMBROOK PRESCRIPTION CENTER SAV ON DRUGS 5 STERLING HEIGHTS STERLING CITY PHARMACY INC STERLING HEIGHTS PHARMACY SUNSHINE PHARMACY MARTIN'S PHARMACY STOCKBRIDGE PHARMACY BAY SHORE PHARMACY HOMETOWN PHARMACY SUTTONS BAY LUEA PHARMACY NEIMAN FAMILY PHARMACY TAWAS SUPER SAV-MOR DRUGS ER DRUGS GODDARD DISCOUNT PHARMACY MENARD PHARMACY OAKWOOD PHARMACY TAYLOR PAR WICK PHARMACY PHARMAX DRUGS PHARMOR PHARMACY TAYLOR PIONEER MEDICAL PHARMACY LLC SEAWAY PHARMACY TAYLOR CITY PHARMACY TAYLOR DISCOUNT PHARMACY TRUE CARE PHARMACY

Provider Name

(517) 831-4140 (586) 698-2264 (586) 566-3490 (586) 566-9400 (586) 439-3550 (586) 323-6400 (586) 697-3877 (586) 698-0017 (586) 448-3649 (586) 274-4332 (586) 698-0336 (586) 268-6266 (586) 698-1874 (248) 805-1981 (586) 939-9580 (586) 739-1450 (248) 268-1641 (586) 983-9740 (586) 286-5005 (269) 429-8441 (517) 851-7575 (231) 271-6111 (231) 271-3881 (810) 635-3355 (989) 362-9180 (989) 362-3311 (734) 955-9110 (313) 299-3300 (734) 287-3880 (313) 887-6077 (313) 292-3750 (313) 357-2700 (734) 720-7355 (734) 250-8858 (313) 291-2182 (313) 395-2120 (313) 299-8813 (313) 292-2716

217 E MAIN ST 37300 DEQUINDRE RD STE 122 43042 SCHOENHERR RD 13721 19 MILE RD 2405 E 14 MILE RD 44344 DEQUINDRE RD STE 120 43337 SCHOENHERR RD 2101 17 MILE RD 6031 19 MILE RD STE A 37771 SCHOENHERR RD 34644 DEQUINDRE RD 3979 17 MILE RD 35814 DEQUINDRE RD 4135 15 MILE RD 39880 VAN DYKE AVE 43500 VAN DYKE 35450 DEQUINDRE RD STE 102 38924 DEQUINDRE RD 43009 HAYES RD 5637 CLEVELAND AVE 110 S CLINTON ST 93A FOURTH ST 321B N SAINT JOSEPH ST 8021 MILLER RD 220 W LAKE ST 306 W LAKE ST 27260 EUREKA RD 25418 GODDARD RD 23241 EUREKA RD 10000 TELEGRAPH STE 115A 22350 WICK RD 10501 TELEGRAPH RD 14625 TELEGRAPH RD 12701 TELEGRAPH RD 8750 TELEGRAPH RD STE 104 23268 ECORSE RD 9320 TELEGRAPH RD 21225 ECORSE RD

STANTON STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STERLING HEIGHTS STEVENSVILLE STOCKBRIDGE SUTTONS BAY SUTTONS BAY SWARTZ CREEK TAWAS CITY TAWAS CITY TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR TAYLOR

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48888-0000 48310-3595 48313-1952 48313 48310-5961 48314-1038 48313 48310-6803 48314-2181 48312-2302 48310 48310-6835 48310-4290 48310-5400 48313-4668 48314-2436 48310-4810 48310-2890 48313-2352 49127-9613 49285-9148 49682-9487 49682-5104 48473-1342 48763 48763-8308 48180-4845 48180-6200 48180-5240 48180 48180-3607 48180-3375 48180-4637 48180-6847 48180-2398 48180-1769 48180-3362 48180-2328

SCHMIDT & SONS PHCY OF TECUMSEH INC SHIVAAY 1 PLLC ANSON PHARMACY

(517) 423-3250 (517) 301-4555 (734) 568-6688

120 E CHICAGO BLVD 6869 S OCCIDENTAL HWY 8926 LEWIS AVE

TECUMSEH TECUMSEH TEMPERANCE

MI MI MI

49286-1587 49286 48182-1607

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 305 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CRARY DRUG GLENS PHARMACY HOMETOWN PHARMACY #46 - TC EAST HOMETOWN PHARMACY LTC HOMETOWN PHCY TRAVERSE CITY MCHC PHARMACY MCHC SPECIALTY CARE PHARMACY

Provider Name

(734) 847-6788 (231) 943-4017 (231) 946-0900 (231) 922-2952 (231) 947-6921 (231) 935-8730 (231) 935-8734

8941 LEWIS AVE 4122 US31 SOUTH 1128 S GARFIELD AVE 404 W. COMMERCE DRIVE STE B 4000 EASTERN SKY DR # 1 550 MUNSON AVE STE 100G 550 MUNSON AVE STE G-100A

TEMPERANCE TRAVERSE CITY TRAVERSE CITY TRAVERSE CITY TRAVERSE CITY TRAVERSE CITY TRAVERSE CITY

MI MI MI MI MI MI MI

48182-1656 49685 49686 49685 49684 49686-3580 49686

MUNSON AMBULATORY TRAVERSE CITY PETERTYL DRUG SIXTH STREET DRUG INC THOMPSON PHARMACY

(231) 935-5678 (231) 946-4830 (231) 946-4570 (231) 947-4212

1105 6TH ST 111 E FRONT ST 1020 6TH ST 324 S UNION ST

TRAVERSE CITY TRAVERSE CITY TRAVERSE CITY TRAVERSE CITY

MI MI MI MI

49684-2349 49684-2508 49684-2302 49684-2535

THOMPSON PHARMACY - OLESON WEST THOMPSON PHARMACY OLESONS EAST BAYVIEW RIVERSIDE PHARMACY KINGSWAY MEDICAL PHARMACY OAKWOOD PHARMACY TRENTON WEST GRANGE SAV-MOR PHARMACY GABECARE DIRECT RX HOMESCRIPTS.COM MED INDEX PHARMACY LLC MEDICAL CENTER PHARMACY ONECARE LTC RX IV INFUSION INC SOMERSET PHARMACY TROY CITY PHARMACY INC TROY PROFESSIONAL PHARMACY UNASOURCE PHARMACY UNIVERSITY RX SAV-MOR PHARMACY MILLER'S PHARMACY MCLAREN DRUG SHOP - VASSAR FREDS VICKSBURG COMM PHCY HILL'S PHARMACY PONTIAC TRAIL SAVMOR PHARMACY ABE'S PHARMACY

(231) 947-2880 (231) 947-2203 (734) 676-3784 (734) 493-3127 (734) 642-2190 (734) 676-6622 (800) 422-3227 (248) 824-6300 (248) 526-0358 (248) 828-8090 (844) 258-8800 (248) 435-9400 (248) 280-2222 (248) 688-9224 (248) 689-0200 (248) 312-0037 (248) 267-5002 (517) 741-3604 (989) 823-9200 (269) 649-0660 (269) 649-1476 (248) 669-2776 (313) 686-8666

3850 N LONG LAKE RD STE 101 1100 E HAMMOND RD 2920 W JEFFERSON AVE 1675 KINGSWAY CT 5450 FORT ST 3390 WEST RD 830 KIRTS BLVD STE 300 500 KIRTS BLVD 1639 E BIG BEAVER RD STE 101 44201 DEQUINDRE RD 1945 HEIDE DR 1938 WOODSLEE DR 1380 COOLIDGE HWY STE 125 1903 E WATTLES RD 2891 E MAPLE RD STE 105 4600 INVESTMENT DRIVE STE 100 2520 LIVERNOIS RD 206 N BROADWAY ST 181 W HURON RD 121 W PRAIRIE ST 110 S MAIN ST 620 N PONTIAC TRAIL 13760 E 12 MILE RD

TRAVERSE CITY TRAVERSE CITY TRENTON TRENTON TRENTON TRENTON TROY TROY TROY TROY TROY TROY TROY TROY TROY TROY TROY UNION CITY VASSAR VICKSBURG VICKSBURG WALLED LAKE WARREN

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

49684-9601 49686 48183 48183-1958 48183-4601 48183-2323 48084-4897 48084-5225 48083-2053 48085-1117 48084-5313 48083-2235 48084 48085-5083 48083-6103 48098 48083-4703 49094-1154 48768-1235 49097-1258 49097-1211 48390 48088-3751

AMERICAN MAIL ORDER PHARMACY INC BC OF MICHIGAN PHARMACY BEAUMONT PHARMACY SOLUTIONS BERKLEY PHARMACY BUCKLEY'S PHARMACY

(586) 772-6872 (586) 578-0220 (586) 753-4180 (586) 573-8300 (586) 558-8787

23290 SCHOENHERR RD 4050 E 12 MILE RD 27027 MOUND RD STE 100 28577 SCHOENHERR RD 29200 RYAN RD

WARREN WARREN WARREN WARREN WARREN

MI MI MI MI MI

48089-4260 48092 48092-2615 48088-4330 48092-4242

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 306 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name CARERX SPECIALTY PHARMACY COMMUNITY RX PHARMACY DOLLAR MART PHARMACY FLETH DISCOUNT PHARMACY GENOA-QOL HEALTHCARE GREATER CARE PHARMACY HOOVER DRUGS LLC NEW MICHIGAN PHARMACY NOOR PHARMACY PHARMOR PHARMACY WARREN RYAN PHARMACY SUSSEX DRUGS UNIVERSAL GRACE PHARMACY LLC UNIVERSAL PHARMACY VILLAGE PHARMACY WARREN PHARMACY WARREN PHARMACY ORCHARD VIEW PHARMACY LLC GENOA-QOL HEALTHCARE HIGHLAND PHARMACY LAKEVIEW PHARMACY NCA PHARMACY VALUE CENTER PHARMACY III WATERFORD MEDICAL PHARMACY WAYLAND VILLAGE DRUG INC A-V PHARMACY CARE HOME RX MHP PHARMACY WAYNE OAKWOOD PHARMACY WAYNE ONE STOP PHARMACY VENOY MEDICAL PHARMACY VENOY RX WAYNE DRUGS WAYNE PROFESSIONAL PHARMACY VILLAGE DRUG SHOP BEAUMONT PHCY WEST BLOOMFIELD LAKES DISCOUNT SAV-MOR PHARMACY MAPLE PHARMACY INC SAV ON 11 EFROS WEST BLOOMFIEL FAMILY FARE PHARMACY OGEMAW PHARMACY COBB CLINIC PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (734) 656-4082 (586) 920-2225 (586) 576-0334 (586) 576-7104 (586) 758-7000 (586) 486-5008 (586) 522-4334 (586) 757-9402 (586) 268-3900 (586) 757-9100 (586) 755-0040 (586) 757-6505 (586) 999-5951 (586) 274-9030 (586) 751-7979 (586) 754-0000 (586) 510-4252 (586) 336-9552 (248) 409-1105 (248) 977-1394 (248) 681-5252 (248) 461-6509 (248) 724-2401 (248) 674-4853 (269) 792-6223 (734) 331-9988 (206) 225-9054 (734) 329-5242 (734) 467-2560 (734) 727-2000 (734) 729-2882 (734) 729-5456 (734) 629-4336 (734) 728-8306 (517) 521-3484 (248) 855-5505 (248) 668-1212 (248) 757-2503 (248) 626-3400 (989) 345-5610 (989) 343-5300 (734) 523-6500

Provider Street 13201 STEPHENS RD STE G 27124 DEQUINDRE RD 13465 E 12 MILE RD 7635 E 8 MILE RD STE 4 24788 FORTERRA DR 24800 HOOVER RD STE B 28783 HOOVER RD 7239 E 9 MILE ROAD 4092 E 14 MILE RD STE 200 27379 VAN DYKE AVE 23421 RYAN RD 22835 VAN DYKE 31500 DEQUINDRE RD STE 300 4600 E 14 MILE RD STE 2 6213 CHICAGO STE 200 26000 HOOVER RD 28792 RYAN RD 12150 30 MILE RD STE 104 279 SUMMIT DR STE 200 4000 HIGHLAND RD STE 113 3901 HIGHLAND RD STE D2 7362 HIGHLAND RD 7300 HIGHLAND 3560 PONTIAC LAKE RD 300 RENO DR 35400 E MICHIGAN AVE 4603 S WAYNE RD 35540 W MICHIGAN AVE 33155 ANNAPOLIS ST 33950 VAN BORN RD 4020 VENOY RD STE 900 4020 VENOY RD STE 900B 34815 W MICHIGAN AVE STE B 34841 VETERANS PLAZA 113 W GRAND RIVER AVE 6900 ORCHARD LAKE RD STE 104 2300 HAGGERTY RD STE 1070 5829 W MAPLE RD # 129 6427 ORCHARD LAKE RD 2206 S M 76 700 COLUMBUS AVE 8623 N WAYNE RD STE 101

Page 307 of 679

Provider City WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARREN WASHINGTON WATERFORD WATERFORD WATERFORD WATERFORD WATERFORD WATERFORD WAYLAND WAYNE WAYNE WAYNE WAYNE WAYNE WAYNE WAYNE WAYNE WAYNE WEBBERVILLE WEST BLOOMFIELD WEST BLOOMFIELD WEST BLOOMFIELD WEST BLOOMFIELD WEST BRANCH WEST BRANCH WESTLAND

State

ZIP code

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48089-4340 48092 48088-3625 48091 48089-4375 48089-1965 48093-4152 48091-2682 48092 48093-2805 48091-1927 48089 48092-1057 48092-4369 48092 48089 48092-2521 48095 48328-3364 48328-2163 48328-2132 48327-1508 48327-1508 48328-2337 49348-1277 48184-1699 48184-2310 48184-1626 48184-2405 48184 48184-2495 48184-1869 48184 48184-1733 48892-5120 48322-3424 48323-2184 48322-2294 48322 48661-9343 48661-8705 48185-1137

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DIAL DRUGS

Provider Name

(734) 427-2850

8226 N MERRIMAN RD

WESTLAND

MI

48185

GOOD NEIGHBOR'S FAMILY PHARMACY JOY HIX CARE + PHARMACY MED HEALTH PHARMACY MED SYNC PHARMACY LLC MINT PHARMACY OAKWOOD PHARMACY WESTLAND PLATINUM LIFE PHARMACY PLLC RX CARE PHARMACY RX EXPRESS PHARMACY SAV-ON DRUGS 19 CHECKER SCRIPTWAY PHARMACY WELLGREENS PHARMACY WESTLAND MAPLE DRUGS INC FAMILY HEALTH CARE PHARMACY PITKIN DRUG AND GIFT SHOPPE SAV ON 15 PROOS PHARMACY D AND W PHARMACY PHARMACY PLUS #2 COMP RX PHARMACY SAV-ON 14 WOODHAVEN PHARMACY GREAT LAKES PHARMACY LLC MEDS & MORE PHARMACY PRIME PHARMACY WYANDOTTE DRUGS WYANDOTTE PHARMACY FAMILY FARE PHARMACY FAMILY FARE PHARMACY PARKWOOD PHARMACY LLC MCLAREN PHARMACY-YALE SHELDON PHARMACY OF YALE INC ANN ARBOR HOME INFUSION PHCY ANN ARBOR PROFESSIONAL PHCY ARBOR LAKES PHARMACY BARRON PHARMACY CANALIS MEDICAL PHARMACY LLC EASTERN SAV MOR PHARMACY FRANK'S DRUGS HIMSON PHARMACY PHARMED PHARMACY SAINT JOSEPH MERCY PHARMACY

(734) 722-8774 (734) 927-5100 (734) 466-5232 (734) 329-2454 (734) 728-5900 (734) 727-1040 (734) 469-2424 (734) 728-4030 (734) 525-6000 (734) 728-5200 (313) 891-2253 (734) 728-4083 (734) 729-2200 (231) 689-6677 (231) 893-5495 (734) 449-0004 (517) 655-1372 (517) 655-2420 (734) 307-7018 (734) 675-2211 (734) 224-6400 (734) 246-2800 (734) 309-7082 (734) 282-2877 (734) 720-0929 (616) 538-1490 (616) 724-1944 (616) 245-2463 (810) 387-0601 (810) 387-4244 (734) 712-2492 (734) 477-9006 (734) 340-6050 (734) 528-9144 (734) 483-0952 (734) 485-9900 (734) 483-0411 (734) 544-0920 (734) 544-8445 (734) 712-2222

1956 S VENOY RD 38409 JOY RD 8024 N MIDDLEBELT RD 2325 S VENOY RD 2074 S WAYNE RD 2001 S MERRIMAN RD STE 200 30785 ANN ARBOR TRL 6300 COMMERCE DR 6149 N WAYNE RD 190 S WAYNE ROAD 1207 S WAYNE RD 1629 S MERRIMAN RD 1949 WAYNE RD 1035 E WILCOX AVE 101 W COLBY ROAD 11912 WHITMORE LAKE ROAD 151 W GRAND RIVER AVE 129 S PUTNAM ST 18930 WEST RD 22981 HALL RD 3247 BIDDLE AVE STE A 2300 BIDDLE AVE STE 101 1948 FORD AVE 364 EUREKA RD 375 EUREKA RD 2900 BURLINGAME AVE SW 1148 28TH ST SW 1106 BURTON ST SW 7470 BROCKWAY RD 25 S MAIN ST 5301 MCAULEY DR 6 W MICHIGAN AVE 1549 HOLMES RD 4870 W CLARK RD STE 108 200 ARNET ST 1159 E MICHIGAN AVE 204 W MICHIGAN AVE 209 S FORD BLVD 1510 WASHTENAW RD STE B 5333 MCAULEY DR RM 1010

WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WESTLAND WHITE CLOUD WHITEHALL WHITMORE LAKE WILLIAMSTON WILLIAMSTON WOODHAVEN WOODHAVEN WYANDOTTE WYANDOTTE WYANDOTTE WYANDOTTE WYANDOTTE WYOMING WYOMING WYOMING YALE YALE YPSILANTI YPSILANTI YPSILANTI YPSILANTI YPSILANTI YPSILANTI YPSILANTI YPSILANTI YPSILANTI YPSILANTI

MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI

48186-4600 48185-1014 48185-1808 48186-4662 48186-5428 48186-5541 48185-2473 48185 48185 48186 48186 48186 48185-3773 49349-8794 49461 48189 48895-1317 48895-1335 48183-3317 48183 48192-5951 48192 48192-2308 48192-5840 48192-5839 49509-2610 49509-2855 49509-1435 48097 48097-3317 48197-1051 48197-5437 48198-4147 48197-1104 48198-5753 48198 48197-5441 48198 48197-2039 48197-1087

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 308 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SALEM'S PHARMACY ST JOSEPH MERCY PHCY TOWERS YPSILANTI FAMILY PHARMACY BUNTE'S PHARMACY FAMILY FARE PHARMACY STERLING DRUG CURT'S LONG TERM CARE PHARMACY CURTS PHARMACY STERLING DRUG ALEXANDRIA APOTHECARY CUB PHARMACY TRUMM DRUG CLINIC PHARMACY TRUMM DRUG INC WHITE DRUG FAIRVIEW ANDOVER PHARMACY GOODRICH PHARMACY-ANDOVER ARENSON HEALTHMART PHARMACY GOODRICH PHARMACY CUB PHARMACY FAIRVIEW CEDAR RIDGE PHARMACY

Provider Name

(734) 487-8500 (734) 712-3333 (734) 434-2448 (616) 772-4685 (616) 748-7384 (507) 483-2332 (507) 377-1062 (507) 373-6337 (507) 373-1486 (320) 763-3065 (320) 759-1135 (320) 763-3116 (320) 763-3111 (320) 762-1531 (763) 862-4445 (763) 434-1901 (320) 274-5415 (763) 421-5540 (952) 431-2221 (952) 997-4155

313 ECORSE RD 5301 MCAULEY DR 3145 W CLARK RD STE 106 115 E MAIN ST 9479 RILEY ST STE 100 209 MAINE AVE 1615 W MAIN ST STE B 1615 W MAIN ST 148 S BROADWAY 1525 BROADWAY ST STE 100 2612 S BROADWAY ST 610 30TH AVE W 600 FILLMORE ST 3015 HIGHWAY 29 S STE 4040 13819 HANSON BLVD NW 15245 BLUEBIRD ST NW 43 OAK AVE N 601 JACOB LN 15350 CEDAR AVE 15650 CEDAR AVE

YPSILANTI YPSILANTI YPSILANTI ZEELAND ZEELAND ADRIAN ALBERT LEA ALBERT LEA ALBERT LEA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ANDOVER ANDOVER ANNANDALE ANOKA APPLE VALLEY APPLE VALLEY

MI MI MI MI MI MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

48198-5733 48197-1051 48197 49464-1793 49464-8748 56110-1225 56007-1868 56007-1868 56007-2544 56308-3008 56308-3415 56308-3426 56308-1706 56308-4523 55304-7608 55304-3554 55302-1199 55303-1621 55124-7021 55124-7022

HEALTHPARTNERS APPLE VALLEY PHARMAC CUB PHARMACY HEALTHPARTNERS ARDEN HILLS PHCY MORREIM PHARMACY MEDICAP PHARMACY STERLING DRUG K&S PHARMACY BARNESVILLE DRUG & HARDWARE SEIP DRUG NOBLE DRUG CUB PHARMACY ESSENTIA HEALTH BAXTER PHCY CENTRA CARE PHARMACY BECKER FIRST CHOICE PHARMACY IVERSON CORNER DRUG INC. MEDSAVE FAMILY PHARMACY MERIT CARE NORTH PHARMACY MERITCARE BEMIDJI PHARMACY

(952) 431-8566 (651) 483-1504 (651) 523-8599 (507) 964-5228 (507) 433-7123 (507) 433-4586 (320) 356-1000 (218) 354-2131 (218) 864-5261 (218) 634-1236 (218) 855-0880 (218) 454-5920 (763) 261-7008 (952) 855-4381 (218) 444-3000 (218) 759-1222 (218) 333-4770 (218) 333-5265

15290 PENNOCK LN 3717 LEXINGTON AVE N 3930 NORTHWOODS DR 201 W MAIN ST 1109 W OAKLAND AVE 1305 1ST AVE SW 107 AVON AVE S STE 1 117 FRONT ST S 113 LAKE AVE N 111 N MAIN AVE 14133 EDGEWOOD DR 13060 ISLE DR 12800 ROLLING RIDGE RD 165 W COMMERCE DRIVE SUITE 110 408 MINNESOTA AVE NW 217 PAUL BUNYAN DR NW 1705 ANNE ST NW STE 3-7 1233 - 34TH STREET, N.W.

APPLE VALLEY ARDEN HILLS ARDEN HILLS ARLINGTON AUSTIN AUSTIN AVON BARNESVILLE BATTLE LAKE BAUDETTE BAXTER BAXTER BECKER BELLE PLAINE BEMIDJI BEMIDJI BEMIDJI BEMIDJI

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55124-7163 55126-3081 55112-6963 55307-9700 55912-2245 55912-1601 56310-8517 56514 56515-4048 56623-2466 56425-8462 56425-8331 55308-8838 56011 56601-3127 56601-2433 56601-6151 56601

SANFORD PHARMACY 1611 ANNE STREET TRUAX PATIENT SERVICES

(218) 333-2450 (218) 444-8217

1611 ANNE ST NW 602 BELTRAMI AVE NW SUITE 105

BEMIDJI BEMIDJI

MN MN

56601-5114 56601

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 309 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BREEN'S PHARMACY, INC. SEIP DRUG BIG FORK VALLEY PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY FAIRVIEW PHARMACY BLAINE GOODRICH PHARMACY BLOOMINGTON DRUG FAIRVIEW OXBORO PHARMACY HEALTHPARTNERS 8170 PHARMACY

Provider Name

(320) 842-4221 (218) 924-2124 (218) 743-4444 (763) 780-7350 (763) 767-4329 (763) 767-8271 (763) 784-0334 (763) 528-2975 (763) 717-0222 (952) 884-7528 (952) 885-6166 (952) 967-6972

1207 PACIFIC AVE 124 2ND AVE NW 258 PINE TREE DR 585 NORTHTOWN DR NE 12595 CENTRAL AVE NE 10881 UNIVERSITY AVE NE 4205 PHEASANT RIDGE DR NE 10961 CLUB WEST PKWY 11855 ULYSSES ST NE 509 W 98TH ST 600 W 98TH ST 8170 33RD AVE S

BENSON BERTHA BIGFORK BLAINE BLAINE BLAINE BLAINE BLAINE BLAINE BLOOMINGTON BLOOMINGTON BLOOMINGTON

MN MN MN MN MN MN MN MN MN MN MN MN

56215-1838 56437-2002 56628-0000 55434-1044 55434-4861 55434-8032 55449-4529 55449-5866 55434 55420-4713 55420-4773 55425-4516

HEALTHPARTNERS BLOOMINGTON PHCY LUNDS PHARMACY #51006 PARK NICOLLET PHARMACY PARK NICOLLET PHARMACY BLUE EARTH DRUG CUB PHARMACY

(952) 541-2802 (952) 224-5034 (952) 977-0470 (952) 993-2530 (507) 526-2121 (218) 828-0440

8600 NICOLLET AVE S 5159 W 98TH ST 8100 NORTHLAND DR 5320 HYLAND GREENS DR 405 S GROVE ST 417 8TH AVE NE

BLOOMINGTON BLOOMINGTON BLOOMINGTON BLOOMINGTON BLUE EARTH BRAINERD

MN MN MN MN MN MN

55420 55437 55431-4800 55437-3934 56013-2629 56401-2806

ESSENTIA HEALTH BRAINERD PHARMACY GUIDEPOINT PHARMACY NYSTROM THRIFTY DRUG BRECKENRIDGE DRUG CUB PHARMACY

(218) 829-7455 (218) 829-0347 (218) 829-3529 (218) 643-5411 (763) 503-6810

2024 S 6TH ST 108 S 6TH ST 223 S 8TH ST 116 5TH ST N 3245 COUNTY RD 10

BRAINERD BRAINERD BRAINERD BRECKENRIDGE BROOKLYN CENTER

MN MN MN MN MN

56401-4529 56401-3575 56401-3620 56520-1421 55429

HEALTHPARTNERS BROOKLYN CTR PHCY PARK NICOLLET PHARMACY SUN PHARMACY CUB PHARMACY CUB PHARMACY POLAR PHCY & MEDICAL SUPPLIES ALLINA HEALTH BUFFALO IN/P CUB PHARMACY STERLING DRUG BYERLY'S PHARMACY CUB PHARMACY CUB PHARMACY FAIRVIEW PHARMACY BURNSVILLE

(763) 503-4418 (952) 993-4800 (763) 561-0722 (763) 424-0525 (763) 315-0737 (763) 777-5995 (763) 684-7676 (763) 682-5828 (763) 682-1911 (952) 435-8145 (952) 894-0712 (952) 892-6262 (952) 405-5630

6845 LEE AVE N 6000 EARLE BROWN DR 6350 BROOKLYN BLVD 7555 W BROADWAY AVE 9655 COLORADO LN 8561 EDINBURGH CENTER DR 303 CATLIN ST 1008 HIGHWAY 55 E 25 EAST DIVISION ST 401 EAST COUNTY RD 42 300 E TRAVELERS TRL 1750 COUNTY ROAD 42 W 14101 FAIRVIEW DR, STE 100

BROOKLYN CENTER BROOKLYN CENTER BROOKLYN CENTER BROOKLYN PARK BROOKLYN PARK BROOKLYN PARK BUFFALO BUFFALO BUFFALO BURNSVILLE BURNSVILLE BURNSVILLE BURNSVILLE

MN MN MN MN MN MN MN MN MN MN MN MN MN

55429-1717 55430-2506 55429 55428-1297 55445-2315 55443 55313-1947 55313-8923 55313-1522 55306-5706 55337-2885 55337-6200 55337

FAIRVIEW RIDGES HOSPITAL PHARMACY PARK NICOLLET PHARMACY

(952) 892-2130 (952) 993-8524

201 E NICOLLET BLVD 14000 FAIRVIEW DR

BURNSVILLE BURNSVILLE

MN MN

55337-5714 55337-5713

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 310 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RIDGEVIEW PHARMACY STERLING DRUG ALLINA HEALTH CAMBRIDGE CUB PHARMACY

Provider Name

(952) 892-2640 (507) 724-3328 (763) 689-7809 (763) 689-0185

303 E NICOLLET BLVD 615 ESCH DR 701 DELLWOOD ST 100 XYLITE ST NE

BURNSVILLE CALEDONIA CAMBRIDGE CAMBRIDGE

MN MN MN MN

55337-4522 55921-1274 55008-1920 55008-5809

MAYO CLINIC PHARMACY CANNON FALLS SCOFIELD DRUG & GIFT GORDYS PHARMACY INC CUB PHARMACY BYERLY'S PHARMACY CUB PHARMACY PARK NICOLLET PHARMACY CENTER DRUG PHARMACY CHANHASSEN CENTER DRUG CUB PHARMACY WEBER & JUDD - CHATFIELD FAIRVIEW PHARMACY CHISAGO CITY CASEY DRUG INC FAIRVIEW LAKES PHARMACY CLARISSA DRUG WHITE DRUG THE MEDICINE SHOPPE THE MEDICINE SHOPPE WHITE DRUG COOK HOSPITAL PHARMACY FRANKS PHARMACY

(507) 263-9825 (507) 263-2881 (651) 257-4500 (763) 422-8700 (952) 380-5970 (952) 934-2865 (952) 993-4430 (952) 949-1002 (952) 949-1002 (952) 448-5112 (507) 867-4425 (651) 213-8080 (218) 254-3318 (651) 717-3401 (218) 756-2242 (218) 776-3111 (218) 879-1501 (218) 879-4547 (218) 879-6768 (218) 666-6229 (218) 666-5325

32021 COUNTY 24 BLVD STE 1716 108 4TH ST N 320 SUMMIT AVE 8600 114TH AVE N 800 W 78TH ST 7900 MARKET BLVD 300 LAKE DR E 111 HUNDERTMARK RD STE 100 111 HUNDERTMARK RD 200 PIONEER TRAIL 237 MAIN ST NORTH 11725 STINSON AVE BLDG B 121 W LAKE ST 7455 VILLAGE DR 210 MAIN ST W 30 MAIN STREET SOUTH 419 SKYLINE BLVD 1208 CLOQUET AVE 707 HIGHWAY 33 S STE 12 10 5TH ST SE 1 W VERMILION DR

CANNON FALLS CANNON FALLS CENTER CITY CHAMPLIN CHANHASSEN CHANHASSEN CHANHASSEN CHASKA CHASKA CHASKA CHATFIELD CHISAGO CITY CHISHOLM CIRCLE PINES CLARISSA CLEARBROOK CLOQUET CLOQUET CLOQUET COOK COOK

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55009 55009-2095 55012-9675 55316-3792 55317-9578 55317-4565 55317-9302 55318-1110 55318 55318 55923-1391 55013 55719 55014-1181 56440 56634 55720-1164 55720-1622 55720-2665 55723-9702 55723-9504

ALLINA HEALTH HOME INFUSION THERAPY ALLINA HEALTH MERCY CUB PHARMACY HEALTHPARTNERS COON RAPIDS PHCY ALLINA HEALTH COTTAGE GROVE CUB PHARMACY HUGOS FAMILY PHARMACY WHITE DRUG CUYUNA LAKES PHARMACY GUIDEPOINT PHARMACY #106 CROSSLAKE DRUG CUB PHARMACY DAWSON DRUG & GIFTS NELSON REXALL DRUG COMPANY OTT DRUG STORE

(763) 236-6991 (763) 236-7111 (763) 754-9036 (763) 587-9016 (651) 241-0424 (651) 459-7324 (218) 281-3174 (218) 281-2540 (218) 546-2345 (218) 546-5144 (218) 692-2502 (763) 287-9797 (320) 769-2229 (320) 769-2546 (218) 246-8642

4050 COON RAPIDS BLVD NW #123 11850 BLACKFOOT ST NW STE 190 2050 NORTHDALE BLVD NW 11475 NW ROBINSON DR 8611 W POINT DOUGLAS RD 8690 E PT DOUGLAS RD S 1310 UNIVERSITY AVE 206 N MAIN ST 320 E MAIN ST STE 2 20 W MAIN ST 14311 GOULD ST 5301 36TH AVE N 812 6TH ST 728 6TH ST # 449 117 MAIN AVE E

COON RAPIDS COON RAPIDS COON RAPIDS COON RAPIDS COTTAGE GROVE COTTAGE GROVE CROOKSTON CROOKSTON CROSBY CROSBY CROSSLAKE CRYSTAL DAWSON DAWSON DEER RIVER

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55433 55433-2583 55433-3036 55433-3746 55016-4005 55016-4007 56716-1163 56716-1743 56441-1645 56441-1422 56442-0578 55422-2811 56232-2401 56232-2400 56636

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 311 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

D L PHARMACY MERITCARE DETROIT LAKES PHARMACY WHITE DRUG CUB PHARMACY ESS HLTH DULUTH 1ST ST PHCY

Provider Name

(218) 847-3537 (218) 846-2275 (218) 847-9248 (218) 727-3010 (218) 786-1685

211 FRAZEE ST E 1245 WASHINGTON AVE 808 WASHINGTON AVE 615 W CENTRAL ENTRANCE 420 E 1ST ST STE A

DETROIT LAKES DETROIT LAKES DETROIT LAKES DULUTH DULUTH

MN MN MN MN MN

56501-3503 56501-3905 56501-3033 55811-5448 55805-1901

ESSENTIA HEALTH DULUTH 3RD STREET P

(218) 786-3137

400 E 3RD ST SUITE A

DULUTH

MN

55805-1951

ESSENTIA HEALTH LAKEWALK PHARMACY ESSENTIA HLTH LAKESIDE PHCY ESSENTIA HLTH WEST DULUTH PHCY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE NORTH LAND PHARMACY BYERLYS PHARMACY CUB PHARMACY CUB PHARMACY PARK NICOLLET PHARMACY HUGOS FAMILY PHARMACY BYERLY'S PHARMACY CUB PHARMACY FAIRVIEW EDEN PRAIRIE PHARMACY GENOA-QOL HEALTHCARE HEALTHPARTNERS PHARMACY HEALTHPARTNERS PHARMACY GUIDEPOINT PHARMACY BYERLY'S PHARMACY CUB PHARMACY FAIRVIEW COMMUNITY PHARMACY LUNDS PHARMACY SOUTHDALE MEDICAL PHARMACY TRUMM DRUG ELBOW LAKE CUB PHARMACY FAIRVIEW NORTHLAND PHARMACY GOODRICH ELK RIVER KEMPER DRUG THE ELY COMMUNITY PHARMACY JON'S DRUG STERLING DRUG ALLINA HEALTH DISTRICT ONE STERLING DRUG SAVER'S CHOICE

(218) 733-1110 (218) 786-3784 (218) 786-3700 (218) 428-9408 (218) 728-2208 (218) 249-2460 (651) 209-2974 (651) 452-5663 (651) 454-5150 (952) 993-4004 (218) 773-0611 (952) 934-5520 (952) 941-6728 (952) 826-6680 (612) 392-0515 (952) 833-0341 (952) 833-0341 (507) 631-0080 (952) 277-8663 (952) 925-3911 (952) 924-1400 (952) 224-9880 (952) 924-1499 (218) 685-4471 (763) 241-8112 (763) 241-5890 (763) 441-0764 (763) 441-1353 (218) 365-8788 (218) 744-2774 (507) 238-2797 (507) 332-4797 (507) 333-5464 (651) 460-6160

1502 LONDON RD STE 101 4621 E SUPERIOR ST STE A 4212 GRAND AVE STE A 332 W SUPERIOR ST STE 300 1401 E 1ST ST 1000 E 1ST ST STE 200 1299 PROMENADE PL 1276 TOWN CENTRE DR 1940 CLIFF LAKE RD 1885 PLAZA DR 224 14TH ST NE 970 PRAIRIE CENTER DR 8015 DEN RD 830 PRAIRIE CENTER DR 11010 PRAIRIE LAKES DR STE 350 9700 W 76TH ST STE 106 9700 W 76TH ST STE 106 735 MAIN ST 7171 FRANCE AVE S 6775 YORK AVE S 6363 FRANCE AVE S 3945 W 50TH ST 6545 FRANCE AVE S 11 CENTRAL AVE S 19216 FREEPORT ST NW 290 MAIN ST STE 110 530 3RD ST 323 JACKSON AVE NW 328 W CONAN ST 318 GRANT AVE 322 S STATE ST 200 STATE AVE 430 2ND AVE NW 115 ELM ST

DULUTH DULUTH DULUTH DULUTH DULUTH DULUTH EAGAN EAGAN EAGAN EAGAN EAST GRAND FORKS EDEN PRAIRIE EDEN PRAIRIE EDEN PRAIRIE EDEN PRAIRIE EDEN PRAIRIE EDEN PRAIRIE EDGERTON EDINA EDINA EDINA EDINA EDINA ELBOW LAKE ELK RIVER ELK RIVER ELK RIVER ELK RIVER ELY EVELETH FAIRMONT FARIBAULT FARIBAULT FARMINGTON

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55812 55804-2338 55807-2737 55802-1844 55805-2407 55805-2297 55121 55123 55122-2492 55122-2612 56721-1628 55344-7304 55344-8017 55344-7301 55344-3801 55344-4200 55344-4201 56128 55435 55435-2514 55435-2129 55424-1203 55435-2131 56531-4101 55330-1265 55330-1272 55330-1445 55330-2523 55731-1145 55734-1524 56031 55021-6339 55021-5142 55024-1033

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 312 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUN MART PHARMACY WHITE DRUG WHITE DRUG WHITE DRUG FOLEY DRUG CUB PHARMACY ROLSETH DRUG CO NORD'S PHARMACY & GIFTS PALUBICKI'S PHARMACY SEIP DRUG FAIRVIEW PHARMACY FRIDLEY GOODRICH PHARMACY TOTAL CARE PHARMACY GUIDEPOINT PHARMACY RIVERWOOD GARRISON CLINIC PHCY FIRST CHOICE PHARMACY TRUMM DRUG GLENWOOD GRAND MARAIS PHARMACY NORTH SHORE PHARMACY GLOBE DRUG AND MEDICAL EQUIP GRAND ITASCA PHARMACY WHITE DRUG STERLING #27 ALLINA HEALTH REGINA CUB PHARMACY STERLING DRUG # 14 LIVING GOOD PHARMACY WAHL DRUG SIVERSONS DRUG STORE

Provider Name

(218) 739-3259 (218) 736-5565 (218) 736-5770 (218) 945-6174 (320) 259-0000 (651) 982-4603 (651) 464-2114 (218) 435-6646 (218) 435-1000 (218) 334-3070 (763) 586-5981 (763) 780-0222 (763) 444-1064 (507) 425-3166 (320) 525-3401 (507) 237-2933 (320) 634-4434 (218) 387-2110 (218) 387-1133 (218) 326-2635 (218) 999-4479 (218) 326-9431 (507) 886-2322 (651) 404-1244 (651) 438-2135 (651) 437-9608 (218) 486-4663 (218) 483-3324 (507) 275-3323

1205 W LINCOLN AVE 1484 LINCOLN AVE WEST 111 W VERNON AVE 203 S MILL ST 351 DEWEY ST 2013 W BROADWAY AVE 107 LAKE ST N 115 JOHNSON AVE N 300 1ST STREET WEST 104 E MAIN AVE 6341 UNIVERSITY AVE NE STE 101 480 OSBORNE RD STE 180 7221 UNIVERSITY AVE 115 N ST PAUL AVE 27278 STATE HIGHWAY 18 660 3RD ST 1 MINNESOTA AVE E 425 W HIGHWAY 61 21 WEST HIGHWAY 61 304 N POKEGAMA AVE 1601 GOLF COURSE ROAD 1105 S POKEGAMA AVE 44 MAIN AVE N 1175 NININGER RD 1729 MARKET BLVD 1399 S FRONTAGE RD 1106 HOBART STREET 403 6TH ST 118 S MAIN ST

FERGUS FALLS FERGUS FALLS FERGUS FALLS FERTILE FOLEY FOREST LAKE FOREST LAKE FOSSTON FOSSTON FRAZEE FRIDLEY FRIDLEY FRIDLEY FULDA GARRISON GAYLORD GLENWOOD GRAND MARAIS GRAND MARAIS GRAND RAPIDS GRAND RAPIDS GRAND RAPIDS HARMONY HASTINGS HASTINGS HASTINGS HAWLEY HAWLEY HENDRICKS

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

56537-1003 56537-2216 56537-2718 56540-4216 56329-8406 55025-9373 55025-2504 56542-1327 56542-1217 56544-4500 55432 55432 55432 56131 56450 55334 56334-1625 55604-2334 55604 55744-2745 55744 55744-3905 55939-8888 55033-1056 55033-1254 55033-2427 56549 56549-4601 56136-1230

ESSENTIA HEALTH HERMANTOWN PHCY BARONS PHARMACY BARON'S PHARMACY ESSENTIA HEALTH HIBBING PHCY WHITE DRUG HOPKINS CENTER DRUG, INC. PARK NICOLLET PHARMACY MESABA DRUG INC FAIRVIEW PHARMACY HUGO CASHWISE PHARMACY FAMILY PHARMACY SOUTH FAMILY REXALL DRUG

(218) 786-3549 (218) 263-7455 (218) 263-4922 (218) 262-5225 (218) 262-6140 (952) 938-2719 (952) 993-4643 (218) 225-2128 (651) 466-1970 (320) 587-8070 (320) 587-3638 (320) 587-2509

4855 W ARROWHEAD RD STE A 1120 E 34TH ST 3605 MAYFAIR AVE 730 E 34TH ST STE A 3517 E BELTLINE 913 HOPKINS CTR 15111 TWELVE OAKS CENTER DR 221 KENNEDY MEMORIAL DR 14712 VICTOR HUGO BLVD N STE 1 1020 HIGHWAY 15 S 3 CENTURY AVE SE 237 HASSAN ST SE

HERMANTOWN HIBBING HIBBING HIBBING HIBBING HOPKINS HOPKINS HOYT LAKES HUGO HUTCHINSON HUTCHINSON HUTCHINSON

MN MN MN MN MN MN MN MN MN MN MN MN

55811-3936 55746-2909 55746-2935 55746-5109 55746-2337 55343-7533 55305-5201 55750-1141 55038-6324 55350-3154 55350-3108 55350-2524

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 313 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FAMILY REXALL DRUG, INC. CITY DRUG ESSENTIA HLTH INTL FALLS CUB PHARMACY HEALTHPARTNERS INVERGROVE HGTS THOMPSONS LAKE COUNTRY DRUG FIRST CHOICE PHARMACY WEBER & JUDD - KASSON STERLING #29 KENNEDY SNYDER DRUG LAKE ELMO PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CORNER DRUG HEALTH MART

Provider Name

(320) 587-2509 (218) 283-3061 (218) 285-6222 (651) 450-0676 (651) 552-2694 (320) 676-3115 (952) 492-3334 (507) 634-3341 (507) 895-8784 (651) 345-3411 (651) 773-0889 (952) 898-4505 (952) 891-5050 (952) 469-8404 (507) 665-3301

237 HASSAN ST SE 314 3RD ST 2501 KEENAN DR STE A 7850 CAHILL AVE 2625 CENEX DR 205 MAIN ST W 255 CREEK LN S 408 WEST MAIN ST 306 MAIN ST 223 S LAKESHORE DR 11240 STILLWATER BLVD N 17756 KENWOOD TRAIL 7435 179TH ST W 20250 HERITAGE DR 204 VALLEY GREEN SQ

HUTCHINSON INTERNATIONAL FALLS INTERNATIONAL FALLS INVER GROVE HEIGHTS INVER GROVE HEIGHTS ISLE JORDAN KASSON LA CRESCENT LAKE CITY LAKE ELMO LAKEVILLE LAKEVILLE LAKEVILLE LE SUEUR

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55350-2524 56649-2309 56649-2181 55076-3057 55077-1724 56342-4560 55352-1214 55944-1142 55947-1828 55041-1642 55042-9640 55044 55044-5264 55044-6869 56058-1915

LINDSTROM THRIFTY WHITE PHARMACY ECONOFOODS PHARMACY THE MEDICINE SHOPPE ST GABRIEL'S HOSPITAL LONG PRAIRIE THRIFTYWHITE PHCY GUIDEPOINT PHARMACY CUB PHARMACY CUB PHARMACY BYERLY'S PHARMACY CUB PHARMACY FAIRVIEW PHARMACY MAPLE GROVE NORTH MEMORIAL RX MAPLE GROVE PHARMACY AT PARK NICOLLET CUB PHARMACY CUB PHARMACY

(651) 257-4074 (320) 693-3261 (320) 693-9314 (320) 631-5692 (320) 732-3228 (218) 363-2640 (507) 345-5066 (507) 625-1241 (763) 420-3005 (763) 494-8355 (763) 898-1800 (763) 581-9200 (952) 993-2200 (651) 777-3113 (651) 489-6271

30699 LINCOLN RD 951 E FRONTAGE RD 329 E HIGHWAY 12 815 2ND ST SE 244 CENTRAL AVE 1472 COUNTY ROAD 5 1200 S RIVERFRONT DR 1800 E MADISON AVE 12880 ELM CREEK BLVD N 8150 WEDGEWOOD LN N 14500 99TH AVE N 9825 HOSPITAL DR STE 100 15800 95TH AVE N 2390 WHITE BEAR AVE N 100 COUNTY ROAD B W

LINDSTROM LITCHFIELD LITCHFIELD LITTLE FALLS LONG PRAIRIE LONGVILLE MANKATO MANKATO MAPLE GROVE MAPLE GROVE MAPLE GROVE MAPLE GROVE MAPLE GROVE MAPLEWOOD MAPLEWOOD

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55045-8083 55355 55355-2295 56345-3505 56347-1303 56655-3002 56001-2410 56001-5448 55369-7052 55369-9400 55369-4730 55369-4770 55369-4400 55109-2273 55117-1931

HEALTHPARTNERS MAPLEWOOD PHARMACY MINNESOTA CANCER CARE PHARMACY GENOA-QOL HEALTHCARE GUIDEPOINT PHARMACY WHITE DRUG MELROSE PHARMACY INC FAIRVIEW NORTHLAND PHCY-MILACA ALLINA HEALTH HEART HOSPITAL ALLINA HEALTH PHILLIPS EYE ALLINA HEALTH PIPER BLDG

(651) 523-9820 (651) 255-8480 (507) 401-2004 (507) 401-8482 (507) 532-5754 (320) 256-7292 (320) 983-3191 (612) 775-3100 (612) 775-8896 (612) 863-5370

2165 WHITE BEAR AVE 1580 BEAM AVE 1212 E COLLEGE DR STE 1 600 SHERMAN AVE 321 W MAIN ST 611 W MAIN ST 115 2ND AVE SW 920 E 28TH ST 2215 PARK AVE 913 E 26TH ST

MAPLEWOOD MAPLEWOOD MARSHALL MARSHALL MARSHALL MELROSE MILACA MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS

MN MN MN MN MN MN MN MN MN MN

55109 55109-1127 56258-2010 56258 56258-1341 56352-1045 56353-1105 55407-1139 55404-3711 55404-4515

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 314 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ALLINA HEALTH UNITY ALLINA HEALTH WESTHEALTH BANADIR PHARMACY LLC BYERLY'S PHARMACY #1007 CENTRAL CARE PHARMACY CHILDRENS HOSPITALS & CLINICS CHILDRENS OUTPATIENT PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY DEGDEG'S CAREPOINT PHARMACY

Provider Name

(763) 236-4111 (763) 577-7007 (612) 825-1669 (952) 929-2315 (612) 886-3005 (612) 813-6210 (612) 813-7290 (612) 821-0547 (612) 788-4246 (612) 721-5840 (612) 302-8740 (952) 546-1951 (612) 866-9921 (952) 346-8625 (612) 781-6405 (952) 888-4310 (763) 586-9150 (763) 559-0778 (763) 421-0065 (612) 341-2273

550 OSBORNE RD 2855 CAMPUS DR 405 E LAKE ST 3777 PARK CENTER BLVD 2336 CENTRAL AVE NE 2525 CHICAGO AVE 2530 CHICAGO AVE 1104 LAGOON AVENUE 1540 NEW BRIGHTON BLVD 2850 26TH AVE S 701 W BROADWAY AVE 5370 W 16TH ST 5937 NICOLLET AVE 8421 LYNDALE AVE S 3930 SILVER LAKE RD NE 10520 FRANCE AVE S 246 57TH AVE NE 16705 COUNTY ROAD 24 12900 RIVERDALE DR NW 2711 E FRANKLIN AVE

MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55432-2718 55441-2649 55408-2425 55416-2515 55418 55404-4518 55404-4517 55408 55413 55406-4129 55411-2611 55416-1734 55419-2421 55420-4580 55421-4351 55431-3573 55432-5420 55447-1287 55448-1282 55406-1105

FAIRVIEW COLUMBIA HEIGHTS PHARMACY FAIRVIEW COMPOUNDING PHARMACY FAIRVIEW- HIAWATHA PHARMACY FAIRVIEW HOME INFUSION FAIRVIEW PHARMACY BROOKLYN PK FAIRVIEW PHARMACY SMILEYS CLIN FAIRVIEW PHCY UNIV VILLAGE FAIRVIEW RIVERSIDE MED CNT FAIRVIEW SPECIALTY SERVICES PHCY

(763) 782-8149 (612) 672-5737 (612) 728-7180 (612) 672-2233 (763) 569-6281 (612) 672-4020 (612) 672-1430 (612) 672-4200 (612) 672-5260

4000 CENTRAL AVE NE 711C KASOTA AVE SE 3809 42ND AVE S 711B KASOTA AVE SE 10000 ZANE AVE N 2020 28TH AVE S 2545 UNIVERSITY AVE SE 2450 RIVERSIDE AVE 711 KASOTA AVE SE

MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS

MN MN MN MN MN MN MN MN MN

55421-2968 55414 55406-3503 55414-2842 55443-1400 55406-1112 55414-3205 55454-1512 55414-2842

FAIRVIEW UNIV MED CNTR DEPT PH #41

(612) 273-6212

425 E RIVER RD UNIT KE

MINNEAPOLIS

MN

55485

FAIRVIEW UNIVERSITY DISCHARGE PHARM FUMC OP PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE HCMC BEWELL CLINIC PHARMACY HCMC NORTHLOOP CLINIC PHARMACY HCMC P-1 PHARMACY HCMC RICHFIELD CLINIC PHARMACY HCMC ST. ANTHONY CLINIC PHARMACY

(612) 273-2121 (612) 626-2828 (612) 284-2197 (651) 583-7093 (612) 873-7012 (612) 352-5710 (612) 873-2233 (612) 352-5810 (612) 873-7210

500 HARVARD ST SE RM 3-017 516 DELAWARE ST SE 1155 FORD RD STE C 1930 COON RAPIDS BLVD NW 701 4TH AVE S STE 100 800 WASHINGTON AVE N 701 PARK AVE 701 PARK AVE 2704 HIGHWAY 88

MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS

MN MN MN MN MN MN MN MN MN

55455-0363 55455-0356 55426-1115 55433-4708 55415 55401 55415 55415 55418-3266

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 315 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HEALTHPARTNERS RIVERSIDE PHCY HHHCC ONCOLOGY PHARMACY HIKMA PHARMACY LAKE CEDAR PHARMACY LUNDS PHARMACY LUNDS PHARMACY #51009

Provider Name

(612) 341-5100 (763) 520-1061 (612) 315-3678 (612) 353-5532 (612) 548-3835 (763) 553-1248

2220 S RIVERSIDE AVE 3435 W BROADWAY AVE STE 1135 615 CEDAR AVE 2423 E FRANKLIN AVE 55 UNIVERSITY AVE SE 3455 VICKSBURG LN N

MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS

MN MN MN MN MN MN

55454-1321 55422-2922 55454 55406-1026 55414-1020 55447-1319

NORTH MEMORIAL EMPLOYEE PHARMACY PARK NICOLLET PHARMACY PARK NICOLLET PHARMACY RIVERSIDE PHARMACY ROSS WESTBANK PHARMACY SCHNEIDER DRUG VALUE PHARMACY BYERLY'S PHARMACY CUB PHARMACY HERRMANN DRUG INC CUB PHARMACY HORNBACHERS PHARMACY CASHWISE PHARMACY MEDICAL PHARMACY MOORHEAD MOORHEAD DRUG CO SANFORD PHARMACY MOORHEAD SUN MART PHARMACY WHITE DRUG CROSSTOWN DRUG RX EXPRESS PETERSON DRUG CUB PHARMACY ST THERESE PHARMACY CASH WISE CLINIC PHARMACY NEW RICHLAND DRUG ALLINA HEALTH NEW ULM CASHWISE PHARMACY NEWPORT DRUGS INC GUIDEPOINT PHARMACY FAIRVIEW PHARMACY NORTH BRANCH CUB PHARMACY ECONOFOODS PHARMACY NORTHFIELD PHARMACY STERLING DRUG MARSDEN PHARMACY

(763) 520-4952 (952) 993-8004 (952) 993-5764 (612) 672-7500 (612) 333-6328 (612) 379-7232 (612) 886-3480 (952) 417-0322 (952) 935-1053 (507) 364-7717 (763) 295-6159 (218) 359-4007 (218) 236-0345 (218) 233-7365 (218) 233-1529 (701) 234-3250 (218) 291-0242 (320) 589-4550 (763) 780-0218 (763) 780-0100 (507) 427-2707 (651) 631-8202 (763) 531-5005 (320) 354-3998 (507) 463-3714 (507) 217-5808 (507) 354-2511 (651) 459-9553 (218) 963-7525 (651) 674-6800 (507) 664-9029 (507) 645-4489 (507) 663-0344 (507) 645-4455 (952) 467-2100

3300 OAKDALE AVE N 2001 BLAISDELL AVE 3931 LOUISIANA AVE S 606 24TH AVE S 327 CEDAR AVE S 3400 UNIVERSITY AVE SE 1839 NICOLLET AVE 13081 RIDGEDALE DRIVE 4801 COUNTY ROAD 101 120 1ST ST S 216 W 7TH ST 950 40TH AVE S 3300 HIGHWAY 10 E 101 11TH ST S 420 CENTER AVE STE 12 4000 28TH AVE S 2605 8TH ST S 3 HIGHWAY 28 EAST 8400 CORAL SEA ST NE 8400 CORAL SEA ST NE 1007 3RD AVE 2600 RICE CREEK RD 8000 BASS LAKE RD 600 PETERSON PARKWAY 112 BROADWAY AVE S 1217 8TH ST N STE 1010 1220 WESTRIDGE RD 1644 HASTINGS AVE 23962 SMILEY RD 5366 386TH ST 2423 HIGHWAY 3 S 603 DIVISION STREET 601 WATER ST S 700 DIVISION ST S 402 FAXON RD

MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNEAPOLIS MINNETONKA MINNETONKA MONTGOMERY MONTICELLO MOOREHEAD MOORHEAD MOORHEAD MOORHEAD MOORHEAD MOORHEAD MORRIS MOUNDS VIEW MOUNDS VIEW MOUNTAIN LAKE NEW BRIGHTON NEW HOPE NEW LONDON NEW RICHLAND NEW ULM NEW ULM NEWPORT NISSWA NORTH BRANCH NORTHFIELD NORTHFIELD NORTHFIELD NORTHFIELD NORWOOD

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55422-2926 55404-2414 55426-5000 55454-1455 55454-1030 55414-3328 55403 55305 55345-2636 56069-1657 55362-8305 56560 56560-2512 56560-2837 56560-1962 56560 56560 56267 55112 55112 56159-1587 55112-5344 55428-3118 56273 56072-2024 56073-1552 56073-1000 55055-1616 56468-0200 55056 55057-4588 55057 55057-2434 55057-2427 55368

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 316 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CUB PHARMACY SWARD KEMP DRUG CO OF OLIVIA ONAMIA DRUG CARLSON DRUG WHITE DRUG ALLINA HEALTH OWATONNA CASHWISE PHARMACY GENOA-QOL HEALTHCARE STERLING DRUG TRUMM DRUG-PARKERS PRAIRIE CENTRACARE HEALTH PAYNESVILLE NUCARA PHARMACY PELICAN DRUG PERHAM HEALTH PHARMACY WHITE DRUG

Provider Name

(651) 739-6247 (320) 523-2110 (320) 532-3633 (320) 839-6102 (320) 859-2161 (507) 977-2020 (507) 451-7886 (507) 413-7752 (507) 451-0240 (218) 338-2661 (320) 243-7702 (320) 243-3781 (218) 863-1441 (218) 347-1570 (218) 346-4840

7191 10TH ST N 801 E DEPUE AVE 516 MAIN STREET 147 NW 2ND ST 200 CENTRAL AVENUE 2250 NW 26TH ST STE 1001 495 W NORTH ST 610 FLORENCE AVE STE 123 410 HOFFMAN DR 114 E SOO ST 200 FIRST ST W 216 WASHBURNE AVE 11 N BROADWAY 1000 CONEY ST. W 211 MARKET DR STE C

OAKDALE OLIVIA ONAMIA ORTONVILLE OSAKIS OWATONNA OWATONNA OWATONNA OWATONNA PARKERS PRAIRIE PAYNESVILLE PAYNESVILLE PELICAN RAPIDS PERHAM PERHAM

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55128 56277-1339 56359-0000 56278 56360 55060-5503 55060-1107 55060-4704 55060-2348 56361-4995 56362-1445 56362-1643 56572-4138 56573 56573-1701

FIRSTLIGHT HEALTH SYSTEM PHARMACY WEBER AND JUDD - PINE ISLAND A AND S DRUGS SNYDER DRUG WEBER & JUDD - PLAINVIEW CUB PHARMACY CUB PHARMACY CUB PHARMACY WEBER & JUDD - PRESTON FAIRVIEW NORTHLAND PHARMACY-PR

(320) 322-5141 (507) 356-8343 (507) 825-3100 (507) 825-4259 (507) 534-3815 (763) 546-2311 (763) 557-0377 (763) 553-2627 (507) 765-2156 (763) 389-6622

1425 MAIN ST N 111 CTY ROAD 11 101 W MAIN ST 802 8TH AVE SE 245 1ST STREET SW 10200 6TH AVENUE NORTH 4445 NATHAN LN N 3550 VICKSBURG LN N 136 MAIN ST SW 919 NORTHLAND DR

PINE CITY PINE ISLAND PIPESTONE PIPESTONE PLAINVIEW PLYMOUTH PLYMOUTH PLYMOUTH PRESTON PRINCETON

MN MN MN MN MN MN MN MN MN MN

55063-6026 55963-9756 56164-1651 56164-1734 55964-1304 55441 55442-2542 55447-1322 55965-1202 55371-2172

FAIRVIEW PHCY PRINCETON INPATIENT FAIRVIEW PHARMACY PRIOR LAKE LTC PRESCRIPTION PROVIDERS ECONOFOODS PHARMACY MAYO CLINIC PHARMACY-RED WING GUIDE POINT PHARMACY SWARD KEMP SNYDER DRUG LUNDS PHARMACY RAINBOW PHARMACY CUB PHARMACY GENOA-QOL HEALTHCARE GUIDEPOINT PHARMACY HUNT LONG TERM CARE

(763) 389-6625 (952) 447-9570 (218) 628-9368 (651) 388-3589 (651) 267-5785 (507) 637-3549 (507) 637-2911 (612) 866-8362 (612) 866-1256 (507) 288-3234 (507) 226-9020 (507) 288-6463 (507) 288-3831

911 NORTHLAND DR 4151 WILLOWWOOD ST SE 220 3RD AVE 623 MAIN ST 701 HEWITT BLVD SUITE 2116 216 S WASHINGTON ST 207 S WASHINGTON ST 6228 PENN AVE S 140 W 66TH STREET 1021 15TH AVE SE 343 WOODLAKE DR SE 202 N BROADWAY 1510 N BROADWAY

PRINCETON PRIOR LAKE PROCTOR RED WING RED WING REDWOOD FALLS REDWOOD FALLS RICHFIELD RICHFIELD ROCHESTER ROCHESTER ROCHESTER ROCHESTER

MN MN MN MN MN MN MN MN MN MN MN MN MN

55371-2172 55372 55810-1617 55066-2249 55066 56283-1656 56283-1700 55423-1135 55423 55904-5149 55904-6242 55906-3646 55906-4146

HUNT SILVER LAKE DRUGS, MED SHOPPE

(507) 289-3901

1510 N BROADWAY

ROCHESTER

MN

55906-4146

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 317 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MAYO CLINC PHARMACY NE MAYO CLINIC PHARMACY EISENBERG MAYO CLINIC PHARMACY MARY BRIGH MAYO CLINIC PHARMACY SUBWAY MAYO PHARMACY MAYO PHARMACY BALDWIN MAYO PHARMACY NORTHWEST OMC NORTHWEST PHARMACY OMC SOUTHEAST PHARMACY WEBER & JUDD - BARLOW PLAZA WEBER & JUDD - SOUTH BROADWAY WEBER & JUDD NURSING RX WEBER AND JUDD - MARRIOTT PLAZA CUB PHARMACY MATTSON PHARMACY, INC. CUB PHARMACY FAIRVIEW PHARMACY ROSEMOUNT CUB PHARMACY CUB PHARMACY OPTION CARE TAREEN DERMATOLOGY PA FAIRVIEW LAKES PHARMACY-RUSH C STERLING DRUG

Provider Name

(507) 538-8550 (507) 266-7416 (507) 255-5731 (507) 284-2021 (507) 284-2021 (507) 284-8880 (507) 266-0966 (507) 535-1974 (507) 292-7255 (507) 289-6368 (507) 282-1422 (507) 285-9079 (507) 289-0716 (763) 428-6080 (218) 463-2465 (651) 423-0316 (651) 322-8855 (651) 489-8620 (651) 633-9720 (651) 635-9272 (651) 633-6883 (320) 358-4757 (507) 864-2153

3041 STONEHEDGE DR NE 201 W CENTER ST 1216 2ND ST SW 200 1ST ST SW STE SL14 200 1ST ST SW 200 1ST ST SW STE 1501 4111 HIGHWAY 52 N 5067 55TH ST NW 210 9TH ST SE 1315 SIXTH ST NW 18 9TH ST SE 1814 15TH ST NW 101 1ST AVE SW 13855 ROGERS DR 111 MAIN AVE S 3784 150TH ST W 15075 CIMARRON AVE STE 3 1201 W LARPENTEUR AVE W 2100 SNELLING AVE N 2750 ARTHUR ST 1835 W COUNTY RD C W STE 250 780 W 4TH ST 115 W JESSIE ST

ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROGERS ROSEAU ROSEMOUNT ROSEMOUNT ROSEVILLE ROSEVILLE ROSEVILLE ROSEVILLE RUSH CITY RUSHFORD

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55906-5426 55902-3003 55902-1906 55905-5002 55905-0001 55905-5003 55901-5919 55901 55904 55901 55904-6423 55901 55902-3146 55374 56751-1421 55068-2762 55068-1635 55113 55113-6000 55113-1303 55113 55069-9063 55971-8837

UNITED COMMUNITY PHARMACY CORP. WEBER AND JUDD - ST. CHARLES AFYA PHARMACY LLC CASH WISE PHARMACY

(612) 259-8275 (507) 932-3160 (320) 744-1993 (320) 258-0155

2500 NEWBRIGHTON BLVD STE 105 401 W 4TH ST 3407 3RD ST N 1001 4TH ST SE

SAINT ANTHONY SAINT CHARLES SAINT CLOUD SAINT CLOUD

MN MN MN MN

55418 55972-2127 56303-4015 56304-1297

CENTRACARE PHARMACY HEALTH PLAZA CENTRACARE PHARMACY NORTHWAY CENTRACARE PHCY ST CLOUD HOSP GENOA-QOL HEALTHCARE GOODRICH PHARMACY CUB PHARMACY METHODIST HOSPITAL PHARMACY PARK NICOLLET PHARMACY ALLINA HEALTH HAPPY VALLEY ALLINA HEALTH UNITED IN/P ALLINA HEALTH UNITED O/P BRIGHTLY PHARMACY CARE INC CAPITOL PHARMACY, INC

(320) 229-4904 (320) 240-3160 (320) 255-5670 (320) 227-2744 (763) 753-0222 (952) 933-3177 (952) 993-6016 (952) 993-3148 (651) 241-3800 (651) 241-8851 (651) 241-8849 (651) 776-9976 (651) 292-9728

1900 CENTRACARE CIR # 1350 1555 NORTHWAY DR STE 150 1406 6TH AVE N 1321 13TH ST N STE 100 23122 SAINT FRANCIS BLVD NW 3620 TEXAS AVE S 6500 EXCELSIOR BLVD 3800 PARK NICOLLET BLVD 14655 GALAXIE AVE 333 NO SMITH AVE # 1793 333 SMITH AVE N 1239 PAYNE AVE STE 202 580 RICE ST

SAINT CLOUD SAINT CLOUD SAINT CLOUD SAINT CLOUD SAINT FRANCIS SAINT LOUIS PARK SAINT LOUIS PARK SAINT LOUIS PARK SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL

MN MN MN MN MN MN MN MN MN MN MN MN MN

56303-5000 56303 56303-1900 56303-2613 55070-9807 55426-4039 55426-4702 55416-2527 55124-8575 55102-2344 55102-2344 55130-3667 55103-2148

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 318 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CHILDRENS HOSPITALS AND CLINICS COMO PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY CUB PHARMACY FAIRVIEW NEW BRIGHTON PHARMACY FAIRVIEW PHARMACY - HIGHLAND P FAIRVIEW-EAGAN PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GILLETTE CHILDRENS SPCLTY HLTHCR GUERTIN PHARMACY HEALTHPARTNERS COMO PHARMACY HEALTHPARTNERS MIDWAY PHCY HEALTHPARTNERS SPECIALTY CNT HEALTHPARTNERS ST PAUL PHCY

Provider Name

(651) 220-6944 (651) 487-0044 (651) 646-8858 (651) 771-0556 (651) 501-4934 (651) 774-7772 (651) 451-1113 (651) 452-5500 (651) 702-1032 (651) 426-5006 (651) 746-2580 (651) 696-5020 (651) 406-8980 (651) 395-7690 (612) 254-9505 (651) 583-7097 (952) 388-0400 (651) 917-4029 (612) 594-8178 (651) 771-0286 (651) 726-2890 (651) 735-8781 (651) 641-6292 (651) 647-2210 (651) 254-8280 (651) 293-8315

345 SMITH AVE N 217 COMO AVE STE 107 1440 UNIVERSITY 892 ARCADE STREET 2197 HUDSON ROAD 1177 CLARENCE ST 2021 ROBERT ST S 1020 DIFFLEY RD 8432 TAMARACK VLG 1059 MEADOWLANDS DR 1151 SILVER LAKE RD NW 2155 FORD PKWY 1440 DUCKWOOD DR 166 4TH ST E STE 244 144 WABASHA ST S 1900 SILVER LAKE RD NW STE 110 3101 OLD HIGHWAY 8 STE 203B 800 TRANSFER RD STE 35 1811 WEIR DR STE 275 317 YORK AVE 200 UNIVERSITY AVE E 21 CENTURY AVE S 2500 COMO AVE 451 DUNLAP ST N 401 PHALEN BLVD 205 SOUTH WABASHA STREET

SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55102-2346 55103-1838 55104 55106 55119 55106-2809 55118-3924 55123-1777 55125-3383 55127-2346 55112-6324 55116-1862 55122-1451 55101-1421 55107-1819 55112-1789 55113-1077 55114-1422 55125-2201 55130-4039 55101-2507 55119-5200 55108-1460 55104-4621 55130 55107-1805

HEALTHPARTNERS UNIVERSITY AVE PHCY LLOYDS PHARMACY LUNDS PHARMACY OUR FAMILY PHARMACY PHALEN FAMILY PHARMACY LTD REGIONS HOSPITAL PHARMACY SETZER PHARMACY INC ST PAUL CORNER DRUG THE MEDICINE SHOPPE WEST SEVENTH PHARMACY FAMILY FRESH MARKET PHARMACY COUNTRY STORE AND PHARMACY HEALTH PARTNERS CMN CLIN PHCY OPTION CARE VILLAGE PHARMACY AND GIFT

(612) 623-4002 (651) 645-8636 (651) 251-3491 (651) 600-3988 (651) 209-9000 (651) 254-9561 (651) 488-0251 (651) 698-8859 (651) 455-6873 (651) 228-1493 (507) 931-5540 (320) 255-0801 (320) 259-7321 (800) 939-5666 (320) 252-1303

2635 UNIVERSITY AVE STE 160 720 SNELLING AVE N 2128 FORD PKWY 601 UNIVERSITY AVE W 1001 JOHNSON PKWY STE B23 640 JACKSON ST 1685 RICE ST 240 SNELLING AVE S 750 MAIN ST STE 103 1106 7TH ST W 612 S MINNESOTA AVE 520 1ST ST NE 2251 CONNECTICUT AVE S 1000 S BENTON DR STE 40 108 2ND AVE S

SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PAUL SAINT PETER SARTELL SARTELL SAUK RAPIDS SAUK RAPIDS

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55114 55104-1844 55116 55103-1940 55106 55101-2502 55113-6802 55105-1944 55118-3764 55102-3829 56082-2100 56377-1274 56377 56379-1227 56379-1410

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 319 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CUB PHARMACY

Provider Name

(952) 447-1611

14075 HIGHWAY 13 S

SAVAGE

MN

55378-3100

ALLINA HEALTH ST. FRANCIS PHARMACY CUB PHARMACY CUB PHARMACY

(952) 428-6337 (952) 445-6344 (952) 401-3990

1455 SAINT FRANCIS AVE STE 100 1198 VIERLING DR E 23800 STATE HIGHWAY 7

SHAKOPEE SHAKOPEE SHOREWOOD

MN MN MN

55379-3374 55379-4313 55331

ESSENTIA HEALTH SILVER BAY PHARMACY GUIDEPOINT PHARMACY #110 RANDY'S FAMILY DRUG PRORX PHARMACY STERLING #28 SPRING PARK PHARMACY WEBER & JUDD - SPRING VALLEY HEALTHPARTNERS WEST PHARMACY REGIONS HOSPITAL PHARMACY SAMUELSONS DRUG STORE WEBER AND JUDD - STEWARTVILLE CUB PHARMACY LAKEVIEW COMMUNITY PHARMACY LAKEVIEW OUTPATIENT PHARMACY SVRX SPECIALTY HUGO'S FAMILY PHARMACY

(218) 226-3829 (507) 873-2075 (507) 794-3631 (651) 457-2725 (507) 498-5509 (952) 471-3784 (507) 346-7273 (952) 541-2644 (952) 967-5049 (320) 239-2246 (507) 533-4245 (651) 430-2362 (651) 430-4670 (651) 430-4563 (651) 439-0557 (218) 681-1515

99 EDISON BLVD SUITE L 2010 JUNIPER AVE 121 1ST AVE S 621 MARIE AVE 137 W MAIN ST 4689 SHORELINE DR STE 100 501 N PARK DR 5100 GAMBLE DR STE 100 640 JACKSON ST 118 W 5TH ST 220 CENTERTOWN PLAZA 1801 MARKET DR 1500 CURVE CREST BLVD W 927 CHURCHILL ST W 421 3RD ST S 215 PENNINGTON AVE

SILVER BAY SLAYTON SLEEPY EYE SOUTH ST PAUL SPRING GROVE SPRING PARK SPRING VALLEY ST LOUIS PARK ST PAUL STARBUCK STEWARTVILLE STILLWATER STILLWATER STILLWATER STILLWATER THIEF RIVER FALLS

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

55614-1269 56172 56085-1364 55075-2039 55974-1225 55384 55975 55416 55101 56381-2426 55976-1245 55082-7599 55082-6040 55082-6605 55082-4955 56701-2900

SANFORD PHARMACY THIEF RIVER FALLS WHITE DRUG JOHNS RX DRUG INC TWIN VALLEY PHARMACY ESSENTIA HLTH TWO HARBORS PHCY LAKE VIEW PHARMACY ESSENTIA HEALTH VIRGINIA PHCY ST ELIZABETH OUTPATIENT PHCY MACKENTHUN BECK PHARMACY INC WACONIA CLINIC PHARMACY SEIP PRESCRIPTION SHOPPE CASHWISE PHARMACY REJUV MEDICAL PHARMACY WHITE DRUG WHITE DRUG WARREN PHARMACY WATERTOWN PHARMACY LUNDS PHARMACY PARK NICOLLET PHARMACY

(218) 683-2725 (218) 681-2932 (507) 629-3801 (218) 584-5147 (218) 834-7202 (218) 834-7799 (218) 749-7828 (651) 565-5611 (952) 442-4407 (952) 442-3274 (218) 632-5440 (320) 259-1148 (320) 217-8480 (218) 547-1016 (218) 547-4734 (218) 745-5481 (952) 955-2153 (952) 473-1687 (952) 993-8200

1720 HIGHWAY 59 S STE 2 201 HORACE AVE N 131 3RD ST 120 MAIN AVE W 802 11TH STREET STE 477 1010 4TH ST 1101 9TH ST N STE A 1200 GRANT BLVD 1ST FLR 851 MARKETPLACE DR 430 STATE HWY 5 WEST 415 JEFFERSON ST N 113 WAITE AVE S 901 3RD ST N 504 MINNESOTA AVE W 110 MICHIGAN AVE W 103 W JOHNSON AVE 204 LEWIS AVE S STE 101 1151 WAYZATA BLVD 250 CENTRAL AVE N

THIEF RIVER FALLS THIEF RIVER FALLS TRACY TWIN VALLEY TWO HARBORS TWO HARBORS VIRGINIA WABASHA WACONIA WACONIA WADENA WAITE PARK WAITE PARK WALKER WALKER WARREN WATERTOWN WAYZATA WAYZATA

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

56701-4333 56701-2024 56175-1211 56584-4000 55616-1670 55616-1200 55792-2329 55981-1042 55387-1548 55387 56482 56387-1348 56387-1964 56484-0000 56484-0000 56762-1102 55388-4501 55391 55391-1206

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 320 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WHEATON DRUG AND GIFTS CUB PHARMACY HEALTHPARTNERS-WHITE BEAR LAKE WHITE BEAR HEALTH MART CASHWISE PHARMACY CASHWISE PHARMACY CUB PHARMACY PRESCRIPTION CENTER, INC. WHITE DRUG GOLTZ PHARMACY PARKVIEW PHARMACY WINONA HLTH SVS CLINIC PHCY KEAVENY DRUG GUIDEPOINT PHARMACY ALLINA HEALTH WOODBURY

Provider Name

(320) 563-4151 (651) 777-2350 (651) 653-2175 (651) 289-4300 (320) 214-6975 (320) 235-2506 (320) 214-8502 (320) 235-2440 (320) 235-1930 (507) 452-2547 (507) 454-4925 (507) 457-7688 (320) 485-2555 (507) 647-8800 (651) 501-3140

1105 BROADWAY 1920 BUERKLE RD 1430 HIGHWAY 96 E 2008 COUNTY ROAD E 101 WILLMAR AVE SW 1300 3RD ST SE 2201 1ST ST S 1110 1ST ST S 2300 1ST ST S 274 E 3RD ST 825 MANKATO AVE 859 MANKATO AVE 150 MAIN ST 112 E 2ND ST 8675 VALLEY CREEK RD

WHEATON WHITE BEAR LAKE WHITE BEAR LAKE WHITE BEAR LAKE WILLMAR WILLMAR WILLMAR WILLMAR WILLMAR WINONA WINONA WINONA WINSTED WINTHROP WOODBURY

MN MN MN MN MN MN MN MN MN MN MN MN MN MN MN

56296-1374 55110 55110-3653 55110-7333 56201-3556 56201-5302 56201-4262 56201-3512 56201-4212 55987-3720 55987-4866 55987 55395 55396 55125-2337

HEALTHPARTNERS WOODBURY PHARMACY STERLING DRUG FAIRVIEW LAKES PHCY-WYOMING WYOMING DRUG FAIRVIEW NORTHLAND PHCY-ZIMMER

(651) 702-5308 (507) 372-7533 (651) 982-7500 (651) 462-2082 (763) 856-6940

8450 SEASONS PKWY 511 10TH ST 5200 FAIRVIEW BLVD 26710 FOREST BLVD 25945 GATEWAY DR

WOODBURY WORTHINGTON WYOMING WYOMING ZIMMERMAN

MN MN MN MN MN

55125 56187 55092-8013 55092-8022 55398-5300

MAIN STREET HEALTH MART PHARMACY WEBER & JUDD ZUMBROTA ADRIAN KREISLER DRUG ADVANCE PHARMACY ALTON DRUG STORE MYERS PHARMACY KREISLER COUNTRY PHARMACY

(507) 732-5311 (507) 732-7309 (816) 297-8833 (573) 722-3562 (417) 778-7000 (417) 778-7727 (660) 476-2142

370 S MAIN ST 228 WEST AVENUE 21 E MAIN ST 110 S OAK RT 71 BOX 1001 603 N.HWY 160 121 W 4TH ST

ZUMBROTA ZUMBROTA ADRIAN ADVANCE ALTON ALTON APPLETON CITY

MN MN MO MO MO MO MO

55992-1544 55992 64720 63730-0187 65606 65606 64724-1401

DIERBERGS ARNOLD COMMONS PHARMACY SHOP 'N SAVE PHARMACY ASH GROVE PHARMACY, INC KILGORE'S MEDICAL PHCY ASHLAND AURORA PROFESSIONAL PHARMACY PRICE CUTTER PHARMACY AVA DRUG MOCH PHARMACY DIERBERGS LAFAYETTE PHARMACY MERCY PHARMACY CLAYTON CLARKSO SINKS PHARMACY PRICE CHOPPER PHARMACY

(636) 282-4817 (636) 282-0591 (417) 751-2111 (573) 657-3333 (417) 678-4136 (417) 678-0493 (501) 296-3337 (417) 683-5739 (636) 591-0600 (636) 256-5111 (573) 859-3100 (816) 265-6006

860 ARNOLD COMMONS DR 1253 WATER TOWER PL 490 N MEDICAL DR 109B EASTSIDE DR 124 S MADISON AVE 708 S ELLIOTT 124 W WASHINGTON AVE 504 NW 10TH AVE 421 LAFAYETTE CTR 15945 CLAYTON RD STE 140 206 N ALVARADO ST # D 109 NORTH CEDAR ST

ARNOLD ARNOLD ASH GROVE ASHLAND AURORA AURORA AVA AVA BALLWIN BALLWIN BELLE BELTON

MO MO MO MO MO MO MO MO MO MO MO MO

63010-2164 63010-2142 65604-1004 65010 65605-1427 65605 65608 65608 63011-3943 63011-2146 65013-3470 64012

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 321 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name OVERTURF PHARMACY TOWN PHARMACY BLOOMSDALE PHARMACY BLUE SPRINGS PRICE CHOPPER PHA MARRS PHARMACY BOLIVAR DRUG CENTRAL CARE CANCER CENTER FAMILY PHARMACY STEPHENS PBA PHARMACY WOODS SUPERMARKET PHARMACY 471 COUNTRY MART PHARMACY OZARK LTC RX LLC PHARMAX PHARMACY USA DRUG #15821 MILLER'S MEDICAL ARTS PHARMACY CLARK'S RX BOWLING GREEN PHARMACY COUNTY MARKET PHARMACY CONVENIENT CARE PHARMACY FAMILY PHARMACY LAKELAND PHARMACY SSM RX EXPRESS GREEN HILLS PHARMACY BUCKNER PHARMACY, LLC CORNER DRUG STORE NYBERG PHARMACY MONARCH PHARMACY SUMMERS PHARMACY #3 CABOOL PBA PHARMACY BOND PHARMACY HOMETOWN PHARMACY LLC GERBES PHARMACY LAKE REGIONAL PHARMACY - CMC LAKER DRUG WILKINSON PHARMACY CAMERON FAMILY PHARMACY THE DRUG STORE SCOTT FAMILY PHARMACY LLC COUNTY MARKET PHARMACY 409 BROADWAY PHARMACY LTC BROADWAY PRESCRIPTION SHOP GENOA-QOL HEALTHCARE

NR_0009_10823 10/2017

Provider Phone Number (573) 293-5531 (573) 568-2643 (573) 483-2626 (816) 229-3252 (816) 229-7755 (417) 326-7455 (417) 326-7200 (417) 326-8747 (417) 326-2416 (417) 326-5208 (573) 358-0099 (573) 755-0800 (573) 358-3301 (573) 358-3311 (660) 882-5208 (573) 732-3403 (573) 324-2112 (573) 324-3383 (417) 335-7700 (417) 551-0324 (417) 336-4701 (314) 344-7300 (660) 258-2122 (816) 650-8288 (417) 345-6500 (417) 345-2321 (660) 679-3010 (660) 679-5002 (417) 962-3133 (573) 796-3145 (573) 796-2225 (573) 346-4155 (573) 346-2300 (573) 873-2626 (573) 346-3396 (816) 632-1760 (816) 632-7223 (573) 246-2514 (573) 288-0355 (573) 803-2040 (573) 335-8207 (573) 837-1982

Provider Street 116 S WALNUT ST 302 PRAIRIE 256 BODERMAN SUITE 1E 1100 SW STATE ROUTE 7 205 NW R D MIZE RD STE 104 2000 S SPRINGFIELD AVE 1501 N OAKLAND AVE 1326 W BROADWAY ST 1100 S SPRINGFIELD AVE 703 E COLLEGE ST 50 BERRY RD 9 BONNEVILLE PLZ 60 NESBIT DR STE A 903 BENHAM 800 MAIN ST 194 OLD HIGHWAY 66 UNIT A 8 N COURT ST 1106 S BUSINESS 61 525 BRANSON LNDG BLVD STE 1005 1494 STATE HIGHWAY 248 STE D 1232 BRANSON HILLS PKWY STE205 12266 DE PAUL DR STE 105 712 S MAIN ST 325 S HUDSON ST 308 W DALLAS 315 S ASH ST 11 S ORANGE ST 11 W DAKOTA ST 518 MAIN 703 W BUCHANAN ST 408 W BUCHANAN ST STE A 555 E HIGHWAY 54 1930-C N BUSINESS ROUTE 5 72 S BUSINESS ROUTE 5 113 E US HIGHWAY 54 1303 N WALNUT ST 610 N WALNUT ST 414 W GRAND AVE 1805 ELM ST 706 BROADWAY ST 710 BROADWAY ST 402 S SILVER SPRINGS RD # 101A

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Provider City BERNIE BLOOMFIELD BLOOMSDALE BLUE SPRINGS BLUE SPRINGS BOLIVAR BOLIVAR BOLIVAR BOLIVAR BOLIVAR BONNE TERRE BONNE TERRE BONNE TERRE BONNE TERRE BOONVILLE BOURBON BOWLING GREEN BOWLING GREEN BRANSON BRANSON BRANSON BRIDGETON BROOKFIELD BUCKNER BUFFALO BUFFALO BUTLER BUTLER CABOOL CALIFORNIA CALIFORNIA CAMDENTON CAMDENTON CAMDENTON CAMDENTON CAMERON CAMERON CAMPBELL CANTON CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU

State

ZIP code

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63822-9508 63825-0000 63627-9099 64014-3219 64014-2520 65613-9654 65613 65613-1815 65613-2512 65613-2630 63628-1373 63628-1307 63628-1347 63628-1305 65233-1658 65441 63334-1534 63334-5233 65616 65616-8160 65616 63044-2541 64628-2307 64016-8142 65622-0000 65622 64730-1805 64730-2007 65689-0000 65018-1227 65018-1223 65020-9004 65020 65020-8892 65020-7320 64429-1326 64429-1831 63933-1524 63435-1685 63701-5514 63701-5514 63703-7536

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HOME PARENTERAL SVCS OF SEMO JOHN'S PHARMACY LLLP JOHNS RX LLLP MEDICAP PHARMACY MEDICENTER PHARMACY PARK PHARMACY SOUTHEAST PHARMACY SOUTHEAST PHARMACY THE MEDICINE SHOPPE BRUNER PHARMACY HOMETOWN PHARMACY HOMETOWN PHARMACY RED CROSS PHARMACY EXPRESS RX OF CARTHAGE PRICE CUTTER PHARMACY #21 WILKINSON PHARMACY HAYDEN PHARMACY PRESCRIPTION DRUG STORE SATER PHARMACY WHITLEY PHARMACY CEDAR HILL DRUG KINKEAD PHARMACY INC MEDICAP PHARMACY L & S DISCOUNT PHARMACY SIMMONS & GRAHAM PHARMACY DIERBERGS MARKETPLACE PHCY DOHMEN LIFE SCIENCE SERVICES MEDICINE SHOPPE ST LUKES PHARMACY CHILLICOTHE FAMILY PHARMACY HOMETOWN PHARMACY JOHNSTON DRUG INC NEMO CLOSED DOOR PHARMACY MEDICAL ARTS PHARMACY SUMMERS PHARMACY SUMMERS PHARMACY INC COLE CAMP PHARMACY BURRELL PHARMACY D & H PBA DRUG D & H PBA DRUG STORES FLOWS PHARMACY FLOW'S PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (573) 332-1955 (573) 334-1300 (573) 651-4004 (573) 335-1002 (573) 651-5250 (573) 334-4432 (573) 519-4550 (573) 331-7900 (573) 334-4761 (417) 649-7021 (660) 542-2020 (660) 542-2020 (660) 886-5535 (417) 359-8185 (417) 358-2624 (417) 358-4840 (573) 333-4606 (573) 333-4890 (417) 847-2315 (417) 847-2717 (636) 274-3111 (573) 682-2155 (573) 887-3622 (573) 683-3307 (573) 683-3366 (636) 537-9408 (866) 849-4481 (314) 469-7171 (314) 205-6023 (660) 240-0828 (660) 646-7455 (660) 699-2432 (660) 699-2432 (314) 862-0333 (660) 885-3147 (660) 383-1800 (660) 668-4646 (573) 777-8430 (573) 777-7373 (573) 777-7333 (573) 449-5366 (573) 447-8093

Provider Street 113 S SILVER SPRINGS RD #101 2001 INDEPENDENCE ST 2003 INDEPENDENCE ST 1020 N KINGSHIGHWAY SUITE A 465 S MOUNT AUBURN RD STE 101 37 DOCTORS PARK 817 S MT AUBURN RD STE 130 1723 BROADWAY ST STE 110 864 N KINGSHWY 102 S MAIN ST 1409 N JEFFERSON ST 1409 N JEFFERSON ST 1003 N US HIGHWAY 65 1601 MISSOURI AVE 1223 W CENTRAL AVE 2017 S GARRISON AVE 1200 WARD AVE 410 WARD AVE 705 MAIN ST 101 W 8TH ST 7032 STATE ROUTE BB 105 S ALLEN ST 211 WEST YOAKUM AVE 406 S MAIN ST 101 NORTH MAIN ST 1730 CLARKSON RD 17877 CHESTERFIELD AIRPORT RD 106 4 SEASONS SHOPPING CTR 224 S WOODS MILL RD STE 350 504 S WASHINGTON ST 601 LOCUST ST 214 N GRAND ST 214B N GRAND ST 211 N MERAMEC AVE 1602 N 2ND ST 605 PAWNEE ST 106 S MAPLE ST 3401 BERRYWOOD DR SUITE 102 1814 PARIS RD 1001 W BROADWAY 1506 E BROADWAY 303 N KEENE ST

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Provider City CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU CAPE GIRARDEAU CARL JUNCTION CARROLLTON CARROLLTON CARROLLTON CARTHAGE CARTHAGE CARTHAGE CARUTHERSVILLE CARUTHERSVILLE CASSVILLE CASSVILLE CEDAR HILL CENTRALIA CHAFFEE CHARLESTON CHARLESTON CHESTERFIELD CHESTERFIELD CHESTERFIELD CHESTERFIELD CHILLICOTHE CHILLICOTHE CLARENCE CLARENCE CLAYTON CLINTON CLINTON COLE CAMP COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA

State

ZIP code

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63703 63703-5805 63703-5805 63701 63703-4926 63703-4927 63703 63701-4556 63701 64834-1000 64633-1945 64633-1945 64633-1972 64836 64836-1032 64836-3613 63830-2204 63830-1451 65625-1421 65625-1311 63016 65240-1303 63740 63834-1644 63834-1632 63017-4976 63005-1211 63017-3173 63017-3451 64601-3038 64601-2250 63437-1604 63437-1604 63105-3745 64735-1192 64735-2757 65325-1120 65201-6515 65201-5538 65203-2121 65201-8078 65201-7193

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GERBES PHARMACY GERBES PHARMACY GERBES PHARMACY KILGORES MEDICAL PHARMACY KILGORE'S PBA PHARMACY MISSOURI CANCER CARE PHARMACY OPTION CARE THE PHCY AT COLUMBIA ORTHO GRP BRITTS CENTRAL DRUG CO LAKELAND PHARMACY TOWNE PHARMACY THE MEDICINE SHOPPE WESTLAND PHARMACY DIERBERGS DES PERES PHARMACY PARKLAND APOTHECARY USA DRUG #15822 D & S DRUG KEY DRUGS AT DEXTER OVERTURF PHARMACY TOWN & COUNTRY PHARMACY COUNTRY MART HOMETOWN PHARMACY E & S PHARMACY INC HOMETOWN PHARMACY MEDICAL CENTER PHARMACY DREXEL PHARMACY FOUNDATION CARE LLC BEAUTONS DRUG SHOP MAIN STREET PHARMACY KNOX COUNTY PHARMACY LLC EVANS DRUGS WILKINSON PHARMACY ELDON DRUG COMPANY GERBES PHARMACY BROWN'S PHARMACY INC FITZPATRICK PHARMACY SHOP 'N SAVE PHARMACY

Provider Name

(573) 474-9418 (573) 445-9451 (573) 442-2951 (573) 447-4444 (573) 442-0194 (573) 817-8527 (573) 814-7100 (573) 876-8410 (660) 463-7981 (417) 723-5241 (573) 885-7212 (636) 586-2202 (636) 586-1766 (314) 238-0444 (573) 431-6677 (573) 431-2242 (573) 614-4243 (573) 614-5900 (573) 624-7452 (573) 624-3733 (573) 759-3073 (573) 759-2230 (573) 996-7157 (573) 996-4000 (573) 996-3784 (816) 657-2448 (877) 291-1122 (573) 649-3923 (573) 649-9229 (660) 397-2244 (417) 876-3313 (417) 876-3511 (573) 392-4588 (573) 392-7336 (573) 663-7707 (636) 394-6622 (636) 227-0830

2900 PARIS RD 1729 W BROADWAY 205 E NIFONG BLVD 1608 CHAPEL HILL RD 700 N PROVIDENCE RD E 1705 E BROADWAY STE 100 3210 BLUFF CREEK DR 1 SOUTH KEENE ST 728 S MAIN ST 104 CORTNEY LN 200 N FRANKLIN 100 MAIN ST 2060 ROCK RD 1080 LINDEMANN RD 617 N COWLING ST STE G 1142 N DESLOGE DR 1226 W BUSINESS US HIGHWAY 60 1007 W BUSINESS US HIGHWAY 60 904 W BUSINESS HWY 60 707 SPECIALITY DR 508 E 5TH ST 206 W 2ND ST 1105 WALNUT ST 110 LEROUX STREET 513 N GRAND 203 E MAIN ST 4010 WEDGEWAY CT 124 N WASHINGTON ST 117 E MAIN ST 105 E REID ST STE C 209 E US HIGHWAY 54 200 E HWY 54 101 S MAPLE ST NORTH & MILL STREET 375 TRIMMER LN 15394 MANCHESTER RD 15446 MANCHESTER RD

COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA CONCORDIA CRANE CUBA DE SOTO DE SOTO DES PERES DESLOGE DESLOGE DEXTER DEXTER DEXTER DEXTER DIXON DIXON DONIPHAN DONIPHAN DONIPHAN DREXEL EARTH CITY EAST PRAIRIE EAST PRAIRIE EDINA EL DORADO SPRINGS EL DORADO SPRINGS ELDON ELDON ELLINGTON ELLISVILLE ELLISVILLE

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

65202-2651 65203-1190 65203-3760 65203-5464 65203-4373 65201-7167 65201-3525 65201 64020-9602 65633-9192 65453 63020 63020-1052 63131-4526 63601-3119 63601-2937 63841-2706 63841-2703 63841 63841-2718 65459-6201 65459-2500 63935 63935 63935 64742-0000 63045-1213 63845-1140 63845-1136 63537-1155 64744 64744-0000 65026-1811 65026 63638-7972 63011-3052 63011-3029

ELSBERRY PHCY, MEDICINE SHOPPE 2028 EXCELSIOR SPRINGS HOSPITAL JACK MONROE PHARMACY KEX RX PHARMACY & HOME CARE

(573) 898-2550 (816) 629-3576 (816) 637-6118 (816) 637-3188

106A BROADWAY 1700 RAINBOW BLVD 1236 N JESSE JAMES RD 1500 KEARNEY RD

ELSBERRY EXCELSIOR SPRINGS EXCELSIOR SPRINGS EXCELSIOR SPRINGS

MO MO MO MO

63343-1345 64024-1182 64024-1119 64024

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RED CROSS LTC PHARMACY RED CROSS PHARMACY FAMILY PHARMACY CLARK'S RX DICUS DRUG OF FARMINGTON HEALTHDIRECT IPS MEDICAP PHARMACY

Provider Name

(816) 743-7320 (816) 637-3400 (417) 551-0324 (937) 428-7970 (573) 756-5425 (800) 689-3683 (573) 760-0200

1000 N JESSE JAMES RD 1018 N JESSE JAMES RD 49 E OLD MILL RD 18 W KARSCH BLVD 125 W KARSCH BLVD 1351 AIRPARK DRIVE 800 VALLEY CREEK DR

EXCELSIOR SPRINGS EXCELSIOR SPRINGS FAIR GROVE FARMINGTON FARMINGTON FARMINGTON FARMINGTON

MO MO MO MO MO MO MO

64024-1244 64024-1244 65648-8452 63640 63640-2156 63640 63640-1969

SOUTHEAST MO MENTAL HLTH CTR PHCY USA DRUG #15823 SAMS HEALTH MART PHARMACY SAMS HEALTH MART PHARMACY DIERBERGS FENTON CROSSING OPTION CARE SHOP 'N SAVE PHARMACY MERCY PHARMACY JEFFERSON PHARMAX PHARMACY PRESCRIPTIONS PLUS SHOP 'N SAVE PHARMACY DIERBERGS FLORISSANT PHCY SHOP ' N SAVE PHARMACY SHOP N SAVE PHARMACY SHOP 'N SAVE PHARMACY THE MEDICINE SHOPPE COUNTRY MART PHARMACY FAMILY PHARMACY DICUS DRUGS PARKLAND HEALTH MART PHARMACY PARKLAND HEALTH MART PHARMACY FULTON STATE HOSPITAL RED CROSS PHARMACY INC SAULTS DRUG INC COURT SQUARE PHARMACY, INC MEDLEY PHARMACY GIDEON PHARMACY PRICE CHOPPER PHARMACY HENDERSONS PBA DRUG STORE RED CROSS PHARMACY INC ALBERS MEDICAL PHARMACY HEART OF AMERICA PHARMACY, LLC PRICE CHOPPER PHARMACY SHERRIS PHARMACY SERVICES

(573) 218-6754 (573) 756-6421 (660) 248-2275 (660) 248-2275 (636) 349-2666 (314) 843-1140 (636) 343-5488 (636) 933-1600 (636) 937-7997 (636) 933-2224 (636) 937-4686 (314) 831-0990 (314) 839-1327 (314) 438-8383 (314) 837-8052 (314) 921-7700 (417) 546-2501 (417) 551-0324 (573) 783-2788 (573) 783-6000 (573) 783-6000 (573) 592-3063 (573) 642-6892 (573) 642-4186 (417) 679-2650 (573) 764-5980 (573) 448-3333 (816) 453-0503 (660) 338-2125 (816) 847-2990 (816) 318-9999 (844) 780-4879 (816) 777-2448 (660) 564-3784

1010 W COLUMBIA ST 120 E KARSCH BLVD 300 N CHURCH ST 300 N CHURCH ST 450 OLD SMIZER MILL RD 535 AXMINISTER DR 45 GRAVOIS BLUFFS PLAZA DR 1400 US HIGHWAY 61 S STE G38 116 WALNUT ST. 1113 W GANNON DR 1275 N TRUMAN BLVD 222 N US HIGHWAY 67 2183 CHARBONIER RD 196 MAYFAIR PLAZA SHOPPING CTR 175 FLOWER VALLEY SHOPPING CTR 2386 N HIGHWAY 67 15720 US HIGHWAY 160 14974 US HIGHWAY 160 210 E MURTA ST 1025 HIGHWAY 72 BYPASS 1025 HWY 72 BYPASS 600 E 5TH ST 600 COURT ST 505 COURT ST 101 E 3RD 733 W SPRINGFIELD AVE 111 MAIN ST 6475 N PROSPECT AVE 523 1ST ST 301 SW EAGLES PKWY 7201 E 147TH ST STE 140 4338 E 142ND ST 12220 SOUTH 71 HIGHWAY 108 S MAIN ST

FARMINGTON FARMINGTON FAYETTE FAYETTE FENTON FENTON FENTON FESTUS FESTUS FESTUS FESTUS FLORISSANT FLORISSANT FLORISSANT FLORISSANT FLORISSANT FORSYTH FORSYTH FREDERICKTOWN FREDERICKTOWN FREDERICKTOWN FULTON FULTON FULTON GAINESVILLE GERALD GIDEON GLADSTONE GLASGOW GRAIN VALLEY GRANDVIEW GRANDVIEW GRANDVIEW GRANT CITY

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63640-2902 63640-1238 65248 65248-1106 63026-3553 63026-2903 63026-4012 63028-4111 63028 63028-2602 63028-1176 63031-5904 63031-5500 63033-8008 63033-1643 63033-2034 65653-8103 65653-8109 63645-1018 63645 63645 65251-1753 65251-1903 65251-1901 65655-1001 63037-2135 63848 64119-1545 65254-1005 64029-8521 64030-4204 64030-3035 64030-1130 64456-8321

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 325 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LAKE REGIONAL PHARMACY - LAURIE LAURIE FAMILY PHARMACY GREENFIELD PHARMACY INC DIERBERGS TOWN CENTER NORTHWEST PHARMACY SERVICES GOSNEY PHARMACY GRAND PHARMACY HANNIBAL REGIONAL HOSPITAL MAXWELL PHARMACY INC ST MARY'S PHARMACY GILLEN PHARMACY PRICE CHOPPER PHARMACY STAR PHARMACY THE PRESCRIPTION DRUG STORE TRAINOR-CLEVENGER DRUG BERLENER PHARMACY HERMANN FAMILY DRUG STORE HERMANN PHARMACY HERMITAGE PROF PHARMACY MEDICINE SHOPPE SHOP 'N SAVE PHARMACY HILLSBORO DRUG COMPANY WILKINSON PHARMACY FAMILY PHARMACY ST MARY'S HOLTS SUMMIT PHCY FORBES PHARMACY HUTCHESON PHARMACY SINKS PHARMACY PHARMAX PHARMACY #1117 AUBURN PHARMACY GENOA-QOL HEALTHCARE STADIUM PHARMACY STERLING PHARMACY CLARK'S RX PARKLAND HEALTH MART PHCY USA DRUG #15820 HORST PHARMACY JONES DRUG STORE INC MEDICENTER PHARMACY CAPITAL CARE PHARMACY GERBES PHARMACY GERBES PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (573) 302-3185 (573) 207-0805 (417) 637-2909 (636) 458-7450 (816) 583-2881 (573) 248-8322 (573) 221-2792 (573) 248-5244 (573) 719-3530 (573) 221-3000 (816) 884-5115 (816) 887-4320 (417) 741-6266 (573) 359-0008 (573) 359-1646 (573) 486-2612 (573) 486-2873 (573) 486-8999 (417) 745-2136 (660) 584-2700 (636) 677-5380 (636) 797-3468 (417) 667-7599 (417) 551-0324 (573) 896-4579 (417) 967-3315 (417) 967-4139 (573) 793-2050 (636) 464-1100 (816) 833-8629 (816) 833-7325 (816) 356-4600 (816) 795-6034 (573) 546-0421 (573) 546-6000 (573) 546-7915 (573) 243-8173 (573) 243-3524 (573) 243-1303 (573) 632-5295 (573) 659-3700 (573) 893-2226

Provider Street 156 MISSOURI BLVD 154 S MAIN ST 105 N GRAND ST STE 1 2460 TAYLOR RD 103 CROSS ST 2900 SAINT MARYS AVE 733 GRAND AVE 6000 HOSPITAL DR 200 S 9TH ST 5 DIAMOND BLVD 2820 E ROCKHAVEN RD STE 110 520 S COMMERCIAL ST 118 E ROLLA ST 308 E MAIN ST 225 S 3RD ST 219 E 1ST ST 195 STATE ROUTE 100 W 2060 VILLAGE LN 106 E JACKSON ST 810 W 35TH ST STE 101 1023 CROSSROADS PL 10666 BUSINESS 21 113 W 2ND ST 180 MALL RD 140 NORTHSTAR ST 100 N GRAND AVE 1330 S SAM HOUSTON BLVD 2322 HIGHWAY 17 1117 MAIN ST 16611 E 23RD ST 17844 E 23RD ST S RM D404 4811 S ARROWHEAD DR 19321 E US HIGHWAY 40 STE P 124 W RUSSELL ST 1500 N HIGHWAY 21 605 N MAIN STREET 2705 E JACKSON BLVD 125 COURT ST 200 W WASHINGTON ST 1125 MADISON ST 2101 SCHOTTHILL WOODS DR 2805 W TRUMAN BLVD

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Provider City GRAVOIS MILLS GRAVOIS MILLS GREENFIELD GROVER HAMILTON HANNIBAL HANNIBAL HANNIBAL HANNIBAL HANNIBAL HARRISONVILLE HARRISONVILLE HARTVILLE HAYTI HAYTI HERMANN HERMANN HERMANN HERMITAGE HIGGINSVILLE HIGH RIDGE HILLSBORO HOLDEN HOLLISTER HOLTS SUMMIT HOUSTON HOUSTON IBERIA IMPERIAL INDEPENDENCE INDEPENDENCE INDEPENDENCE INDEPENDENCE IRONTON IRONTON IRONTON JACKSON JACKSON JACKSON JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY

State

ZIP code

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

65037-5394 65037-6196 65661-8198 63040-1222 64644-8311 63401-3715 63401-3183 63401 63401 63401 64701 64701-1634 65667-8403 63851-1639 63851-1617 65041-1113 65041-1577 65041 65668-9231 64037-1865 63049-2236 63050-5097 64040-1322 65672-9602 65043-1123 65483-1222 65483-2045 65486 63052-2323 64055-1922 64057-1840 64055-6981 64055-5486 63650 63650-9147 63650 63755-2918 63755-1807 63755-1858 65101-5227 65101-5520 65109-0545

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JCMG PHARMACY JEFFERSON CITY APOTHECARY LLC PYRAMID PHARMACY SSM HEALTH PHARMACY TOLSON DRUG WHALEYS EAST END DRUG WHALEYS MEDICAL CTR PHARMACY WHALEY'S PRO-CARE SERVICES WHALEY'S WEST SIDE PHARMACY ACCESS FAMILY CARE FAMILY PHARMACY LAKELAND PHARMACY MAY'S DRUG STORE OZARK CENTER PHARMACY PRICE CUTTER PHARMACY QUICKMEDS PHARMACY QUICKMEDS PHCY- FREEMAN WEST THE MEDICINE SHOPPE CLARK COUNTY PHARMACY INC ALBERS MEDICAL PHARMACY BURNS & MCDONNELL PHARMACY CARONDELET PHCY @ ST JOSEPHS CHILDREN'S MERCY HOSP AND CLINICS CHILDRENS MERCY PHCY BROADWAY DCI PHARMACY KANSAS CITY GASHLAND PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GREAT OAK PHARMACY HEN HOUSE PHARMACY KANSAS CITY CARE CLINIC MARSH'S SUNFRESH PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY #288 ROCKHILL PHARMACY

Provider Name

(573) 556-7780 (573) 634-8300 (573) 556-5551 (573) 681-3740 (573) 636-4022 (573) 636-3733 (573) 634-3606 (573) 632-2001 (573) 659-0650 (417) 782-7209 (417) 551-0324 (417) 781-8383 (417) 624-6300 (417) 347-7490 (417) 626-0851 (417) 347-6337 (417) 347-3792 (417) 781-2332 (660) 727-2214 (816) 931-0100 (816) 321-7821 (816) 943-4879 (816) 234-1556 (816) 960-2950 (816) 941-2162 (816) 468-1684 (816) 527-8130 (816) 533-6843 (816) 453-9450 (816) 746-1475 (816) 777-2709 (816) 931-1505 (816) 777-0533 (816) 361-5000 (816) 452-8845 (816) 468-7666 (816) 883-2775 (816) 799-0123

1241 W STADIUM BLVD 1739 E ELM CT STE 108 3501 W TRUMAN BLVD STE H 2505 MISSION DR 226 E HIGH ST 630 E HIGH ST 1431 SOUTHWEST BLVD 630B E HIGH ST 3526 AMAZONAS DR 530 S MAIDEN LN 3202 INDIANA AVE 1227 E 32ND ST STE 6 3222 S MAIN ST 530 E 34TH ST STE 204 1850 MAIDEN LN 3201 MCCLELLAND BLVD 1102 W 32ND ST 2131 E 32ND ST STE 3 250 S JOHNSON ST 4400 BROADWAY ST STE 106 9450 WARD PKWY 1000 CARONDELET DR STE 120 2401 GILLHAM RD 3101 BROADWAY ST 650 CARONDELET DR 9411 N OAK TRFY STE 120 3100 NE 83RD ST STE 1107 6801 E 117TH ST STE A 7275 N OAK TRFY 6238 N CHATHAM AVE 3515 BROADWAY BLVD 4001 MILL ST 1030 W 103RD ST 8430 WORNALL RD 4820 N OAK TRFY 500 NE BARRY RD 9717 N ASH AVE 4240 SOUTHWEST TRFY

JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JOPLIN JOPLIN JOPLIN JOPLIN JOPLIN JOPLIN JOPLIN JOPLIN JOPLIN KAHOKA KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY KANSAS CITY

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

65109-6023 65101-4303 65109-5715 65109-9508 65101-3207 65101-3219 65109-2468 65101-3219 65109-5716 64801 64804-4037 64804-2904 64804-3824 64804-3966 64801 64804-3524 64804-3503 64804 63445-1635 64111-3395 64114 64114-4673 64108-4619 64111-2659 64114-4672 64155-2262 64119-4460 64134-3701 64118-1852 64151-2472 64111-2537 64111-3008 64114-4510 64114-5812 64118-4691 64155-2879 64157-9678 64111-6910

SAINT LUKE'S ADVANCED CARE PHARMACY SPALITTOS PBA PHARMACY ST LUKES HOSPITAL PHARMACY

(816) 756-1160 (816) 231-4717 (816) 932-2923

10920 ELM AVE 3801 INDEPENDENCE AVE 4401 WORNALL RD

KANSAS CITY KANSAS CITY KANSAS CITY

MO MO MO

64134-4108 64124-2703 64111

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 327 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ST LUKE'S NORTH OP PHCY STARK PROFESSIONAL PHARMACY SUN FRESH PHARMACY

Provider Name

(816) 880-3850 (816) 333-6611 (816) 734-3600

5844 NW BARRY RD STE 20 6650 TROOST AVE 10225 N OAK TRFY

KANSAS CITY KANSAS CITY KANSAS CITY

MO MO MO

64154-1421 64131-1215 64155-1715

SWOPE PARKWAY HEALTH CTR PHARMACY UNIVERSITY HEALTH PHARMACY

(816) 923-5800 (816) 404-4200

3801 BLUE PKWY 2101 CHARLOTTE ST

KANSAS CITY KANSAS CITY

MO MO

64130-2807 64108-2727

WESTERN MISSOURI MENTAL HEALTH PHCY RED CROSS PHARMACY CORNERSTONE PHCY KENNETT LLC HARRIS PHARMACY SEMO DRUGS OF KENNETT INC TEKO PHARMACY KIRKSVILLE PHARMACY MED DEPOT PHARMACY RIDER DRUG GREENTREE PHARMACY SHOP 'N SAVE PHARMACY LA PLATA PHARMACY LAKE REGIONAL PHARMACY - LO

(816) 512-7474 (816) 635-4485 (573) 888-9094 (573) 888-6006 (573) 888-8880 (573) 888-6673 (660) 956-7010 (660) 665-7239 (660) 665-4666 (314) 394-2404 (314) 984-0422 (660) 332-4456 (573) 964-6200

1000 E 24TH ST 101 W STATE ROUTE 92 STE A 123 1ST ST 1224 1ST ST 1300 1ST ST 501 TEACO RD 1611 S BALTIMORE ST STE B 800 W JEFFERSON ST 1207 S BALTIMORE ST 301 S KIRKWOOD RD 10461 MANCHESTER RD 29936 JULY RD 1870C BAGNELL DAM BLVD

KANSAS CITY KEARNEY KENNETT KENNETT KENNETT KENNETT KIRKSVILLE KIRKSVILLE KIRKSVILLE KIRKWOOD KIRKWOOD LA PLATA LAKE OZARK

MO MO MO MO MO MO MO MO MO MO MO MO MO

64108-2776 64060-7591 63857-2051 63857-2528 63857-2526 63857-3721 63501-4536 63501-1443 63501-4528 63122 63122-1522 63549-3129 65049-8658

LIME IN THE COCONUT SPEC COMPD PHCY THE MEDICINE SHOPPE THE MED STATION WILKINSON PHARMACY LAMAR LANCASTER DRUG MONROE PBA PHARMACY HOMETOWN PHARMACY JOE'S PBA PHARMACY

(573) 964-6786 (636) 321-1000 (417) 681-0999 (417) 682-5838 (660) 457-3220 (816) 580-3415 (417) 532-9110 (417) 532-7128

111 CROSSINGS W 149 POND FORT TRL 54B SE 1ST LN 605A W 12TH ST 100 N GREEN ST STE A 412 N PENNSYLVANIA 223 E 7TH ST 489 S JEFFERSON AVE

LAKE OZARK LAKE SAINT LOUIS LAMAR LAMAR LANCASTER LAWSON LEBANON LEBANON

MO MO MO MO MO MO MO MO

65049-8705 63367-4022 64759-9226 64759-1703 63548 64062-9998 65536-2706 65536-3261

JORDAN VALLEY COMMUNITY HLTH CNTR SMITTYS PHARMACY ST. JOHN'S PHARMACY-LEBANON WILKINSON PHARMACY COSENTINO'S PRICE CHOPPER GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GREAT PLAINS PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY THE MEDICINE SHOPPE COUNTY MARKET PHARMACY 191

(417) 334-8337 (417) 588-3313 (417) 533-6770 (417) 532-4431 (816) 246-7300 (816) 347-0075 (816) 600-0398 (630) 981-8023 (816) 554-2951 (816) 744-2104 (816) 524-8444 (573) 497-2727

860 LYNN ST 601 S JEFFERSON 200 HOSPITAL DR 143 W ELM ST 937 NE WOODS CHAPEL RD 901 NE INDEPENDENCE AVE 1535 NE RICE RD STE A 348 NW CAPITAL DR 300 SW BLUE PKWY 251 SW GREENWICH DR 1405 NE DOUGLAS ST 219 W MAIN ST

LEBANON LEBANON LEBANON LEBANON LEES SUMMIT LEES SUMMIT LEES SUMMIT LEES SUMMIT LEES SUMMIT LEES SUMMIT LEES SUMMIT LEWISTOWN

MO MO MO MO MO MO MO MO MO MO MO MO

65536 65536-3665 65536-9215 65536-3517 64064-1989 64086-5544 64086-5849 64086-4723 64063-3982 64082-4426 64086-4609 63452-0246

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 328 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MINUTEMAN PHARMACY RED CROSS PHARMACY LEIGHR PHARMACY RINNE PHARMACY ST JOHN'S SISK PHARMACY LINN DRUGS #15826 LOCKWOOD PHARMACY FAMILY DRUG MILLER REXALL DRUG RED CROSS PHARMACY MALDEN PHCY & HOME MED EQUIP OVERTURF PHARMACY DIRECTRX PHARMACY MANSFIELD DRUG SHOP 'N SAVE PHARMACY TWIN CITY PHARMACY MARCELINE FAMILY PHARMACY MARIONVILLE PHARMACY RED CROSS LTC PHARMACY RED CROSS PHARMACY RED CROSS PHARMACY INC FAMILY PHARMACY MARSHFIELD CLINIC PHARMACY STANLEYS PHARMACY ROGERS PHARMACY RANDOLPH DRUG STORE SCOTLAND COUNTY PHARMACY A & B PBA RX PARKWAY PHARMACY THE MEDICINE SHOPPE WEBBER PBA PHARMACY INC MILAN U SAVE HILS PHARMACY KRIBBS FAMILY PHARMACY SAMS HEALTH MART PHARMACY SAM'S HEALTH MART PHARMACY

Provider Name

(660) 259-3455 (660) 886-5535 (816) 736-4232 (573) 674-2995 (573) 674-2922 (573) 897-4140 (417) 232-4721 (573) 754-4551 (660) 385-2167 (660) 385-2147 (573) 276-3784 (573) 276-2218 (636) 220-1655 (417) 924-8877 (314) 645-8495 (573) 238-4177 (660) 376-2705 (417) 258-2526 (660) 886-5533 (660) 886-5558 (660) 886-5533 (417) 551-0324 (417) 468-4442 (417) 468-2530 (660) 562-2300 (816) 449-2700 (660) 465-2400 (573) 581-1350 (573) 567-7077 (573) 581-7561 (573) 581-6930 (660) 265-3779 (302) 540-5178 (660) 263-8020 (660) 263-0909 (660) 263-6710

538 S BUSINESS HIGHWAY 13 1030 MAIN ST 1170 W KANSAS ST STE K 100 DEER LICK 101 N MAIN 304 E MAIN ST 725 MAIN 301 GEORGIA ST 115 VINE ST 402 E BRIGGS DR 214 W MAIN ST 212 W MAIN ST 140 ENCHANTED PKWY STE 100 101 N BUSINESS HWY 60 7355 MANCHESTER RD 106 N 1ST ST 1509 N MISSOURI AVE 201 SOUTH U.S. HIGHWAY 60 157 S JEFFERSON AVE 941 S CHEROKEE STE 1 161 S BENTON 759 W WASHINGTON ST 483 POMME DE TERRE 1369 SPUR DR 125 E SOUTH AVE 301 S POLK ST 445 GRAND AVE 201 E MONROE ST 340 KELLEY PKWY SUITE D 200 E JACKSON ST 1101 W MONROE STE 103 111 E 2ND ST 715 N MORLEY STE A 319 W REED ST 300 N MORLEY ST 643 N MORLEY

LEXINGTON LEXINGTON LIBERTY LICKING LICKING LINN LOCKWOOD LOUISIANA MACON MACON MALDEN MALDEN MANCHESTER MANSFIELD MAPLEWOOD MARBLE HILL MARCELINE MARIONVILLE MARSHALL MARSHALL MARSHALL MARSHFIELD MARSHFIELD MARSHFIELD MARYVILLE MAYSVILLE MEMPHIS MEXICO MEXICO MEXICO MEXICO MILAN MOBERLY MOBERLY MOBERLY MOBERLY

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

64067 64067-1345 64068-2177 65542 65542-9026 65051-9000 65682-1001 63353-1717 63552-1654 63552-1982 63863-2114 63863-2114 63021 65704 63143-3107 63764-9218 64658-1009 65705 65340-2132 65340-2914 65340 65706-2234 65706-2386 65706-2311 64468-2669 64469-4037 63555-1501 65265-2852 65265-3811 65265-2821 65265-0000 63556 65270-2617 65270-1558 65270-2334 65270

SAM'S HEALTH MART PHARMACY # 2 LTC BRUNER PBA PHARMACY MONETT PROFESSIONAL PHARMACY OLD TOWN PHARMACY PRICE CUTTER PHARMACY

(660) 263-0615 (417) 235-3139 (417) 354-1253 (417) 635-1100 (417) 236-2820

530 EAST 24 HIGHWAY 321 E BROADWAY ST 801 N LINCOLN AVE 100 CHAPEL DR 2150 E CLEVELAND AVE

MOBERLY MONETT MONETT MONETT MONETT

MO MO MO MO MO

65270 65708-2329 65708-1641 65708-9370 65708-6134

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 329 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FAMILY PHARMACY THE MEDICINE SHOPPE ROGERS PHARMACY LANDRUM DRUG INC MT VERNON HOMETOWN PHARMACY FAMILY PHARMACY MOUNTAIN GROVE PHARMACY COUNTRY CARE PHARMACY MITCHELL'S DOWNTOWN DRUG STORE MITCHELL'S DRUG STORES ON THE QUICK MEDS PHARMACY NEOSHO COMMUNITY PHARMACY WILKINSON PHARMACY WOODS SUPERMARKET PHARMACY PRATTS PHARMACY FREDS PHARMACY NEW MADRID PHARMACY FAMILY PHARMACY PRICE CUTTER PHARMACY ST. JOHN'S PHARMACY-NIXA NOEL PHARMACY DIERBERGS DEER CREEK XING POWERS HEALTHMART PHARMACY SHOP ' N SAVE PHARMACY SHOP 'N SAVE PHARMACY WHARF PHARMACY RED CROSS PHARMACY THE DRUG STORE LAKE REGIONAL PHARMACY - OBMP

Provider Name

(573) 564-2273 (573) 564-1111 (660) 442-3355 (417) 461-1100 (417) 466-2000 (417) 926-9655 (417) 926-4156 (417) 451-9301 (417) 451-3776 (417) 451-9501 (417) 455-4378 (417) 667-6044 (417) 667-7802 (417) 667-3953 (573) 237-3321 (573) 748-5285 (573) 748-3080 (417) 551-0324 (417) 725-6606 (417) 724-5350 (417) 475-3292 (636) 379-8910 (636) 265-2924 (636) 561-8450 (636) 240-1262 (636) 887-4008 (816) 633-5518 (816) 633-8000 (573) 302-2700

806 N STURGEON ST 635 S STURGEON ST 607 STATE ST 1319 S LANDRUM ST STE E 606 E MOUNT VERNON BLVD 1600 N MAIN ST 106 N UNION ST 1504 N BUSINESS 71 115 E HICKORY ST 719 S NEOSHO BLVD STE A 336 S JEFFERSON ST 900 S ADAMS ST 105 S OAK ST 1407 W AUSTIN BLVD 100 DWAYNE VONBEHREN DRIVE 415 MOTT ST 457 MAIN ST 105 RIDGECREST STE 1 & 2 400 MASSEY BLVD 940 W MOUNT VERNON ST STE 130 222 MAIN ST 2979 HIGHWAY K 7776 WINGHAVEN BLVD 7909 HIGHWAY N 235 HIGHWAY 175 2175 W TERRA LN 101 S 2ND ST 408 N 4TH ST 1057 MEDICAL PARK DR STE B

MONTGOMERY CITY MONTGOMERY CITY MOUND CITY MOUNT VERNON MOUNT VERNON MOUNTAIN GROVE MOUNTAIN GROVE NEOSHO NEOSHO NEOSHO NEOSHO NEVADA NEVADA NEVADA NEW HAVEN NEW MADRID NEW MADRID NIXA NIXA NIXA NOEL O FALLON O FALLON O FALLON O FALLON O FALLON ODESSA ODESSA OSAGE BEACH

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63361-1426 63361-2707 64470-1146 65712-1976 65712-9100 65711-1010 65711-1724 64850-1975 64850-1806 64850 64850-1769 64772 64772-3436 64772-2805 63068 63869 63869 65714 65714 65714-9613 64854-9373 63368 63368 63368 63366 63366-2366 64076-1245 64076-1152 65065-3000

CMH OSCEOLA COMMUNITY PHARMACY EVANS DRUGS MEDLEY PHARMACY FAMILY PHARMACY FAMILY PHARMACY HIXSON DRUG PHARMACY LAWRENCE DRUG MERCY PHARMACY EVANS ROAD PRICE CUTTER PHARMACY COUNTY MARKET PHARMACY PARIS PHARMACY COUNTRY MART

(417) 646-5052 (417) 646-2301 (573) 437-3440 (417) 581-6310 (417) 551-0324 (417) 581-7777 (417) 485-8555 (417) 885-3357 (417) 581-9288 (573) 769-0343 (660) 327-4514 (573) 431-8537

855 ARDUSER DR 675 3RD ST 601 E LINCOLN AVE 1156 W JACKSON ST 1152 W JACKSON ST 604A E SOUTH ST 5540 N FARMER BRANCH RD 3050 E RIVER BLUFF BLVD 5504 N 17TH ST 1208 SOUTH MAIN STREET 223 N MAIN ST 301 T J STEWART DR

OSCEOLA OSCEOLA OWENSVILLE OZARK OZARK OZARK OZARK OZARK OZARK PALYMRA PARIS PARK HILLS

MO MO MO MO MO MO MO MO MO MO MO MO

64776 64776-2934 65066-1440 65721-9164 65721-9164 65721-8912 65721-5315 65721 65721 63461 65275-1328 63601-2500

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 330 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PHARMAX PHARMACY AUBURN PHARMACY HOMETOWN PHARMACY HEALTH CARE HEALTHMART PHCY PRESCRIPTION PLUS MEDICINE SHOPPE MEDICAL CENTER PHARMACY OLD TOWN PHARMACY MILLER PROFESSIONAL PHCY INC PRICE CHOPPER PHARMACY RED CROSS PHARMACY PRICE CHOPPER PHARMACY THE PHARMACY @ PLEASANT HOPE DILLE'S DISCOUNT PHARMACY EAST SIDE DISCOUNT PHARMACY HARPS PHARMACY KEY DRUGS KEY DRUGS AT NORTHWEST KNEIBERT CLINIC PHARMACY LETASSY PHARMACY PHYSICIAN'S PARK PHARMACY SOUTHEASTHEALTH PHARMACY SUPER SAVER DISCOUNT PHARMACY THE MEDICINE SHOPPE BUTLER DRUG STORE INC AUSTIN PLAZA PHARMACY GENOA-QOL HEALTHCARE PHARMAX PHARMACY PUXICO DRUGS PRICE CHOPPER PHARMACY FOXS DRUG STORE FAMILY PHARMACY LAKELAND PHARMACY FAMILY PHARMACY HINES STREET PHARMACY LLC PRICE CUTTER PHARMACY WILKINSON PHARMACY RICH HILL YORK & CO. PHARMACY C & C DISCOUNT PHARMACY RED CROSS PHARMACY PHILLIPS FAMILY PHARMACY RIVERSIDE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (573) 431-5040 (816) 587-2211 (816) 425-2900 (573) 547-2517 (573) 547-4960 (636) 475-2810 (573) 223-4235 (417) 476-2828 (816) 858-2400 (816) 431-2751 (816) 539-2121 (816) 540-3581 (417) 267-6337 (573) 785-0984 (573) 686-7238 (573) 778-9156 (573) 785-8218 (573) 727-9444 (573) 778-7190 (573) 785-8421 (573) 778-9238 (573) 778-1608 (573) 686-1919 (573) 686-7216 (573) 379-5469 (573) 438-2349 (573) 436-0127 (573) 438-2189 (573) 222-6206 (816) 265-6134 (816) 353-1600 (417) 551-0324 (417) 272-8064 (417) 551-0324 (417) 735-0055 (417) 732-4212 (417) 395-4700 (573) 765-3321 (816) 776-6926 (660) 886-5535 (816) 569-2125 (816) 741-8844

Provider Street 113 SAINT FRANCOIS PLZ 9107 NW HIGHWAY 45 501 SCHUG AVE 628 OLD SAINT MARYS RD 212 HOSPITAL LN STE 102 8640 COMMERCIAL BLVD RR 4 BOX 4515 119 E MAIN ST 2703 RUNNING HORSE RD 2600 ENSIGN HILL DR 400 W CLAY AVE 2101 N STATE ROUTE 7 5492 HIGHWAY H UNIT E 909 W PINE ST 400 E PINE ST 1301 SHELBY RD 910 N WESTWOOD BLVD 2210 BARRON RD 686 LESTER STREET 1014 W PINE ST 225 PHYSICIANS PARK STE 100 2002 KANELL BLVD 449 S HWY 53 200 N 10TH ST 222 E MAIN ST 410 E HIGH ST 1 SOUTHTOWNE DR 610 E HIGH ST 176 E RICHARDSON AVE 900 W FOXWOOD DR 10004 E 63RD ST 18192 BUSINESS 13 STE A 18565 BUSINESS 13 285 US HIGHWAY 60 W 1173 E HINES ST 1013 E HIGHWAY 60 301 N 14TH ST 104 W MCCLURG AVE 401 WOLLARD BLVD 706 WOLLARD BLVD 2401 NW PLATTE RD 616 NW PLATTE VALLEY DR

Page 331 of 679

Provider City PARK HILLS PARKVILLE PECULIAR PERRYVILLE PERRYVILLE PEVELY PIEDMONT PIERCE CITY PLATTE CITY PLATTE CITY PLATTSBURG PLEASANT HILL PLEASANT HOPE POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF POPLAR BLUFF PORTAGEVILLE POTOSI POTOSI POTOSI PUXICO RAYMORE RAYTOWN REEDS SPRING REEDS SPRING REPUBLIC REPUBLIC REPUBLIC RICH HILL RICHLAND RICHMOND RICHMOND RIVERSIDE RIVERSIDE

State

ZIP code

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63601-4454 64152-3958 64078 63775-1837 63775-4204 63070-1529 63957-9417 65723-1296 64079 64079 64477 64080-9374 65725-8227 63901 63901-5401 63901 63901-4242 63901-1908 63901 63901-4840 63901-3918 63901 63901-7204 63901-4856 63873-1614 63664 63664-5729 63664-1406 63960-9181 64083-7200 64133-5102 65737-8637 65737-9659 65738-1432 65738-1277 65738 64779-2146 65556-9998 64085 64085-2205 64150-9627 64150-9798

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STONER DRUG FAMILY PHARMACY ROGERSVILLE PHARMACY HILLCREST DRUG INC SINKS PHARMACY SINKS PHARMACY SOUTH ST JOHNS PHARMACY ROLLA SHOP 'N SAVE PHARMACY DIERBERGS BOGEY HILLS PHCY GENOA-QOL HEALTHCARE MEDICINE SHOPPE ST. CHARLES SHOP 'N SAVE PHARMACY SHOP 'N SAVE PHARMACY SSM ST CHRLS CLNC MED GRP PHCY SINKS PHARMACY ST CLAIR REXALL DRUG THE MEDICINE SHOPPE FOREST CITY HEALTH MART

Provider Name

(660) 744-2433 (417) 551-0324 (417) 753-7774 (573) 364-3258 (573) 364-9616 (573) 308-4899 (573) 458-6433 (314) 426-4180 (636) 947-0929 (636) 373-8840 (636) 949-5593 (636) 441-3300 (636) 300-0629 (636) 669-2223 (636) 629-8085 (636) 629-0710 (636) 629-2022 (573) 265-5400

315 S MAIN ST 432 S MILL ST 319 S MAIN ST STE N 1100B S BISHOP AVE 1375 B EAST 10TH ST 1024 S BISHOP AVE 1605 MARTIN SPRINGS DR # 220 10634 SAINT CHARLES ROCK RD 2021 ZUMBEHL RD 102 COMPASS POINT DR STE A 488 S 5TH ST 60 HARVESTER SQ 3740 MONTICELLO PLZ 1551 WALL ST 1435 N MAIN ST 855 N COMMERCIAL AVE 920 PLAZA DR STE H 125 N JEFFERSON ST

ROCK PORT ROGERSVILLE ROGERSVILLE ROLLA ROLLA ROLLA ROLLA SAINT ANN SAINT CHARLES SAINT CHARLES SAINT CHARLES SAINT CHARLES SAINT CHARLES SAINT CHARLES SAINT CLAIR SAINT CLAIR SAINT CLAIR SAINT JAMES

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

64482-1533 65742-7601 65742-9361 65401-4418 65401-2565 65401-4416 65401-2931 63074-1619 63303-2723 63301-4414 63301-2633 63303-6357 63304-8613 63303-3539 63077-1033 63077-1118 63077-1137 65559-1917

FOREST CITY MEDICAL CENTER PHARMACY ST JOHN'S PHARMACY-ST JAMES APOTHECARY PHARMACY BENDERS PRESCRIPTION SHOP GENOA-QOL HEALTHCARE NW MO PSYCHIATRIC REHAB CTR PHCY PRICE CHOPPER PHARMACY ROGERS PHARMACY STEVENSON PBA PHARMACY THE PHARMACY AT APPLE MARKET AVELLA OF ST LOUIS INC BARNES-JEWISH HOSP PHARMACY BEVERLY HILLS PHARMACY BWELL PHARMACY CARDINAL GLENNON AMB CARE CTR CENTERPOINTE PHARMACY CLAYTON HEALTH PHARMACY DIEBERGS BRENTWOOD POINTE DIERBERG WARSON WOODS PHCY DIERBERGS HERITAGE PL PHCY DIERBERGS LEMAY PLAZA PHCY DIERBERGS MACKENZ PTE PHCY DIERBERGS SOUTHROADS PHCY

(573) 265-2525 (573) 265-8901 (816) 279-2590 (816) 279-1668 (816) 396-5800 (816) 387-2564 (816) 596-8041 (816) 232-3348 (816) 238-2424 (816) 260-6346 (314) 227-2560 (314) 454-7666 (314) 381-8600 (314) 328-1100 (314) 577-5677 (314) 292-7388 (314) 768-8870 (314) 962-9036 (314) 919-0611 (314) 542-2194 (314) 894-7755 (314) 752-7881 (314) 849-3880

1000 N JEFFERSON ST 105 W ELDON 1517 ST JOSEPH AVE 3829 FREDERICK AVE 724 N 22ND ST 3505 FREDERICK AVE 2219 N BELT HIGHWAY 2524 FREDERICK AVE 6201 KING HILL AVE 3734 PEAR ST 450 N NEW BALLAS RD STE 258 216 KINGS HIGHWAY BLVD 7150 NATURAL BRIDGE RD 5201 CHIPPEWA ST 1465 S GRAND BLVD 763 S NEW BALLAS RD 1035 BELLEVUE AVE 8450 EAGER RD 9901 MANCHESTER RD 12595 OLIVE BLVD 2516 LEMAY FERRY RD 7233 WATSON RD 12420 TESSON FERRY RD

SAINT JAMES SAINT JAMES SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT JOSEPH SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

65559-1078 65559-1903 64505-2631 64506-3020 64506-2604 64506-2914 64506 64506-2751 64504-2063 64503 63141-6836 63110 63121-5151 63109-2355 63104-1003 63141-8704 63117-1854 63144-1413 63122-1915 63141-6311 63125-3131 63119-4401 63128-2702

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DIERBERGS TELEGRPH PLZ PHCY DIERBERGS WEST OAK PHCY EBERHART PHARMACY EXPRESS CARE PHARMACY FAMILY CARE PHARMACY FAMILY CARE PHARMACY GATEWAY APOTHECARY GENOA-QOL HEALTHCARE GOLDSMITH MEDICENTER PHARMACY HEALTH DIRECT IPS, INC IMRAN PHARMACY KELLER PBA APOTHECARY LADUE PHARMACY, LLC LINDENWOOD DRUG MEDICINE SHOPPE PHARMACY MERCY PHARMACY OLIVE MASON MERCY PHARMACY ST LOUIS LOBBY MERCY PHARMACY TOWER A/B MERCY SPECIALTY PHARMACY STL MILLBROOK PHARMACY MYRTLE HILLIARD DAVIS CHC NEELS PHARMACY OLIVE STREET PHARMACY LLC ON THE HILL HEALTH MART PHARMACY PLACES FOR PEOPLE PHARMACY QUADRANGLE PHARMACY LLC READYMED PHARMACY REHOBOTH PHARMACY SAMC CLOSED DOOR PHARMACY SHOP N SAVE PHARMACY SHOP 'N SAVE PHARMACY SHOP 'N SAVE PHARMACY SHOP 'N SAVE PHARMACY SHOP 'N SAVE PHARMACY SHOP 'N SAVE PHARMACY SHOP 'N SAVE PHARMACY ST LOUIS CANCER CARE LLP ST LOUIS CHILDRENS HOSP PHCY

Provider Name

(314) 846-5778 (314) 432-5708 (314) 638-1000 (314) 396-6711 (314) 996-7501 (314) 653-5200 (314) 381-1818 (314) 227-0995 (314) 432-5020 (314) 373-1111 (314) 381-9394 (314) 352-5201 (314) 993-4031 (314) 781-2445 (314) 865-1528 (314) 251-8989 (314) 251-6900 (314) 251-7444 (314) 251-4400 (314) 802-7012 (314) 367-5820 (314) 849-3123 (314) 736-5555 (314) 776-9460 (314) 669-9701 (314) 935-6649 (610) 724-6643 (314) 885-3333 (314) 525-1633 (314) 869-2897 (314) 733-0607 (314) 752-2156 (314) 771-0218 (314) 645-1371 (314) 544-4963 (314) 867-3024 (314) 842-7301 (314) 454-2777

5640 TELEGRAPH RD 11481 OLIVE BLVD 4221 BAYLESS AVE 2319 WELDON PKWY 3023 N BALLAS RD STE 100D 11125 DUNN RD 4473 FOREST PARK AVE 9890 CLAYTON RD STE 125 777 S NEW BALLAS RD 2000 WESTPORT CENTER DR 3737 N KINGS HWY BLVD #100 5346 DEVONSHIRE AVE 9832 CLAYTON RD 6903 LANSDOWNE AVE 3137 S GRAND BLVD 12680 OLIVE BLVD STE 150 615 S NEW BALLAS RD 621 S NEW BALLAS RD 607 S NEW BALLAS RD STE 1415 7010 PERSHING AVE 5471 DR MARTIN LUTHER KING DR 8 CRESTWOOD EXECUTIVE CTR 10420 OLD OLIVE ST RD #103 5378 SOUTHWEST AVE 4130 LINDELL BLVD STE B 6643 SHEPLEY DR 13080 TESSON FERRY RD. 9944 W FLORISSANT AVE 10010 KENNERLY RD 9521 LEWIS AND CLARK BLVD 9070 SAINT CHARLES ROCK RD 4660 CHIPPEWA ST 3865 GRAVOIS AVE 7057 CHIPPEWA ST 1032 LEMAY FERRY RD 10805 OLD HALLS FERRY RD 3844 S LINDBERGH BLVD STE 216 1 CHILDRENS PL

SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63129-4243 63141-7184 63123-7513 63146-3207 63131-2331 63136-6132 63108-2211 63124-1685 63141-8705 63146 63115-1703 63109-2304 63124-1604 63109-1949 63118-1020 63141-6364 63141-8221 63141-8232 63141-8222 63130-4318 63112-4265 63126-1904 63141-5937 63139-1446 63108 63105-2354 63128-3442 63136-1432 63128-2106 63136-5201 63114-4246 63116-1611 63116-4657 63119-5672 63125-1744 63136-4542 63127-1369 63110-1002

ST LOUIS PSYCHIATRIC REHAB CTR PHCY ST. LOUIS HILLS PHARMACY LLC THE MEDICINE SHOPPE

(314) 877-6104 (314) 832-2480 (314) 367-3009

5300 ARSENAL ST 4365 CHIPPEWA ST STE 100 625 N EUCLID AVE STE 150

SAINT LOUIS SAINT LOUIS SAINT LOUIS

MO MO MO

63139-1463 63116 63108-1673

NR_0009_10823 10/2017

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Provider Street

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE WA UNIVERSITY CANCER CNT PHCY

Provider Name

(314) 427-1818 (314) 638-3535 (314) 275-0909 (314) 428-7676 (314) 747-8646

2514 WOODSON RD 7922 MACKENZIE RD 3229 LEMAY FERRY RD 4441 BROWN RD 4921 PARKVIEW PL FL 7

SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS

MO MO MO MO MO

63114-5437 63123-2721 63125-4419 63134-3405 63110-1032

WASHINGTON UNIV CNCR CTR PHY W CNTY WEST PINE PHARMACY WINKELMANN SONS DRUG CO WUCC PHARMACY SOUTH COUNTY DIERBERGS MID RIVERS PHCY DIERBERGS PHCY AT 94 XING GENOA-QOL HEALTHCARE SHOP N SAVE PHARMACY ST PETERS COMMUNITY PHARMACY THE MEDICINE SHOPPE ST JOHN'S PHARMACY-ST ROBERT COUNTRY MART PHARMACY KLEIN'S MEDICAL CTR PHCY COUNTRY MART PHARMACY MOSER PHARMACY VANDIVORT DRUG RED CROSS PHARMACY THE MEDICINE SHOPPE PRATERS PHARMACY COUNTRYSIDE PHARMACY SAVANNAH PBA FAMILY PHARMACY MEDICAP PHARMACY MEDICAL CTR PHCY PLAZA WEST PHARMACY SWORDS FAMILY PHARMACY WOODS PHARMACY WOODS PHARMACY 2470 SEMO DRUGS INC PRATERS PHARMACY DOWNTOWN DRUG SEYMOUR PHARMACY SHELBINA PHARMACY LLC PLAZA PHARMACY MEDICAL ARTS PHARMACY MISSOURI DELTA PHARMACY RANDY'S RX

(314) 996-3354 (314) 533-1081 (314) 353-3300 (314) 286-1929 (636) 970-3510 (636) 936-3020 (636) 486-4264 (636) 441-9600 (636) 244-5385 (636) 278-6561 (573) 336-2180 (573) 883-3524 (573) 883-5788 (573) 729-4091 (573) 729-3300 (573) 729-4114 (660) 388-5221 (314) 842-0910 (417) 548-7184 (816) 324-5111 (816) 324-4211 (573) 264-2450 (660) 826-2626 (660) 827-0000 (660) 826-0462 (660) 827-2400 (417) 326-7603 (573) 738-2097 (417) 776-8701 (417) 935-9003 (417) 935-4900 (573) 588-2143 (417) 858-2200 (573) 471-5454 (573) 472-7450 (573) 471-0285

10 BARNES WEST DR STE 100 BLDG 4401 W PINE BLVD 3300 MERAMEC ST 5225 MIDAMERICA PLZ 290 MID RIVERS CTR 6211 MID RIVERS MALL DR 255 SPENCER RD STE 202 100 JUNGERMANN RD 4885 MEXICO RD 7833 MEXICO RD 586 OLD ROUTE 66 190 PLAZA DR 601 CENTER DR 1204 E HIGHWAY 32 900 S MAIN ST 117 W 4TH ST 227 S BROADWAY 11551 GRAVOIS RD 1412 HIGH ST 402 E PRICE AVE 205 S US HIGHWAY 71 2220 MAIN ST 1700 S INGRAM AVE 3330 W 10TH ST 300 S OHIO AVE 1400 S LIMIT AVE STE 3 701 E BROADWAY BLVD 102 W COMMERCIAL ST 1711 CHEROKEE AVE 122 WEST WASHINGTON STREET 214 S MAIN ST 201 N CENTER ST STE A 24875 STATE HWY 39 808 E WAKEFIELD AVE 1008 N MAIN ST 1012 N MAIN ST

SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT LOUIS SAINT PETERS SAINT PETERS SAINT PETERS SAINT PETERS SAINT PETERS SAINT PETERS SAINT ROBERT SAINTE GENEVIEVE SAINTE GENEVIEVE SALEM SALEM SALEM SALISBURY SAPPINGTON SARCOXIE SAVANNAH SAVANNAH SCOTT CITY SEDALIA SEDALIA SEDALIA SEDALIA SEDALIA SENATH SENECA SEYMOUR SEYMOUR SHELBINA SHELL KNOB SIKESTON SIKESTON SIKESTON

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63141-6350 63108-2301 63118-4311 63129-0002 63376-4325 63304-1102 63376-2576 63376-1608 63376-2577 63376-1122 65584-3729 63670-1828 63670-1801 65560-2844 65560-1639 65560-1255 65281-1035 63126-3611 64862-8323 64485-1742 64485-1726 63780-1329 65301-7536 65301-2111 65301-4432 65301-5119 65301-6040 63876 64865 65746 65746 63468 65747 63801-5147 63801 63801-5044

NR_0009_10823 10/2017

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Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SIKESTON MEDICENTER PHARMACY CITY PBA PHARMACY MEDICINE SHOPPE PRICE CHOPPER PHARMACY FAMILY PHARMACY ALPS PHARMACY ALPS PHARMACY #2 ALPS SPECIALTY PHARMACY BURRELL PHARMACY CONVENIENT CARE PHARMACY CONVENIENT CARE PHARMACY CONVENIENT CARE PHARMACY COXHEALTH PHARMACY DANS DISCOUNT DRUG MART DOWNTOWN PHARMACY DOWNTOWN PHARMACY SOUTH FAMILY PHARMACY FAMILY PHARMACY GEORGE'S PHARMACY GROVE PHARMACY GROVE PHARMACY GUARDIAN PHARMACY OF MISSOURI HOME PARENTERAL SERVICES INTEGRITY PHARMACY LAWRENCE DRUG INC MERCY PHARMACY-SPRINGFIELD MIDTOWN PHARMACY

Provider Name

(573) 471-4401 (660) 529-2255 (816) 532-0977 (816) 532-6140 (417) 551-0324 (417) 865-1547 (417) 893-3900 (417) 719-4510 (417) 761-5150 (417) 269-8880 (417) 269-5584 (417) 269-7470 (417) 269-5988 (417) 869-9003 (417) 351-3774 (417) 720-4772 (417) 551-0324 (417) 551-0324 (417) 889-7898 (417) 881-2910 (417) 881-8822 (417) 864-5873 (417) 887-7525 (417) 865-2900 (417) 886-6880 (417) 820-2752 (417) 866-3054

507 N MAIN ST 227 MAIN ST 1103 S 169 HWY 122 N US HIGHWAY 169 7154 STATE HIGHWAY 14 E 2650 W KEARNEY ST STE 116 2828 N NATIONAL AVE STE A 2828 N NATIONAL STE B 1300 E BRADFORD PKWY 1443 N ROBBERSON AVE 1000 E PRIMROSE ST 1001 E PRIMROSE ST 3800 S NATIONAL AVE STE 110 2625 N KANSAS EXPY 655 S CAMPBELL AVE 222 E PRIMROSE ST STE B 527 W KEARNEY ST 4728 S CAMPBELL AVE STE 132 3650 E SUNSHINE ST 1522 E SUNSHINE ST 3050 S NATIONAL AVE STE 109 2103 E ROCKHURST ST STE 108 2240 W SUNSET ST 509 S UNION AVE 1454 E REPUBLIC RD 1235 E CHEROKEE ST 811 E DIVISION ST

SIKESTON SLATER SMITHVILLE SMITHVILLE SPARTA SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

63801-2105 65349-1411 64089 64089-9701 65753-8939 65803-2037 65803-4306 65803-4306 65804-4264 65802-1928 65807-5154 65807-5155 65807-5251 65803-1114 65806-2901 65807-5233 65803-2523 65810-1715 65809 65804-1214 65804-4242 65802 65807-5980 65802-2659 65804-6507 65804-2203 65803-3115

ONC HEMA ASSOC OF SPRINGFIELD MOMDP ORCHARD HILLS PHARMACY PRICE CUTTER PHARMACY PRICE CUTTER PHARMACY PRICE CUTTER PHARMACY PRICE CUTTER PHARMACY PRICE CUTTER PHARMACY PRICE CUTTER PHARMACY #52 ST JOHNS PHARMACY-FREMONT ST JOHNS PHARMACY-SGC SUNSHINE HEALTH MART PHARMACY TAYLOR HEALTH CENTER PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE

(417) 882-4880 (417) 868-8288 (417) 874-7428 (417) 863-1123 (417) 887-5516 (417) 889-6828 (417) 866-7702 (417) 823-4875 (417) 820-3577 (417) 841-0116 (417) 863-0002 (417) 836-4050 (417) 869-1866 (417) 881-8841

3850 S NATIONAL STE 600 3816A W CHESTNUT EXPY 1720 W GRAND 335 N NOLTING AVE 3260 E BATTLEFIELD 4228 S NATIONAL 1901 E DIVISION 2021 W REPUBLIC RD 1965 S FREMONT AVE 3231 S NATIONAL AVE 1536 W SUNSHINE ST 715 S FLORENCE AVE 1474 N BOONVILLE AVE 1302 E SUNSHINE ST

SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD

MO MO MO MO MO MO MO MO MO MO MO MO MO MO

65807-5230 65802-5500 65802 65802 65804 65810 65803-4517 65807-5702 65804-2201 65807-7304 65807-2349 65807 65802-1806 65804-1144

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TRANSITIONS PHARMACY FOREST PARK PHARMACY TPD PHARMACY FAMILY HEALTH MART PHARMACY GREENE PHARMACY COUNTRY MART PHARMACY STEELVILLE DRUG WOODS PHARMACY ZUMWALT PHARMACY FAMILY PHARMACY CLARK'S RX STRAUSER DRUGS #15827 WOODS PHARMACY SWEET SPRINGS PHARMACY ROGERS PHARMACY COOPER DRUG THAYER DRUG STORE THEODOSIA PHARMACY ST MARYS TIPTON PHARMACY CHILDRENS HOSPITAL SPECIALTY CARE HOMETOWN PHARMACY-TRENTON BECKWITH PHARMACY THE MEDICINE SHOPPE GENOA-QOL HEALTHCARE HEARTLAND DISCOUNT PHARMACY SHOP N SAVE PHARMACY ONE TO ONE PHARMACY THE MEDICINE SHOPPE VAN BUREN DRUG COUNTRY MARKET PHARMACY 392 CLINIC PHARMACY VERSAILLES PHARMACY IRON COUNTY DRUG STORE SINKS PHARMACY RED CROSS PHARMACY WOODS PHARMACY GENOA-QOL HEALTHCARE BORING REXALL DRUG J&D TRUECARE PHARMACY MERCY PHARMACY WASHINGTON

Provider Name

(417) 761-6350 (314) 645-9990 (314) 381-2224 (660) 783-0700 (573) 695-4533 (572) 775-4666 (573) 775-2900 (417) 276-3670 (417) 276-3128 (417) 551-0324 (573) 468-2388 (573) 468-6464 (913) 339-0800 (660) 335-6300 (660) 736-5512 (417) 264-7115 (417) 264-3784 (417) 273-4555 (660) 433-5404 (314) 454-3232 (660) 359-5700 (636) 528-8462 (636) 462-7005 (636) 741-3005 (636) 583-2646 (636) 583-2110 (660) 947-2480 (636) 225-5123 (573) 323-8159 (573) 594-2136 (573) 378-4661 (573) 378-5000 (573) 244-3784 (573) 437-3440 (660) 886-5535 (660) 747-7449 (636) 456-9007 (660) 438-5162 (660) 438-7331 (636) 390-7333

323 E GRAND 3535 S JEFFERSON 5937 W. FLORISSANT AVE SUITE 1 102 W 1ST ST 128 W MAIN ST 43 E HIGHWAY 8 503 W MAIN 1109 SOUTH ST 19 PUBLIC SQUARE 106 E PINE ST 254 SOUTH SERVICE ROAD EAST 6 E SPRINGFIELD RD 13655 N STATE HIGHWAY 5 401 S LOCUST ST 411 MAIN ST 200 WARMFORK RD 623 S 6TH ST 255 US HIGHWAY 160 W 875 STATE ROUTE 5 13001 N OUTER FORTY RD 1903 E 9TH ST 107 N LINCOLN DR 10 CENTERLINE DR 1780 OLD HIGHWAY 50 EAST 707 US HIGHWAY 50 W 500 US HIGHWAY 50 W 121 S 16TH ST 16 STONEGATE CTR 406 MAIN ST 1555 US 54 WEST 901 KIDWELL DR 700 WEST CLAY ROAD 1 VIBURNUM CENTER RD STE B 606 HWY 63 SOUTH 509 BURKARTH RD 1047 S MAGUIRE 19515 BRUNE PKWY 161 W MAIN ST 1330 COMMERCIAL 851 E 5TH ST

SPRINGFIELD ST LOUIS ST LOUIS STANBERRY STEELE STEELVILLE STEELVILLE STOCKTON STOCKTON STRAFFORD SULLIVAN SULLIVAN SUNRISE BEACH SWEET SPRINGS TARKIO THAYER THAYER THEODOSIA TIPTON TOWN AND COUNTRY TRENTON TROY TROY UNION UNION UNION UNIONVILLE VALLEY PARK VAN BUREN VANDALIA VERSAILLES VERSAILLES VIBURNUM VIENNA WARRENSBURG WARRENSBURG WARRENTON WARSAW WARSAW WASHINGTON

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO

65807 63118 63136 64489-1161 63877-1434 65565-4591 65565 65785-9456 65785-7617 65757-8471 63080 63080-1310 65079 65351-1308 64491-1544 65791-7510 65791-1436 65761-1001 65081-8441 63017 64683-2645 63379-1315 63379-1393 63084 63084-1941 63084-1938 63535-1624 63088-1215 63965-0000 63382-1566 65084-1784 65084 65566 65582 64093 64093 63383-6505 65355 65355 63090-3135

MERCY PHARMACY-PATIENTS FIRST DRIVE

(636) 266-7090

901 PATIENTS FIRST DR # 1400

WASHINGTON

MO

63090-4700

NR_0009_10823 10/2017

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Provider Street

Page 336 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SCHROEDER DRUGS INC PRICE CUTTER PHARMACY SINKS PHARMACY BRUNER'S PHARMACY PRICE CUTTER PHARMACY PRONTO PHARMACY STONE'S CORNER PHARMACY THE MEDICINE SHOPPE COLONIAL VILLAGE PHARMACY CENTERPOINTE PHARMACY

Provider Name

(636) 239-4707 (573) 774-8469 (573) 433-2550 (417) 673-4663 (417) 673-6302 (417) 673-2000 (417) 624-6590 (417) 673-4909 (314) 962-1065 (636) 939-7179

201 ELM ST 300 ICHORD CTR 1000 GW LN STE 105 101 W DAUGHERTY 1503 W MACARTHUR DR 501 S MADISON AVE SUITE S 6059 N MAIN STREET RD 1107 S MADISON ST STE A 7945 BIG BEND BLVD 4801 WELDON SPRING PKWY #400

WASHINGTON WAYNESVILLE WAYNESVILLE WEBB CITY WEBB CITY WEBB CITY WEBB CITY WEBB CITY WEBSTER GROVES WELDON SPRING

MO MO MO MO MO MO MO MO MO MO

63090-2326 65583 65583-2339 64870-1924 64870-1669 64870-2426 64870-7219 64870-2831 63119 63304-9101

DIERBERGS WENTZVILLE CROSSING PHCY GENOA-QOL HEALTHCARE ST JOSEPH HC WENTZVILLE BRADFORD PHARMACY BURTON CREEK PHARMACY OZARKS MED CENTER EMPLOYEE PHCY PRICE CUTTER PHARMACY #9 WEST PLAINS HEALTH MART FAMILY PHARMACY PILL BOX PHARMACY LAKELAND PHARMACY #7 COMPASS HEALTH PHARMACY MERRYFIELD PHARMACY WINFIELD PHARRMACY INC LEXI'S MEDICINE INC LEGACY DRUGSTORE CURRIE'S FAMILY CARE PHARMACY ACKERMAN DISCOUNT DRUGS LIFECORE PHARMACY AMORY PRIORITY CARE AT COTTON GIN PT PRIORITY CARE PHARMACY SOLUTIONS ASHLAND DISCOUNT DRUGS FREDS PHARMACY MEDICAL ARTS PHARMACY NEWPOINTE PHARMACY DAVIS FAMILY PHARMACY MEDICAP PHARMACY MIDTOWN PHARMACY AND GIFTS

(636) 887-3317 (412) 931-3131 (314) 650-0804 (417) 256-7533 (417) 256-2274 (417) 256-1793 (417) 256-4620 (417) 256-7706 (417) 551-0324 (417) 742-3508 (417) 469-9009 (660) 647-3020 (660) 647-2134 (636) 668-8891 (573) 325-4241 (636) 791-1274 (662) 369-7775 (662) 285-9333 (662) 640-4595 (662) 256-5800 (888) 980-1985 (662) 224-8922 (662) 365-8877 (662) 365-5036 (601) 943-6913 (662) 563-9262 (662) 563-0266 (228) 229-9038

1820 WENTZVILLE PKWY 1032 CROSSWINDS CT 500 MEDICAL DR 307 N KENTUCKY ST 805 N KENTUCKY STE 2 1211 PORTER WAGONER BLVD 1211 PARKWAY SHOPPING CTR 1453 GIBSON ST 520 E JACKSON ST STE A 304 E JACKSON ST 857 E MAIN SUITE 3-5 200 W FLORENCE ST 200 W BENTON ST 37 WINFIELD PLZ 211 ASH 13000 VETERANS MEM PKWY #A 314 HIGHWAY 145 N 518 CHESTER STREET SUITE 2 317 MAIN ST 1506 HWY 278 E STE G 211 10TH AVE N 15917 BOUNDARY DR 441 N FOURTH ST 735 S FOURTH ST 4295 HIGHWAY 42 124 PUBLIC SQ 110 HIGHWAY 51 N 620 BLUE MEADOW RD

WENTZVILLE WENTZVILLE WENTZVILLE WEST PLAINS WEST PLAINS WEST PLAINS WEST PLAINS WEST PLAINS WILLARD WILLARD WILLOW SPRINGS WINDSOR WINDSOR WINFIELD WINONA WRIGHT CITY ABERDEEN ACKERMAN AMORY AMORY AMORY ASHLAND BALDWYN BALDWYN BASSFIELD BATESVILLE BATESVILLE BAY SAINT LOUIS

MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MS MS MS MS MS MS MS MS MS MS MS MS

63385 63385-4836 63385 65775-2074 65775 65775-1826 65775-1856 65775-1870 65781-9210 65781-9333 65793 65360-1127 65360-1104 63389-3451 65588 63390-1041 39730-2310 39735 38821 38821 38821-1827 38603-7740 38824-1525 38824-2612 39421-4424 38606-2122 38606-2347 39520-2834

JASPER GENERAL HOSPITAL NURSING HOM STANDARD DRUGS

(601) 764-2101 (601) 764-2862

15S 6 ST 3 N THIRD ST

BAY SPRINGS BAY SPRINGS

MS MS

39422 39422-9792

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PHARMACY IN THE BAY BEAUMONT DRUGS REDIMEDS PHARMACY AT HOME REDIMEDS PHARMACY, LLC BELMONT PHARMACY, LLC G AND P PHARMACY BURNHAM-MCKINNEY PHCY #5 LLC CEDAR LAKE PHARMACY LLC. COASTAL FAMILY HEALTH CENTER DOCTOR'S SPECIALTY PHARMACY ECONOMY DRUGS LADNER DRUGS LEE PHARMACY MEDICAL ANALYSIS PHARMACY MEDICAL ARTS PHARMACY POLK'S DRUGS TURNER DRUGS WOOLMARKET PHARMACY INC BOONEVILLE COMMUNITY PHARMACY COX-BLYTHE DRUGS DAVIDSON DISCOUNT PHARMACY SMITH DRUG AND HOME MEDICAL BRANDON DISCOUNT DRUGS GENOA-QOL HEALTHCARE OLDE TOWNE DRUGS PMO PHARMACY POLKS CROSSGATES DISCOUNT DRUG POLKS DISCOUNT DRUGS POLKS DISCOUNT DRUGS BANE'S DRUG INC CLINT'S PHARMACY GUYS PHARMACY OF BROOKHAVEN LARUES DISCOUNT DRUG BROOKSVILLE PHARMACY STEPP-SAVER PHARMACY KING'S DISCOUNT PHARMACY PEOPLES DRUG STORE BURNSVILLE DISCOUNT DRUGS BYHALIA DRUG COMPANY, LLC POLKS DISCOUNT DRUGS CALEDONIA PHARMACY CHANDLER DRUGS

NR_0009_10823 10/2017

Provider Phone Number (228) 270-1055 (601) 784-3313 (662) 350-3119 (662) 231-3243 (662) 454-9902 (662) 247-2555 (228) 475-3411 (228) 396-4412 (228) 374-2494 (228) 207-7716 (228) 432-5581 (228) 354-9616 (228) 396-4412 (228) 385-2550 (228) 432-7071 (228) 207-0505 (228) 392-0219 (228) 392-5355 (662) 728-1951 (662) 728-5732 (662) 728-4401 (662) 728-5323 (601) 825-2897 (601) 824-1667 (601) 724-1904 (601) 420-5150 (601) 825-8660 (601) 825-4507 (601) 992-4466 (601) 833-1922 (601) 833-3160 (601) 833-6333 (601) 833-7455 (662) 738-5041 (662) 983-4011 (601) 384-2898 (601) 384-2383 (662) 427-0200 (662) 838-3784 (601) 371-8662 (662) 356-4000 (662) 628-5331

Provider Street 1140 HIGHWAY 90 881 HWY 198 3466 MCCULLOUGH BLVD STE D-1 3466 MCCULLOUGH BLVD STE D-2 338 2ND ST 109 CHURCH ST 608 HOWARD AVE 921 CEDAR LAKE RD. STE F 1025 DIVISION ST STE A 1720A MEDICAL PARK DR STE 160 1053 HOWARD AVE 12435 SHRINERS BLVD 917 DIVISION STREET 1025 DIVISION ST 120 CAILLAVET ST 1845 POPPS FERRY RD 10595 AUTO MALL PKWY 13034 SHRINERS BLVD STE A 206 N 2ND ST 122 W COLLEGE ST 203 N 2ND ST 100 S SECOND ST 200 TAMBERLIN ST 608 MARQUETTE RD 1645 W GOVERNMENT CV STE E 335 CROSSGATES BLVD 335 CROSSGATES BLVD 1031 STAR RD 1866 SPILLWAY RD 360 W MONTICELLO ST 201 HIGHWAY 51 N 1005 W CONGRESS ST 430 HIGHWAY 51 N 139 N OLIVER ST 203 N NEWBERGER AVE 44 HWY 98 EAST 100 MAIN ST N 603 S HIGHWAY 365 2438 CHURCH ST 7264 S SIWELL RD 741 MAIN STREET 131 PUBLIC SQ

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Provider City BAY ST LOUIS BEAUMONT BELDEN BELDEN BELMONT BELZONI BILOXI BILOXI BILOXI BILOXI BILOXI BILOXI BILOXI BILOXI BILOXI BILOXI BILOXI BILOXI BOONEVILLE BOONEVILLE BOONEVILLE BOONEVILLE BRANDON BRANDON BRANDON BRANDON BRANDON BRANDON BRANDON BROOKHAVEN BROOKHAVEN BROOKHAVEN BROOKHAVEN BROOKSVILLE BRUCE BUDE BUDE BURNSVILLE BYHALIA BYRAM CALEDONIA CALHOUN CITY

State

ZIP code

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

39520-7067 39423 38826 38826 38827 39038-3929 39530-4310 39532 39530 39532-2135 39530-3776 39532-8249 39530 39530 39530-4102 39532-2108 39540-3761 39532-8250 38829-2702 38829-3410 38829-2701 38829-3225 39042 39042-3037 39042-4602 39042 39042-2602 39042-9010 39047-6063 39601-3206 39601-2653 39601 39601-2351 39739 38915-9430 39630 39630-7117 38833-9706 38611-9552 39272-8703 39740 38916

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BJP PHARMACY CANTON DISCOUNT DRUGS MISSISSIPPI DISCOUNT DRUGS MISSISSIPPI DISCOUNT DRUGS MOSBYS DRUG STORE NISSAN FAMILY PHARMACY CARTHAGE HEALTHMART PHARMACY THE PRESCRIPTION SHOP FREDS PHARMACY SOUTHERN DISC DRUGS-CHRLSTN DELTA DISCOUNT DRUGS HAIRE DRUG CENTER HENDERSON DRUG INC MEDICAP PHARMACY WESTGATE DRUGS INC BUCKLEY'S PHARMACY HAIRE DRUG CO INC MEDICAL ARTS PHARMACY SOUTH STREET PHARMACY LLC

Provider Name

(601) 859-0050 (601) 859-3827 (601) 859-3939 (601) 855-7330 (601) 859-4212 (601) 855-8600 (601) 267-4533 (601) 267-8078 (662) 647-5541 (662) 647-5172 (662) 624-5190 (662) 624-2526 (662) 624-6591 (662) 627-0100 (662) 627-7857 (662) 843-3654 (662) 843-4211 (662) 843-4214 (662) 843-6700

1668 W PEACE ST 726 E PEACE ST 195 E PEACE ST 276 NISSAN PKWY STE 300 1301 E PEACE ST 300 NISSAN DR 602 HIGHWAY 16 E 301 ELLIS ST 304 MAIN ST 109 W WALNUT ST 731 S STATE ST 549 MEDICAL DR 270 DELTA AVE 425 DESOTO AVE 1015 LEE DR 301 HOSPITAL DR 805 1ST ST 810 E SUNFLOWER RD STE 100D 410 SOUTH ST

CANTON CANTON CANTON CANTON CANTON CANTON CARTHAGE CARTHAGE CHARLESTON CHARLESTON CLARKSDALE CLARKSDALE CLARKSDALE CLARKSDALE CLARKSDALE CLEVELAND CLEVELAND CLEVELAND CLEVELAND

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

39046-5332 39046-4731 39046 39046-7006 39046-4937 39046-8562 39051-4212 39051-3808 38921 38921-2242 38614-4801 38614-6733 38614-4213 38614-5214 38614-3698 38732-2358 38732-2309 38732-2828 38732-3450

MISSISSIPPI DISCOUNT DRG HEALTHMART PARKWAY PHARMACY THE DRUG STORE LLC COLDWATER PHARMACY C & C DRUGS INC CALEB'S HOMETOWN PHARMACY, LLC CLAYTON DRUG STORE INC COLUMBIA DISCOUNT DRUGS INC COOK & FORTENBERRY PHARMACY SAV-ON DRUGS OF COLUMBIA INC SHEPARDS DISCOUNT DRUGS

(601) 924-5212 (601) 924-8935 (662) 675-2775 (662) 622-7441 (601) 765-6817 (601) 765-5055 (601) 765-4323 (601) 736-1514 (601) 736-3481 (601) 736-6321 (601) 736-8212

224 CLINTON BLVD 134 E NORTHSIDE DR 31 FRONT ST 421 CENTRAL ST 204 MAIN ST 801 MAIN STREET 216 MAIN ST 1201 HWY 13 N 718 MAIN ST 345 BROAD ST 431 BROAD ST

CLINTON CLINTON COFFEEVILLE COLDWATER COLLINS COLLINS COLLINS COLUMBIA COLUMBIA COLUMBIA COLUMBIA

MS MS MS MS MS MS MS MS MS MS MS

39056-5126 39056-3440 38922 38618 39428-0000 39428 39428-0000 39429-2015 39429-2938 39429-2964 39429-3038

BAPTIST MEMORIAL HOSP-GT O/P PHCY CHRIS' PHARMACY ENTRUSTRX FAMILY PHARMACY FAMILY PHARMACY FAMILY PHARMACY AT ALLEGRO PLAZA FAMILY PHARMACY NORTH FREDS PHARMACY MEDICAL ARTS PHARMACY NEW HOPE PHARMACY

(662) 244-1173 (662) 328-4300 (866) 279-3314 (662) 329-9060 (662) 329-1810 (662) 798-0707 (662) 329-0054 (662) 327-1614 (662) 328-8660 (662) 328-8028

2520 5TH AVE N 2320 5TH ST N 402 WILKINS WISE RD STE 38 1245 N LEHMBERG RD 113 N LEHMBERG RD 3600 BLUECUTT RD STE 2 1214 HIGHWAY 45 N 115 ALABAMA ST 504 MILITARY RD 3654 NEW HOPE RD

COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS

MS MS MS MS MS MS MS MS MS MS

39701-5111 39705-2214 39705-1716 39702-3224 39702-5541 39705-1303 39705-2142 39702 39701 39702-8521

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Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROBERT'S APOTHECARY SOUTHERN DRUGS BORROUMS DRUG STORE INC FORMULAONE PHARMACEUTICALS LLC GUNN DRUG COMPANY JAMES BENNETT APOTHECARY MEDICAL PLAZA ON HARPER MEDICAL PLAZA PHARMACY CITY DRUGS FREDS PHARMACY

Provider Name

(662) 327-5400 (662) 328-0833 (662) 286-3361 (662) 594-1594 (662) 287-8062 (662) 286-6914 (662) 286-6337 (662) 286-6991 (601) 892-4121 (601) 892-2227

2219 5TH ST N 1202 MAIN ST 604 WALDRON ST 127 PRATT DR 1815 E SHILOH RD 2049 E SHILOH RD 1425 S HARPER ROAD 111 ALCORN DR 113 BO BO DR 25096 HIGHWAY 51

COLUMBUS COLUMBUS CORINTH CORINTH CORINTH CORINTH CORINTH CORINTH CRYSTAL SPRINGS CRYSTAL SPRINGS

MS MS MS MS MS MS MS MS MS MS

39705 39701-5833 38834 38834-6026 38834-3638 38834-3726 38834 38834-9359 39059-2741 39059-9690

GUY'S PHARMACY OF CRYSTAL SPRINGS FREDS XPRESS WHEELER DRUG STORE PHARMACY IN DIAMONDHEAD BACK BAY DRUGS HOWELL & HEGGIE DRUG COMPANY FRIENDSHIP PHARMACY, LLC ELLISVILLE DRUG #15828 JONES COUNTY DRUG INC. WARDS PHARMACY ENTERPRISE PHARMACY DABBS FAMILY PHARMACY MURPHY DRUGS AND GIFTS FLORA PHARMACY, LLC THE PHARMACY AT RAMEY'S POLKS FLORENCE DISCOUNT DRUGS ADVANCED RX PHARMACY 024 F & M SPECIALTY PHARMACY INFUSION PLUS MARTYS PHARMACY AND COMPOUNDING CEN THE TRANSPLANT PHARMACY FRENCH'S PHARMACY OF FOREST FARMER'S MEDSHOPPE FAMILY PHARMACY OF FULTON S & W PHARMACY

(601) 647-0030 (601) 743-2917 (601) 635-2646 (228) 222-4662 (228) 392-2228 (662) 653-6441 (662) 488-0317 (601) 477-3573 (601) 477-3030 (601) 477-8587 (601) 659-9909 (662) 258-4422 (662) 258-2631 (601) 401-5060 (601) 879-5544 (601) 845-8610 (601) 983-2840 (601) 939-9353 (601) 863-1300

512 WEST MARION AVE. 14916 HIGHWAY 16 W 95 W BROAD ST 4405 E ALOHA DR 10437 LAMEY BRIDGE RD STE A 389 NORTHWEST AVE 5532 HWY 15 STE 1 915 HILL ST 407 HILL ST 122 S FRONT ST 83 OLD MILL CREEK RD 1536 VETERANS MEMORIAL BLVD 1357 VETERANS MEMORIAL BLVD 740 HIGHWAY 49 STE U 130 EDWARDS CIR 118 E MAIN ST 2470 FLOWOOD DR 117 LUCKNEY STATION 885 LIBERTY RD STE 500

CRYSTAL SPRINGS DE KALB DECATUR DIAMONDHEAD DIBERVILLE DURANT ECRU ELLISVILLE ELLISVILLE ELLISVILLE ENTERPRISE EUPORA EUPORA FLORA FLORA FLORENCE FLOWOOD FLOWOOD FLOWOOD

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

39059 39328-7918 39327-8959 39525-3380 39540-2710 39063-3330 38841 39437-2419 39437 39437-3118 39330-9649 39744-2001 39744-2064 39071-9653 39071-9015 39073-8410 39232 39232 39232-9000

(601) 932-2027 (769) 230-8335 (601) 469-1418 (601) 424-3530 (662) 862-7979 (662) 862-9025

1042 RIVER OAKS DR 217 KATHERINE DR. SUITE A 512 AIRPORT RD 62 HIGHWAY 587 1313 S ADAMS ST 116 S CUMMINGS ST

FLOWOOD FLOWOOD FOREST FOXWORTH FULTON FULTON

MS MS MS MS MS MS

39232-9594 39232 39074-4032 39483-5026 38843 38843-1802

BURNHAM MCKINNEY PHARMACY NUM 3 FREDS PHARMACY SINGING RIVER SERVICES REGION XIV DIXONS DISCOUNT PHARMACY

(228) 497-4483 (228) 497-4090 (228) 497-0690 (601) 384-7907

2525 HIGHWAY 90 1693 HIGHWAY 90 3407 SHAMROCK COURT 434 S CAPTAIN GLOSTER DR B

GAUTIER GAUTIER GAUTIER GLOSTER

MS MS MS MS

39553-5247 39553-5450 39553 39638

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Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

A & A INFUSION & SPECIALTY BROWN'S MAIN STREET PHARMACY CLINIC PHARMACY CLINIC PHARMACY 7 CONDON'S EAST UNION PHARMACY FREDS PHARMACY FREDS PHARMACY FREDS PHARMACY FREDS PHARMACY FREDS PHARMACY

Provider Name

(662) 332-0177 (662) 332-2010 (662) 378-5445 (870) 265-2220 (662) 332-0941 (662) 335-3385 (662) 378-2060 (662) 332-3600 (662) 390-5997 (662) 332-2331

2044 HIGHWAY 1 SOUTH 1685 S MAIN ST 1907 N MEDICAL PARK DR 1467 HIGHWAY 1 S 1403 E UNION ST 202 E STARLING ST 1427 S MAIN ST 1221 E UNION ST 1600 S COLORADO ST 2616 HIGHWAY 82 E

GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE

MS MS MS MS MS MS MS MS MS MS

38701 38701-7326 38703 38701-7141 38703-3247 38701-4707 38701-7000 38703-3243 38703-7216 38703-8224

GREENWOOD DOWNTOWN DRUGS INC GREENWOOD DRUGS LIFE HELP FIRST HEALTH MARASCALCOS SAV-MOR DRUGS QUICK CARE PHARMACY BEACH PHARMACY FRENCH DRUG CO. INC JACKSONS DISCOUNT PHARMACY LYMAN PHARMACY MEMORIAL OUTPATIENT PHARMACY SARTIN'S DISCOUNT DRUGS T-D PHARMACY INC TRIPLETT-DAY DRUG COMPANY ADVANCED RX PHARMACY 028 DOWNTOWN PHARMACY FAIRVIEW PHCY & COMPOUNDING FREEDOM PHARMACY HIGHLAND SPECIALTY PHARMACY NEWPOINTE PHARMACY OAK GROVE PHARMACY OWL DRUG STORE PHARMACY ASSISTANCE CENTER PINE BELT MENTAL HEALTH PHARMACY THRIVERX UNICARE RX VITAL CARE COMPOUNDER ALLREDS PHARMACY ROSE'S SUPER DISCOUNT DRUGS DR MICHAEL LYONS PC PHARMACY FUNDERBURK'S PHARMACY

(662) 453-4401 (662) 477-0700 (662) 453-6211 (662) 226-0666 (662) 226-6741 (662) 307-2221 (228) 896-7070 (228) 896-5656 (228) 832-8000 (228) 831-9997 (228) 865-3525 (228) 864-3514 (228) 832-1414 (228) 863-2363 (601) 554-7449 (601) 544-7111 (601) 544-4871 (601) 450-6979 (601) 268-6033 (601) 450-3345 (601) 264-1198 (601) 268-5740 (601) 544-4163 (601) 544-4641 (601) 852-1099 (601) 544-4848 (601) 261-0503 (601) 894-3571 (601) 894-1222 (662) 469-9602 (662) 429-5337

105 CARROLLTON AVE 400 W PARK AVE 2504 BROWNING ROAD 1300 SUNSET DR STE C 1967 COMMERCE ST 350 SUNSET DR 1110 COWAN RD 400 E PASS RD 11340A THREE RIVERS RD 20006 HIGHWAY 53 STE B 4500 13TH ST 4300 15TH ST STE 1 12372 HIGHWAY 49 2429 14TH ST 3688 VETERANS MEMORIAL DR #200 511 W LAUREL AVE 500 KATIE AVE 3902 HARDY ST 23 TOWN CENTER SQUARE 6555 U S HIGHWAY 98 STE 6 5039 OLD HIGHWAY 11 STE 1 2 MEDICAL BLVD 62 OLD AIRPORT RD 103 S 19TH AVE 6440 US HWY 98 124 WALNUT CIR STE 1 115 S 40TH AVE 214 W GALLATIN ST 218 CALDWELL DR 1558 MONTEITH AVE 134 W COMMERCE ST

GREENWOOD GREENWOOD GREENWOOD GRENADA GRENADA GRENADA GULFPORT GULFPORT GULFPORT GULFPORT GULFPORT GULFPORT GULFPORT GULFPORT HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HATTIESBURG HAZLEHURST HAZLEHURST HERNANDO HERNANDO

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

38930-4436 38930-2904 38930-9417 38901-4081 38901-5107 38901 39507-3441 39507-3236 39503-3366 39503-7843 39501-1801 39501-2524 39503-2741 39501-2020 39401-8246 39401-3504 39401 39402 39402 39402-8440 39402-8845 39401-7230 39401 39401-6171 39402-8437 39401-3501 39402-6600 39083-3026 39083-2712 38632 38632-2240

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Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name REGION IV DESOTO COUNTY PHCY HICKORY FAMILY PHARMACY CITY DRUGS LIDDY'S HEALTH MART PHARMACY RIGHT WAY MEDS TYSON DRUG COMPANY WMC- PHARMACY SUPER DRUG FREDS PHARMACY HOUSTON FAMILY PHARMACY PEARSONS DISCOUNT DRUGS LLC RX EXPRESS PHARMACY MAGIC MART PHARMACY INC MARTINS PHARMACY BARNETT APOTHECARY LLC IUKA DISCOUNT DRUGS RUSHING DRUGS BAPTIST FAMILY PHARMACY BEEMON DRUGS DRUGS FOR LESS METRO PHARMACY MR DISCOUNT DRUGS MS STATE DEPT OF HEALTH PHCY SPORTS MEDICINE PHARMACY TAKE CARE PHARMACY UMC PAVILION PHARMACY UNIVERSITY HOSP & CLINIC PHCY BOYDS DRUGS PICKLES DRUG STORE SULLIVANS DISCOUNT DRUGS DIKETS PROFESSIONAL DRUG MEDICINE CABINET OF LAUREL QUINN PHARMACY SOUTH CENTRAL REGIONAL MED CTR THOMAS PHARMACY-GARDINER CTR WALLACE DISCOUNT DRUGS WELLS PHARMACY HODGES PHARMACY PEOPLES DRUG STORE LEXINGTON LIBERTY DRUG STORE CHARLEY MCCOOLS PRESCRIPTIONS DAN'S DISCOUNT DRUG

NR_0009_10823 10/2017

Provider Phone Number (662) 449-4025 (601) 934-2488 (662) 827-5561 (662) 252-2285 (662) 252-8913 (662) 252-2321 (662) 252-8464 (662) 280-7455 (662) 448-6011 (662) 542-8464 (662) 456-2551 (228) 588-2888 (662) 887-4135 (662) 887-4533 (662) 423-9994 (662) 423-9039 (662) 423-3629 (601) 968-6350 (601) 366-9431 (601) 371-0468 (601) 346-5561 (601) 973-3550 (601) 713-3457 (601) 354-4488 (601) 427-7101 (601) 984-6455 (601) 815-3857 (662) 289-2211 (662) 289-1112 (662) 289-3234 (601) 425-2527 (601) 425-0450 (601) 428-0688 (601) 426-4024 (601) 428-5977 (601) 428-1277 (601) 426-2362 (601) 394-2602 (662) 834-2722 (601) 657-8051 (501) 296-3337 (662) 773-7847

Provider Street 2705 HIGHWAY 51 SOUTH 18205 HWY 80 101 W WASHINGTON ST 575 CRAFT ST 149A SOUTH MARKET ST 145 E VAN DORN AVE 1938 CRESCENT MEADOW DR 1433 GOODMAN RD W 905 N PONTOTOC ST 339 E MADISON ST 101 E WASHINGTON ST 7100 H HWY 614 903 HWY 82 E BLG G 124 E BAKER ST 606 BATTLEGROUND DR 1411 W QUITMAN ST 1519 W QUITMAN ST 1225 N STATE ST 1220 E NORTHSIDE DR 540 RAYMOND RD 1815 HOSPITAL DR STE 118 3202 W CAPITOL ST 3156 LAWSON ST 1325 E FORTIFICATION STREET 350 W WOODROW WILSON AVE # 311 1410 E WOODROW WILSON AVE # 50 350 W WOODROW WILSON AVE 101 W JEFFERSON ST 100 N JACKSON ST STE 1 109 HIGHWAY 12 E 240 S 13TH AVE 30 CIRCLE J DR 3160 AUDUBON DR 1220 JEFFERSON ST 170 BEACON ST 520 N MAGNOLIA ST 725 SAWMILL RD 413 ST FRANCIS ST #699 102 COURT SQ 110 MAIN ST 109 W MAIN ST 403 S CHURCH AVE

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Provider City HERNANDO HICKORY HOLLANDALE HOLLY SPRINGS HOLLY SPRINGS HOLLY SPRINGS HOLLY SPRINGS HORN LAKE HOUSTON HOUSTON HOUSTON HURLEY INDIANOLA INDIANOLA IUKA IUKA IUKA JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON KOSCIUSKO KOSCIUSKO KOSCIUSKO LAUREL LAUREL LAUREL LAUREL LAUREL LAUREL LAUREL LEAKESVILLE LEXINGTON LIBERTY LOUISVILLE LOUISVILLE

State

ZIP code

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

38632-2634 39332 38748-3845 38635-3249 38635 38635-3025 38635 38637-1404 38851-1516 38851-2322 38851-2225 39555 38751 38751-2451 38852-1313 38852-1130 38852-1132 39202-2064 39211-5503 39204-3600 39204-3437 39209-4101 39213-5754 39202 39213-7681 39216-5114 39213-7681 39090-3618 39090-3730 39090-3303 39440 39440-1980 39440-1926 39440-4355 39440-4428 39440 39440-3971 39451-0000 39095-3626 39645-7227 39339-2619 39339-2921

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name TABOR DRUGS BURNHAM DRUGS EDWARDS DISCOUNT DRUGS GEORGE COUNTY PHARMACY JIM'S DISCOUNT DRUGS JOHNS DISCOUNT DRUGS CITY DRUG STORE FREDS EXPRESS KEYSTONE PHARMACY LLC MS CENTER FOR ADVANCED MED PHCY PARTNERS OF MISSISSIPPI UPTOWN PHARMACY GENE POLK PHARMACY CORNER DRUG STORE FREDS XPRESS FREDS PHARMACY QUITMAN DRUG CO FAMILY PHARMACY INNOVATIVE PHARMACY MEDICAL CENTER PHARMACY SOUTHWEST DISCOUNT DRUGS THE PHARMACY AT THE MEDICAL CTR THRIFT DRUGS SUPER SAVE DRUGS MCGUFFEE DRUG INC SERVICE REXALL DRUGS INC CLARKDALE PHARMACY AND GIFTS GREATER MERIDIAN HLTH CLNC PHY MERIDIAN ONCOLOGY ASSOCIATES OLE TOWNE FAMILY PHARMACY REGION 10 PHARMACY SOUTHEAST PHARMACY THE PHARMACY AT RUSH VITAL CARE OF MERIDIAN VITAL CARE RX HUDSON PHARMACY D & B DISCOUNT DRUGS FRENCH'S PHARMACY BURNHAM DRUGS BURNHAM DRUGS FREDS PHARMACY POWELL DRUG STORE

NR_0009_10823 10/2017

Provider Phone Number (662) 773-5363 (228) 475-3411 (601) 947-4941 (601) 673-6383 (601) 947-6331 (601) 796-4761 (662) 726-5143 (662) 726-5151 (601) 707-9727 (601) 499-0935 (601) 398-9980 (601) 631-1667 (601) 849-2533 (601) 783-2321 (662) 282-4245 (662) 326-8609 (662) 326-3505 (601) 684-7621 (601) 684-4127 (601) 684-9602 (601) 684-4541 (205) 533-9112 (601) 684-3401 (601) 384-2288 (601) 847-2511 (601) 847-2323 (601) 553-0668 (601) 693-0162 (601) 482-1555 (601) 693-0033 (601) 483-4821 (601) 483-5600 (205) 533-9112 (601) 482-4003 (877) 229-1724 (601) 587-4011 (601) 732-8366 (601) 732-8821 (228) 475-3411 (228) 475-3909 (228) 475-6912 (601) 797-3355

Provider Street 104 W MAIN ST 12114 OLD HWY 63 S 103 W FRONTAGE RD STE A 92 W RATLIFF ST 705 WINTER ST 410 W MAIN AVE 314 S JEFFERSON ST 59 FRONTAGE RD 106 HIGHLAND WAY STE 206 7731 OLD CANTON ROAD SUITE B 136 ENTERPRISE DR 1042 GLUCKSTADT RD STE D 406 SIMPSON HIGHWAY 149 101 W RAILROAD AVE N 67 WATSON DR 1098 MARTIN LUTHER KING DR 1026 MARTIN LUTHER KING DR 200 MARION AVENUE 312B MARION AVE 312 MARION AVE 1220 LASALLE ST 215 MARION AVE STE 200 119 W PRESLEY BLVD 488 MAIN ST E 102 MAIN ST N 3069 SIMPSON HIGHWAY 13 6935C HIGHWAY 145 2701 DAVIS ST 1704 23RD AVE FL 2 2000 24TH AVE 1415 COLLEGE DR 2402 LONG CREEK RD 1800 12TH ST 1501 23RD AVE 1501 23RD AVE STE B 702 E BROAD ST 4581 HIGHWAY 80 365 S FOURTH ST 5001 MAIN ST 7709 HIGHWAY 613 7818 HIGHWAY 613 519 MAIN ST

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Provider City LOUISVILLE LUCEDALE LUCEDALE LUCEDALE LUCEDALE LUMBERTON MACON MACON MADISON MADISON MADISON MADISON MAGEE MAGNOLIA MANTACHIE MARKS MARKS MCCOMB MCCOMB MCCOMB MCCOMB MCCOMB MCCOMB MEADVILLE MENDENHALL MENDENHALL MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MERIDIAN MONTICELLO MORTON MORTON MOSS POINT MOSS POINT MOSS POINT MOUNT OLIVE

State

ZIP code

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

39339-2620 39452 39452-5836 39452-6537 39452-5729 39455-2437 39341-2716 39341-2198 39110-6929 39110 39110 39110 39111-3416 39652-2835 38855-8390 38646-1825 38646-1832 39648 39648 39648-2708 39648-5158 39648-2705 39648-5521 39653-9292 39114-3562 39114-3077 39301-9771 39301-5708 39301-3103 39301-3120 39307 39301 39301 39301-4027 39301 39654-7696 39117-3432 39117-3407 39563-2738 39563-9390 39563-9315 39119-5114

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ERNST PHARMACY WILSON-HOLDER DRUG CO. FREDS XPRESS HOSPITAL HEALTH MART PHARMACY MEDICAL CENTER PHARMACY SUPER SAVER DRUGS FREDS XPRESS COASTAL PHARMACY COASTAL PHARMACY FREDS PHARMACY OCEAN SPRING DISCOUNT PHARMACY ON CALL MEDICAL CLINIC, PLLC POLK'S DRUGS SAVE RITE PHARMACY THE PHARMACY AT OCEAN SPRINGS FREDS PHARMACY OKOLONA PHARMACY LLC MIKE'S PHARMACY

Provider Name

(601) 442-9853 (601) 442-7611 (662) 963-2856 (662) 534-9036 (662) 534-2101 (662) 534-4774 (601) 683-3391 (228) 215-1911 (228) 215-1088 (228) 875-1061 (228) 875-8330 (228) 875-9598 (228) 215-1020 (228) 818-3391 (228) 818-1320 (662) 447-5400 (662) 447-0300 (901) 210-8451

300 HIGHLAND BLVD STE F 636 FRANKLIN ST 7122 WILL ROBBINS HWY 212 STATE HIGHWAY 30 W 218 OXFORD RD 498 W BANKHEAD ST 304 NORTHSIDE DR 998 N HALSTEAD RD STE A 1264 OCEAN SPRINGS RD 3176 BIENVILLE BLVD 2120 BIENVILLE BLVD 3091 BIENVILLE BLVD 6008 WASHINGTON AVE 6390 WASHINGTON AVE 3109 BIENVILLE BLVD 511 W MONROE AVE 203 S CHURCH ST 9065 E SANDIDGE CNTR CV STE A

NATCHEZ NATCHEZ NETTLETON NEW ALBANY NEW ALBANY NEW ALBANY NEWTON OCEAN SPRINGS OCEAN SPRINGS OCEAN SPRINGS OCEAN SPRINGS OCEAN SPRINGS OCEAN SPRINGS OCEAN SPRINGS OCEAN SPRINGS OKOLONA OKOLONA OLIVE BRANCH

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

39120-4600 39120-3312 38858-5918 38652-3112 38652-3115 38652-3319 39345-2378 39564-3107 39564-3409 39564 39564-3017 39564-4308 39564 39564-2301 39564 38860-1616 38860-1608 38654-3574

PARKWOOD BEHAVIORAL HEALTH SYSTEM CHANEYS PHARMACY G & M PHARMACY INC N MISSISSIPPI FOOT SPECIALISTS FREDS PHARMACY GULF COAST SAV-REX MEDICAL ARTS PHARMACY RX EXPRESS PHARMACY THE PHARMACY AT SINGING RIVER LOVE'S PHARMACY & GIFTS INC HEALTHPLUS PHARMACY & WELLNESS RHODES & ROBBY DRUGS INC PARK PLACE PHARMACY PETAL DRUG COMPANY RODGER'S FAMILY PHARMACY BROWNS DISCOUNT DRUGS HOSPITAL DISCOUNT DRUGS

(662) 893-7033 (662) 234-7221 (662) 236-2222 (662) 513-6600 (228) 938-9599 (228) 471-4688 (228) 762-1682 (228) 762-5664 (228) 809-2110 (228) 255-7800 (601) 914-4848 (601) 854-8252 (601) 450-3673 (601) 545-3141 (601) 582-8351 (601) 656-2272 (601) 656-2621

8135 GOODMAN RD BLDG D 501 BRAMLETT BLVD 2159 S LAMAR BLVD 1735 UNIVERSITY AVE 2511 INGALLS AVE 1965 MARKET ST 4105 HOSPITAL ST 2952 MARKET ST 2809 DENNY AVE 12345 VIDALIA RD 238 S PEARSON RD 114 N BROOKS ST 46 PARKWAY LN 201 OLD RICHTON RD 130 W CENTRAL AVE 584 E MAIN ST STE B3 919 HOLLAND AVE

OLIVE BRANCH OXFORD OXFORD OXFORD PASCAGOULA PASCAGOULA PASCAGOULA PASCAGOULA PASCAGOULA PASS CHRISTIAN PEARL PELAHATCHIE PETAL PETAL PETAL PHILADELPHIA PHILADELPHIA

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

38654-2103 38655-4129 38655-5223 38655-4109 39567-6719 39567-5710 39581-5312 39567-5163 39581 39571-8309 39208-5637 39145-3092 39465-3035 39465-2943 39465-2314 39350-2330 39350-2115

NESHOBA COUNTY HOSPITAL PHARMACY STRIBLING DRUGS CITY REXALL DRUG STORE MEDICAL CENTER PHARMACY MONTGOMERY DRUGS

(601) 663-1270 (601) 656-2472 (601) 798-4761 (601) 798-2100 (662) 489-5555

1001 HOLLAND AVE 430 E BEACON ST 349 S MAIN ST 141 KIRKWOOD ST 349 HIGHWAY 15 N

PHILADELPHIA PHILADELPHIA PICAYUNE PICAYUNE PONTOTOC

MS MS MS MS MS

39350-2161 39350-2953 39466-4415 39466-3833 38863-1105

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 344 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name FREDS PHARMACY PEARL RIVER DRUG SAV RITE DISCOUNT DRUGS SMALL TOWN PHARMACY POTTS CAMP FAMILY PHARMACY PALACE DRUG STORE ANDERSON DRUGS JOHNS DISCOUNT DRUGS INC FREDS PHARMACY HAMMACK DRUGS QUITMAN DRUGS LITTLES PHARMACY RAYMOND DRUG STORE POLKS DISCOUNT DRUGS FREDS PHARMACY ADVANCED INFUSION SOLUTIONS HOMECARE PLUS INC RIDGELAND APOTHECARY SAVER EXPRESS PHARMACY SERVICE DRUGS TOWNE CENTER PHARMACY, LLC SMITH DRUG COMPANY HOLLIS DISCOUNT PHARMACY RIPLEY DRUG COMPANY DEEP DELTA DRUGS NORTH SUNFLOWER MED CTR PHCY SALTILLO PHARMACY AND SOLUTIONS R & D PHARMACY MOORE'S PHARMACY CRANFORDS DRUG STORE INC SEMINARY DRUGS COMMUNITY DISCOUNT PHARMACY MAYS PHARMACY SHELBY DRUG CO SHERMAN DRUGS ACCESS FAMILY HEALTH IH PHCY COMPLETE DIABETES FIRST PHARMACY SERVICES GENOA-QOL HEALTHCARE GOODMAN PHARMACY OLIVER DRUG STORE PHARM CARE INC

NR_0009_10823 10/2017

Provider Phone Number (601) 795-0581 (601) 795-4239 (601) 437-5781 (601) 437-5121 (662) 333-7782 (601) 792-4959 (601) 794-5525 (601) 794-6701 (601) 776-6282 (601) 776-3711 (601) 776-2146 (601) 782-4552 (601) 857-8773 (601) 932-8609 (601) 788-6335 (601) 988-1700 (601) 957-9174 (601) 981-0070 (601) 368-8907 (601) 853-4611 (601) 790-3746 (662) 462-5314 (662) 837-7300 (662) 837-7664 (662) 873-6006 (662) 756-2711 (662) 269-2781 (228) 832-1898 (601) 625-7158 (601) 722-3291 (601) 245-1020 (662) 562-5268 (662) 562-8550 (662) 398-7487 (662) 844-8880 (662) 651-4637 (662) 280-5090 (662) 349-3300 (877) 498-9347 (662) 536-3330 (662) 349-9481 (662) 349-7150

Provider Street 1388 S MAIN ST 510 S MAIN ST 310 CHURCH ST 1005 MARKET ST 41 S CENTER ST 2234 COLUMBIA AVE 5796 US HIGHWAY 11 117 SHELBY SPEIGHTS DR 125 MAIN ST 101A W DONALD ST 205 N ARCHUSA AVE 122 MAIN ST 112 W MAIN ST 1201 HIGHWAY 49 S 505 N FRONT ST 623 HIGHLAND COLONY PKWY #100 864 WILSON DR STE B 500 HIGHWAY 51 N STE Q 1051 HIGHLAND COLONY PKWY #C 680 HIGHWAY 51 STE G 202 W JACKSON ST STE 100 77 S FRONT ST 1008 CITY AVE N 1010 CITY AVE N 56 SOUTH 4TH ST 860 N OAK AVE 2698 HIGHWAY 145 23457 CENTRAL DR 16831 HIGHWAY 21 N 121 W MAIN ST 104 W MAIN ST 305 NORFLEET DR 4385 HIGHWAY 51 S 1211 BROADWAY ST 670 HWY 178 STE 1 60021 MONROE ST 8830 CENTRE STREET STE 1 5185 GETWELL RD 480 AIRPORT INDUSTRIAL DR 470 GOODMAN RD E 25 PHYSICIANS LN 3449 COBBLESTONE BLVD S

Page 345 of 679

Provider City POPLARVILLE POPLARVILLE PORT GIBSON PORT GIBSON POTTS CAMP PRENTISS PURVIS PURVIS QUITMAN QUITMAN QUITMAN RALEIGH RAYMOND RICHLAND RICHTON RIDGELAND RIDGELAND RIDGELAND RIDGELAND RIDGELAND RIDGELAND RIENZI RIPLEY RIPLEY ROLLING FORK RULEVILLE SALTILLO SAUCIER SEBASTOPOL SEMINARY SEMINARY SENATOBIA SENATOBIA SHELBY SHERMAN SMITHVILLE SOUTHAVEN SOUTHAVEN SOUTHAVEN SOUTHAVEN SOUTHAVEN SOUTHAVEN

State

ZIP code

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

39470 39470-3023 39150-2108 39150 38659-9531 39474 39475-5004 39475-4094 39355-2109 39355-2013 39355-2416 39153-9802 39154-9524 39218-9425 39476-2210 39157-6077 39157-4512 39157 39157-8722 39157-2103 39157 38865-9797 38663-1413 38663-1413 39159 38771 38866-6941 39574-7521 39359-9700 39479 39479 38668-2205 38668-2533 38774 38869 38870 38671 38671 38671-5870 38671-9557 38671-6102 38672-7075

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name THE PHARMACY AT DESOTO BAZE PHARMACY SYNERGY PHARMACY LLC ZIP SCRIPTS STATE LINE DRUGS HUDSONS SUMNER DRUG STORE W & D PHARMACY SUMRALL DRUG STORE FREDS XPRESS HAIRE DRUG CENTER GATLINS PHARMACY TUNICA PHARMACY FREDS PHARMACY MISSISSIPPI SENIOR CARE REGION III PHARMACY TUPELO RXS PM RETAIL, LLC SUPER D DRUGS THOMAS STREET APOTHECARY TUPELO DRUGS TUPELO FAMILY PHARMACY ZIP SCRIPTS BRUMFIELDS DRUGS FREDS XPRESS BURNHAM MCKINNEY PHARMACY NUMBER 4 FREDS PHARMACY BATTLEFIELD DISCOUNT DRUGS BATTLEFIELD EXPRESS DRUGS DURST DISCOUNT DRUGS DURST DISCOUNT DRUGS HELPING HAND FAMILY PHARMACY DUNCAN'S PHARMACY, INC. MOORE'S PHARMACY TURNAGE DRUG STORE INC WAVELAND PHARMACY BONNER DISCOUNT DRUGS LAB DISCOUNT DRUGS INC POINT CITY DRUGS ROSE DRUG COMPANY COUNTY DISCOUNT DRUG WHITE'S PHARMACY WILSON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number

State

ZIP code

(205) 533-9112 (662) 323-5033 (662) 268-8226 (662) 323-0885 (601) 848-7866 (662) 375-8813 (662) 375-8768 (601) 758-4243 (601) 785-6812 (662) 235-4301 (662) 438-6605 (662) 363-1431 (662) 620-9606 (662) 844-0400 (662) 256-5566 (662) 840-6411 (662) 844-0432 (662) 844-0444 (855) 612-1385 (662) 844-7811 (662) 620-6400 (601) 876-3665 (601) 774-8283

7601 SOUTHCREST PKWY 900 STARK RD 101 E G T THAMES DR 200 HOSPITAL RD BLDG 3 194 MAIN ST 108 COURT SQ 110 COURT SQ 1109 HWY 42 402 PINE ST 112 MERCER ST 18 FIRST AVENUE 1181 MAIN ST 1776 MCCULLOUGH BLVD 86 S THOMAS ST 499 GLOSTER CREEK VLG STE A-1 2801 W MAIN ST 738 S GLOSTER ST 86 S THOMAS ST 715 GARFIELD STREET 1244 E MAIN ST 501 S GLOSTER ST 109 BALL AVE 801 E JACKSON RD

Provider Street

SOUTHAVEN STARKVILLE STARKVILLE STARKVILLE STATE LINE SUMNER SUMNER SUMRALL TAYLORSVILLE TCHULA TISHOMINGO TUNICA TUPELO TUPELO TUPELO TUPELO TUPELO TUPELO TUPELO TUPELO TUPELO TYLERTOWN UNION

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

38671-4739 39759-3613 39759 39759 39362 38957-0000 38957-0217 39482 39168-5528 39169-9400 38873-9802 38676 38801-7101 38801 38801 38801-3001 38801-4932 38801 38801 38804-2952 38801-5527 39667-0329 39365-2213

(228) 826-4747 (228) 826-4403 (601) 636-3374 (601) 619-1550 (601) 636-4333 (601) 636-5042 (601) 631-6837 (662) 223-4727 (601) 253-2599 (662) 473-2442 (228) 463-1055 (601) 735-2141 (601) 735-4444 (662) 495-0008 (662) 494-3341 (601) 928-4482 (601) 928-4421 (601) 928-4446

12500 HIGHWAY 57 12101 HIGHWAY 57 3040A INDIANA AVE 2080 S FRONTAGE RD STE 101 3117 HALLS FERRY RD 2122 CLAY ST 1670 HIGHWAY 61 N 28271 HIGHWAY 15 103 CHADWICK AVE. 323 N MAIN ST 112 AUDERER BLVD 1017 AZALEA DR 923 WAYNE ST 849 HIGHWAY 45 ALTERNATE NORTH 137 COMMERCE ST 820 HALL ST 301 FIFTH AVE W 101 PINE AVE E

VANCLEAVE VANCLEAVE VICKSBURG VICKSBURG VICKSBURG VICKSBURG VICKSBURG WALNUT WALNUT GROVE WATER VALLEY WAVELAND WAYNESBORO WAYNESBORO WEST POINT WEST POINT WIGGINS WIGGINS WIGGINS

MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS

39565-9614 39565-7199 39180-4355 39180-5328 39180-5109 39183-3119 39183-3411 38683-0000 39189 38965-2505 39576-2432 39367-2552 39367-2571 39773 39773-2919 39577-2100 39577-2204 39577-2752

Page 346 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HAMMONDS PHARMACY INC PHARMNET FREDS XPRESS VANJONS PHARMACY WEBBS PHARMACY YAZOO DRUGS STOKES PHARMACY ANACONDA THRIFTY DRUG STORE

Provider Name

(662) 283-8802 (662) 283-1331 (601) 888-3346 (662) 746-3562 (662) 746-3253 (662) 746-7423 (406) 563-8410 (406) 563-8441

405C N APPLEGATE ST 403 SUMMIT ST 211 US HIGHWAY 61 S 320 E FIFTEENTH ST 216 S MAIN ST 730 EAST 15TH ST 1525 W PARK AVENUE 201 E PARK AVE

WINONA WINONA WOODVILLE YAZOO CITY YAZOO CITY YAZOO CITY ANACONDA ANACONDA

MS MS MS MS MS MS MT MT

38967-1826 38967-2113 39669-3586 39194-2632 39194-4010 39194 59711 59711-2340

BIGHORN VALLEY PHARMACY - ASHLAND ALBERTSON'S PHARMACY LEE & DAD'S PHARMACY BIG SANDY PHARMACY

(406) 784-2346 (406) 388-0901 (406) 388-4111 (406) 378-5588

501 MAIN STREET 6999 JACKRABBIT LN 205 W MADISON AVE 158 JOHANNES AVE

ASHLAND BELGRADE BELGRADE BIG SANDY

MT MT MT MT

59003 59714-8961 59714-3906 59520

BOZEMAN DEACONESS PHCY AT BIG SKY BIGFORK DRUG INC ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ASPEN MEADOWS PHARMACY BILLINGS CLINIC ATRIUM PHARMACY COMMUNITY HEALTH CENTER PHARMA CTR FOR HEALTHY AGING PHCY FIRST PHARMACY JURO'S UNITED DRUG OPTION CARE PHARMACY ONE ST. VINCENTS HEALTHCARE PHARMACY ELKHORN PHARMACY ALBERTSON'S PHARMACY GENOA-QOL HEALTHCARE HIGHLAND PARK PHARMACY OPTION CARE PRICE RITE DRUG CENTER ROSAUERS PHARMACY ROSAUERS PHARMACY SMITH'S PHARMACY STUDENT HEALTH SERVICE PHCY BROADUS IGA PHARMACY

(406) 993-9390 (406) 837-4370 (406) 259-1441 (406) 656-6652 (406) 245-4301 (406) 652-8359 (406) 245-6979 (406) 238-5977 (406) 238-2084 (406) 247-3330 (406) 655-5836 (406) 896-8325 (406) 259-2562 (800) 644-8203 (406) 245-6717 (406) 237-8117 (406) 225-3240 (406) 587-8800 (406) 404-6978 (406) 585-1030 (406) 587-1050 (406) 587-0608 (406) 587-4005 (406) 587-4005 (406) 586-3550 (406) 994-5498 (406) 436-2270

36 CENTER LANE STE 2 8111 MT HIGHWAY 35 611 N 27TH ST 2334 CENTRAL AVE 511 CENTRAL AVE 3137 GRAND AVE 670 MAIN ST 3155 AVENUE C 2800 10TH AVE N 123 S 27TH ST # E-1 2223 MISSION WAY 1540 13TH ST W 2043 GRAND AVE 404 N 31ST ST STE 401 2900 12TH AVE N STE 110A 1233 N 30TH ST 215 N MAIN 200 S 23RD AVE 699 FARMHOUSE LN STE P 925 HIGHLAND BLVD 682 S FERGUSON AVE STE 1 910 N 7TH AVE 3255 TECHNOLOGY BLVD W 3255 TECHNOLOGY BLVD W 1400 N 19TH AVE MONTANA STATE UNIVERSITY 120 N PARK AVE

BIG SKY BIGFORK BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BILLINGS BOULDER BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BOZEMAN BROADUS

MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT

59716 59911-3588 59101-1112 59102-4665 59102-5813 59102-6570 59105-3224 59102-8109 59101-0703 59101-4200 59102 59102-3202 59102-2614 59101-1211 59101-7506 59101-0127 59632-0026 59718-3965 59715-9402 59715-6900 59718-6491 59715-2500 59718-6854 59718-6854 59718-3647 59717-0000 59317-9582

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 347 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

BUTTE COMMUNITY HEALTH CENTER PHARM DRISCOLL DRUG MEDICAL ARTS PHARMACY OPTION CARE THREE BEARS PHARMACY CHESTER PHARMACY REMEDIES PHARMACY & GIFT CHINOOK PHARMACY CHOTEAU DRUG INC COLSTRIP FAMILY PHARMACY GOOD MEDICINE PHARMACY SMITH'S PHARMACY STILLWATER FAMILY PHARMACY OLSON'S DRUG VILLAGE DRUG CORVALLIS DRUG STORE CULBERTSON PHARMACY ALBERTSON'S PHARMACY KEYSTONE DRUG VANS PHARMACY ENNIS PHARMACY EUREKA DRUG FAIRFIELD DRUG INC FLORENCE PHARMACY NORTH YELLOWSTONE PHARMACY GRANITE PHARMACY FRENCHTOWN 5TH AVENUE PHARMACY AND GIFT WESTERN DRUG OF GLASGOW ALBERTSON'S PHARMACY GABERT CLINIC PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ANDERSON FAMILY PHARMACY BIG SKY MANAGED CARE CLINIC PHARMACY PLAZA PHARMACY PUBLIC DRUG CO SMITH'S PHARMACY SNYDER DRUG ALBERTSON'S PHARMACY BITTERROOT DRUG

(406) 496-6029 (406) 723-3308 (406) 723-2441 (866) 252-9342 (406) 494-4116 (406) 759-5050 (406) 759-5225 (406) 357-3333 (406) 466-2700 (406) 213-7010 (406) 892-9997 (406) 892-8333 (406) 322-5652 (406) 278-3261 (406) 278-3267 (406) 961-3221 (406) 787-5313 (406) 873-2055 (406) 846-2120 (406) 988-7121 (406) 682-4246 (406) 297-7748 (406) 467-2336 (406) 273-6565 (406) 346-2134 (406) 626-4113 (406) 228-3693 (406) 228-4308 (406) 365-5209 (406) 345-7948 (406) 761-8420 (406) 727-9880 (406) 761-8781 (406) 315-1989 (406) 771-3399 (406) 727-0070 (406) 453-1497 (406) 771-0475 (406) 452-6461 (406) 363-7089 (406) 363-3611

NR_0009_10823 10/2017

Provider Street 445 CENTENNIAL AVE 327 S EXCELSIOR AVE 435 S CRYSTAL ST STE 230 800 W PLATINUM ST STE D 45 THREE BEARS DR 30 MAIN STREET 500 EAST WASHINGTON AVE 300 INDIANA ST 102 N MAIN AVE 6230 MAIN ST STE B101 2100 9TH ST W 419 NUCLEUS AVE 133 N 5TH 5 4TH AVE SE 600 S MAIN ST STE 2 1029 MAIN ST 115 BROADWAY 501 W MAIN ST 407 MAIN ST 110 SOUTHSIDE BLVD 130 MAIN ST 546 US HIGHWAY 93 N 407 CENTRAL AVE 5549 OLD HWY 93 1025 MAIN ST 16862 BECKWITH ST STE P 621 3RD ST S 537 2ND AVE S 307 HARMON ST 107 DILWORTH ST 1414 3RD ST NW 2250 10TH AVE S 2828 10TH AVE S 915 1ST AVE S STE 110 1400 29TH ST S 2800 11TH AVE S 324 CENTRAL AVE 1601 MARKET PLACE DR 2515 6TH AVE N 1313 N 1ST ST 211 W MAIN ST

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Provider City BUTTE BUTTE BUTTE BUTTE BUTTE CHESTER CHESTER CHINOOK CHOTEAU COLSTRIP COLUMBIA FALLS COLUMBIA FALLS COLUMBUS CONRAD CONRAD CORVALLIS CULBERTSON CUT BANK DEER LODGE DILLON ENNIS EUREKA FAIRFIELD FLORENCE FORSYTH FRENCHTOWN GLASGOW GLASGOW GLENDIVE GLENDIVE GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS GREAT FALLS HAMILTON HAMILTON

State

ZIP code

MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT

59701-2870 59701-1536 59701-1506 59701-2200 59701 59522 59522 59523-9715 59422-0000 59323-9520 59912-4416 59912-4007 59019-0000 59425-2327 59425-2532 59828-0000 59218 59427-2823 59722-1058 59725-3513 59729-0000 59917-9053 59436 59833-6564 59327-0000 59834-9646 59230 59230-2320 59330-1510 59330-2053 59404-1928 59405-2809 59405-3241 59401-3705 59405-5353 59405-5263 59401-3114 59404-3481 59401-1909 59840-3104 59840-2553

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HEALTHCARE PROVIDERS TIMBER RIDGE PHARMACY BIGHORN VALLEY PHARMACY PHARMCARE OF HARDIN INC MILK RIVER PHARMACY

Provider Name

(406) 363-6203 (406) 363-9003 (406) 867-4141 (406) 665-1602 (406) 353-3535

1900 N 1ST ST 1131 N 1ST ST 10 WEST 4TH ST SUITE B 901 N CENTER AVE 42465 US HWY 2

HAMILTON HAMILTON HARDIN HARDIN HARLEM

MT MT MT MT MT

59840-3115 59840-2150 59034 59034-1322 59526

REMEDIES PHARMACY AND HARDWARE

(406) 632-4532

100 N CENTRAL AVENUE

HARLOWTON

MT

59036

BULLHOOK COMMUNITY HLTH CTR PHCY HEALTH MART NORTHERN MONTANA PHARMACY WESTERN DRUG PHARMACY GENEVA WOODS PHARMACY OSCO PHARMACY ST PETERS COMMUNITY PHARMACY ST PETERS PHARMACY BROADWAY ALBERTSON'S PHARMACY EVERGREEN PHARMACY

(406) 395-6906 (406) 265-1229 (406) 262-1701 (406) 265-9601 (406) 443-0505 (406) 449-2295 (406) 444-2350 (406) 444-2200 (406) 257-7556 (406) 257-2083

521 4TH ST 730 1ST ST 20 13TH ST 123 5TH AVE STE B 2600 WINNE AVE STE A 3151 N MONTANA AVE 2475 E BROADWAY ST 2550 BROADWAY 900 W IDAHO ST 2141 US HIGHWAY 2 E STE 300

HAVRE HAVRE HAVRE HAVRE HELENA HELENA HELENA HELENA KALISPELL KALISPELL

MT MT MT MT MT MT MT MT MT MT

59501-3649 59501-3702 59501-5222 59501-3624 59601-4900 59602-7813 59601-4928 59601 59901-3844 59901-2889

KALISPELL REGIONAL MED CENTER PHCY MEDICAL ARTS PHARMACY ROSAUERS SMITH'S PHARMACY SYKES PHARMACY INC REMEDIES LAKESIDE ALBERTSON'S PHARMACY SEIDEN DRUG FRANK'S PHARMACY

(406) 752-1761 (406) 752-2492 (406) 755-5099 (406) 257-1397 (406) 257-4806 (406) 844-2103 (406) 538-6674 (406) 535-1470 (406) 293-3784

310 SUNNYVIEW LN 209 CONWAY DR 2150 US HIGHWAY 93 S 195 3RD AVENUE NE 202 2ND AVE W 206 STONER LOOP RD 117 W JANEAUX ST 310 WENDELL AVE STE 102 1401 MINNESOTA AVE

KALISPELL KALISPELL KALISPELL KALISPELL KALISPELL LAKESIDE LEWISTOWN LEWISTOWN LIBBY

MT MT MT MT MT MT MT MT MT

59901-3129 59901-3111 59901-5782 59901 59901-4488 59922 59457-3073 59457-2267 59923-2309

NORTHWEST COMMUNITY HEALTH CNTR ALBERTSON'S PHARMACY WESTERN DRUG PHARMACY LOLO DRUG LLC VALLEY DRUG COMPANY ALBERTSON'S PHARMACY BIG SKY PHARMACY 406 CLINIC PHARMACY 406 CLINIC PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BROADWAY PHARMACY

(406) 283-6900 (406) 222-1188 (406) 222-7332 (406) 273-2322 (406) 654-2632 (406) 232-4627 (406) 234-1241 (406) 544-8808 (406) 544-8808 (406) 549-5127 (406) 549-7717 (406) 728-1118 (406) 327-1650

320 E 2ND ST 2120 PARK ST S 1313 W PARK STREET 103 GLACIER DR 131 SOUTH FIRST AVE E 519 S HAYNES AVE 701 MAIN ST 1315 WYOMING ST STE B 1315 WYOMING ST STE A 2205 OXFORD ST 3800 S RUSSELL ST 2230 N RESERVE ST 500 W BROADWAY ST

LIBBY LIVINGSTON LIVINGSTON LOLO MALTA MILES CITY MILES CITY MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA

MT MT MT MT MT MT MT MT MT MT MT MT MT

59923-2010 59047-4127 59047 59847-8700 59538-0000 59301-4768 59301 59801-1725 59801-1725 59801-7936 59801-8554 59808-1396 59802-4008

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 349 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name GRANITE PHARMACY MISSOULA HEALTH SERVICE PHARMACY MISSOULA FRESH MARKET MISSOULA FRESH MARKET PHARMACY MISSOULA PHARMACY OSCO PHARMACY PALMER'S DRUG PARTNERSHIP HEALTH CENTER ROSAUERS PHARMACY SAVMOR DRUG I INC GRANITE PHARMACY PLAINS DRUG PROVIDENCE LAKESHORE PHARMACY PROVIDENCE ST JOSEPH PHARMACY POPLAR PHARMACY RED LODGE DRUG CO INC FAMILY HEALTH PHARMACY R & R HEALTH CARE SOLUTIONS MISSION DRUG PHARMACY SEELEY SWAN PHARMACY NORTHTOWN DRUG LLC MACS CHC PHARMACY CLINIC PHARMACY WHITE DRUG FAMILY PHARMACY INC RIDGEWAY PHARMACY VALLEY DRUG & VARIETY DOUG'S DRUG RAILWAY DRUG TOWNSEND DRUG KOOTENAI DRUG NORTH RIDGE PHARMACY SILVERTIP PHARMACY CASTLE MOUNTAIN DRUG ALPINE APOTHECARY WHITEFISH DISCOUNT PHARMACY WHITEHALL DRUG NE MT HEALTH SERVICES WOLFPOINT ABERDEEN PRESCRIPTION SHOPPE BERMUDA RUN PHARMACY DRUGCO DISCOUNT PHARMACY MIZELLE'S DISCOUNT DRUG CO INC

NR_0009_10823 10/2017

Provider Phone Number (406) 926-2940 (406) 243-5171 (406) 251-5415 (406) 721-6009 (406) 728-5650 (406) 549-6163 (406) 549-4125 (406) 258-4139 (406) 721-5330 (406) 721-6017 (406) 859-3784 (406) 826-3552 (406) 883-0342 (406) 883-8444 (406) 768-6147 (406) 446-1017 (406) 676-2111 (406) 676-5600 (406) 745-3000 (406) 677-8989 (406) 434-5115 (406) 842-7434 (406) 488-6563 (406) 482-1420 (406) 777-5002 (406) 777-4410 (406) 777-5591 (406) 827-4349 (406) 759-5225 (406) 266-4379 (406) 295-4361 (406) 642-9898 (406) 646-7056 (406) 547-2316 (406) 862-7434 (406) 862-7070 (406) 287-3931 (406) 653-6572 (910) 944-1313 (336) 998-1030 (252) 332-4101 (252) 332-3444

Provider Street 2230 27TH AVE W STE 2 634 EDDY AVE 3801 S RESERVE ST 800 W BROADWAY ST 1211 S RESERVE ST STE 102 1003 E BROADWAY ST 918 SW HIGGINS AVE 323 W ALDER ST 2350 S RESERVE ST 1610 S 3RD ST W 106 N. MONTGOMERY ST 214 RAILROAD ST 50331A US HWY 93 6 13TH AVE E 213 H ST EAST 211 NORTH BROADWAY 63307 US HIGHWAY 93 63802 US HIGHWAY 93 STE B 110 N MAIN ST 3027 MT HIGHWAY 83 N STE J 333 MAIN ST 117 N MAIN ST 214 14TH AVE SW 402 E MAIN ST 3804 EASTSIDE HWY 39 STEVI CUTOFF RD 301 MAIN ST 1221 MAIN STREET 117 MAIN STE A 308 BROADWAY 611 E. MISSOULA AVE 2824 HIGHWAY 93 N STE B 120 N CANYON ST STE F 25 E MAIN 6475 US HIGHWAY 93 S 1111 BAKER AVE 203 W LEGION ST 1115 4TH AVE N 1389 N SANDHILLS BLVD 313 NC HIGHWAY 801 N 312 ACADEMY ST S 925 MEMORIAL DR E

Page 350 of 679

Provider City MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA MISSOULA PHILIPSBURG PLAINS POLSON POLSON POPLAR RED LODGE RONAN RONAN SAINT IGNATIUS SEELEY LAKE SHELBY SHERIDAN SIDNEY SIDNEY STEVENSVILLE STEVENSVILLE STEVENSVILLE THOMPSON FALLS THREE FORKS TOWNSEND TROY VICTOR WEST YELLOWSTONE WHITE SUIPHUR SPRING WHITEFISH WHITEFISH WHITEHALL WOLF POINT ABERDEEN ADVANCE AHOSKIE AHOSKIE

State

ZIP code

MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT MT NC NC NC NC

59804 59801-2801 59801 59802-3944 59801-3103 59802 59803-1425 59802-4123 59801-6447 59801-9012 59858 59859 59860 59860-5315 59255 59068-1030 59864-2702 59864-3414 59865-9031 59868 59474-1967 59749-9516 59270-3521 59270-4633 59870 59870 59870 59873 59752 59644-2222 59935 59875 59758 59645 59937-8282 59937 59759-7743 59201-1829 28315-2211 27006-7905 27910-3200 27910-3915

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RCCHC PHARMACY ALBEMARLE PHARMACY MEDICAL PHARMACY OF UWHARRIE MEDICAL PHCY. OF ALBEMARLE INC KERR DRUG TURNER DISC MEDICINE SHOPPE KERR DRUG APEX PHARMACY ARCHDALE DRUG CO CAROLINA DRUG INGLES PHARMACY NCRX SELECT CARE PHARMACY ASHEBORO DRUG CAROLINA PHARMACY CARTERS FAMILY PHARMACY

Provider Name

(252) 862-4928 (704) 983-8222 (704) 550-9006 (704) 982-9179 (828) 321-5801 (828) 321-3327 (919) 639-2910 (919) 629-7332 (336) 434-2776 (336) 431-4040 (828) 684-9019 (828) 483-3344 (828) 585-2034 (336) 625-5666 (336) 625-6146 (336) 625-8650

120 HEALTH CENTER DR 105 YADKIN ST STE 103 1420 US HWY 52 N 320 YADKIN ST 286 MAIN ST 451 MAIN ST 116 W DEPOT ST 904 W WILLIAMS ST 11220 N MAIN ST 10102 UNIT S, SOUTH MAIN ST 301 LONG SHOALS RD 2690 HENDERSONVILLE RD 15 GLENN BRIDGE RD STE A 306 WHITE OAK ST 534 GREENSBORO ST 700 N FAYETTEVILLE ST

AHOSKIE ALBEMARLE ALBEMARLE ALBEMARLE ANDREWS ANDREWS ANGIER APEX ARCHDALE ARCHDALE ARDEN ARDEN ARDEN ASHEBORO ASHEBORO ASHEBORO

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27910-8161 28001-3450 28001-2622 28001-3447 28901-9250 28901-9648 27501-6696 27502-5201 27263-2891 27263 28704-7713 28704-8576 28704-8481 27203-5434 27203-4670 27203-4611

CENTRAL CAROLINA PHARMACEUTICAL SER PREVO DRUG URGENT HEALTHCARE PHARMACY ZOO CITY DRUG ZOO CITY DRUG II AB COMMUNITY PHARMACY ASHEVILLE DISCOUNT PHARMACY B & B PHARMACY BLUE RIDGE PHARMACY INC GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY KERR DRUG MEDICAL CENTER PHARMACY MISSION COMMUNITY PHARMACY MISSION PHARMACY CANCER CENTER RIPLEY DRUG & COMPOUNDING SKYLAND PHARMACY THE MEDICINE SHOPPE

(336) 629-9666 (336) 625-4311 (336) 629-4524 (336) 626-3784 (336) 626-9002 (828) 398-0123 (828) 258-8511 (828) 252-2718 (828) 298-3636 (828) 348-8083 (828) 490-7573 (828) 277-7466 (828) 274-1328 (828) 255-8949 (828) 255-4612 (828) 298-1425 (828) 225-2756 (828) 665-9361 (828) 236-1519 (828) 213-0051 (828) 213-9470 (828) 213-2950 (828) 782-5571 (828) 575-9977 (828) 255-8757

308 WHITE OAK ST 363 SUNSET AVE 197 NC HWY 42 N. STE C 1204 SHAMROCK RD 415 NC HIGHWAY 49 S 356 BILTMORE AVE STE 209 76 PATTON AVE 462 HAYWOOD RD 805 FAIRVIEW RD STE 100 119 TUNNEL RD STE G 1314 PATTON AVE STE E 780 HENDERSONVILLE RD 1865 HENDERSONVILLE RD 915 MERRIMON AVE 29 TUNNEL RD 1141 TUNNEL RD 575 NEW LEICESTER HWY 863 BREVARD RD 1124 PATTON AVE 509 BILTMORE AVE 2 MEDICAL PARK DR STE 100 21 HOSPITAL DRIVE FIRST FLOOR 530 HENDERSONVILLE RD STE B 1800 HENDERSONVILLE RD STE 8 760 MERRIMON AVE

ASHEBORO ASHEBORO ASHEBORO ASHEBORO ASHEBORO ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE ASHEVILLE

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27203-5434 27203-5611 27203 27203-6947 27205-9561 28801 28801-3315 28806-4263 28803-1011 28805-1869 28806-2648 28803-2900 28803-3229 28804-2361 28805-1229 28805-2019 28806-2122 28806-2205 28806-2706 28801-4601 28803-7778 28801 28803-2826 28803-3262 28804-2451

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 351 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ATKINSON DRUG BEACH PHARMACY II EDWARDS PHARMACY KERR DRUG BAILEY PHARMACY BAKERSVILLE PHARMACY BANNER ELK PHARMACY NORTHSIDE FAMILY PHARMACY BAYBORO PHARMACY BEAUFORT DRUG COMPANY EXPRESS CARE PHARMACY MEDICAL PARK PHARMACY EAST KERR DRUG ONEALS DRUG STORE PUNGO RIVER PHARMACY INC BELMONT'S DRUG STORE COLLEGE PARK PHARMACY PRIMECARE PHARMACY CARLIE CS PHARMACY

Provider Name

(910) 283-5400 (252) 995-3811 (252) 746-3126 (252) 746-3026 (252) 235-3562 (828) 688-3241 (828) 898-4271 (252) 985-4263 (252) 745-5539 (252) 728-2006 (252) 838-1540 (252) 504-2800 (252) 943-6260 (252) 943-2463 (252) 943-2585 (704) 829-9897 (704) 825-5179 (704) 812-8487 (919) 270-0744

124 W MAIN ST 41934 NC HIGHWAY 12 131 3RD ST 140 NC HWY 102 WEST 6311 DEANS ST 580 S HIGHWAY 226 110 PARK AVE 3920 BISHOP RD 702 MAIN ST 1404 LIVE OAK ST 708 HWY 70 EAST OTWAY 1513 LIVE OAK ST 418 US HIGHWAY 264 BYP 820 W MAIN ST 892 US HWY 264 EAST BYPASS 403 CATAWBA ST STE 100 682 PARK ST 1948 PERFECTION AVE 604 S WALL ST

ATKINSON AVON AYDEN AYDEN BAILEY BAKERSVILLE BANNER ELK BATTLEBORO BAYBORO BEAUFORT BEAUFORT BEAUFORT BELHAVEN BELHAVEN BELHAVEN BELMONT BELMONT BELMONT BENSON

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28421-0069 27915 28513-7252 28513 27807-8641 28705 28604-6604 27809-9038 28515-9634 28516-1517 28516 28516-1518 27810-9291 27810-1120 27810-0000 28012-3392 28012-2728 28012-2173 27504-1824

EASTERN CAROLINA MEDICAL CNTR PHCY KERR DRUG MEDICAP PHARMACY WARREN DRUG COMPANY CENTRAL DRUG OF BESSEMER CITY BETHEL PHARMACY BEULAVILLE PHARMACY INC BISCOE PHARMACY INC HEALTHRIDGE PHARMACY SUNSHINE PHARMACY THE MEDICINE SHOPPE VILLAGE PHARMACY PROFESSIONAL PHARMACY BOONE DRUG @ DEERFIELD BOONE DRUG AT GREENWAY BOONE DRUG AT KING STREET BOONE DRUG AT NEW MARKET GORDON FAMILY PHARMACY INGLES PHARMACY METCALF PHARMACY TRANSYLVANIA REGIONAL HOSPITAL BRYSON CITY PHARMACY

(919) 207-1027 (919) 207-0637 (919) 938-3800 (919) 894-4651 (704) 629-2163 (252) 825-7271 (910) 298-3093 (910) 428-1150 (828) 669-9970 (828) 669-0090 (910) 863-3949 (828) 295-3482 (704) 434-9897 (828) 264-3055 (828) 264-8696 (828) 264-8929 (828) 264-9144 (828) 877-6111 (828) 883-2358 (828) 877-3800 (828) 883-5282 (828) 488-1705

1 MEDICAL DR 403 E MAIN ST 70 CRAPE MYRTLE DR STE 103 209 E MAIN ST 112 W VIRGINIA AVE 7433 MAIN STREET 103 CROSSOVER RD 2295 NC HIGHWAY 24 27 EAST 3130 US 70 HWY 206 E STATE ST STE 1 102 S MAIN ST 625 CHESTNUE RIDGE PKWY 139 1/2 E COLLEGE AVE 345 DEERFIELD RD 579 GREENWAY RD STE 100 202 W KING ST 245 NEW MARKET CTR 518 S BROAD ST 684 N BROAD ST 50 ASHEVILLE HWY 260 HOSPITAL DR 200 HIGHWAY 19 S

BENSON BENSON BENSON BENSON BESSEMER CITY BETHEL BEULAVILLE BISCOE BLACK MOUNTAIN BLACK MOUNTAIN BLADENBORO BLOWING ROCK BOILING SPRINGS BOONE BOONE BOONE BOONE BREVARD BREVARD BREVARD BREVARD BRYSON CITY

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27504-1177 27504-1530 27504-8034 27504-1508 28016-2373 27812 28518-8800 27209-9743 28711 28711-3545 28320 28605-8962 28017 28607-5009 28607-4809 28607-3516 28607-3993 28712 28712-3176 28712-3386 28712-3378 28713-9513

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 352 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KERR DRUG BUNN DRUG COMPANY KERR DRUG VALUE RX PHARMACY ARMC EXTENDED CARE PHARMACY ASHER-MCADAMS DRUG BURLINGTON CHC PHARMACY CHARLES DREW CHC PHARMACY EDGEWOOD PHARMACY GENOA-QOL HEALTHCARE GLEN RAVEN PHARMACY MEDICAL VILLAGE APOTHECARY MEDICAP PHARMACY TOTAL CARE PHARMACY INGLES PHARMACY

Provider Name

(828) 488-6677 (919) 497-1700 (910) 259-2514 (919) 259-2116 (336) 570-8357 (336) 226-1619 (336) 506-5835 (336) 532-0414 (336) 584-8878 (336) 578-9226 (336) 584-3736 (336) 228-1336 (336) 222-9811 (336) 570-2273 (828) 682-7636

HWY 19 AND SLOPE 23 NC 98 HWY E 206 US HIGHWAY 117 S 111 S WRIGHT ST 1840 BROOKWOOD AVE 305 TROLLINGER ST 1214 VAUGHN RD 221 N GRAHAM HOPEDALE RD 2213 EDGEWOOD AVE 2732 ANN ELIZABETH DR 1902 W WEBB AVE 1610 VAUGHN RD 378 W HARDEN ST 2479 S CHURCH ST 400 E US HIGHWAY 19 E BYP

BRYSON CITY BUNN BURGAW BURGAW BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURNSVILLE

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28713 27508-7289 28425-7799 28425-5567 27215-3200 27215-2227 27217-2863 27217-2971 27215-4547 27215-5111 27217-1062 27217-2864 27215-7516 27215-5201 28714-7165

THE PRESCRIPTION PAD OF BURNSVILLE MURDOCH CENTER PHARMACY QUALITY DRUGS INC OF BUTNER SEASHORE DRUGS CAROLINA MOUNTAIN PHARMACY INGLES PHARMACY MISSION PHARMACY-ENKA INGLES PHARMACY REALO DISCOUNT DRUGS CARRBORO CHC PHARMACY CARRBORO FAMILY PHARMACY, INC FOOD LION PHARMACY KERR DRUG THE PRESCRIPTION SHOPPE THE VILLAGE APOTHECARY INC ASHWORTH DRUGS ASPIRAR PHARMACY CAROLINA CMPDING PHCY & HLTH C SWIFT CREEK PHARMACY CASHIERS VALLEY PHARMACY INGLES PHARMACY MEDICAP PHARMACY KOONCE DRUG COMPANY 501 PHARMACY GOVERNORS PHARMACY KERR DRUG

(828) 678-3914 (919) 575-1285 (919) 575-6571 (919) 579-3200 (828) 633-6700 (828) 665-4976 (828) 213-5330 (828) 235-2795 (252) 393-3345 (919) 537-0097 (919) 933-7629 (910) 949-2071 (910) 947-2690 (910) 947-2106 (910) 949-3700 (919) 467-1877 (919) 977-9011 (919) 467-7110 (919) 518-4483 (828) 743-3114 (828) 743-6312 (828) 241-2422 (919) 654-4194 (984) 999-0501 (919) 918-2092 (919) 942-8738

730 E MAIN ST 1600 E C ST 309 CENTRAL AVE 10227 BEACH DR SW 7 OLD PISGAH HWY STE 100 1572 SAND HILL RD 1388 SANDHILL RD, SUITE 100 630 CHAMPION DR 181 ENTERPRISE AVE 301 LLOYD ST 104 HWY 54 W BYPASS UNIT J 7475 NC HIGHWAY 22 1006 MONROE ST 1016 MONROE ST 7305 NC HIGHWAY 22 105 W CHATHAM ST 135 PKWY OFFICE CT STE 105 254 TOWNE VILLAGE DR 2703 JONES FRANKLIN RD STE 104 72 CASHIERS SHOPPING CTR 230 US 64 W 201 SECOND AVE SW 112 E 7TH AVE 98 CHAPELTON CT STE 300 50241 GOVERNORS DR 1106 ENVIRON WAY

BURNSVILLE BUTNER BUTNER CALABASH CANDLER CANDLER CANDLER CANTON CAPE CARTERET CARRBORO CARRBORO CARTHAGE CARTHAGE CARTHAGE CARTHAGE CARY CARY CARY CARY CASHIERS CASHIERS CATAWBA CHADBOURN CHAPEL HILL CHAPEL HILL CHAPEL HILL

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28714-3102 27509-2530 27509-2315 28467-2703 28715-8306 28715 28715 28716-3032 28584-8516 27510-1823 27510-0000 28327-8514 28327-7387 28327-7387 28327-8512 27511-3331 27518 27513-8910 27518-7172 28717-4501 28717 28609 28431-1402 27516-8487 27517-8621 27517-4418

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 353 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SOUTHERN VILLAGE PHARMACY STUDENT STORES PHARMACY UNC EMPLOYEE PHARMACY UNC HOSPITALS PHARMACY

Provider Name

(919) 240-4084 (919) 966-8166 (984) 974-6511 (919) 966-7694

300 MARKET ST STE 114 207 SOUTH RD 101 MANNING DR 101 MANNING DR

CHAPEL HILL CHAPEL HILL CHAPEL HILL CHAPEL HILL

NC NC NC NC

27516-4493 27514 27514-4220 27514-4423

UNC HOSPITALS PHARMACY (AMBULATORY A2Z HEALTHMART PHARMACY BENZER PHARMACY CANNON PHARMACY MORROCROFT CANNON PHARMACY SEDGEFIELD CAREFIRST SPECIALTY PHARMACY CAROLINA CARE CAROLINA PHARMACY CHS CMC BEHAVIORAL HLTH PHCY CMC BIDDLE POINT PHARMACY CMC MYERS PARK PHCY CMC NORTHPARK PHARMACY CMC RX MEDICAL CENTER PLAZA CMC RX MEDICAL CENTER PLAZA CMC RX STEELE CREEK DILWORTH DRUG DOCS PHARMACY FAMILY CARE SPECIALTY PHARMACY FAMILY CARE SPECIALTY PHARMACY FAMILYCARE SPECIALTY PHARMACY FRIENDLY FAMILY PHARMACY FRIENDLY FAMILY PHCY PAW CREEK GENOA-QOL HEALTHCARE GIANT GENIE PHARMACY HOSKINS PHARMACY KAITLYNS PHARMACY LE'S PHARMACY LONG'S DRUGS MOE'S RX CLINIC NALLE PHARMACY NOVANT HEALTH PHARMACY ONCOLOGY SPC OF CHARLOTTE PIKE'S PHARMACY INC

(919) 966-2372 (980) 355-0906 (704) 531-5232 (704) 367-7440 (704) 523-8608 (704) 504-8646 (704) 512-6800 (704) 909-4700 (704) 358-2860 (704) 350-1090 (704) 446-1400 (704) 446-0902 (704) 355-6900 (704) 512-6040 (704) 512-5300 (704) 910-4288 (704) 900-6001 (704) 909-5610 (704) 688-5330 (704) 837-1790 (704) 531-5881 (704) 398-9700 (704) 972-8134 (704) 344-6494 (980) 226-5566 (704) 558-9623 (980) 207-3267 (704) 525-3956 (704) 910-1242 (704) 342-8180 (704) 384-9065 (704) 342-1900 (704) 563-2286

102 MASON FARM RD 1408 ARCHDALE DR 6018 THE PLAZA 4501 CAMERON VALLEY PKWY #125 2334 SOUTH BLVD 11100 S TRYON ST 4400 GOLF ACRES DR 8035 PROVIDENCE RD STE 300 501 BILLINGSLEY RD 1801 ROZZELLES FERRY RD 1350 S KINGS DR 251 EASTWAY DR 1001 BLYTHE BLVD STE 201 4525 CAMERON VALLEY PKWY STE 1 13640 STEELE CROFT PKWY #120 1300 EAST BLVD STE B 2860 FREEDOM DR 4922 ALBEMARLE RD 9740B UNIVERSITY CITY BLVD 6700 ALBEMARLE RD 6413 ALBEMARLE RD 517 LITTLE ROCK RD 5700 EXECUTIVE CENTER DR STE 2 2516 CENTRAL AVE 4023 BROOKSHIRE BLVD STE F 9100 S TRYON ST STE A 1600 PURSER DR 5123 SOUTH BLVD STE A 1711 CENTRAL AVE 1918 RANDOLPH RD STE 120 200 HAWTHORNE LN 2711 RANDOLPH RD STE 100 2133 SHAMROCK DR

CHAPEL HILL CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27599-6134 28210 28215-2450 28211-4297 28203-5008 28273-4503 28208-5990 28277-9716 28211-1009 28208-4228 28207-2134 28213-7103 28203-5863 28211-4371 28278 28203-5802 28208 28205-6618 28213-3608 28212-3856 28212 28214-1915 28212-8858 28205-5313 28216-3957 28273-3113 28215-2935 28217-2756 28205-5107 28207-1107 28204-2515 28207-2027 28205-2132

PREMIER PHARMACY AND WELLNESS CTR RANDOLPH MEDICAL PHARMACY RX CARE PHARMACY

(704) 496-9182 (704) 365-0707 (980) 201-9240

3010 MONROE RD STE 101 3541 RANDOLPH RD 7701 SHARON LAKES RD STE H

CHARLOTTE CHARLOTTE CHARLOTTE

NC NC NC

28205-7533 28211-1082 28210-7429

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 354 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RX CLINIC PHARMACY RX CLINIC PHARMACY SHARON LAKES PHARMACY STAR BRIGHT PHARMACY UNC CHARLOTTE STUDENT HLTH CTR WALKERS DRUG STORE WALKERS DRUG STORE HOUSER DRUG COMPANY MEDICAL CENTER PHARMACY TAS DRUG CHINA GROVE DRUG COMPANY FOOD LION PHARMACY PRICE PHARMACY CHOCOWINITY PHARMACY INC MEDICAP PHARMACY CLARKTON DRUG BEDDINGFIELD DRUGS LLC FOOD LION PHARMACY HEALTHSMART PHARMACY REALO DISCOUNT DRUGS

Provider Name

(704) 537-0909 (704) 900-2832 (704) 551-8700 (704) 827-7557 (704) 687-5873 (704) 364-3444 (704) 321-0027 (704) 435-6011 (704) 435-3263 (704) 435-5082 (704) 857-7951 (704) 855-1316 (704) 856-2579 (252) 946-4000 (828) 459-2149 (910) 647-0437 (919) 553-6224 (919) 553-5945 (919) 359-1474 (919) 359-9164

7308 E INDEPENDENCE BLVD # A2 6010 E W T HARRIS BLVD 816 E ARROWOOD RD STE D 231 MT HOLLY HUNTERSVILLE #160 9201 UNIVERSITY CITY BLVD 4390 COLWICK RD 8145 ARDREY KELL RD, STE 105 100 E MAIN ST 607 E ACADEMY ST 500 W CHURCH ST 112 S MAIN ST 1460 MAIN STREET 422 S US 29 HWY 633 NC HIGHWAY 33 E 3319 EAST MAIN 80 E GREEN ST 95 SPRINGBROOK AVE 50 NEUSE RIVER PKWY 9197 CLEVELAND RD 322 PRITCHARD RD

CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHARLOTTE CHERRYVILLE CHERRYVILLE CHERRYVILLE CHINA GROVE CHINA GROVE CHINA GROVE CHOCOWINITY CLAREMONT CLARKTON CLAYTON CLAYTON CLAYTON CLAYTON

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28227 28215-4084 28217-5818 28214-9357 28223-0001 28211-2310 28277-5720 28021-3407 28021-3429 28021-2812 28023-2448 28023 28023 27817-9005 28610 28433-5002 27520 27527-5275 27520 27527-6511

MEDICAL PLAZA-CLEMMONS PHARMACY CLEVELAND DRUG COMPANY CLINTON DRUG COMPANY MATTHEWS DRUG STORE SOUTHEASTERN MED ONCOLOGY CTR HAYWOOD PHARMACY COATS PHARMACY INC COLUMBIA PHARMACY FOOTHILLS PHARMACY CANNON PHARMACY CONCORD CMC RX GATEWAY CMC RX PAVILION

(336) 713-0900 (704) 278-4788 (910) 592-8444 (910) 592-3121 (910) 592-5727 (828) 454-5455 (910) 897-8500 (252) 796-2421 (828) 894-6112 (704) 788-6337 (704) 403-8680 (704) 403-3190

2311 LEWISVILLE-CLEMMONS RD 11745B STATESVILLE BLVD 307 BEAMAN STREET 408 NORTHEAST BLVD 211 BEAMAN ST 221 PARAGON PKWY 393 N MCKINLEY ST 214 MAIN ST 80 SHUFORD RD 760 CABARRUS AVE W W 1085 NE GATEWAY CT NE STE 190 920 CHURCH ST N

CLEMMONS CLEVELAND CLINTON CLINTON CLINTON CLYDE COATS COLUMBIA COLUMBUS CONCORD CONCORD CONCORD

NC NC NC NC NC NC NC NC NC NC NC NC

27012-8905 27013-9419 28328 28328-2434 28328-2905 28721-8509 27521-8132 27925 28722-7406 28027-6851 28025-2407 28025-2927

CONCORD PHARMACY & SURGICAL SUPPLY MEDICAP PHARMACY MEDICINE SHOPPE MOOSE PROFESSIONAL PHARMACY BOWMAN DRUG COMPANY MEDICAL VILLAGE PHARMACY MEDICAP PHARMACY DAVIE DISCOUNT DRUGS

(704) 918-4419 (704) 789-9681 (704) 786-0135 (704) 784-9613 (828) 464-1354 (828) 322-4505 (828) 464-4491 (336) 284-2537

3497 US HIGHWAY 601 S 361 GEORGE W. LILES PKWY, NW 807 DAVIDSON DR NW 270 COPPERFIELD BLVD NE STE 10 126 1ST AVE S 815 FAIRGROVE CHURCH ROAD SE 317 1ST STREET E 141 MARGINAL ST

CONCORD CONCORD CONCORD CONCORD CONOVER CONOVER CONOVER COOLEEMEE

NC NC NC NC NC NC NC NC

28025-0490 28027 28025-4351 28025-2443 28613-2112 28613 28613 27014-0768

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 355 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CRAMERTON DRUG COMPANY CREEDMOOR DRUG COMPANY FOOD LION PHARMACY DALLAS EXPRESS PHARMACY INGLES PHARMACY STOKES PHARMACY OF DANBURY RIEGELWOOD MUTUAL DRUG DENTON DRUG STORE YADKIN VALLEY HEALTHCARE LLC KERR DRUG SURRY DRUG COMPANY FREDS PHARMACY HOSPITAL PHARMACY INC PHYSICIANS DISCOUNT DRUG THE MEDICINE CENTER THOMAS DRUG STORE

Provider Name

(704) 824-2521 (919) 528-0041 (919) 528-1644 (704) 922-3001 (704) 922-7187 (336) 593-8070 (910) 655-2667 (336) 859-2191 (336) 859-0272 (336) 386-4168 (336) 356-4912 (910) 892-8187 (910) 892-4224 (910) 230-0662 (910) 892-1176 (910) 892-2114

149 8TH AVE 108 N MAIN ST 2531 E LYON STATION RD STE J 111A N HOFFMAN ST 715 W TRADE ST 1011 HANGING ROCK PARK ROAD 27449 ANDREW JACKSON HWY E 17941 S HWY 109 17955 S NC HIGHWAY 109 101 E ATKINS ST 105 BUSINESS PARK LN 710 ERWIN RD 200 N ELLIS AVE 741 TILGHMAN DR 1402 W CUMBERLAND ST 609 E CUMBERLAND ST

CRAMERTON CREEDMOOR CREEDMOOR DALLAS DALLAS DANBURY DELCO DENTON DENTON DOBSON DOBSON DUNN DUNN DUNN DUNN DUNN

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28032-1401 27522-0000 27522-9401 28034-1597 28034-1544 27016 28436-8822 27239 27239-6533 27017-8700 27017-9026 28334-4522 28334-3807 28334-5507 28334-4504 28334-5021

CAROLINA BEHAVORIAL CARE PHARMACY CENTRAL PHARMACY CLINIC PHARMACY DURHAM PHARMACY FOOD LION PHARMACY GURLEYS PHARMACY JOSEFS PHARMACY KERR DRUG KERR DRUG KERR DRUG LINCOLN HOSPITAL PHARMACY CTR MAIN STREET PHARMACY TRIANGLE PHARMACY INC UNC HOMECARE SPECIALISTS UNC SHARED SERVICE CNTR PHCY UPCHURCH DRUGS EASTOVER DRUG EDEN DRUG HEALTH MART LAYNECARE LLC LAYNE'S FAMILY PHARMACY INC MITCHELL'S DISCOUNT DRUGS INC BLOUNT'S MUTUAL DRUGS INC OVERMAN & STEVENSON TARHEEL PHARMACY TODDS NORTHSIDE PHARMACY

(919) 972-7719 (919) 220-5121 (919) 383-7495 (919) 224-1234 (919) 620-1947 (919) 688-8978 (919) 680-1540 (919) 530-8774 (919) 682-9271 (919) 383-9428 (919) 956-4055 (919) 688-1368 (919) 544-1711 (919) 465-9300 (919) 957-5603 (919) 477-7325 (910) 483-4555 (336) 627-4854 (336) 627-0146 (336) 627-4600 (919) 623-3132 (252) 482-2127 (252) 335-5401 (252) 384-1000 (252) 331-1333

4102 BEN FRANKLIN BLVD 2609 N DUKE ST STE 103 2726 CROASDAILE DR STE 104 5826 FAYETTEVILLE RD STE 105 3808 GUESS RD 114 W MAIN ST 3421 N ROXBORO ST 710 FAYETTEVILLE STREET 1812 HOLLOWAY ST 1821 HILLANDALE RD 1301 FAYETTEVILLE ST 213 W MAIN ST 1700 E HIGHWAY 54 4400 EMPEROR BLVD STE 100 4400 EMPEROR BLVD 5108 N ROXBORO ST 3591 DUNN RD 103 W STADIUM DR 509 S VAN BUREN RD STE A 509 S VAN BUREN RD 544 MORGAN RD 323 S BROAD ST 512 E MAIN ST 902 ROANOKE AVE 1141 N ROAD ST

DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM DURHAM EASTOVER EDEN EDEN EDEN EDEN EDENTON ELIZABETH CITY ELIZABETH CITY ELIZABETH CITY

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27704-2140 27704-3048 27705 27713-8684 27705-1506 27701 27704-3257 27701-3911 27703-2210 27705-2659 27707-2325 27701-3213 27713 27703 27703-8418 27704-1420 28312-8794 27288-3329 27288-5018 27288-5018 27288-2524 27932-1933 27909-4430 27909-5565 27909-3354

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 356 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TODDS PHARMACY INC ANDERSON'S DRUG STORE DICKERSON'S PHARMACY BRIDGE STREET PHARMACY ELK PHARMACY INC ELLERBE PHARMACY HARVEST FAMILY HEALTH CTR PHCY DRUGCARE PHARMACY CARLIE C'S PHARMACY ETOWAH PHARMACY ELVINGTON DRUG FREDS PHARMACY KERR DRUG

Provider Name

(252) 335-2901 (910) 862-8411 (910) 862-3465 (336) 835-3131 (336) 835-2621 (910) 652-6261 (252) 443-7744 (252) 445-3155 (910) 897-5014 (828) 890-0022 (910) 649-7721 (910) 628-6362 (910) 628-6068

207 S POINDEXTER ST 206 S POPLAR ST 503 DOCTORS DR 817 N BRIDGE ST 116 E MAIN ST 274 SECOND STREET 8282 SOUTH NC 58 HIGHWAY 132 WHITFIELD ST 801 S 13TH ST 6527 BREVARD RD 1126 MAIN ST 214 S MAIN ST 414 NORTH WALNUT ST

ELIZABETH CITY ELIZABETHTOWN ELIZABETHTOWN ELKIN ELKIN ELLERBE ELM CITY ENFIELD ERWIN ETOWAH FAIR BLUFF FAIRMONT FAIRMONT

NC NC NC NC NC NC NC NC NC NC NC NC NC

27909-4834 28337-9008 28337-0000 28621-3008 28621-3429 28338 27822 27823-1340 28339-2635 28729-8739 28439 28340 28340-2038

SOUTH ROBESON MEDICAL CNTR PHARMACY AMERICARE PHARMACY FAISON PHARMACY BEST VALUE DRUG BORDEAUX DRUG COMPANY CAPE FEAR DISCOUNT DRUG CAPE FEAR DISCOUNT DRUG NORTH CARLIE CS IGA CARLIE C'S PHARMACY CENTER PHARMACY EXPRESS DISCOUNT PHARMACY MASSEY HILL DRUG COMPANY MEDICAL ARTS PHARMACY MEDICAP PHARMACY QWIKMED PHARMACY THE MEDICINE SHOPPE THE PAVILION PHARMACY TWO RIVERS PHARMACY VALLEY PHARMACY VILLAGE PHARMACY LLC INGLES PHARMACY CANE CREEK PHARMACY INC INGLES PHARMACY MISSION PARDEE HLTH CAMP PHCY HARDINS DRUG HARDIN'S DRUG INGLES PHARMACY MEDICAL ARTS PHARMACY

(910) 535-4003 (828) 628-3121 (910) 267-0080 (252) 753-2092 (910) 485-4117 (910) 484-6100 (910) 884-3053 (910) 483-8972 (910) 826-8942 (910) 615-1800 (910) 491-2431 (910) 484-0159 (910) 323-9696 (910) 486-5936 (910) 676-7570 (910) 483-5117 (910) 615-3900 (910) 483-5450 (910) 615-7895 (910) 483-3466 (828) 692-0546 (828) 628-3675 (828) 684-2838 (828) 213-0048 (828) 657-5353 (828) 245-7274 (828) 245-0786 (828) 245-7294

1212 SOUTH WALNUT ST 1185 CHARLOTTE HWY STE K 206 SW CENTER ST 3708 N MAIN ST 1758 OWEN DR 2800 RAEFORD RD STE 18 4417 RAMSEY ST 600 CEDAR CREEK RD 690 S REILLY RD 101 ROBESON ST STE 107 3613A RAEFORD RD 1072 SOUTHERN AVE 1047 MURCHISON RD STE 106 1431 RAMSEY ST 204 WESTWOOD SHOPPING CTR 530 GROVE ST 6387 RAMSEY ST STE 130 101 BROADFOOT AVE 1638 OWEN DR 5106 NC HIGHWAY 87 S STE 100 220 N HIGHLAND LAKE RD 785 CANE CREEK RD 2901 HENDERSONVILLE RD 2651 HENDERSONVILLE RD 1281 US HWY 221-A 720 S CHURCH ST 756 S CHURCH ST 924 W MAIN ST

FAIRMONT FAIRVIEW FAISON FARMVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FAYETTEVILLE FLAT ROCK FLETCHER FLETCHER FLETCHER FOREST CITY FOREST CITY FOREST CITY FOREST CITY

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28340 28730-7783 28341-0000 27828-1499 28304-3419 28303-5465 28311-2134 28312-6504 28314-5625 28301-5520 28304-2113 28306-1766 28301-7027 28301-4405 28314-1528 28301-5140 28311-9420 28305-5001 28304-3424 28306-3424 28731-8568 28732-9472 28732-8237 28732 28043-9317 28043-3942 28043-3941 28043-2518

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 357 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDICINE BOX PHARMACY SMITH'S DRUGS OF FOREST CITY, INC. PARKER PHARMACY REALO DISCOUNT DRUGS SMART PHARMACY U SAVE IT FRANKLIN KERR DRUG FREMONT PHARMACY BENZER PHARMACY KERR DRUG REALO DISCOUNT DRUGS ALLCARE PHARMACY SERVICES MEDICAP PHARMACY AKERS CENTER PHARMACY INC ANDERSON HEALTH MART PHARMACY DSD PHARMACY INC GASTON FAM HLTH SVCS PHCY GASTON HEMATOLOGY & ONCOLOGY GASTON PHARMACY HIGHLAND HEALTH CENTER PHCY MEDICAL CENTER PHARMACY MOSS DRUGS NEW HOPE PHARMACY

Provider Name

(828) 245-1696 (828) 245-4591 (919) 963-3535 (919) 980-4031 (828) 369-3784 (828) 524-0156 (919) 494-7715 (919) 242-4573 (919) 557-8300 (919) 552-4248 (919) 552-1126 (919) 772-5878 (919) 772-6902 (704) 865-3411 (704) 879-4010 (980) 320-1533 (704) 853-5011 (704) 865-5210 (980) 888-4900 (704) 874-3360 (704) 867-5343 (704) 867-9611 (704) 671-4811

664 S BROADWAY ST 139 E MAIN ST 5829 US HIGHWAY 301 S 6030 US HIGHWAY 301 S 10 W PALMER ST 20 FRANKLIN PLAZA DR 3422 US HWY 1 113 E MAIN ST 305 N JUDD PKWY 816 N MAIN ST 1526 BROAD STREET 5176 NC HWY 42 W UNIT H 127 MAST DR 1595 E GARRISON BLVD 1546 UNION RD STE B 1401 E FRANKLIN BLVD 991 W HUDSON BLVD 2610 ABERDEEN BLVD 2605 S YORK RD 609 N HIGHLAND ST 515 COX RD 701 W FRANKLIN BLVD 2211 N NEW HOPE RD

FOREST CITY FOREST CITY FOUR OAKS FOUR OAKS FRANKLIN FRANKLIN FRANKLINTON FREMONT FUQUAY VARINA FUQUAY VARINA FUQUAY-VARINA GARNER GARNER GASTONIA GASTONIA GASTONIA GASTONIA GASTONIA GASTONIA GASTONIA GASTONIA GASTONIA GASTONIA

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28043-4247 28043-3125 27524-9327 27524-7420 28734-3046 28734-3204 27525 27830-9455 27526-2370 27526-2067 27526 27529 27529-6718 28054-5138 28054 28054-4059 28052-6430 28054-0637 28052-6265 28052-2179 28054-0628 28052-3830 28054

PREMIER PHARMACY AND WELLNESS CTR PRESCRIPTIONS PLUS INC THE PHARMACY @ 321 UNION DRUGS TODDS PHARMACY OF GATES COUNTY GIBSONVILLE PHARMACY CLINIC DRUG INC. CARLIE C'S PHARMACY COOR'S PHARMACY MARMAC PHARMACY OBERRY CENTER PHARMACY RAPER DRUGS, INC ROSEWOOD PHARMACY SOUTHEAST FAMILY PHARMACY

(704) 917-7787 (704) 867-3518 (704) 396-6849 (980) 320-1102 (252) 357-1800 (336) 449-5501 (828) 584-0741 (919) 736-1973 (919) 735-0400 (919) 734-0888 (919) 581-4686 (919) 734-0741 (919) 734-4447 (919) 778-1110

2557 W FRANKLIN BLVD 1614 W FRANKLIN BLVD 555 N CHESTER ST 1546 UNION RD STE B 504 MAIN STREET 220 BURLINGTON AVE 106 LINVILLE ST 1805 WAYNE MEMORIAL DR 1103 WAYNE MEMORIAL DR 110 FIVE POINTS RD 400 OLD SMITHFIELD RD 2303 WAYNE MEMORIAL DR 514 NC HWY 581 S 223 NC HWY 111 S

GASTONIA GASTONIA GASTONIA GASTONIA GATESVILLE GIBSONVILLE GLEN ALPINE GOLDSBORO GOLDSBORO GOLDSBORO GOLDSBORO GOLDSBORO GOLDSBORO GOLDSBORO

NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28052 28052-1423 28052-7320 28054-5521 27938-0000 27249-2461 28628 27534-2241 27534-2957 27530-0916 27530-8464 27534-1725 27530-7854 27534

SOUTHEASTERN MEDICAL ONCOLOGY CNTR WAYNE PHARMACY SOUTH COURT DRUG COMPANY

(919) 580-0000 (919) 735-4034 (336) 226-4401

203 COX BLVD 2302 WAYNE MEMORIAL DR 210 E ELM ST STE A

GOLDSBORO GOLDSBORO GRAHAM

NC NC NC

27534-9479 27534-1726 27253-3055

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 358 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TAR HEEL DRUG INC FOOD LION PHARMACY GRANITE DRUG CENTER INGLES PHARMACY PRICE PHARMACY PAMLICO PHARMACY ADAMS FARM PHARMACY ADLER PHARMACY BENNETT'S PHARMACY INC BROWN-GARDINER DRUG COMMUNITY HEALTH AND WELLNESS FRIENDLY PHARMACY GATE CITY PHARMACY GENOA-QOL HEALTHCARE GOVE HEALTH CTR PHCY UNC-G GREENSBORO FAMILY PHARMACY KERR DRUG KERR DRUG M.E.S.H. PHARMACY MOSES CONE OUTPATIENT NCAT STATE UNIVERSITY PIEDMONT DRUG RANDLEMAN PLAZA PHARMACY STARMOUNT PHARMACY LLC SUMMIT PHCY & SURGICAL SUPPLY WESLEY LONG OUTPATIENT PHCY ECU PHARMACY FAMILY PRACTICE CENTER PHARMACY GENOA-QOL HEALTHCARE HEALTHWISE PHARMACY

Provider Name

(336) 227-2093 (252) 453-8500 (828) 396-2144 (828) 726-6027 (704) 279-2579 (252) 745-6337 (336) 632-4141 (336) 897-3810 (336) 272-7255 (336) 273-0596 (336) 832-3630 (336) 790-7343 (336) 292-6888 (336) 252-5608 (336) 334-3348 (336) 938-0111 (336) 275-7657 (336) 379-1053 (336) 547-2988 (336) 832-6279 (336) 334-7880 (336) 856-7577 (336) 763-6878 (757) 513-8987 (336) 763-7282 (336) 832-6271 (252) 744-2721 (252) 744-4680 (252) 565-4650 (252) 752-0338

316 S MAIN ST 123 FORBES LOOP UNIT C 21 FALLS AVE 2630 CONNELLY SPRINGS RD 110 E BANK ST 11326 NC HWY 55 E 5710 W GATE CITY BLVD STE Z 1320 LEES CHAPEL RD 301 E WENDOVER AVE STE 115 2101 N ELM ST 201 E WENDOVER AVE 3712 LAWNDALE DR STE G 803 FRIENDLY CENTER RD STE C 201 N EUGENE ST 107 GRAY DR 2290 GOLDEN GATE DR 3001 E MARKET ST 2190 LAWNDALE DR 700 S HOLDEN RD 1131 N CHURCH ST 112 N BENBOW ROAD 4620 WOODY MILL RD STE B 3230 RANDLEMAN RD STE C 4601 W MARKET ST 930 SUMMIT AVE 515 N ELAM AVE 517 MOYE BLVD 101 HEART DRIVE 2602 COURTIER DR STE 2200 615B S MEMORIAL DR

GRAHAM GRANDY GRANITE FALLS GRANITE FALLS GRANITE QUARRY GRANTSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENSBORO GREENVILLE GREENVILLE GREENVILLE GREENVILLE

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27253-3320 27939-9625 28630-1519 28630-9227 28146 28529 27407-7047 27455-2611 27401-1234 27408-5111 27401-1205 27455-3066 27408-2024 27401-2221 27412-5008 27405-4302 27405-7525 27408-7102 27407-2321 27401-1007 27401 27406-8779 27406-6529 27407-1231 27405-7918 27403-1118 27834-2849 27834 27834-7818 27834-2856

HOMETOWN DISCOUNT PHCY GREENVILLE LEO JENKINS CANCER CTR PHARMACY MEDICAL PARK PHARMACY PHARMACY EAST REALO DISCOUNT DRUGS H & H DRUG COMPANY BIRMINGHAM DRUG COMPANY MABRY'S DRUG STORE JOHNSON DRUG HAMPSTEAD REALO DISCOUNT DRUGS VILLAGE PHARMACY

(252) 752-0003 (252) 744-4602 (252) 321-0222 (252) 413-6208 (252) 355-3538 (252) 524-4101 (910) 582-3585 (919) 582-1776 (910) 270-2223 (910) 821-1066 (910) 319-6050

1631 GREENVILLE BLVD SE 600 MOYE BLVD RM 240 1872 W ARLINGTON BLVD STE M 1850 W ARLINGTON BLVD # 100-MA 1913 E FIRE TOWER RD 512 W QUEEN ST 27 W MAIN ST 41 W MAIN ST 17230 US HIGHWAY 17 N STE 222 15441 US HWY 17 SUITE 801 14057 US HIGHWAY 17 N STE 100

GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GRIFTON HAMLET HAMLET HAMPSTEAD HAMPSTEAD HAMPSTEAD

NC NC NC NC NC NC NC NC NC NC NC

27858-4809 27834-4300 27834-5704 27834-5704 27858-4126 28530-5000 28345-3629 28345-3629 28443-7463 28443 28443-3771

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 359 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HARMONY DRUG

Provider Name

(704) 546-5885

111 W MEMORIAL HWY

HARMONY

NC

28634-9049

HARRISBURGS HOMETOWN PHARMACY BEACH PHARMACY OF HATTERAS HAVELOCK DRUG COMPANY INC HAW RIVER PHARMACY FREDS PHARMACY INGLES PHARMACY KERR DRUG KING'S PHARMACY FOOD LION PHARMACY FOOD LION PHARMACY MAST FAMILY DRUG CENTER MAST LONG TERM CARE MEDICAL ARTS PHARMACY SOUTHSIDE DRUG COMPANY BLUE RIDGE COMMUNITY HLTH PHCY BLUE RIDGE PHCY HENDERSONVILLE ECONOMY DRUGS INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY SHELTON PHARMACY WHITLEY DRUGS INC FAMILY CARE PHARMACY WOODARDS PHARMACY BETHLEHEM PHARMACY

(704) 454-7948 (252) 986-2400 (252) 444-0910 (336) 578-0202 (828) 389-6900 (828) 389-2804 (828) 389-6343 (828) 516-9950 (252) 438-2539 (252) 762-0156 (252) 438-4158 (252) 492-6344 (252) 492-3404 (252) 438-5128 (828) 692-3106 (828) 233-0848 (828) 692-4266 (828) 698-1116 (828) 698-2592 (828) 694-3746 (828) 692-1022 (828) 692-4236 (252) 426-2214 (252) 426-5527 (828) 495-8258

5006 HIGHWAY 49 S 57353 NC HIGHWAY 12 1204 E MAIN ST 740 E MAIN ST 808 NC HWY 69 230 HWY 64 EAST 44 HWY 64 WEST 16 WAYNE BROOKS LN 1241 DABNEY DR 1419 E ANDREWS AVE 501 S CHESTNUT ST 1910 ROSS MILL RD 253 RUIN CREEK RD 1005 NICHOLAS ST 709 N JUSTICE ST 600 CAROLINA VILLAGE RD STE Z 605 5TH AVE W 1980 ASHEVILLE HWY 3643 HOWARD GAP RD 625 SPARTANBURG HWY 2315 ASHEVILLE HWY STE 50 814 GREENVILLE HWY 606 S CHURCH ST 101 N CHURCH ST 9471 NC HIGHWAY 127

HARRISBURG HATTERAS HAVELOCK HAW RIVER HAYESVILLE HAYESVILLE HAYESVILLE HAYESVILLE HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSONVILLE HENDERSONVILLE HENDERSONVILLE HENDERSONVILLE HENDERSONVILLE HENDERSONVILLE HENDERSONVILLE HENDERSONVILLE HERTFORD HERTFORD HICKORY

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28075-8465 27943 28532-2405 27258 28904 28904 28904 28904-9602 27536-3558 27536-5202 27536-4102 27537-8789 27536-5916 27536-4945 28791-3454 28792-1800 28739-4205 28791-2110 28792-3164 28792-5762 28791-1561 28792-5725 27944-1205 27944-1103 28601-8394

CATAWBA VALLEY MED CTR EMPL PHARMCY EVANS DRUG & COMPANY HEALTHSMART PHCY OF STARTOWN HICKORY FAMILY PHARMACY LLC LONG VIEW DRUG CO MEDICAL CENTER PHARMACY THE COMPOUNDING PHARMACY TRIDENTCARE RX VIEWMONT PHARMACY ADVANCED HOME CARE ARCHDALE DRUG AT CORNERSTONE DEEP RIVER DRUG

(828) 326-3310 (828) 495-3784 (828) 449-8910 (828) 324-4630 (828) 324-7948 (828) 322-7717 (828) 324-4115 (828) 855-9767 (828) 322-1816 (336) 878-8950 (336) 882-0555 (336) 454-3784

810 FAIRGROVE CHURCH RD SE 10187 NC HIGHWAY 127 1985 STARTOWN RD STE 101 1501 TATE BLVD STE 102 2637 1ST AVE SW 126 N CENTER ST 750 4TH ST SW 910 TATE BLVD SE STE 111 53 13TH AVE NE 4001 PIEDMONT PKWY 1814 WESTCHESTER DR STE 205 2401 HICKSWOOD RD STE B

HICKORY HICKORY HICKORY HICKORY HICKORY HICKORY HICKORY HICKORY HICKORY HIGH POINT HIGH POINT HIGH POINT

NC NC NC NC NC NC NC NC NC NC NC NC

28602 28601-8380 28602-8307 28602-4243 28602-1912 28601-6215 28602 28602-4030 28601-3747 27265-9402 27262-7010 27265-1538

MEDCENTER HIGHPOINT OUTPATIENT PHCY

(336) 832-6271

2630 WILLARD DAIRY RD

HIGH POINT

NC

27265-8351

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 360 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HIGHLANDS PHARMACY EAST BURKE PHARMACY INC

Provider Name

(828) 526-2366 (828) 397-3420

195 MAIN ST 300 MAIN AVENUE WEST

HIGHLANDS HILDEBRAN

NC NC

28741-8305 28637

HILLSBOROUGH PHCY & NUTRITION LLC KERR DRUG LLOYD'S PHARMACY INC

(919) 245-1212 (919) 732-6263 (919) 732-1500

110 BOONE SQUARE ST STE 29 200 US HIGHWAY 70 E 118 W KING ST STE A

HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH

NC NC NC

27278 27278-7500 27278-2682

UNC HILLSBOROUGH OUTPATIENT PHCY RHG PHARMACY REALO DISCOUNT DRUGS HOLLY SPRINGS PHARMACY CLINIC PHARMACY CALDWELL DISCOUNT DRUG COMPANY MELANIE'S HOMETOWN PHARMACY CMC RX NORTHCROSS SOUTHERN ONCOLOGY SPECIALISTS INDIAN TRAIL PHARMACY MED CARE PHARMACY FUTRELL PHARMACY SERVICES DOCTORS PARK PHARMACY FAMILY CARE PHARMACY JOHNSON DRUG COMPANY INC JOHNSON DRUG WILLIAMSBURG JOHNSON WESTPARK DRUGS NORTHWOODS DRUG COMPANY REALO DISCOUNT DRUGS REALO DISCOUNT DRUGS REALO DISCOUNT DRUGS

(984) 974-6511 (252) 536-5886 (910) 329-1134 (919) 346-6689 (910) 425-6106 (828) 292-4294 (828) 572-2655 (704) 801-2566 (704) 947-5005 (704) 821-7617 (704) 821-6885 (252) 534-6001 (910) 353-5733 (910) 353-5050 (910) 347-5185 (910) 938-0582 (910) 455-9222 (910) 347-2141 (910) 219-3550 (910) 347-9684 (910) 455-9982

430 WATERSTONE DR 204 EVANS RD 13500 NC HIGHWAY 50 648 HOLLY SPRINGS RD 3736 S MAIN ST 425 MAIN ST 120 CEDAR VALLEY RD 16455 STATESVILLE RD STE 101 10030 GILEAD RD STE 290 106 INDIAN TRAIL RD S 7892 IDLEWILD RD 9435 NC HIGHWAY 305 403 WESTERN BLVD 114 MEMORIAL DR STE B 714 NEW BRIDGE ST 2200 GUM BRANCH RD STE I 3085 RICHLANDS HWY STE 4 344 HENDERSON DR 835 PINEY GREEN RD STE 400 423 YOPP RD STE 200 2680 HENDERSON DR

HILLSBOROUGH HOLLISTER HOLLY RIDGE HOLLY SPRINGS HOPE MILLS HUDSON HUDSON HUNTERSVILLE HUNTERSVILLE INDIAN TRAIL INDIAN TRAIL JACKSON JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE JACKSONVILLE

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27278-9078 27844 28445-7934 27540-9030 28348-1959 28638-2328 28638-2507 28078-7125 28078 28079-9669 28079-8675 27845-9679 28546-6870 28546-6328 28540-5435 28540-4568 28540-2977 28540-5606 28546 28540-3594 28546-5296

SOUTHEASTERN MEDICAL ONCOLOGY CTR JAMESTOWN FAMILY PHARMACY KERR DRUG JEFFERSON DRUG D-REX PHARMACY CANNON PHARMACY MAIN CANNON PHARMACY NORTH MOOSE PHARMACY OF KANNAPOLIS KENANSVILLE PHARMACY DAVIS DRUG COMPANY KENLY DRUG AND PHARMACY INC GATEWAY PHARMACY KERNERSVILLE PHARMACY

(910) 353-0819 (336) 307-3073 (336) 454-3101 (336) 246-9492 (336) 835-6407 (704) 933-6337 (704) 933-7948 (704) 932-9111 (910) 296-0500 (919) 284-2010 (919) 284-2333 (336) 992-2111 (336) 497-4511

217 STATION ST 108 W MAIN ST STE H 407 W MAIN ST 418 E MAIN ST 450 WINSTON RD 1706 S CANNON BLVD 1402 N CANNON BLVD 1113 N MAIN ST 134 LIBERTY SQUARE SUITE B 110 W 2ND ST 104 EAST SECOND STREET 510 PINEVIEW DR 841 OLD WINSTON RD STE 90

JACKSONVILLE JAMESTOWN JAMESTOWN JEFFERSON JONESVILLE KANNAPOLIS KANNAPOLIS KANNAPOLIS KENANSVILLE KENLY KENLY KERNERSVILLE KERNERSVILLE

NC NC NC NC NC NC NC NC NC NC NC NC NC

28546 27282-9812 27282-9558 28640-9728 28642-2255 28083-6104 28083-2662 28081-2256 28349 27542-9278 27542-0000 27284-3663 27284-7145

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 361 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NOVANT HEALTH PHARMACY NUFACTOR INC KING DRUG COMPANY NOVANT HEALTH PHARMACY STOKES PHARMACY INC INGLES PHARMACY KM PHARMACY MOUNTAIN STREET PHARMACY PRESCRIPTIONS PLUS CASWELL CENTER PHARMACY DEMPSEY'S DRUGS KINSTON CLINIC NORTH PHARMACY MEDSOURCE PHARMACY MEDSOURCE PHARMACY PHARM-SAVE INC REALO DISCOUNT DRUG REALO DISCOUNT DRUGS BEAR DRUGS SUNSHINE FAMILY PHARMACY KNIGHTDALE PHARMACY DEMPSEY'S DRUGS FOOD LION PHARMACY INGLES PHARMACY MISSION PHARMACY - LAKE TOXAWAY VILLAGE PRESCRIPTION CENTER COMMUNITY DRUG

Provider Name

(336) 996-9543 (844) 871-4773 (336) 983-3147 (336) 983-0970 (336) 983-3118 (704) 739-2350 (704) 739-1698 (704) 739-7225 (704) 739-4519 (252) 208-4265 (252) 208-0180 (252) 523-3187 (252) 522-0353 (252) 522-2200 (252) 522-3030 (252) 527-6929 (252) 523-6069 (252) 261-7999 (252) 715-0170 (919) 295-1112 (252) 582-3600 (252) 566-9595 (828) 625-0748 (828) 213-0048 (910) 646-3435 (910) 276-6061

291 BROAD ST 1601 OLD GREENSBORO RD 142 S MAIN ST 212 MOORE RD # RD8 607B S MAIN ST 2111 SHELBY RD 1106 SHELBY RD 709 W MOUNTAIN ST 703 E KING ST # 1 2415 W VERNON AVE 701 DOCTORS DR STE P-2 701 DOCTORS DR STE P 505 W VERNON AVE STE 100 2202 US HIGHWAY 258 N 2545 JETPORT RD 300 N QUEEN ST 1302 W VERNON AVE 5200 N CROATAN HWY 1187 DUCK RD UNIT 5 6602 KNIGHTDALE BLVD STE 120 603 E WASHINGTON ST 301 E WASHINGTON ST 276 NC HWY 9 16821 ROSMAN HWY 108 OLD E HWY 74/76 1028 ATKINSON ST

KERNERSVILLE KERNERSVILLE KING KING KING KINGS MOUNTAIN KINGS MOUNTAIN KINGS MOUNTAIN KINGS MOUNTAIN KINSTON KINSTON KINSTON KINSTON KINSTON KINSTON KINSTON KINSTON KITTY HAWK KITTY HAWK KNIGHTDALE LA GRANGE LA GRANGE LAKE LURE LAKE TOXAWAY LAKE WACCAMAW LAURINBURG

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27284-2932 27284-6855 27021-9011 27021-8703 27021-9016 28086-8971 28086-2742 28086-2711 28086-3115 28504-3337 28501-1589 28501-1584 28501-3739 28504-7223 28504-7339 28501-4932 28504-3528 27949-3990 27949-4570 27545-6526 28551-9214 28551-1834 28746 28747-9593 28450-0148 28352-4721

HLTH INNOVATIONS PHCY OF LAURINBURG KERR DRUG MEDICAL VILLAGE PHARMACY SCOTLAND DRUG COMPANY SCOTLAND ONCOLOGY PHARMACY FALLSTON PHARMACY INC FAMILY PHARMACY INC CAJAHS MOUNTAIN DIS DRUGS COMMUNITY PHARMACY FOOTHILLS PHARMACY GAMEWELL FAMILY DRUG KERR DRUG MEDICAL ARTS PHARMACY LEWISVILLE DRUG COMPANY

(910) 361-4731 (910) 276-6445 (910) 276-1154 (910) 276-3001 (910) 291-6879 (704) 538-4034 (910) 371-3181 (828) 726-8632 (828) 757-5162 (828) 754-6453 (828) 754-9500 (828) 758-5196 (828) 758-2356 (336) 946-0220

901 S MAIN ST 1110 ABERDEEN RD 517 E LAUCHWOOD DR 140 MAIN ST 500 LAUCHWOOD DR 5011 FALLSTON RD 112G VILLAGE RD NE 2006 CONNELLY SPRINGS RD 321 MULBERRY ST SW 202 HARPER AVE NW STE A 2655 MORGANTON BLVD SW 625 HARPER AVE 328 MULBERRY ST SW 6715 SHALLOWFORD RD

LAURINBURG LAURINBURG LAURINBURG LAURINBURG LAURINBURG LAWNDALE LELAND LENOIR LENOIR LENOIR LENOIR LENOIR LENOIR LEWISVILLE

NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28352-4736 28352-2607 28352-5502 28352 28352-5501 28090-9585 28451-7412 28645-7830 28645 28645-5196 28645-8183 28645-5250 28645-5717 27023-9847

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 362 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

A1 PHARMACY AND SURGICAL SUPPLY LLC DAVIDSON HEALTH SERVICES LEXINGTON DRUG COMPANY LEXINGTON FAMILY PHARMACY MEDICAL PARK PHARMACY TYRO FAMILY PHARMACY YOUR PHARMACY OF LEXINGTON LIBERTY FAMILY PHARMACY, INC HOGAN'S PHARMACY REALO DISCOUNT DRUGS REALO SPECIALTY CARE PHARMACY BI LO PHARMACY HELPING HANDS HLTH CLINIC PHCY INGLES PHARMACY KEEVER PHARMACY SENTRY DRUG CENTER SENTRY DRUG CENTER THE DRUG STORE DRUGCO DISCOUNT PHARMACY FUTRELL PHARMACY OF LITTLETON MEDICAL PHARMACY OF LOCUST FAMILY PHARMACY OF LOUISBURG HARRIS PHARMACY INC DRUGS AMERICA FREDS PHARMACY HOMERX HEALTHCARE LUMBERTON DRUG CO LUMBERTON DRUG WEST

(336) 224-6500 (336) 243-7475 (336) 248-5623 (336) 237-0648 (336) 243-2428 (336) 853-2744 (336) 249-0322 (336) 644-7288 (910) 893-4544 (910) 814-1853 (910) 814-1943 (704) 732-8266 (704) 735-7145 (704) 735-2791 (704) 735-9072 (704) 735-2551 (704) 732-1194 (704) 735-2556 (252) 586-3836 (252) 586-3414 (704) 888-3784 (919) 340-1100 (919) 496-3543 (910) 739-4198 (910) 738-3757 (910) 671-9000 (910) 671-9000 (910) 671-9000

124 FOREST HILL RD 420 N SALISBURY ST 405 E CENTER ST 800 E CENTER ST 2316 S MAIN ST 4320 S NC HIGHWAY 150 100 W 3RD ST 430 N GREENSBORO ST 815 W FRONT ST 41 BAIN ST 130 PINE STATE ST STE C 742 W HIGHWAY 27 206 GAMBLE DR STE C 2130 E MAIN ST 102 DOCTORS PARK 2622 E MAIN ST 1446 E GASTON ST 626 CENTER DR 139 ELAMS RD 123 E SOUTH MAIN ST 236 MARKET ST 339 S BICKETT BLVD 105 N MAIN ST 103 E 24TH ST 2200 N PINE ST 707 FARRINGDOM ST 4340 FAYETTEVILLE RD 104 WEST 27TH ST

LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LIBERTY LILLINGTON LILLINGTON LILLINGTON LINCOLNTON LINCOLNTON LINCOLNTON LINCOLNTON LINCOLNTON LINCOLNTON LINCOLNTON LITTLETON LITTLETON LOCUST LOUISBURG LOUISBURG LUMBERTON LUMBERTON LUMBERTON LUMBERTON LUMBERTON

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27295-2008 27292-3548 27292-4109 27292-4402 27292-3655 27295-5161 27292-2362 27298-2901 27546-9735 27546-6185 27546-9414 28092-8020 28092-4439 28092-3921 28092-4406 28092-4319 28092-4412 28092 27850-8479 27850 28097 27549-2701 27549-2515 28358-3651 28358 28358-0007 28358-2677 28358

LUMBERTON HEALTH CENTER PHARMACY SOUTHEASTERN PHARMACY SOUTHEASTERN PHARMACY

(910) 674-3174 (910) 735-8858 (910) 735-8806

402 N PINE ST 2934 N ELM ST STE C 300 W 27TH ST

LUMBERTON LUMBERTON LUMBERTON

NC NC NC

28358-5563 28358-2981 28358-3075

SOUTHEASTERN PHARMACY HEALTH PARK SRMC WOODHAVEN PHARMACY MADISON PHARMACY AND HOMECARE TAS DRUG OF MAIDEN ISLAND PHARMACY INC MAPLE HILL PHARMACY MARION PHARMACY INC MARION PHARMACY WEST

(910) 671-4223 (910) 671-5719 (336) 548-0049 (828) 428-0668 (252) 473-5801 (910) 259-8880 (828) 652-4400 (828) 652-2700

4901 DAWN DR STE 1200 1150 PINE RUN DR 125 W MURPHY ST 201 ISLAND FORD RD STE D 210 S HWY 64 4811 NC HIGHWAY 50 232 S MAIN ST 2293 SUGAR HILL RD

LUMBERTON LUMBERTON MADISON MAIDEN MANTEO MAPLE HILL MARION MARION

NC NC NC NC NC NC NC NC

28360-8207 28358-2118 27025-1923 28650-8733 27954 28454-8153 28752-4551 28752-7787

NR_0009_10823 10/2017

Page 363 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MCDOWELL FAMILY PHARMACY LLC MOUNTAINMED LLC INGLES PHARMACY INGLES PHARMACY MADISON PHARMACY & GIFTS INC

Provider Name

(828) 237-0149 (828) 652-9633 (828) 680-9569 (828) 649-1636 (828) 649-1632

2668 HWY 70 W 74 N GARDEN ST 225 CARL ELLER RD 5580 HWY 25/70 4401 US HIGHWAY 25/70

MARION MARION MARS HILL MARSHALL MARSHALL

NC NC NC NC NC

28762 28752-4037 28754-6004 28753 28753

MARSHVILLE PHARMACY & SURGICAL SUP CMC RX MATTHEWS GIANT GENIE PHARMACY GPS PHARMACY THE MEDICINE SHOPPE MAYODAN PHARMACY WARRENS DRUG STORE MIDDLESEX PHARMACY MOOSE MIDLAND PHARMACY MILLERS CREEK PHARMACY INGLES PHARMACY MINT HILL PHARMACY RX CARE PHARMACY FOSTER DRUG COMPANY INC MONCURE CHC PHARMACY FAULKNER'S DRUGS GIANT GENIE PHARMACY MONROE MEDICAP PHARMACY MONROE FAMILY PHARMACY VCARE PHARMACY CANNON PHARMACY HEALTHSMART PHARMACY HEALTHSMART PHARMACY PHARM-SAVE III COMMUNITY PHARMACY MEDICAL PARK PHARMACY MEDICAL PARK PHARMACY WEST MOREHEAD CITY DRUG COMPANY BURKE PHARMACY INC CANNON PHARMACY INGLES PHARMACY JAY'S HOMETOWN PHARMACY JONES DRUGS MORGANTON DRUG, INC. TABLE ROCK PHARMACY

(704) 624-2131 (704) 512-6870 (704) 814-0154 (980) 245-2028 (910) 844-3100 (336) 949-9423 (919) 563-3102 (252) 235-4367 (704) 888-2114 (336) 838-3145 (828) 890-8159 (704) 910-2718 (704) 573-6899 (336) 751-2141 (919) 542-2850 (704) 283-8131 (704) 289-1523 (704) 291-7070 (704) 776-9760 (704) 776-4831 (704) 658-9870 (704) 658-1184 (704) 799-6870 (704) 664-9600 (252) 726-7787 (252) 726-0777 (252) 726-0279 (252) 726-2106 (828) 437-5800 (828) 433-5120 (828) 437-3833 (828) 438-1866 (828) 437-1565 (828) 433-6353 (828) 433-6020

6330 W MARSHVILLE BLVD #A 332 SAM NEWELL RD STE 1300 1730 MATTHEWS TWNSHP PKWY # A1 163 S TRADE ST STE A1 102 N PATTERSON ST 400 S 2ND AVE 614 N FIRST ST 10196 S NASH ST 12925 HIGHWAY 601 3012 N NC HIGHWAY 16 3338 BOYLSTON HWY 7200 MATTHEWS MINT HILL RD 11304 HAWTHORNE DR #120 495 VALLEY RD 7228 MONCURE PITTSBORO RD 215 E JEFFERSON ST 610 E FRANKLIN ST 751 E ROOSEVELT BLVD 108 E SUNSET DR 1402 E FRANKLIN ST 521 E PLAZA DR 108 LEANING OAK DR 594 N MAIN ST 947 N MAIN ST 3302 BRIDGES ST STE A 301 PENNY LN 278 NC HIGHWAY 24 STE M 1704 ARENDELL ST 301 W MEETING ST 342 E PARKER RD 120 CARBON CITY RD 612 S STERLING ST 208 AVERY AVE 500 S STERLING ST 200 W FLEMING DR

MARSHVILLE MATTHEWS MATTHEWS MATTHEWS MAXTON MAYODAN MEBANE MIDDLESEX MIDLAND MILLERS CREEK MILLS RIVER MINT HILL MINT HILL MOCKSVILLE MONCURE MONROE MONROE MONROE MONROE MONROE MOORESVILLE MOORESVILLE MOORESVILLE MOORESVILLE MOREHEAD CITY MOREHEAD CITY MOREHEAD CITY MOREHEAD CITY MORGANTON MORGANTON MORGANTON MORGANTON MORGANTON MORGANTON MORGANTON

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28103 28105-6886 28105-4927 28105 28364-1735 27027-2804 27302-2106 27557 28107-9536 28651-9137 28759 28227-7593 28227-9467 27028-2074 27559-9595 28112-4865 28112-5702 28112-5133 28112-6057 28112-5160 28115-8071 28117 28115-2328 28115-2355 28557-3218 28557-4307 28557-2531 28557-4040 28655-3866 28655-5111 28655-4226 28655-3575 28655-3103 28655-3573 28655-3918

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 364 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

MORRISVILLE PHARMACY & COMPOUNDING OPTION CARE GATES PHARMACY KERR DRUG NMG FAMILY MEDICINE PHARMACY WALLYS PHARMACY COCHRANE RIDENHOUR DRUG CO CHARLIES DRUG SUNDRY CENTER STREET PHARMACY MT OLIVE PHARMACY PARKER DRUG CO MOOSE PHARMACY TODDS PHARMACY OF CURRITUCK MT AIRY DRUG COLONIAL PHARMACY INC KING'S PHARMACY MURPHY MEDICAL CENTER DRUGCO PHARMACY - NASHVILLE KERR DRUG MCDOWELL COMMUNITY PHARMACY BYNUMS DRUG STORE DOWN EAST PHARMACY MCCARTHY SQUARE PHARMACY PHARMACY PLUS OF NEW BERN REALO DISCOUNT DRUGS REALO DISCOUNT DRUGS REALO DISCOUNT DRUGS OF E.N.C. REALO DISCOUNT DRUGS OF ENC TRENT EAST PHARMACY AVERY PHARMACY & HEALTH CARE CROSSNORE DRUG STORE PREMIER PHARMACY MEDICAL PARK PHARMACY NEWPORT CROSSROADS PHARMACY H & W DRUG COMPANY MEDICAP PHARMACY NEWTON GROVE DRUG CO INC RURAL HEALTH GROUP INC BLUE RIDGE PHARMACY BLUE RIDGE PHARMACY-MIDTOWN BRAME HUIE PHARMACY

(919) 463-7990 (919) 481-9110 (336) 789-5050 (336) 789-9006 (336) 719-6010 (336) 789-9089 (910) 439-6541 (704) 827-2211 (919) 658-4313 (919) 658-8660 (919) 635-0011 (704) 436-9613 (252) 232-0278 (336) 786-5506 (252) 398-3138 (828) 837-7474 (828) 835-7565 (252) 677-5565 (252) 459-2639 (828) 659-5791 (252) 637-3123 (252) 672-4440 (252) 514-2900 (252) 636-3322 (252) 636-1711 (252) 631-5444 (252) 514-0374 (252) 636-0236 (252) 638-6500 (828) 737-7476 (828) 733-2486 (828) 733-0061 (252) 223-3080 (704) 276-1078 (828) 464-0881 (828) 466-1500 (919) 594-1183 (252) 536-5831 (336) 667-6484 (336) 838-3782 (336) 838-8988

NR_0009_10823 10/2017

Provider Street 3500 DAVIS DR 1015 AVIATION PKWY STE 700 364 N SOUTH ST 722 W INDEPENDENCE BLVD 280 N POINTE BLVD 933 OLD ROCKFORD ST STE 5 116 S MAIN ST 125 W CENTRAL AVE 128 N CENTER ST 615 N BREAZEALE AVE 113 NW CENTER ST 8374 FRANKLIN ST W 532A CARATOKE HWY 725 W INDEPENDENCE BLVD 700 E MAIN ST 30 PEACHTREE ST 3990 US HIGHWAY 64 E ALT 163 NASHVILLE COMMONS DR 703 EAST WASHINGTON ST 401 NEBO SCHOOL RD 240 MIDDLE ST 1904 MLK JR BLVD 609 MCCARTHY BLVD 1204 S GLENBURNIE RD 1301 COMMERCE DR 502 W THURMAN RD 2630 DR ML KING JR BLVD 135 BRIDGE TOWN BLVD 937 US HIGHWAY 70 E 436 HOSPITAL DR 4263 LINVILLE FALLS HWY 107 ESTATOA AVE 129 NINE FOOT RD 3123 PLATEAU RD 12 E 1ST ST 401 W A ST 128 WEEKS CIRCLE 110 DIVISION ST 23 SPARTA RD APT A 306 WILKESBORO AVE 1920 W PARK DR

Page 365 of 679

Provider City MORRISVILLE MORRISVILLE MOUNT AIRY MOUNT AIRY MOUNT AIRY MOUNT AIRY MOUNT GILEAD MOUNT HOLLY MOUNT OLIVE MOUNT OLIVE MOUNT OLIVE MOUNT PLEASANT MOYOCK MT AIRY MURFREESBORO MURPHY MURPHY NASHVILLE NASHVILLE NEBO NEW BERN NEW BERN NEW BERN NEW BERN NEW BERN NEW BERN NEW BERN NEW BERN NEW BERN NEWLAND NEWLAND NEWLAND NEWPORT NEWTON NEWTON NEWTON NEWTON GROVE NORLINA NORTH WILKESBORO NORTH WILKESBORO NORTH WILKESBORO

State

ZIP code

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27560-8819 27560-8540 27030 27030-3574 27030-2267 27030-5356 27306-9254 28120-1616 28365 28365-1203 28365-0000 28124-8511 27958-8740 27030-3575 27855-1214 28906-2940 28906 27856-1823 27856-1713 28761 28560-2142 28560-4542 28562-5232 28562-2609 28562-2213 28562-7020 28562 28560-7192 28560-6535 28657 28657-8007 28657 28570 28658-8900 28658-3200 28658-3954 28366-0000 27563-9041 28659-3196 28659-4228 28659-3563

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NORWOOD PHARMACY SEASHORE DRUGS CROSSROADS PHARMACY OAKBORO PHARMACY FREDS PHARMACY PROFESSIONAL PHARMACY HEALTHKEEPERZ PHARMACY JULIAN PIERCE HLTH CNTR PHCY KERR DRUG OLD MAIN PHARMACY PEMBROKE DRUG WATERS DRUG COMPANY FOOD LION PHARMACY MOUNT PILOT DRUG INC

Provider Name

(704) 474-4171 (910) 579-3200 (336) 441-4041 (704) 485-3636 (828) 668-4347 (919) 693-8555 (910) 522-1041 (910) 668-1173 (910) 521-3910 (910) 521-5600 (910) 734-4896 (910) 522-5152 (919) 242-2067 (336) 368-3500

269 S MAIN ST 7917 E OAK ISLAND DR 7605-B NC HWY 68 N 218 ALONZO RD 40 W MAIN ST 140 ROXBORO RD 812 CANDY PARK RD 307 E. WARDELL DRIVE 503 E 3RD ST 407 W 3RD ST 205 W 3RD ST 5823 NC HWY 711 4700 US HIGHWAY 117 N 119 W MAIN ST

NORWOOD OAK ISLAND OAK RIDGE OAKBORO OLD FORT OXFORD PEMBROKE PEMBROKE PEMBROKE PEMBROKE PEMBROKE PEMBROKE PIKEVILLE PILOT MOUNTAIN

NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28128-6435 28465-8062 27310-8801 28129-0000 28762-8932 27565-2642 28372-9129 28372 28372-7989 28372 28372-8768 28372 27863-9580 27041-9303

CAROLINA BEHAVIORAL CARE PHARMACY FIRSTHEALTH OUTPATIENT PHARMACY PINEHURST MEDICAL CLINIC PHCY

(910) 295-8471 (910) 715-4250 (910) 235-3204

289 OLMSTEAD BLVD STE 1 155 MEMORIAL DR 15 REGIONAL DR FL 2

PINEHURST PINEHURST PINEHURST

NC NC NC

28374 28374-8710 28374-8850

QUALITY CARE PHARMACY OF PINEHURST SERVICE DRUG STORE OF PINETOPS PINK HILL PHARMACY INC REALO DISCOUNT DRUG STORES INC KERR DRUG PITTSBORO DISCOUNT DRUG PLEASANT GARDEN DRUG STORE KERR DRUG WOMBLE DRUG STORE ALLEN DRUGS

(910) 215-3784 (252) 827-5532 (252) 568-4131 (252) 568-3161 (919) 542-1661 (919) 542-7283 (336) 674-5611 (252) 793-1175 (252) 793-9036 (252) 224-5591

65 PARKER LANE 102 WEST HAMLETT STREET 100 S CENTRAL AVE 107 W BROADWAY ST 321 EAST ST 628 EAST ST 4822 PLEASANT GARDEN RD 11 US HIGHWAY 64 E 454 US HIGHWAY 64 E 9026 US HIGHWAY 17

PINEHURST PINETOPS PINK HILL PINK HILL PITTSBORO PITTSBORO PLEASANT GARDEN PLYMOUTH PLYMOUTH POLLOCKSVILLE

NC NC NC NC NC NC NC NC NC NC

28674-7919 27864 28572-8083 28572-7998 27312-8227 27312-9474 27313-8253 27962-2200 27962-9593 28573-9507

REALO DISCOUNT DRUG POLLOCKSVILLE WOODARD DRUG STORE, INC. PROSPECT HILL CHC PHARMACY BARBEE PHARMACY INC HCC PHARMACY-DME HOKE PHARMACY HOWELL DRUG COMPANY INC ACARIAHEALTH PHARMACY INC ADVANCE COMMUNITY HLTH PHCY SW ALVAREZ PHCY & DISCOUNT INC BLUE RIDGE PHARMACY CITY PHARMACY

(252) 224-0404 (919) 936-3151 (336) 562-5972 (910) 875-6111 (910) 848-0630 (910) 904-8700 (919) 875-3365 (800) 511-5144 (919) 755-5060 (844) 613-2038 (919) 781-7986 (919) 703-0717

9041 US HIGHWAY 17 102 E EDWARDS 322 MAIN ST 415 HARRIS AVE 137 N MAIN ST 300 MEDICAL PAVILION DR # 100 311 TEAL DR 7231 ACC BLVD STE 103 1011 ROCK QUARRY RD 2645 E MILLBROOK RD STE C 2601 BLUE RIDGE RD 3110 NEW BERN AVE STE 108

POLLOCKSVILLE PRINCETON PROSPECT HILL RAEFORD RAEFORD RAEFORD RAEFORD RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH

NC NC NC NC NC NC NC NC NC NC NC NC

28573-9507 27569-7241 27314-9438 28376-3111 28376-2803 28376-9137 28376-2527 27617-8737 27610 27604-2851 27607-6481 27610-1200

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 366 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name FALLS RIVER PHARMACY FOOD LION PHARMACY FOOD LION PHARMACY GILEAD PHARMACY GLENWOOD SOUTH PHCY + MARKET GREYSTONE VILLAGE PHARMACY HAMLIN DRUG COMPANY HAYES-BARTON PHARMACY HEALTH PARK PHARMACY HOLLY PARK PHARMACY KERR DRUG KERR DRUG KERR DRUG KERR DRUG KERR DRUG KERR DRUG KERR DRUG MEDICAP PHARMACY MEDS DELIVERY PHARMACY OBERLIN ROAD PHARMACY ONERX PHARMACY PERSON STREET PHARMACY PSP PHARMACY RALEIGH NEUROLOGY PHARMACY RALEIGH PHARMACY REX PHARMACY OF RALEIGH VRX PHARMACY WAKEMED EMPLOYEE PHARMACY WAKEMED OUTPATIENT PHARMACY KERR DRUG RAMSEUR PHARMACY RANDLEMAN DRUG LLC RED SPRINGS DRUG COMPANY RED SPRINGS OLD MAIN TOWNSEND PHARMACY BELMONT PHARMACY INC CAROLINA APOTHECARY REIDSVILLE PHARMACY FUTRELL PHARMACY SVCS BIG VALUE DISCOUNT DRUGS KERR DRUG DRUGCO DISCOUNT PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (919) 844-2055 (919) 847-4235 (919) 875-1488 (919) 212-2555 (919) 856-9502 (919) 844-7939 (919) 828-2391 (919) 832-4641 (919) 847-7645 (919) 865-9993 (919) 833-5531 (919) 467-6364 (919) 876-7283 (919) 787-1155 (919) 847-8101 (919) 569-6741 (919) 845-9356 (919) 676-6161 (919) 856-9501 (919) 322-4726 (919) 351-1539 (919) 832-6432 (919) 250-7878 (919) 215-0240 (919) 703-0154 (919) 784-3242 (919) 307-8460 (919) 350-2200 (919) 350-8196 (336) 824-1276 (336) 824-8247 (336) 495-5100 (910) 843-4431 (910) 227-2425 (910) 843-4531 (336) 342-4221 (336) 342-0071 (336) 342-9175 (252) 539-2552 (910) 324-3164 (910) 324-1656 (252) 537-7010

Provider Street 10930 RAVEN RIDGE RD STE 109 1121 FALLS RIVER AVE 7440 LOUISBURG RD 2100 NEW BERN AVE 401 GLENWOOD AVE STE 101 7713 LEAD MINE RD 126 E HARGETT ST 2000 FAIRVIEW RD STE B 8300 HEALTH PARK STE 227 3004 WAKE FOREST RD STE 112 3205 AVENT FERRY RD 1219 BUCK JONES RD 6140 FALLS OF NEUSE RD 4441 SIX FORKS RD 8385 CREEDMOOR RD 2901 WAKEFIELD PINES DRIVE 9650 STRICKLAND RD STE 105 6675 FALLS OF NEUSE RD STE 101 745 W JOHNSON ST STE A 815 OBERLIN RD 8490 HONEYCUTT RD STE 103 702 N PERSON ST 4111 NEW BERN AVE 1540 SUNDAY DR 927 W MORGAN ST STE 100 4420 LAKE BOONE TRL 3058 WAKE FOREST RD 3024 NEW BERN AVE 3000 NEW BERN AVE 6525 JORDAN RD 6215 B US HWY 64 E 600 W ACADEMY ST 114 S MAIN ST 300 S MAIN ST 111 S MAIN ST 105 PROFESSIONAL DR 726 S SCALES ST 924 S SCALES ST 124 S MAIN ST 8406 RICHLANDS HWY. 9005 RICHLANDS HWY 107 SMITH CHURCH RD

Page 367 of 679

Provider City RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RALEIGH RAMSEUR RAMSEUR RANDLEMAN RED SPRINGS RED SPRINGS RED SPRINGS REIDSVILLE REIDSVILLE REIDSVILLE RICH SQUARE RICHLANDS RICHLANDS ROANOKE RAPIDS

State

ZIP code

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27614-8725 27614-6731 27616-6482 27610-2431 27603-1219 27615-4805 27601-1440 27608-2316 27615-4731 27609-7844 27606-2720 27606-3326 27609-3528 27609-5729 27613-1385 27614-9826 27615-1902 27615-6803 27603-1238 27605-1130 27615-2263 27604 27610-1372 27607-6010 27603-1511 27607-7505 27609 27610 27610 27316-9528 27316 27317-1302 28377-1512 28377-1624 28377-1511 27320 27320-5330 27320-5318 27869 28574 28574-6380 27870-4911

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DRUGCO HEALTH GENOA-QOL HEALTHCARE SPEARS PHARMACY INC TAR HEEL DRUG COMPANY KERR DRUG MISSION PHARMACY-TALLULAH ROBBINSVILLE PHARMACY VILLAGE PHARMACY FAMILY PHARMACY MEDICAL CENTER PHARMACY MEDICAL PARK PHARMACY THE SANDHILLS PHARMACY COUNTRY PHARMACY INC CRESCENT PHARMACY ALMAND'S DRUG ALMAND'S DRUG STORE OAKWOOD PHARMACY PHARMBLUE NORTH CAROLINA LLC

Provider Name

(252) 537-7010 (252) 365-4337 (252) 537-1146 (910) 948-2921 (828) 479-8791 (828) 213-1132 (828) 479-2273 (252) 795-3130 (910) 895-7775 (910) 997-4471 (910) 417-3490 (910) 997-4012 (704) 209-3313 (704) 279-2288 (252) 446-0014 (252) 443-3138 (252) 442-8159 (800) 609-0822

107 SMITH CHURCH RD STE A 60 NC HIGHWAY 125 405 BECKER DR 215 S MIDDLETON ST 219 RODNEY ORR BYP 409 TALLULAH RD 238 RODNEY ORR BYPASS 108 S MAIN ST 2124 FAYETTEVILLE RD STE E 805 S LONG DR 921 S LONG DR 310 1/2 E WASHINGTON ST 610A W MAIN ST 314 E MAIN ST 1329 TARBORO ST 3621 SUNSET AVE 329 N FAIRVIEW RD 300 N GRACE ST STE 150

ROANOKE RAPIDS ROANOKE RAPIDS ROANOKE RAPIDS ROBBINS ROBBINSVILLE ROBBINSVILLE ROBBINSVILLE ROBERSONVILLE ROCKINGHAM ROCKINGHAM ROCKINGHAM ROCKINGHAM ROCKWELL ROCKWELL ROCKY MOUNT ROCKY MOUNT ROCKY MOUNT ROCKY MOUNT

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27870-4911 27870-6304 27870-3301 27325-8412 28771-8420 28771-8500 28771-8420 27871-0000 28379-4015 28379-4317 28379-4874 28379-3644 28138 28138-6761 27801-6070 27804-3411 27801-6065 27804-5345

ROCKY MOUNT MEDICAL PARK PHARMACY ROCKY POINT PAVILION PHARMACY KERR DRUG ROWLAND OLD MAIN PHARMACY COLE'S PHARMACY INC COMMUNITY PHCY OF ROXBORO FOOD LION PHARMACY THOMAS & OAKLEY DRUG STORE BROAD STREET PHARMACY MEDICINE BOX OF RUTHERFORDTON BRISSON DRUGS KERR DRUG ST PAULS DRUG FOOD LION PHARMACY INNES ST DRUG COMPANY INC INNES STREET DRUG COMPANY MEDEXPRESS PHARMACY MOOSE PHARMACY OF SALISBURY NOVANT HEALTH PHARMACY THE MEDICINE SHOPPE FOOD LION PHARMACY HOME TOWN PHARMACY KERR DRUG

(252) 443-7979 (910) 210-2030 (910) 525-5100 (910) 422-3774 (336) 599-2171 (336) 599-9293 (336) 599-0851 (336) 599-3712 (336) 969-0444 (828) 287-7117 (919) 865-4135 (910) 865-1242 (910) 865-4134 (704) 216-2070 (704) 633-4521 (704) 636-1712 (704) 633-3113 (704) 636-6340 (704) 638-2538 (704) 637-6120 (919) 498-1962 (919) 292-1423 (919) 776-2727

901 N WINSTEAD AVE STE 100 7910 US HIGHWAY 117 S STE 110 218 W MARTIN LUTHER KING BLVD 101 S BOND ST 117 N MAIN ST 719 N MAIN ST 1005 N MADISON BLVD 109 N MAIN ST 8055 BROAD ST 200 CHARLOTTE RD 217 W BROAD ST 419 W BROAD ST 202 W BROAD ST 525 JAKE ALEXANDER BLVD W 112 S MAIN ST 1706 W INNES ST 1431 W INNES ST 1408 W INNES ST 911 W HENDERSON ST STE L20 1357 W INNES ST 1655 BUFFALO LAKE ROAD 101 S VANCE ST 1050 S HORNER BLVD

ROCKY MOUNT ROCKY POINT ROSEBORO ROWLAND ROXBORO ROXBORO ROXBORO ROXBORO RURAL HALL RUTHERFORDTON SAINT PAULS SAINT PAULS SAINT PAULS SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SALISBURY SANFORD SANFORD SANFORD

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27804-8712 28457-8410 28382-7461 28383 27573-5534 27573 27573-4529 27573-5534 27045-9363 28139-2914 28384-1533 28384-1537 28384-1534 28147-1370 28144-4942 28144-2552 28144-2501 28144-2502 28144-2706 28144-3101 27332 27330-4239 27330-5323

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 368 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDICINE PARK PHARMACY KERR DRUG MCDOWELLS PHARMACY CAROLINA PHARMACY-SEAGROVE SEA LEVEL HOSP/EXTENDED CARE PHCY CREECH DRUG COMPANY MINTZ COASTAL DRUG STORE THOMAS DRUGS COMMUNITY PHARMACY INGLES PHARMACY LAFAYETTE STREET PHARMACY MEDICAL ARTS PHARMACY SHELBY DRUGSTORE INC FOOD LION PHARMACY SILER CITY CHC PHARMACY SILER CITY PHARMACY CARROLL PHARMACY JOHNSTON HEALTH OUTPT PHCY

Provider Name

(919) 776-2814 (252) 826-3007 (252) 826-4137 (336) 873-8246 (252) 225-4921 (919) 965-2316 (910) 754-6563 (252) 754-8220 (704) 482-4457 (704) 482-5401 (704) 481-0076 (704) 487-8068 (704) 487-2939 (919) 742-9969 (919) 663-0348 (919) 663-5541 (919) 934-7164 (919) 938-7386

100 PARK AVE 805 MAIN ST 1004 MAIN ST 510 N BROAD ST 440 US HIGHWAY 70 SEALEVEL 126 N RAIFORD ST 4802 MAIN ST 4750 MAIN ST 1194 WYKE RD 1818 W DIXON BLVD 620 S LAFAYETTE ST 108 E GROVER ST 701-1 EAST GROVER STREET 109 FOOD LION PLZ 224 S 10TH AVE 202 E RALEIGH ST STE A 840 S BRIGHTLEAF BLVD 509 N BRIGHT LEAF BLVD

SANFORD SCOTLAND NECK SCOTLAND NECK SEAGROVE SEALEVEL SELMA SHALLOTTE SHALLOTTE SHELBY SHELBY SHELBY SHELBY SHELBY SILER CITY SILER CITY SILER CITY SMITHFIELD SMITHFIELD

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

27330-4027 27874-1227 27874-1232 27341-8583 28577-9602 27576-2833 28470-1863 28470-1880 28150-4259 28152-4351 28150 28150-3804 28150 27344-2835 27344-2779 27344-3416 27577-4377 27577

REALO DISCOUNT DRUGS JOHNSTON CO SNEADS FERRY FAMILY PHARMACY INC KERR DRUG REALO DISCOUNT DRUGS HEALTH INNOVATIONS PHARMACY MCCLAIN DRUG GALLOWAY-SANDS PHARMACY #2 KERR DRUG HALSEY DRUG COMPANY KERR DRUG KERR DRUG SPINDALE DRUG

(919) 934-2111 (910) 327-2454 (252) 747-6512 (252) 747-7004 (910) 246-5155 (910) 246-9355 (910) 454-9090 (910) 457-4721 (336) 372-5599 (336) 372-2101 (704) 633-1604 (828) 286-3746

601 N 8TH ST STE D 1016 OLD FOLKSTONE RD 1106 KING GOLD ROAD 104 PARKWOOD DR 295 PINEHURST AVE BLDG 2 735 SOUTH BENNETT ST 1513 N HOWE ST STE 8 1531 N HOWE ST 55 S MAIN ST 454 S MAIN ST 317 N SALISBURY AVE 109 W. MAIN ST

SMITHFIELD SNEADS FERRY SNOW HILL SNOW HILL SOUTHERN PINES SOUTHERN PINES SOUTHPORT SOUTHPORT SPARTA SPARTA SPENCER SPINDALE

NC NC NC NC NC NC NC NC NC NC NC NC

27577-4119 28460-9414 28580 28580-1336 28387 28387 28461-2770 28461-2608 28675-9643 28675-9606 28159-2513 28160

SPINDALE LONG TERM CARE PHARMACY SOUTHSIDE PHARMACY ANDERSON CREEK PHARMACY INC HOSPITAL DRIVE PHARMACY INGLES PHARMACY MISSION PHARMACY - BLUE RIDGE ALLEN DRUG FAMILYMED PHARMACY 1ST RX PHARMACY 1ST RX PHARMACY INC GREENBRIAR

(828) 288-1044 (252) 478-5969 (910) 497-6337 (828) 765-2025 (828) 765-0235 (828) 213-0048 (704) 263-4876 (704) 263-0810 (704) 872-0880 (704) 878-6225

107 W MAIN ST 98 DODD STREET 6779 OVERHILLS RD 409 ALTAPASS HWY 125 GREENWOOD RD 189 HOSPITAL DR 220 S MAIN ST 110 E DALLAS RD 837 N CENTER ST 308A MOCKSVILLE HWY

SPINDALE SPRING HOPE SPRING LAKE SPRUCE PINE SPRUCE PINE SPRUCE PINE STANLEY STANLEY STATESVILLE STATESVILLE

NC NC NC NC NC NC NC NC NC NC

28160-1539 27882 28390 28777-6508 28777-2938 28777 28164-2011 28164 28677-3222 28625-8267

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 369 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BANNER DRUG FAMILY PHARMACY OF STATESVILLE ISLAND PHARMACY LOWRY DRUG COMPANY INC SOUTHSIDE DRUG COMPANY STATESVILLE FAMILY MEDICINE PHCY FOOD LION PHARMACY STEDMAN DRUG CENTER STOKESDALE FAMILY PHARMACY THE DRUG STORE MACK'S 1ST RX PHARMACY RHG PHARMACY GALLOWAY SANDS PHARMACY ASSOCIATED PHARMACEUTICAL SRVS INGLES PHARMACY PSA CLINIC PHARMACY FAMILY CARE PHARMACY EASTGATE PHARMACY KEL-SAVE DRUGS MARK'S HEALTH MART PHARMACY DAMERON DRUG STORE MEDICINE MART LTC TABOR CITY MEDICINE MART BRYAN CLINIC PHARMACY BRYAN DRUGS

Provider Name

(704) 878-6681 (704) 872-0296 (704) 873-0000 (704) 873-2247 (704) 873-7612 (704) 838-1234 (910) 483-9482 (910) 323-4555 (336) 298-4160 (336) 573-2200 (704) 585-2102 (252) 436-6903 (910) 754-7200 (828) 686-3804 (828) 686-5081 (828) 686-3804 (910) 326-6600 (828) 586-4605 (828) 586-2213 (828) 631-5547 (910) 653-3080 (910) 653-6802 (910) 653-4800 (252) 823-3178 (252) 823-6081

3478 E BROAD ST 208 OLD MOCKSVILLE RD 2181A OLD MOUNTAIN RD 750 HARTNESS RD 430 WESTERN AVE 1022 SHELTON AVE 5179 CLINTON RD 7445 CLINTON RD 8500 US HIGHWAY 158 104 N HENRY STREET 8782 NC HWY 90 E 100 DURHAM STREET 58 PHYSICIANS DR STE 5 2294 1/2 US 70 HWY 2299 US 70 HWY 2294 US 70 HWY 1106-B MAIN STREET EXT 93 EASTGATE DR 38 E MAIN ST 836 ASHEVILLE HWY 100 S MAIN ST 214A S MAIN ST 220 S MAIN ST 101 CLINIC DR 421 N MAIN ST

STATESVILLE STATESVILLE STATESVILLE STATESVILLE STATESVILLE STATESVILLE STEDMAN STEDMAN STOKESDALE STONEVILLE STONY POINT STOVALL SUPPLY SWANNANOA SWANNANOA SWANNANOA SWANSBORO SYLVA SYLVA SYLVA TABOR CITY TABOR CITY TABOR CITY TARBORO TARBORO

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28625 28625-1930 28625-1631 28677-3400 28677-5730 28677-6729 28391-9516 28391-8901 27357-9248 27048-0000 28678-9425 27582 28462 28778-8209 28778-9304 28778-8209 28584-9114 28779-5171 28779-3040 28779-2743 28463-1910 28463-1904 28463-1904 27886-1935 27886-4310

FREEDOM HILL COMM HEALTH CTR PHY THORNE DRUG COMPANY OFFICE PRACTICE OF PHARMACY PEOPLES DRUG STORE TOWN & COUNTRY DRUGS GUYS FAMILY PHARMACY THOMASVILLE FAMILY PHARMACY COMMUNITY PHCY OF TIMBRLKE INC

(252) 824-3800 (252) 823-5655 (828) 632-8591 (828) 632-2271 (828) 632-2278 (336) 476-5632 (336) 313-6143 (336) 364-1053

162 NC 33 EAST 2900 N MAIN ST 24 COMMERCE DRIVE 255 NC HIGHWAY 16 S 53 E MAIN AVE 817 RANDOLPH ST 1116 LEXINGTON AVE 413 HELENA MORIAH RD

TARBORO TARBORO TAYLORSVILLE TAYLORSVILLE TAYLORSVILLE THOMASVILLE THOMASVILLE TIMBERLAKE

NC NC NC NC NC NC NC NC

27886 27886-1921 28681-2383 28681-3048 28681-2540 27360-5714 27360-3415 27583-7324

REALO DISCOUNT DRUG STORE OF TRENT KERR DRUG TROUTMAN 1ST RX PHARMACY STANDARD DRUG WHITE STAR DISCOUNT PHARMACY OWENS PHARMACY BLUE RIDGE LTC PHARMACY

(252) 448-2901 (704) 528-0043 (704) 528-6611 (910) 572-2070 (910) 572-2129 (828) 859-9181 (828) 580-5460

155 W JONES ST 533 N MAIN ST 106 WAGNER ST 522 ALLEN ST STE 102 436 ALBEMARLE RD 38 N TRADE ST 298 PERKINS RD SE

TRENTON TROUTMAN TROUTMAN TROY TROY TRYON VALDESE

NC NC NC NC NC NC NC

28585-7599 28166-9529 28166-9627 27371-2861 27371-3102 28782 28690-9403

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 370 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DREXEL DISCOUNT DRUG ROCK DRUG STORE TAS DRUG WEST LINCOLN THE DRUG STORE VALE VANCEBORO PHARMACY COOPERS PHARMACY ANSON PHARMACY PARSONS-BIAS INC HEALTHFIRST PHARMACY VILLAGE PHARMACY OF WAKE FOREST WAKE FOREST DRUG WALKERTOWN FAMILY PHARMACY REALO DISCOUNT DRUGS FAMILY PHARMACY HICKS PHARMACY WARRENSVILLE DRUG STORE FUTRELL PHARMACY OF WARRENTON KERR DRUG VALUE RX PHARMACY MEDICAL PARK PHARMACY TAYLOE'S HOSPITAL PHARMACY INGLES PHARMACY KIMS PHARMACY WAYNESVILLE PHARMACY INC INGLES PHARMACY WEAVERVILLE DRUG COMPANY WENDELL DRUG CO QUALITY CARE PHARMACY SEVEN LAKES PRESCRIPTION SHOPPE INGLES PHARMACY PEOPLES DRUG BALDWIN WOODS PHARMACY GUITONS DRUG STORE LIBERTY MEDICAL SPECIALTIES

Provider Name

(828) 437-7961 (828) 879-9812 (704) 276-3484 (704) 462-0226 (252) 244-1086 (910) 245-4672 (704) 694-9358 (704) 694-2310 (919) 569-0500 (919) 556-2757 (919) 554-2699 (336) 595-6979 (910) 285-1120 (336) 591-7171 (336) 591-4345 (336) 384-3900 (252) 257-2147 (252) 257-2922 (910) 293-4334 (252) 623-2100 (252) 946-4113 (828) 452-7455 (828) 452-2313 (828) 456-5112 (828) 645-7499 (828) 645-3087 (919) 365-8800 (910) 673-3784 (910) 673-7467 (336) 219-0016 (336) 246-9990 (910) 642-8141 (910) 642-4188 (910) 642-2250

2728 US 70 E 240 MAIN ST W 4417 WEST NC HWY 27 9576 NC HIGHWAY 10 W 421 FARM LIFE AVE 3353 US HWY 1 806 CAMDEN RD 100 S GREEN ST 2001 S MAIN ST 900 S FRANKLIN ST STE 102 3113 ROGERS RD STE 100 2905 DARROW RD 5655 S NC 41 HWY 317 N MAIN ST 1072 N MAIN ST 5121 NC HIGHWAY 88 W 108B S MAIN ST 126 E MACON ST 107 S PINE ST 1316 JOHN SMALL AVE 601 E 12TH ST 259 BARBER BLVD 366 RUSS AVE STE 4 477 HAZELWOOD AVE 140 WEAVER BLVD 3 N MAIN ST 3430 WENDELL BLVD 1103 SEVEN LAKES DR 120 MACDOUGALL DR 60 ASHEMONT DR 423 E 2ND ST 607 JEFFERSON ST 801 S MADISON ST 612 JEFFERSON ST STE 10

VALDESE VALDESE VALE VALE VANCEBORO VASS WADESBORO WADESBORO WAKE FOREST WAKE FOREST WAKE FOREST WALKERTOWN WALLACE WALNUT COVE WALNUT COVE WARRENSVILLE WARRENTON WARRENTON WARSAW WASHINGTON WASHINGTON WAYNESVILLE WAYNESVILLE WAYNESVILLE WEAVERVILLE WEAVERVILLE WENDELL WEST END WEST END WEST JEFFERSON WEST JEFFERSON WHITEVILLE WHITEVILLE WHITEVILLE

NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC NC

28690-9004 28690 28168 28168 28586-7797 28394 28170-2642 28170-2781 27587-1612 27587 27587-3803 27051-9682 28466-6095 27052 27052-9312 28693-9209 27589-1930 27589-2018 28398-1924 27889-3843 27889-3408 28786-3686 28786-2938 28786-1946 28787-8345 28787-9427 27591-6925 27376-9778 27376 28694-9514 28694 28472-3707 28472-4613 28472-3708

MCNEILL'S LONG TERM CARE PHARMACY MCNEILLS PHARMACY MIDTOWN PHARMACY CHEROKEE PHARMACY WILKES FAMILY PHARMACY AGAPE COMM HLTH CLINIC WILLIAM COSTWISE PHARMACY INC

(910) 642-0388 (910) 642-3065 (336) 446-0099 (828) 497-2273 (336) 667-9347 (252) 802-3062 (252) 809-4288

712 TRAM RD 612 JEFFERSON ST # 4 941 CENTER CREST DRIVE STE A 664 CASINO TRL 1300A WESTWOOD LN 1130 GODWIN DR 712 WASHINGTON ST

WHITEVILLE WHITEVILLE WHITSETT WHITTIER WILKESBORO WILLIAMSTON WILLIAMSTON

NC NC NC NC NC NC NC

28472-3520 28472-3708 27377 28789-7193 28697-2600 27892 27892-2648

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 371 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MAST PHARMACY CAPE FEAR PHARMACY KERR DRUG

Provider Name

(252) 792-1014 (910) 798-0900 (910) 763-6231

307 WEST BLVD 5235 S COLLEGE RD 2601B CASTLE HAYNE RD

WILLIAMSTON WILMINGTON WILMINGTON

NC NC NC

27892-2145 28412-2209 28401

KING'S PHARMACY & COMPOUNDING LAB MARKET STREET PHARMACY MEDICAL CENTER PHARMACY MEDICAL CENTER PHARMACY WHA NHRMC ED NORTH PHARMACY NHRMC OUTPATIENT/EMPLOYEE PHCY OPTION CARE PHARMACY INNOVATIONS SEASHORE DRUGS WINTER PARK DRUG STORE INC MEDICAP PHARMACY REALO DISCOUNT DRUGS

(910) 452-7098 (910) 763-0845 (910) 763-1896 (910) 343-9518 (910) 662-9071 (910) 815-5180 (910) 791-7885 (910) 859-8211 (910) 762-6278 (910) 791-2346 (252) 237-2111 (252) 991-6967

2231 S COLLEGE RD 1612 MARKET ST 912 S 16TH ST 2421 SILVER STREAM LN 151 SCOTTS HILL MEDICAL DR 2131 S 17TH ST 131 RACINE DR STE 100B 3608 OLEANDER DR STE E 2059 CAROLINA BEACH RD 5220 WRIGHTSVILLE AVE 1000 TARBORO ST W STE A 3900 NASH STREET N

WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILMINGTON WILSON WILSON

NC NC NC NC NC NC NC NC NC NC NC NC

28403-5546 28401-4953 28401-8016 28401-7684 28411-7983 28401 28403-8781 28403 28401-7239 28403-7056 27893-4758 27896

REGIONAL MEDICAL ONCOLOGY ASSOCIATE SOUTHEASTERN MED ONCOLOGY CTR THOMAS DRUG STORE WILSON COMMUNITY HLTH CTR PHCY WILSONVALUE DRUG STORE KERR DRUG PITTMAN'S PHARMACY ANDREWS APOTHECARY BAPTIST HOSPITAL SPECIALTY RX

(252) 991-5261 (252) 293-0777 (252) 237-1188 (252) 243-9800 (252) 293-4177 (252) 794-9222 (252) 794-3431 (336) 723-1679 (336) 713-8075

2624 ORTHO DR 2624 ORTHO DR 303 NASH ST W 303 GREEN ST E BLDG A 404 E NASH ST 119 US HIGHWAY 13 N 305 W GRANVILLE ST 3072-A TRENWEST DR 1 MEDICAL CENTER BLVD

WILSON WILSON WILSON WILSON WILSON WINDSOR WINDSOR WINSTON SALEM WINSTON SALEM

NC NC NC NC NC NC NC NC NC

27893 27893-3484 27893-3834 27893-4105 27893-3743 27983-7243 27983-1815 27103 27103

COMPREHENSIVE CANCER CENTER PHARM

(336) 713-6808

1 MEDICAL CENTER BLVD

WINSTON SALEM

NC

27103

DOWNTOWN HEALTH PLAZA PHARMACY GENOA-QOL HEALTHCARE JONESTOWN PHARMACY M L K PHARMACY MARLEY DRUG MEDICAP PHARMACY MEDICAP PHARMACY N.C. BAPTIST OUTPATIENT PHCY NOVANT HEALTH PHARMACY NOVANT HEALTH PHARMACY NOVANT HEALTH PHARMACY NOVANT HEALTH PHARMACY NOVANT HEALTH PHARMACY

(336) 713-9677 (336) 448-3199 (336) 774-1445 (336) 722-0077 (336) 771-7672 (336) 631-0093 (336) 922-1990 (336) 716-3363 (336) 718-0400 (336) 718-1044 (336) 718-7894 (336) 277-8990 (336) 277-7094

1200 N MARTIN LUTHER KING JR D 4140 CHERRY ST 300 JONESTOWN RD STE 5 1489 NEW WALKERTOWN RD 5008 PETERS CREEK PKWY 1345 N LIBERTY ST 3719 REYNOLDA RD 1 MEDICAL CENTER BLVD 1381 WESTGATE CENTER DR 255 CHARLOIS BLVD 105 VEST MILL CIR 3333 SILAS CREEK PKWY 3333 SILAS CREEK PKWY

WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM

NC NC NC NC NC NC NC NC NC NC NC NC NC

27101-3006 27105-2536 27104-4731 27101-3319 27127-7276 27105-6625 27106-2231 27103 27103 27103-1507 27103-2943 27103-3013 27103-3013

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 372 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NOVANT HEALTH PHARMACY NUESTRA FARMACIA LLC PIEDMONT PLAZA PHARMACY ROBINHOOD FAMILY PHARMACY LLC SOUTH PARK FAMILY PHARMACY SOUTHSIDE DISCOUNT PHARMACY STANLEYVILLE FAMILY PHARMACY TRIAD CHOICE PHARMACY WSSU WELLNESS CENTER PHCY YADKIN VALLEY PHARMACY NORTH VILLAGE PHARMACY YANCEYVILLE DRUG COMPANY ZEBULON DRUG COMPANY INC ARTHUR DRUG WHITE DRUG BELCOURT DRUG CHURCHILL PHARMACY DAKOTA PHARMACY

Provider Name

(336) 718-0560 (336) 793-2090 (336) 716-5800 (336) 682-5546 (336) 293-4755 (336) 830-8774 (336) 377-3979 (336) 893-6286 (336) 750-3366 (336) 677-5000 (336) 694-4104 (336) 694-9323 (919) 269-7481 (701) 967-8900 (701) 288-3355 (701) 477-0202 (701) 224-0339 (701) 255-1881

100 ROBINHOOD MEDICAL PLAZA 516 WAUGHTOWN ST 1920 W 1ST ST 3443 ROBINHOOD RD STE S R 1215 W CLEMMONSVILLE RD 3085 WAUGHTOWN ST 193 N SUMMIT SQUARE BLVD 626 E MONMOUTH ST 601 S MLK JR DR BLAIR HALL 207 ASH ST 1493 MAIN ST 106 COURT SQUARE 520 W GANNON AVE 325 MAIN ST 109 W MAIN ST 1110 HOSPITAL RD STE 1 1190 W TURNPIKE AVE 705 E MAIN AVE

WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM WINSTON SALEM YADKINVILLE YANCEYVILLE YANCEYVILLE ZEBULON ARTHUR ASHLEY BELCOURT BISMARCK BISMARCK

NC NC NC NC NC NC NC NC NC NC NC NC NC ND ND ND ND ND

27106-5472 27127 27104-4220 27106-4760 27127-4790 27107-1634 27105-1476 27107-3227 27110 27055-6869 27379-8793 27379 27597-2510 58006 58413-7003 58316 58501-1300 58501

GATEWAY HEALTH MART PHARMACY NORTH

(701) 224-9521

3101 N 11TH ST STE NUMBER-2

BISMARCK

ND

58503-0594

GATEWAY HEALTHMART PHARMACY SOUTH

(701) 223-1656

835 S WASHINGTON ST STE 2

BISMARCK

ND

58504-5416

GATEWAY HEALTHMART PHCY SUNRISE HERITAGE PHARMACY EAST HERITAGE PHARMACY GATEWAY MALL HERITAGE PHARMACY MAIN HORIZON PHARMACY MAYO PHARMACY PROFESSIONAL PHARMACY SANFORD RETAIL PHARMACY ST ALEXIUS COMMUNITY PHARM THE MEDICINE SHOPPE UND CENTER FOR FAMILY MED PHCY WHITE DRUG CARRINGTON DRUG INC CASSELTON DRUG BELL DRUG CLINIC PHARMACY RAMSEY DRUG INC WHITE DRUG CLINIC PHARMACY INC

(701) 425-0789 (701) 530-6311 (701) 530-5800 (701) 530-6050 (701) 712-3030 (701) 223-2424 (701) 223-6854 (701) 323-6099 (701) 530-6906 (701) 224-0175 (701) 751-6803 (701) 223-0936 (701) 652-2521 (701) 347-4281 (701) 662-3022 (701) 662-4427 (701) 662-3117 (701) 662-6270 (701) 483-4401

3103 YORKTOWN DR STE 2 1000 E ROSSER AVE 2700 STATE ST STE F13 401 N 9TH ST 4535 NORTHERN SKY DR STE 3 303 N 4TH ST 3124 COLORADO LANE STE 400 300 N 7TH ST 900 E BROADWAY AVE 1304 E BOULEVARD AVE 701 E ROSSER 117 N 5TH ST 415 MAIN ST 622 FRONT ST 323 5TH ST 1001 7TH ST NE 401 COLLEGE DR SOUTH 425 COLLEGE DR S 2615 FAIRWAY ST

BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK BISMARCK CARRINGTON CASSELTON DEVILS LAKE DEVILS LAKE DEVILS LAKE DEVILS LAKE DICKINSON

ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND

58503 58501-4414 58503-0674 58501-4507 58503 58501-4020 58503 58501-4439 58501-4520 58501-4234 58501 58501-4087 58421-1671 58012-3300 58301-2427 58301-2719 58301-3501 58301-3537 58601

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 373 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDICINE SHOPPE ND PHARMACY INC ND PHARMACY WEST WHITE DRUG DUNSEITH DRUG INC EDGELEY PHARMACY ELLENDALE PHARMACY INC NUCARA PHARMACY DAKOTA CLINIC PHARMACY DAKOTA CLINIC PHARMACY ON 32ND LINSON PHARMACY M-D PHARMACY MEDICAL PHARMACY SOUTH NORTHPORT DRUG PRAIRIE PHARMACY SANFORD PHARMACY BROADWAY SANFORD PHARMACY MILLS AVENUE

Provider Name

(701) 227-8265 (701) 225-4434 (701) 483-0724 (701) 225-4421 (701) 244-0202 (701) 493-2810 (701) 349-3390 (701) 437-2464 (701) 364-3450 (701) 364-7800 (701) 293-6022 (701) 364-5690 (701) 282-8075 (701) 235-5543 (701) 373-0325 (701) 234-2416 (701) 234-3330

1571 W VILLARD ST UNIT 1 446 18TH ST W STE 2 1283 ROUGHRIDER BLVD 2265 3RD AVE W 10 MAIN ST SW 509 MAIN ST 117 MAIN STREET 308 RAILWAY ST 1702 UNIVERSITY DR S 3000 32ND AVE S 3175 25TH ST S 4101 13TH AVE S 4151 45TH ST SO 2522 BROADWAY 4731 13TH AVE S 737 BROADWAY 801 BROADWAY N

DICKINSON DICKINSON DICKINSON DICKINSON DUNSEITH EDGELEY ELLENDALE ENDERLIN FARGO FARGO FARGO FARGO FARGO FARGO FARGO FARGO FARGO

ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND

58601 58601-3022 58601 58601-2605 58329 58433 58436 58027 58103-4940 58103-6132 58103 58103-3342 58104 58102-1405 58103-7205 58102 58102-3641

SANFORD PHARMACY SOUTH UNIVERSITY SEIP DRUG SEIP PRESCRIPTION SHOPPE SOUTHPOINTE PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE WEST ACRES PHARMACY, INC. WHITE DRUG WHITE DRUG WHITE DRUG SPIRIT LAKE HEALTH CENTER PHCY GLEN ULLIN PHARMACY GRAFTON DRUG WHITE DRUG ALTRU CLINIC PHARMACY ALTRU CLINIC PHCY FAMILY MED CTR ALTRU RETAIL PHARMACY EMBRACE PHARMACY INC FAMILY MEDICINE RESIDENCY PHCY INSPIRE PHARMACY SKIPS BUDGET DRUG

(701) 280-4469 (701) 373-0890 (701) 373-0685 (701) 234-9912 (701) 293-0221 (701) 293-3060 (701) 282-0285 (701) 893-9217 (701) 893-9050 (701) 235-5511 (701) 766-1600 (701) 348-3303 (701) 352-0831 (701) 352-1760 (701) 772-4875 (701) 795-2020 (701) 780-3444 (701) 757-1552 (701) 780-6870 (701) 757-4407 (701) 772-4805

1720 UNIVERSITY DR S 5675 26TH AVE S STE 136B 5675 26TH AVE S STE 136A 2400 32ND AVE S 2802 BROADWAY 1605 S UNIVERSITY DR 3902 13TH AVE S STE 3706 706 38TH ST N STE B 706 38TH ST N STE A 1401 33RD ST S 3883 74TH AVE NE 113 S MAIN ST 38 E 12TH ST 737 W 12TH ST 1000 S COLUMBIA RD 1380 S COLUMBIA RD 1200 S COLUMBIA RD 2424 32ND AVE STE 101B 725 HAMLINE ST 360 DIVISION AVE STE 100 2015 LIBRARY CIRCLE STE 102

FARGO FARGO FARGO FARGO FARGO FARGO FARGO FARGO FARGO FARGO FORT TOTTEN GLEN ULLIN GRAFTON GRAFTON GRAND FORKS GRAND FORKS GRAND FORKS GRAND FORKS GRAND FORKS GRAND FORKS GRAND FORKS

ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND

58103-4940 58104 58104-8975 58103-5800 58102-1420 58103-4154 58103-7512 58102-2953 58102-2953 58103-3413 58335 58631-0670 58237-2212 58237-2117 58201-4032 58201-4059 58201-4036 58201 58203-2819 58201-4702 58201

UNIV OF N DAKOTA STUDENT HLTH PHCY WALLS HEALTH MART PHARMACY

(701) 777-3965 (701) 732-2900

2891 2ND AVE N STOP 9038 1451 44TH AVE STE 101 D

GRAND FORKS GRAND FORKS

ND ND

58202-9038 58201-3434

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 374 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WALLS MEDICINE CENTER WHITE DRUG HANKINSON DRUG SERVICE DRUG AND GIFT WHITE DRUG THE MEDICINE SHOPPE WHITE DRUG WHITE DRUG LAMOURE DRUG STORE LANGDON COMMUNITY DRUG WHITE DRUG NUCARA PHARMACY WHITE DRUG WHITE DRUG GATEWAY PHARMACY-MANDAN ST ALEXIUS MANDAN PHARMACY THE MEDICINE SHOPPE B&B NORTHWEST PHARMACY KEYCARE PHARMACY MARKET PHARMACY THE MEDICINE SHOPPE WHITE DRUG WHITE DRUG WHITE DRUG CENTRAL PHARMACY NEW SALEM PHARMACY TARAS THRIFTY WHITE WHITE DRUG HEART OF AMERICA CLINIC PHCY WHITE DRUG DAKOTA DRUG CO STANLEY TURTLE LAKE REXALL DRUG CENTRAL AVENUE PHARMACY NUCARA PHARMACY CORNER DRUG STORE WAHPETON DRUG COMPANY BARRETT PHARMACY HEALTH CENTER PHARMACY SKRIPTS PHARMACY THE PRESCRIPTION SHOP INC G & G PHARMACY N.D. PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (701) 746-0497 (701) 775-4209 (701) 242-7414 (701) 324-2227 (701) 567-2533 (701) 252-3002 (701) 251-1432 (701) 252-5980 (701) 883-5339 (701) 256-3330 (701) 254-5432 (701) 683-5282 (701) 683-4691 (701) 438-2567 (701) 667-1843 (701) 530-3750 (701) 663-1151 (701) 838-2213 (701) 857-7900 (701) 839-8883 (701) 852-1524 (701) 852-0388 (701) 852-4181 (701) 756-6000 (701) 947-5313 (701) 843-7563 (701) 742-3824 (701) 246-3600 (701) 776-2531 (701) 776-5741 (701) 628-2255 (701) 448-2542 (701) 845-5280 (701) 845-2652 (701) 642-6223 (701) 642-9211 (701) 842-3311 (701) 364-5800 (701) 281-2222 (701) 282-4665 (701) 572-7979 (701) 572-4181

Provider Street 708 S WASHINGTON ST 2475 32ND AVE S 323 MAIN AVE S 815 LINCOLN AVE 112 S MAIN ST 703 1ST AVE S 310 1ST AVE S 320 10TH ST SE 100 1ST AVE SW 805 3RD ST 121 N BROADWAY ST 407 MAIN ST 404 MAIN ST 108 CENTRAL AVE N 500 BURLINGTON ST SE 2500 SUNSET DRIVE NW, SUITE 2 116 2ND AVE NW 20 BURDICK EXPY W 400 BURDICK EXPY E 1930 S BROADWAY 209 11TH AVE SW 2211 16TH STREET NW STE B 1015 S BROADWAY 115 MAIN ST W 4 8TH ST N 509 ASH AVE 610 MAIN AVE 208 MAIN STREET 800 S MAIN AVE 107 2ND ST SE 107 S MAIN ST 218 MAIN 323 CENTRAL AVE N STE 101 234 CENTRAL AVE N 619 DAKOTA AVE 508 DAKOTA AVE 145 N MAIN ST 1401 13TH AVE E 750 23RD AVE E 1210 SHEYENNE ST 1500 14TH ST W STE 150 20 26TH ST E

Page 375 of 679

Provider City GRAND FORKS GRAND FORKS HANKINSON HARVEY HETTINGER JAMESTOWN JAMESTOWN JAMESTOWN LAMOURE LANGDON LINTON LISBON LISBON MADDOCK MANDAN MANDAN MANDAN MINOT MINOT MINOT MINOT MINOT MINOT MOHALL NEW ROCKFORD NEW SALEM OAKES ROLETTE RUGBY RUGBY STANLEY TURTLE LAKE VALLEY CITY VALLEY CITY WAHPETON WAHPETON WATFORD CITY WEST FARGO WEST FARGO WEST FARGO WILLISTON WILLISTON

State

ZIP code

ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND ND

58201-4328 58201-3606 58041-4100 58341-1521 58639-7031 58401-4745 58401-4154 58401-5555 58458-7415 58249 58552-7018 58054-0601 58054-4142 58348-7204 58554-4263 58554 58554-3122 58701-4498 58701-4768 58701-6508 58701-4642 58703 58701-4667 58761-4313 58356-1518 58563 58474-1639 58366 58368-2118 58368-1801 58784 58575-7100 58072-2915 58072-2951 58075-4325 58075-4415 58854-7101 58078-3468 58078-7804 58078-2637 58801-4064 58801-3046

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SERVICE DRUG PHARMACY WHITE DRUG WISHEK DRUG LAKE CREST PHARMACY GOOD LIFE PHARMACY WELLS HEALTHMART HAYS PHARMACY ARAPAHOE PHARMACY ASHLAND PHARMACY WEST HOLT PHARMACY HYRUM'S FAMILY VALUE PHARMACY U SAVE PHARMACY JIMS U SAVE PHARMACY ROCK COUNTY PHARMACY CLABAUGH PHARMACY DEINES PHARMACY POLING DRUG BAKER'S PHARMACY BAKER'S PHARMACY CHI HEALTH PHARMACY - BELLEVUE

Provider Name

(701) 572-6721 (701) 774-3923 (701) 452-2368 (402) 988-7145 (402) 395-3353 (402) 395-2184 (308) 928-2022 (308) 962-7895 (402) 944-3303 (402) 925-2651 (402) 274-5225 (402) 274-4186 (402) 694-3187 (402) 684-2730 (402) 223-3591 (402) 223-4779 (402) 223-3529 (402) 292-0331 (402) 292-3580 (402) 291-5076

317 MAIN ST 300 11TH ST W 9 SO CENTENNIAL ST. 620 MAIN ST STE B 124 S 4TH ST 113 S 4TH ST 706 MAIN ST 507 NEBRASKA AVE 1401 SILVER ST 313 W PEARL ST 2115 14TH ST STE 201 2220 J ST 219 Q ST 801 S STATE ST 501 COURT ST 910 COURT ST 711 COURT ST 801 GALVIN RD S 3614 TWIN CREEK DR 3308 SAMSON WAY STE 106

WILLISTON WILLISTON WISHEK ADAMS ALBION ALBION ALMA ARAPAHOE ASHLAND ATKINSON AUBURN AUBURN AURORA BASSETT BEATRICE BEATRICE BEATRICE BELLEVUE BELLEVUE BELLEVUE

ND ND ND NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE

58801-5303 58801-5159 58495 68301-8277 68620-1216 68620-1215 68920-2164 68922-2832 68003-1845 68713-4958 68305 68305-2602 68818-1118 68714-5062 68310-3923 68310-4085 68310-3927 68005-2203 68123-4065 68123-3235

THE NEBRASKA MEDICAL CENTER (NMC) S BENKELMAN PHARMACY HEALTH MART PHARMACY HEALTH MART PHARMACY BLOOMFIELD PHARMACY RONS PHARMACY NEIN PHARMACY SONNYS PHARMACY HOLCOMB PHARMACY PC VARNEY HEALTH MART BURWELL PHARMACY SEVEN VALLEYS HEALTH MART MARKS PHARMACY CORNER DRUG NORMS U SAVE PHARMACY PETERSEN DRUG WESTERN DRUG OF CHAPPELL BOB'S U-SAVE PHARMACY GENOA-QOL HEALTHCARE SUPER SAVER PHARMACY TOOLEY DRUG COMPANY

(402) 595-1156 (308) 423-2759 (402) 932-5556 (402) 426-9066 (402) 373-4411 (402) 756-3811 (308) 262-1070 (308) 262-0580 (308) 872-5231 (308) 872-2321 (308) 346-4747 (308) 836-2219 (308) 697-3400 (308) 946-2205 (308) 946-3859 (308) 432-2400 (308) 874-2200 (402) 564-2883 (402) 835-4126 (402) 563-3349 (402) 564-7205

2510 BELLEVUE MED CTR DR #100 509 CHIEF ST 15817 CW HADAN DR 238 S 8TH ST 105 S BROADWAY ST STE 1 537 W GAGE ST 1012 MAIN ST 310 MAIN ST 540 S 8TH AVE 744 S E ST 137 GRAND ST 200 EAST PACIFIC 624 PATTERSON ST 401 G ST 1414 16TH ST 302 MAIN ST 650 2ND ST 2759 33RD AVE 4321 41ST AVE STE 1 3318 23RD ST 2615 13TH ST

BELLEVUE BENKELMAN BENNINGTON BLAIR BLOOMFIELD BLUE HILL BRIDGEPORT BRIDGEPORT BROKEN BOW BROKEN BOW BURWELL CALLAWAY CAMBRIDGE CENTRAL CITY CENTRAL CITY CHADRON CHAPPELL COLUMBUS COLUMBUS COLUMBUS COLUMBUS

NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE

68123 69021-3065 68007 68008-2410 68718-4419 68930-8000 69336-4035 69336-4051 68822-2456 68822-2428 68823 68825-0130 69022-6597 68826 68826-1812 69337-2395 69129 68601-2327 68601 68601-3072 68601-4915

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 376 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name TOOLEY'S CLINIC PHARMACY SERVICE DRUG STORE U SAVE PHARMACY COZAD MANIONS DRUG STORE KEN'S U-SAVE PHARMACY DAVID CITY DISCOUNT PHARMACY E STREET DISCOUNT PHARMACY DONIPHAN PHARMACY ELGIN PHARMACY GENEVA PHARMACY, LLC U SAVE PHARMACY ELKHORN GLOBE REXALL DRUG KEX RX PHARMACY AND HOME CARE FOOD 4 LESS PHARMACY KUBAT PHARMACY INC JOHNSON PHARMACY REIMER PHARMACY WEAVER PHARMACY GENOA COMMUNITY PHARMACY GERING U SAVE PHARMACY LAMBERTS FAMILY PHARMACY STOCKMEN'S DRUG GOTHENBURG DISCOUNT PHARMACY GI VILLAGE PHARMACY ST FRANCIS MEDICAL CENTER SUPER SAVER PHARMACY SUPER SAVER PHARMACY #19 U-SAVE PHARMACY 4TH STREET U-SAVE PHARMACY NW U-SAVE PHARMACY SOUTH U-SAVE PHCY GI CLINIC GRANT PHARMACY U SAVE PHARMACY GRETNA STEFFEN DRUG ALLENS DISCOUNT PHARMACY BERTS PRESCRIPTION PHARMACY BERTS REXALL DRUG CROSIER PARK PHARMACY KEITHS DRIVE-IN DRUG INC KEITHS MEDICAL PARK PHARMACY REDLINE PHARMACY VITAL CARE RUSS'S MARKET PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (402) 562-8627 (308) 784-2238 (308) 784-3500 (402) 358-3535 (402) 826-3784 (402) 367-3068 (402) 367-3122 (402) 845-6700 (402) 843-5555 (402) 759-9104 (402) 289-2576 (402) 729-2620 (402) 245-2029 (402) 727-1995 (402) 727-4044 (402) 947-2341 (308) 536-2641 (402) 759-4433 (402) 993-2400 (308) 436-2181 (308) 468-5210 (308) 282-1114 (308) 537-7155 (308) 385-3646 (308) 389-5569 (402) 464-6297 (308) 398-2151 (308) 384-7372 (308) 384-9010 (308) 382-3784 (308) 389-4282 (308) 352-4860 (402) 332-5990 (402) 254-3549 (402) 463-2240 (402) 462-4466 (402) 462-4343 (402) 462-4600 (402) 462-6101 (402) 463-0515 (402) 462-2929 (402) 463-8503

Provider Street 4306 38TH ST 133 E 8TH ST 312 W 8TH 719 MAIN ST 1302 LINDEN AVE 422 N 5TH ST 470 E ST 2011 W CLARICE ST 112 S 2ND 20513 NICHOLAS CIR STE 3 940 N 204TH AVE STE 270 424 E ST 120 E 18TH ST 1531 N BELL ST 350 W 23RD ST 151 MAPLE ST 312 BROADWAY ST 1014 G ST 508 WILLARD AVE 1400 10TH ST 814 1ST ST 116 N MAIN ST 902 AVENUE D 4075 TIMBERLINE ST 2620 W FAIDLEY AVE 710 WEST STATE ST 1602 W 2ND ST 423 W 4TH ST 3224 W 13TH ST 2105 S LOCUST ST 2444 W FAIDLEY AVE 218 CENTRAL AVE 611 N HIGHWAY 6 214 N BROADWAY AVE 1115 W 2ND ST 1021 W 14TH ST 700 W 2ND ST 405 E 14TH ST 500 N HASTINGS AVE 2115 N KANSAS AVE STE 101 401 W 33RD ST STE 100 611 N BURLINGTON AVE

Page 377 of 679

Provider City COLUMBUS COZAD COZAD CREIGHTON CRETE DAVID CITY DAVID CITY DONIPHAN ELGIN ELKHORN ELKHORN FAIRBURY FALLS CITY FREMONT FREMONT FRIEND FULLERTON GENEVA GENOA GERING GIBBON GORDON GOTHENBURG GRAND ISLAND GRAND ISLAND GRAND ISLAND GRAND ISLAND GRAND ISLAND GRAND ISLAND GRAND ISLAND GRAND ISLAND GRANT GRETNA HARTINGTON HASTINGS HASTINGS HASTINGS HASTINGS HASTINGS HASTINGS HASTINGS HASTINGS

State

ZIP code

NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE

68601 69130-1729 69130-1772 68729-0085 68333-1554 68632-1627 68632-1637 68832 68636-4409 68022-2971 68022-4682 68352-2535 68355 68025-3536 68025-2592 68359-1030 68638-3152 68361-2007 68640-3039 69341-2817 68840-6206 69343-1501 69138-1900 68803-6553 68803-4205 68801 68801-5766 68801-4503 68803-2445 68801-8217 68803-4327 69140-3016 68028-4491 68739-4619 68901-4974 68901-3046 68901-5103 68901-3204 68901-5110 68901-2615 68901-2577 68901

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PRIEFERT PHARMACY DAVE'S PHARMACY HENDERSON PHARMACY HOLDREGE PHARMACY MIKES U SAVE PHARMACY ADAMS DRUG COMPANY INC ABC DRUG CO

Provider Name

(402) 768-6319 (308) 487-5212 (402) 723-4475 (308) 995-5414 (308) 995-4401 (308) 882-4949 (308) 237-2178

428 LINCOLN AVE 508 NIOBRARA 1060 N MAIN ST 516 W 14TH AVE STE 500 1317 HILL ST 513 BROADWAY 2123 CENTRAL AVE

HEBRON HEMINGFORD HENDERSON HOLDREGE HOLDREGE IMPERIAL KEARNEY

NE NE NE NE NE NE NE

68370-1526 69348 68371-9798 68949-1215 68949-1237 69033-3119 68847-5303

HAEBERLES GRAND CENTRAL PHARMACY MEDICAP PHARMACY SUN MART PHARMACY VALLEY PHARMACY INC BEMIS DRUG CHI HEALTH PHARMACY - LAVISTA MAIN STREET APOTHECARY BARMORE DRUG U SAVE PHARMACY LEX ALIVATION PHARMACY GENOA-QOL HEALTHCARE KOHLL'S PHARMACY & HOMECARE LINCOLN REGIONAL CENTER PHCY MEDICAP PHARMACY NATIONAL PHARMACY OPTION CARE RELYCARE LTC PHCY LINCOLN RELYCARE PHARMACY RUSS'S MARKET PHARMACY RUSS'S MARKET PHARMACY RUSS'S PHARMACY RUSS'S PHARMACY SOUTHEAST NEBRASKA CANCER CTR STOCKWELL PHARMACY SUPER SAVER PHARMACY SUPER SAVER PHARMACY SUPER SAVER PHARMACY SUPER SAVER PHARMACY THE PHARMACY UNIV OF NE HEALTH CENTER PHCY WELLNESS PHARMACY BLAKE PHARMACY GOOD LIFE DISCOUNT PHARMACY LOUP CITY RX SHOPPE INC

(308) 237-2545 (308) 234-8056 (308) 234-6086 (308) 234-3300 (308) 235-3936 (402) 717-9510 (402) 256-3511 (308) 324-4611 (308) 324-6325 (402) 476-5686 (253) 218-0830 (402) 476-3341 (402) 479-5343 (402) 435-4800 (402) 476-6231 (402) 423-1333 (402) 466-6083 (402) 466-7283 (402) 489-6085 (402) 421-1333 (402) 474-2102 (402) 435-8241 (402) 420-7000 (402) 423-8588 (402) 464-6297 (402) 464-8822 (402) 420-8269 (402) 466-7775 (402) 466-6082 (402) 472-7457 (402) 413-9950 (402) 234-3025 (308) 745-1614 (308) 745-2109

7 W 25TH ST 2706 2ND AVE STE A 3920 2ND AVE 211 W 33RD ST 129 S CHESTNUT 8248 S 96TH ST STE 101 201 E 2ND ST 600 N WASHINGTON ST 603 N WASHINGTON ST 8550 CUTHILLS CIR 2301 O ST STE 3 800 N 27TH ST 801 W PROSPECTOR PL 2555 KENSINGTON DR 3306 A ST 5831 S 58TH ST STE B 1219 N COTNER BLVD 1221 N COTNER BLVD STE 1 130 N 66TH ST 4400 S 33RD CT 1709 WASHINGTON ST 1550 S CODDINGTON AVE 201 S 68TH STREET PL STE 200 3811 S 27TH ST 840 FALLBROOK BLVD 233 N 48TH ST 2525 PINE LAKE RD 2662 CORNHUSKER HWY 1221 N COTNER BLVD STE 1 1500 U ST 4640 CHAMPLAIN DR STE 113 213 MAIN ST 707 O ST 133 S 7TH ST

KEARNEY KEARNEY KEARNEY KEARNEY KIMBALL LA VISTA LAUREL LEXINGTON LEXINGTON LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LINCOLN LOUISVILLE LOUP CITY LOUP CITY

NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE

68847-4432 68847-4430 68847-2485 68845-3456 69145-1256 68128-3126 68745-1989 68850-1916 68850-1915 68526-9474 68510-1124 68503-2599 68522-1970 68521-4758 68510-4512 68516-3649 68505-1837 68505-1879 68505 68516-1037 68502-2552 68522-4402 68510-2496 68502-5713 68521 68504-3598 68512-3632 68521-1464 68505-1837 68588 68521-4714 68037-6002 68853-8001 68853-8019

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 378 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FARRELL DRUG

Provider Name

(308) 345-1781

120 W B ST

MC COOK

NE

69001-3652

U SAVE PHARMACY AND MEDICAL SUPPLY MILFORD PHARMACY L T PEDLEY DRUG MOSERS U-SAVE PHARMACY HILLTOP DRUGS ETC WANEK PHARMACY MEDS & MORE NORTHEAST NEBRASKA LTC, LLC PONCA HILLS HEALTH & WELLNESS THE PILL BOX U SAVE PHARMACY MEDICINE MAN PHARMACY RX EXPRESS PHARMACY UNION PACIFIC RR EMP HLTH SYS PHCY U-SAVE PAVILION PHARMACY U-SAVE PHARMACY U-SAVE PHARMACY WESTFIELD PHARMACY CORNER DRUG STORE U SAVE PHARMACY OGALLALA AMBER PHARMACY ARJ INFUSION SERVICES, INC BAKER'S PHARMACY BAKER'S PHARMACY BAKER'S PHARMACY 30TH & WEBER BAKER'S PHARMACY EAGLE RUN BAKER'S PHARMACY LAKESIDE BAKER'S PHARMACY PEPPERWOOD BAKER'S PHARMACY PLAZA NORTH BAKER'S PHARMACY SADDLECREEK BROOKSIDERX, LLC CANCER SPECIALTY PHARMACY CHI HEALTH PHARMACY - FLORENCE CHI HEALTH PHARMACY - IMMANUEL CHI HEALTH PHARMACY 42ND AND L CHI HEALTH PHARMACY -LAKESIDE CHI HEALTH PHCY - BERGAN MERCY CHI HEALTH SPECIALTY PHARMACY CHI HLTH PHMCY - 161ST & MAPLE CHI HLTH PHMCY-132ND & CENTER

(308) 345-5670 (402) 761-2222 (308) 832-2815 (402) 873-3397 (402) 887-5551 (402) 887-5426 (402) 371-6673 (402) 371-0172 (402) 371-8780 (402) 844-8299 (402) 379-8728 (402) 652-3217 (308) 532-7010 (308) 534-8886 (308) 221-6993 (308) 532-0310 (308) 532-0310 (308) 532-5539 (402) 685-5883 (308) 284-2242 (402) 896-5000 (866) 451-8804 (402) 571-3122 (402) 333-6500 (402) 451-3980 (402) 965-8339 (402) 333-5351 (402) 964-0888 (402) 573-0947 (402) 556-5600 (402) 374-4021 (402) 334-6100 (402) 451-2125 (402) 572-2300 (402) 717-7055 (402) 758-5006 (402) 398-6781 (402) 398-5503 (402) 717-9770 (402) 717-9410

902 N HIGHWAY 83 610 1ST ST 419 N COLORADO AVE 1821 S 11TH ST 108 W 11TH STREET 410 M ST 1226 W PASEWALK AVE 120 N 27TH ST STE 200A 1800 SYRACUSE AVE 2700 W NORFOLK AVE 1001 W BENJAMIN AVE 748 MAIN ST 402 N JEFFERS ST 810 W REID AVE 611 W FRANCIS ST STE 130 211 WEST LEOTA ST 211 W LEOTA 1845 W A ST 301 N OAKLAND AVE 23 N SPRUCE ST 10004 S 152ND ST STE A 11304 ELM ST 4405 N 72ND ST 12025 W CENTER RD 7312 N 30TH ST 13250 W MAPLE RD 17370 LAKESIDE HILLS PLZ 505 N 155TH PLZ 5555 N 90TH ST 888 S SADDLE CREEK RD 11020 Q ST 17545 GOLD PLAZA 8613 N 30TH ST 6901 N 72ND ST 4220 L ST 16909 LAKESIDE HILLS CT #107 7710 MERCY RD STE 110 7710 MERCY RD STE 102 16101 EVANS STREET SUITE 101 13315 W CENTER RD STE 101

MC COOK MILFORD MINDEN NEBRASKA CITY NELIGH NELIGH NORFOLK NORFOLK NORFOLK NORFOLK NORFOLK NORTH BEND NORTH PLATTE NORTH PLATTE NORTH PLATTE NORTH PLATTE NORTH PLATTE NORTH PLATTE OAKLAND OGALLALA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA

NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE

69001-2981 68405-9611 68959-1654 68410 68756 68756-1423 68701-4944 68701-3286 68701 68701 68701-2804 68649-5003 69101-3931 69101-6583 69101-0614 69101 69101 69101-4534 68045-1132 69153 68138-3931 68144-4733 68134-2350 68144-3953 68112-2821 68164-2402 68130-2352 68154-3775 68134-1805 68106-1959 68137-3742 68130-5602 68112-1807 68122-1709 68107-1048 68130-4661 68124-2346 68124-2372 68116 68144-3449

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 379 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CHI HLTH PHMCY-15TH & FARNAM CREIGHTON U MED CTR CLINIC PHY

Provider Name

(402) 717-2780 (402) 449-4560

310 S 15TH ST 2412 CUMING ST STE 201

OMAHA OMAHA

NE NE

68102-2207 68131-1602

DIABETES SUPPLY CTR OF THE MIDLANDS EDS REXALL DRUG ELMWOOD PHARMACY FAMILY FARE PHARMACY GENOA-QOL HEALTHCARE HEM & ONCOLOGY CONSULT PHCY KOHLL'S PHARMACY & HOMECARE KOHLLS PHCY & HOMECARE KOHLLS PHCY & HOMECARE KOHLLS PHCY & HOMECARE KOHLLS PHCY & HOMECARE KUBAT PHARMACY KUBAT PHARMACY INC MEDICINE MAN PHARMACY

(402) 399-8444 (402) 342-1731 (402) 551-5200 (402) 896-1450 (402) 979-8011 (402) 572-3524 (402) 553-8900 (402) 342-6547 (402) 733-2000 (402) 895-3101 (402) 408-0012 (402) 731-4333 (402) 558-8888 (402) 496-9757

2910 S 84TH ST 2701 S 10TH ST 808 S 52ND ST 1221 S 203RD ST 4001 LEAVENWORTH ST STE 150A 6901 N 72ND ST STE 2244 5000 DODGE ST 2923 LEAVENWORTH ST 5110 L ST 12739 Q ST 622 N 114TH ST 2401 N ST 4924 CENTER ST 715 N 132ND ST

OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA

NE NE NE NE NE NE NE NE NE NE NE NE NE NE

68124-3213 68108-1610 68106-1802 68130-2808 68105-1026 68122 68132-2920 68105-2739 68117-1330 68137-3211 68154-1571 68107-2708 68106-3219 68154-4000

MIDWEST SURGICAL HOSPTIAL PHARMACY NCS OUTPATIENT PHARMACY NE MED PHCY AT LAURITZEN OP CNTR NE OR HOSPITAL RET PHCY

(402) 399-1975 (402) 691-5102 (402) 552-7999 (402) 609-3344

7915 FARNAM DR 17201 WRIGHT ST STE 200 4014 LEAVENWORTH ST 2808 S 143RD PLZ

OMAHA OMAHA OMAHA OMAHA

NE NE NE NE

68114-4504 68130-2042 68105 68144-5611

NEBRASKA MEDICAL CTR CLINIC PHARMAC NEIGHBORHOOD LTC PHARMACY ONE WORLD PHARMACY OPTION CARE QUANTUM MED PHARMACY REDLERS LTC PHARMACY STEIER PHARMACY SUPER SAVER PHARMACY THINK AKSARBEN PHARMACY TOWER PHARMACY EXPRESS U SAVE PHARMACY UNION PACIFIC HEALTH SYSTEM OM UROLOGY CANCER CENTER, P.C. U-SAVE PHARMACY U-SAVE PHARMACY VIA RX O'NEILL FAMILY PHARMACY ANDERSON PHARMACY GOOD LIFE DISCOUNT PHCY

(402) 559-5215 (402) 983-9600 (402) 502-5832 (402) 331-0980 (402) 339-4036 (402) 592-5244 (402) 572-3553 (402) 895-5644 (402) 506-9000 (402) 932-8709 (402) 934-2744 (402) 544-3740 (402) 991-8468 (402) 933-3311 (402) 493-3952 (402) 614-6363 (402) 336-2660 (308) 728-5922 (308) 728-3295

989200 NEBRASKA MEDICAL CTR 5115 S 111TH ST 4920 S 30TH ST STE 103 10918 JOHN GALT BLVD 3744 S 132ND ST 13831 CHALCO VALLEY PKWY # 101 6828 N 72ND ST 5710 S 144TH ST 7100 W CENTER RD 349 N 78TH ST 16869 AUDREY ST 1400 DOUGLAS ST STOP 0050 17607 GOLD PLZ 5011 S 108TH ST STE B 2728 N 108TH ST STE 105 825 N 90TH ST 317 E DOUGLAS ST 1429 M ST 125 S 16TH ST

OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA OMAHA ONEILL ORD ORD

NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE

68198-9200 68137 68107-1656 68137-2309 68144-3608 68138-6101 68122-1700 68137-2655 68106-2700 68114-3640 68136-3178 68179-1001 68130-5606 68137-2333 68164-3763 68114-2702 68763-1829 68862-1426 68862-1415

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 380 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name TOOLEY'S OSCEOLA PHARMACY CAMPBELL DRUG OSMOND PHARMACY CHI HEALTH PHARMACY - MIDLANDS KOHLLS PHCY & HOMECARE PETES PHARMACY THE APOTHECARY SHOP PLAINVIEW PHARMACY KELLER PHARMACY SVANDA PHARMACY VILLAGE PHARMACY BREHM DRUG INC SCHUYLER PHARMACY COMMUNITY PHARMACY AT REGIONAL WEST SCRIBNER PHARMACY MUERI DRUG PAC N' SAVE DISCOUNT PHARMACY SEWARD FAMILY PHARMACY WESTERN DRUG COMPANY SPALDING PHARMACY SPRINGFIELD DRUG YUNGDAHL'S APOTHECARY SUPERIOR PHARMACY SUTTON PHARMACY SYRACUSE TOWN & COUNTRY PHCY CHIEF DRUG STORE HASSELBALCH PHARMACY TEKAMAH DRUG COMPANY HOFMANN PHARMACY HEART CITY DRUG VALLEY PHARMACY SAUNDERS MEDICAL CENTER LTC URBAN CLINIC PHARMACY INC WAHOO PHARMACY & GIFTS U-SAVE PHARMACY U SAVE PHARMACY TOMS REXALL DRUG BARNAS RX DRUGS WISNER APOTHECARY ARBOR STATE PHARMACY CHARLIES U SAVE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number

State

ZIP code

(402) 747-8994 (308) 772-3333 (402) 748-3708 (402) 827-4200 (402) 331-8632 (402) 852-2322 (402) 385-3350 (402) 582-4202 (402) 755-2216 (308) 452-3672 (402) 746-3335 (308) 754-4611 (402) 352-3020

415 HAWKEYE STREET 311 MAIN ST 322 N STATE ST 11109 S 84TH ST STE 1841 1413 S WASHINGTON ST 643 G STREET 100 VALLEY VIEW DR STE 2 103 S MAIN ST 119 E 3RD ST 314 GRAND AVE 317 N WEBSTER ST 608 HOWARD AVE 122 W 16TH ST

Provider Street

OSCEOLA OSHKOSH OSMOND PAPILLION PAPILLION PAWNEE CITY PENDER PLAINVIEW PONCA RAVENNA RED CLOUD SAINT PAUL SCHUYLER

NE NE NE NE NE NE NE NE NE NE NE NE NE

68651 69154-6112 68765-5723 68046-4133 68046-4178 68420 68047 68769-4121 68770-7220 68869-1322 68970-2549 68873-2023 68661

(308) 630-1900 (402) 664-3133 (402) 643-3332 (402) 643-2918 (402) 646-4607 (308) 254-2032 (308) 497-2250 (402) 253-2000 (402) 764-2827 (402) 879-4234 (402) 773-4300 (402) 269-2001 (402) 335-3375 (402) 335-3303 (402) 374-2500 (402) 368-5385 (402) 376-5959 (402) 359-2284 (402) 443-4191 (402) 443-1630 (402) 443-4167 (402) 786-0225 (402) 375-2922 (402) 372-2108 (402) 821-2834 (402) 529-3550 (402) 645-3080 (402) 362-4429

3911 AVENUE B STE M-200 416 MAIN ST 544 SEWARD ST 1519 W HIGHWAY 34 STE 1 250 N COLUMBIA AVE 806 ILLINOIS ST 230 W ST JOSEPH ST 205 MAIN ST 313 COMMERCIAL ST 348 N CENTRAL AVE 210 N SAUNDERS AVE 448 5TH ST 123 S 3RD ST 143 S 3RD ST 410 SO 13TH STREET 103 E 2ND ST 265 N MAIN ST 123 E GARDINER ST 1760 COUNTY ROAD J 1760 COUNTY ROAD J 526 N LINDEN ST 13851 GUILDFORD ST STE D 216 E 7TH ST 124 N MAIN ST 124 W 3RD ST 1024 AVE E 203 S 7TH ST STE B 2029 N LINCOLN AVE

SCOTTSBLUFF SCRIBNER SEWARD SEWARD SEWARD SIDNEY SPALDING SPRINGFIELD STROMSBURG SUPERIOR SUTTON SYRACUSE TECUMSEH TECUMSEH TEKAMAH TILDEN VALENTINE VALLEY WAHOO WAHOO WAHOO WAVERLY WAYNE WEST POINT WILBER WISNER WYMORE YORK

NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE NE

69361-4617 68057 68434 68434-2338 68434-2226 69162-1642 68665-6007 68059-5203 68666-4414 68978-1715 68979-2511 68446-9302 68450-2456 68450-0537 68061-0009 68781-4793 69201-1840 68064-9715 68066-4152 68066-4152 68066-1961 68462-1453 68787-2213 68788-1416 68465-3143 68791-2248 68466-2101 68467-1025

Page 381 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BEDFORD PHARMACY SHAWS PHARMACY

Provider Name

(603) 472-3919 (603) 356-5888

209 ROUTE 101 1150 EASTMAN RD

BEDFORD CENTER CONWAY

NH NH

03110-5440 03813-4221

SUGAR RIVER PHARMACY OF CLAREMONT INDIAN STREAM HEALTH CNTR PHCY FISHERVILLE PHARMACY GRANITE STATE PHARMACY PENACOOK PHARMACY LLC PRESCRIPTION CENTER THE SHAWS PHARMACY THE PRESCRIPTION CENTER COLONIAL VILLAGE PHCY GENOA-QOL HEALTHCARE SHAWS PHARMACY WENTWORTH DGLAS HOSP EMPL PHCY FAMILY PHARMACY PROF ASSOC CARE PHARMACY-EPSOM SHAWS PHARMACY HOWE'S PHARMACY DICK HALL'S HOUSE-PHCY DEPT HENNIKER PHARMACY SHAWS PHARMACY HOLLIS PHARMACY PRICE CHOPPER PHARMACY GENOA-QOL HEALTHCARE DARTMOUTH-HITCHCOCK PHCY PRICE CHOPPER PHARMACY

(603) 542-6337 (603) 237-4170 (603) 565-0210 (603) 224-7429 (603) 753-6391 (603) 224-9591 (603) 228-2279 (603) 226-4848 (603) 746-4600 (603) 965-0255 (603) 437-9654 (603) 740-3253 (603) 632-5720 (603) 736-9308 (603) 524-5240 (603) 497-4771 (603) 646-9456 (603) 428-3456 (603) 464-4133 (603) 465-7100 (603) 352-2469 (603) 556-8477 (603) 653-3785 (603) 448-3753

109 PLEASANT ST 141 CORLISS LN 219 FISHERVILLE RD # C 5 CLINTON ST 305 VILLAGE ST 125 N MAIN ST 246 LOUDEN ROAD 246 PLEASANT ST STE 100 54 PARK LN 10 TSIENNETO RD 55 CRYSTAL AVE 789 CENTRAL AVE 505 US ROUTE 4 1912 DOVER RD 1400 LAKE SHORE RD 39 MAIN ST 5 ROPE FERRY RD 4 BRIDGE ST 276 W MAIN ST 6 ASH ST 16 ASH BROOK RD 111 CHURCH ST 1 MEDICAL CENTER DR 370 MIRACLE MILE

CLAREMONT COLEBROOK CONCORD CONCORD CONCORD CONCORD CONCORD CONCORD CONTOOCOOK DERRY DERRY DOVER ENFIELD EPSOM GILFORD GOFFSTOWN HANOVER HENNIKER HILLSBOROUGH HOLLIS KEENE LACONIA LEBANON LEBANON

NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH NH

3743 3576 03303-2074 03301-2303 03303-4508 03301-4921 3301 03301-2548 03229-3101 03038-1505 03038-1702 03820-2526 03748-3218 03234-4132 03249-2249 03045-1748 03755-1404 03242-3202 03244-5224 03049-6548 03431-5918 03246-3432 03756-1000 03766-2635

AMMONOOSUC COMM HLTH SRVCS,INC

(603) 444-7979

25 MOUNT EUSTIS RD

LITTLETON

NH

03561-3712

NORTHERN NEW ENGLAND COMPOUNDING SHAWS PHARMACY SHAWS PHARMACY ELLIOT PHCY AT RIVER'S EDGE GENOA-QOL HEALTHCARE KENS PHARMACY INC PILLPACK SHAWS OSCO PHARMACY SHAWS PHARMACY GENOA-QOL HEALTHCARE HARBOR CARE HEALTH AND WELLNESS MEDICINE WORLD INC

(603) 444-0094 (603) 444-6673 (603) 437-6933 (606) 663-3278 (603) 606-5920 (603) 623-2813 (855) 745-5725 (603) 429-0759 (603) 424-4519 (603) 318-2058 (603) 816-1966 (603) 881-9500

338 UNION ST 751 MEADOW ST 1 ORCHARD VIEW DR 175 QUEEN CITY AVE STE 1 1555 ELM ST STE A 36 ELM ST 250 COMMERCIAL ST STE 2012 7 CONTINENTAL BLVD 570 DANIEL WEBSTER HWY 7 PROSPECT ST STE 100 45 HIGH STREET 262 MAIN DUNSTABLE RD

LITTLETON LITTLETON LONDONDERRY MANCHESTER MANCHESTER MANCHESTER MANCHESTER MERRIMACK MERRIMACK NASHUA NASHUA NASHUA

NH NH NH NH NH NH NH NH NH NH NH NH

03561-5616 03561-3622 03053-3366 3101 03101-1203 03101-2724 03101-1142 03054-4303 03054-3430 03060-3921 3060 03062-1914

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 382 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SHAWS PHARMACY WINGATES PHARMACY COLONIAL PHARMACY-NEW LONDON ROBERTS SCARLETT PHARMACY HEALTH CENTER PHARMACY SUGAR RIVER PHARMACY

Provider Name

(603) 579-5445 (603) 882-9733 (603) 526-2233 (603) 526-2002 (603) 865-5445 (603) 863-4111

300 MAIN ST 129 MAIN ST 247 NEWPORT RD 276 NEWPORT RD STE 109 11 JOHN STARK HIGHWAY 46 JOHN STARK HWY

NASHUA NASHUA NEW LONDON NEW LONDON NEWPORT NEWPORT

NH NH NH NH NH NH

03060-4635 03060-2718 03257-5420 3257 3773 03773-1811

MARTINS POINT PORTSMOUTH PHARMACY CARE PHARMACY-ROCHESTER GENOA-QOL HEALTHCARE PERFORMIX SPECIALTY PHARMACY GOODWIN COMMUNITY HEALTH SHAWS PHARMACY WARNER PHARMACY PRICE CHOPPER PHARMACY SHAWS/OSCO PHARMACY CARE PHARMACY HUGGINS HOSPITAL PHARMACY PANTHER VALLEY PHARMACY & GIFTS ALLENTOWN PHARMACY VILLAGE PHARMACY ANDOVER APOTHECARY HOME DRUGS STORE QUICK MED PHARMACY ATLANTICARE PHARMACY JOGI DISCOUNT PHARMACY TRENTON AVENUE PHARMACY BAYSHORE PHARMACY WELLCURE PHARMACY AVENEL PHARMACY INC WELLCARE PHARMACY LLC JERSEY SHORE PHARMACY MEDICAP PHARMACY KRESS SPECIALTY APOTHECARY ALLCARE PHARMACY LLC BAYONNE PHARMACY BERGEN POINT APOTHECARY BMC PHARMACY BROADWAY CARE PHARMACY BROCKMANS PHARMACY DITTMARS PHARMACY HUDACKO PHARMACY

(603) 436-0562 (603) 332-4281 (608) 822-7168 (603) 870-9618 (603) 516-2752 (603) 773-5992 (603) 456-3556 (603) 298-9680 (603) 437-3481 (603) 515-1213 (603) 569-7521 (908) 852-8818 (609) 259-6121 (609) 259-2202 (973) 786-5300 (732) 774-3400 (732) 897-1500 (609) 441-7088 (609) 957-6499 (609) 345-8901 (732) 291-2900 (856) 288-2064 (732) 634-1914 (201) 428-8930 (609) 660-1111 (609) 698-2200 (856) 323-8723 (973) 453-4071 (201) 339-1200 (201) 436-5875 (201) 858-5215 (201) 437-5100 (201) 437-2175 (201) 339-0405 (201) 436-4488

161 CORPORATE DR 161 S MAIN ST 25 OLD DOVER RD UNIT B 25 PELHAM RD STE 104 311 ROUTE 108 100 SHAWS LN 11 E MAIN ST 285 PLAINFIELD RD 43 INDIAN ROCK RD 36 CENTER ST UNIT 3 240 SOUTH MAIN ST RT 517 VILLAGE SQUARE MALL 2 S MAIN ST 1280 YARDVILLE ALLENTOWN RD 4 LENAPE RD 814 MAIN ST 1221 MAIN ST 1401 ATLANTIC AVE STE 1000 1502 ATLANTIC AVE 3803 VENTNOR AVE 2 BAYSHORE PLZ 26 S WHITE HORSE PIKE 994 RAHWAY AVE 517 AVENEL ST 580 N MAIN ST 912 W BAY AVE STE 120 208 WHITE HORSE PIKE STE 9 590 AVENUE C 651 BROADWAY 110 W 4TH ST 29 E 29TH ST 516 BROADWAY 78 AVENUE C 924 BROADWAY 876 BROADWAY

PORTSMOUTH ROCHESTER ROCHESTER SALEM SOMERSWORTH STRATHAM WARNER WEST LEBANON WINDHAM WOLFEBORO WOLFEBORO ALLAMUCHY ALLENTOWN ALLENTOWN ANDOVER ASBURY PARK ASBURY PARK ATLANTIC CITY ATLANTIC CITY ATLANTIC CITY ATLANTIC HIGHLANDS AUDUBON AVENEL AVENEL BARNEGAT BARNEGAT BARRINGTON BAYONNE BAYONNE BAYONNE BAYONNE BAYONNE BAYONNE BAYONNE BAYONNE

NH NH NH NH NH NH NH NH NH NH NH NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

03801-6825 03867-3123 03867-3490 03079-4872 03878-1522 03885-6532 03278-4421 03784-2029 03087-1607 03894-4324 3894 07820-0000 08501-1600 08501-1818 07821-4568 07712-5910 07712-5940 08401-7022 08401-7011 08401-5944 07716-1109 08106-1303 07001-1946 07001-1149 08005-2594 08005-1290 08007-1322 07002-8829 07002-4710 07002-1150 7002 07002-3712 07002-2439 07002-3034 07002-3054

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 383 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JERRY'S DRUG & SURGICAL LIBERTY PHARMACY QUICK CHEK PHARMACY ST MARIA PHARMACY, CORP STOP & SHOP PHARMACY ULTRA CARE PHARMACY WELL CARE PHARMACY GENOA-QOL HEALTHCARE KAPLERS PHARMACY HEALTH FIRST PHARMACY QUICK CHEK PHARMACY FAR HILLS PHARMACY VALLEY PHARMACY MIDDLETOWN PHCY AND MED EQUIP ABBOTS DRUG STORE BARNABAS HEALTH RETAIL PHARMACY BELLEVILLE PHARMACY

Provider Name

(201) 339-1992 (201) 436-7000 (201) 437-2193 (201) 535-0440 (201) 823-8411 (201) 455-8200 (201) 455-8600 (732) 503-8958 (609) 492-9221 (732) 818-1882 (732) 349-6116 (908) 234-1101 (908) 658-4900 (732) 471-9100 (973) 759-8181 (973) 450-2581 (973) 759-1956

455 BROADWAY 208 BROADWAY 260-280 BROADWAY 1093 AVE C 1 LEFANTE DR 557 BROADWAY 779 BROADWAY 160 ATLANTIC CITY BLVD RM 11 BAY AND CENTRE ST 600 ATLANTIC CITY BLVD 658 ATLANTIC CITY BLVD 405 MAIN ST 75 WASHINGTON VALLEY RD 877 MAIN ST 531 WASHINGTON AVE 1 CLARA MAASS DRIVE 338 WASHINGTON AVE

BAYONNE BAYONNE BAYONNE BAYONNE BAYONNE BAYONNE BAYONNE BAYVILLE BEACH HAVEN BEACHWOOD BEACHWOOD BEDMINSTER BEDMINSTER BELFORD BELLEVILLE BELLEVILLE BELLEVILLE

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07002-3623 7002 7002 7002 07002-5024 07002-3829 07002-3943 08721-1229 8008 8722 08722-4048 07921-2605 07921-2119 07718-2001 07109-3332 7109 07109-3249

ESSEX ONCOLOGY OF NORTH JERSEY PA GOOD HEALTH PHARMACY P&P PHARMACY BELMAR TOWN PHARMACY BERGENFIELD PHARMACY BERLIN PHARMACY LLC PROFESSIONAL CENTER PHARMACY NORTH WARREN PHARMACY & GIFTS ICARE PHARMACY NEW JERSEY UROLOGY LLC PHARM-D RX STOP & SHOP PHARMACY TERRY DRUG COMPANY HOMETOWN PHARMACY MAIN PHARMACY OF BOONTON INC PRESTON DRUGS AND SURGICALS ACME SAV-ON PHARMACY BOYDS PHARMACY OF BORDENTOWN MAST PHARMACY & SURGICAL WARD PHARMACY UNION AVENUE PHARMACY-LEGEND BRADLEY BEACH PHARMACY RARITAN VALLEY PHARMACY BAYWOOD PHARMACY

(973) 759-3076 (973) 759-2761 (973) 759-2796 (732) 280-1600 (201) 384-2820 (856) 336-2855 (856) 767-6663 (908) 362-5156 (973) 429-0444 (973) 873-7000 (973) 743-3300 (973) 743-9218 (973) 338-7300 (973) 838-0909 (973) 334-0519 (973) 334-3460 (609) 324-2820 (609) 298-1811 (609) 298-7773 (609) 747-5758 (732) 356-3113 (732) 774-7174 (908) 429-5544 (732) 477-0600

36 NEWARK AVE STE 304 530 JORALEMON ST 570 BELLEVILLE AVE 911 MAIN ST 32 S WASHINGTON AVE STE 1 360 S WHITE HORSE PIKE UNIT C 339 N ROUTE 73 155 STATE ROUTE 94 194 BROAD ST STE B 1515 BROAD ST SUITE B 140 312 GLENWOOD AVENUE 8 FRANKLIN ST 1049 BROAD ST 36 MAIN ST # A 203 MAIN ST 131 HAWKINS PL 260 DUNNS MILL RD 118 FARNSWORTH AVE 338 FARNSWORTH AVE 310 WARD AVE STE 2 433 W UNION AVE 128 MAIN ST 1055 US HIGHWAY 202 N 323 DRUM POINT RD

BELLEVILLE BELLEVILLE BELLEVILLE BELMAR BERGENFIELD BERLIN BERLIN BLAIRSTOWN BLOOMFIELD BLOOMFIELD BLOOMFIELD BLOOMFIELD BLOOMFIELD BLOOMINGDALE BOONTON BOONTON BORDENTOWN BORDENTOWN BORDENTOWN BORDENTOWN BOUND BROOK BRADLEY BEACH BRANCHBURG BRICK

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07109-4121 07109-1844 07109-1308 07719-2723 07621-2325 8009 08009-9707 07825-2112 07003-2606 7003 7003 07003-5785 07003-2845 07403-1724 07005-1749 07005-1185 08505-4748 08505-1308 8505 08505-2335 08805-1220 07720-1030 08876-3936 08723-6875

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 384 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BRIARMILL PHARMACY HALCYON PHARMACY MERIDIAN AMBULATORY PHCY OMC NJHO ASSOCIATES LLC STOP & SHOP PHARMACY WOODRUFF'S DRUGS LIPKINS PHARMACY POWER'S PHARMACY KINGSWAY PHARMACY BURLINGTON PHARMACY MEDICINE EXPRESS PHARMACY SUNSET RX PHARMACY WAYNE PHARMACY BELL PHARMACY BROADWAY DISCOUNT PHARMACY DIRECT MEDS CAMDEN INC DOGANIEROS PHARMACY FARMACIA SAN ANTONIO FARMACIA SUNRAY GENOA-QOL HEALTHCARE HOMETOWN PHARMACY MIGUEL'S PHARMACY MILLY'S PHARMACY #15829 NORTHGATE COMM PHCY MED EQUIP GENOA-QOL HEALTHCARE REEF FAMILY PHARMACY STOP & SHOP PHARMACY CARTERET PHARMACY & SURGICALS THE MEDICINE SHOPPE SCHRAFT'S 2.0 TOWNE PHARMACY ADLERS PHARMACY LTC INC COVERED BRIDGE PHARMACY GENOA-QOL HEALTHCARE LAMBERTS PHARMACY NBN INFUSIONS INC PENN MEDICINE CHERRY HILL PHCY TETRA RX ROSVOLD PHARMACY SHOPRITE CINNAMINSON PHARMACY PFSP PROMPTCARE HOME INFUSION LLC

NR_0009_10823 10/2017

Provider Phone Number (732) 840-1800 (848) 241-3129 (732) 836-4545 (732) 840-8880 (732) 255-2660 (856) 451-6755 (856) 456-6121 (609) 893-4700 (973) 448-3702 (609) 386-0141 (609) 386-3630 (609) 521-4900 (973) 492-5400 (856) 963-4742 (856) 963-6333 (856) 966-0980 (856) 966-4400 (856) 964-4600 (856) 963-2900 (856) 288-1033 (856) 541-2990 (856) 757-0200 (856) 963-0300 (856) 541-8242 (609) 536-9227 (609) 465-0004 (201) 842-9985 (732) 541-5411 (973) 239-3339 (855) 724-7238 (973) 538-6787 (856) 685-7440 (856) 429-8700 (856) 315-1150 (856) 428-5888 (856) 669-0217 (856) 433-2877 (856) 751-8356 (856) 829-4877 (856) 303-2655 (844) 527-9486 (866) 776-6782

Provider Street 1820 LANES MILL RD 1659 ROUTE 88 WEST STE C 425 JACK MARTIN BLVD 1608 ROUTE 88 W STE 250 55 BRICK BLVD 30 N LAUREL ST 101 NEW BROADWAY 558 LAKEHURST RD 135 US HIGHWAY 46 301 HIGH ST 1005 SUNSET RD 1104 SUNSET RD 1481 RT 23 S STE 3 1201 HADDON AVE 315 S BROADWAY 1 COOPER PLAZA 1552 MOUNT EPHRAIM AVE 2319 FEDERAL ST 2500 FEDERAL ST 400 MARKET ST STE 200 2940 YORKSHIP SQ 3213 RIVER RD 2626 FEDERAL ST 433 N 7TH ST 128 CREST HAVEN RD STE 100 804 S ROUTE 9 675 PATERSON AVE 58 WASHINGTON AVE 792 POMPTON AVE 3 WING DR STE 102 103 RIDGEDALE AVE 100 DOBBS LN STE 205 1501 RT 70 E 53 HADDONFIELD RD STE 316 # 35 1601 KINGS HWY N STE 400 2 PIN OAK LN STE 250 1865 ROUTE 70 EAST 1930 RT 70 EAST 2702 ROUTE 130 N 141 ROUTE 130 S STE K 210 WESTFIELD AVE 51 TERMINAL AVE STE B

Page 385 of 679

Provider City BRICK BRICK BRICK BRICK BRICK TOWNSHIP BRIDGETON BROOKLAWN BROWNS MILLS BUDD LAKE BURLINGTON BURLINGTON BURLINGTON BUTLER CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAMDEN CAPE MAY COURT HOUSE CAPE MAY COURT HOUSE CARLSTADT CARTERET CEDAR GROVE CEDAR KNOLLS CEDAR KNOLLS CHERRY HILL CHERRY HILL CHERRY HILL CHERRY HILL CHERRY HILL CHERRY HILL CHERRY HILL CINNAMINSON CINNAMINSON CLARK CLARK

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

08724-1483 08724-3011 08724-7732 8724 8723 08302-1908 08030-2545 08015-6060 07828-2514 8016 08016-2251 08016-2208 7405 08103-3105 08103-1209 08103-1461 08104-1662 08105-1929 08105-1939 08102-1526 08104-2895 08105-4215 08105-1936 08102-2212 08210-1651 08210-2358 07072-1601 7008 07009-1229 07927-1017 07927-1611 08034-1436 8034 08002-4802 08034-2303 08003-1630 08003-2013 8003 08077-3015 08077-3373 07066-1539 7066

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

AJ'S PHARMACY INC NATURE MED PHARMACY LLC SUNNY PHARMACY CLIFTON PHARMACY & COMPOUNDING CNTR COLONIAL PHARMACY CUREMED PHARMACY DAMIANO PHARMACY JERUSALEM PHARMACY LAKEVIEW PHARMACY MEDICAL HOME PHARMACY MIDDLE VILLAGE PHARMACY, INC. NOUR PHARMACY RED APPLE PHARMACY SHEEFA PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY VAN HOUTEN PHARMACY CLINTON PHARMACY GRAYROCK PHARMACY STOP & SHOP PHARMACY COLONIA NATURAL PHARMACY COLTS NECK PHARMACY BOYD'S PHCY OF MANSFIELD INC ALERO HEALTH BARON DRUGS CRESSKILL PHARMACY HUDSON DRUG DAYTON PARK PHARMACY STOP & SHOP PHARMACY MEDICAL HOME PHARMACY ACE PHARMACY GERARD'S PHARMACY

Provider Name

(201) 945-0772 (201) 945-8006 (201) 313-9797

673 ANDERSON AVE 518 ANDERSON AVE 711 ANDERSON AVE

CLIFFSIDE PARK CLIFFSIDE PARK CLIFFSIDE PARK

NJ NJ NJ

07010-1919 07010-1636 07010-2032

(973) 777-2428 (973) 473-4000 (862) 225-9432 (973) 546-6700 (973) 340-6200 (973) 510-0250 (973) 772-0005 (973) 478-0600 (973) 955-4000 (973) 773-7000 (973) 772-7600 (973) 778-2800 (973) 779-7831 (973) 779-1122 (908) 735-5316 (908) 638-4000 (201) 784-7190 (732) 381-3400 (732) 780-5480 (609) 298-7474 (609) 662-4884 (908) 276-6100 (201) 568-4737 (201) 567-2235 (732) 329-2626 (732) 329-2935 (856) 393-7840 (862) 209-4555 (973) 627-0187

595 VAN HOUTEN AVE 828 CLIFTON AVE 353 CROOKS AVE 270 PARKER AVE 1414 MAIN AVE 244 LAKEVIEW AVE 251 CLIFTON AVE 393 PIAGET AVE 1578 MAIN AVE 1135 MAIN AVE 472 CLIFTON AVE 1187 BROAD ST 160 KINGSLAND RD 669 VAN HOUTEN AVE 30 MAIN ST 2004 STATE ROUTE 31 UNIT 4 400 DEMAREST AVE 515 INMAN AVE 420 STATE ROUTE 34 N STE 309 23202 COLUMBUS RD STE E 5 CEDAR BROOK DR STE 5 34 EASTMAN ST 2 UNION AVE 48 UNION AVE 365 GEORGES RD SUITE 5 24 SUMMERFIELD BLVD 4000 ROUTE 130 UNIT 17 16 POCONO RD STE 115 490 EAST MAIN ST

CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLIFTON CLINTON CLINTON CLOSTER COLONIA COLTS NECK COLUMBUS CRANBURY CRANFORD CRESSKILL CRESSKILL DAYTON DAYTON DELRAN DENVILLE DENVILLE

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07013-2113 07013-1816 07011-1660 07011-1400 07011-2157 07011-4051 7011 07011-3001 07011-2160 07011-2353 07011-3228 07013-3327 07014-1915 07013-2125 08809-1328 08809-2040 07624-2513 07067-1114 07722-1017 08022-1904 8512 07016-2109 07626-2125 07626-2125 08810-1513 08810-2438 8075 07834-2905 7834

ONCOLOGY & HEMATOLOGY SPCLSTS, PA DIRECT MEDS OF DOVER GOODALE PHARMACY STOP & SHOP PHARMACY DEVINES PHARMACY RAY PHARMACY HANOVER PHARMACY BRUNSWICK SQUARE PHARMACY

(973) 394-0332 (800) 394-5070 (973) 366-0976 (201) 385-6262 (732) 968-0003 (732) 968-1481 (973) 781-9877 (732) 257-5200

23 POCONO RD STE 100 400 W BLACKWELL ST 16 N SUSSEX ST 20 WASHINGTON AVE 374 NORTH AVE 2 S WASHINGTON AVE 434 RIDGEDALE AVENUE 1177 ROUTE 18

DENVILLE DOVER DOVER DUMONT DUNELLEN DUNELLEN E HANOVER EAST BRUNSWICK

NJ NJ NJ NJ NJ NJ NJ NJ

07834-3023 07801-2525 07801-3958 07628-3615 08812-1221 08812-1299 7936 8816

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 386 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

CENTRAL JERSEY ONCOLOGY CENTER PA LEXINGTON PHARMACY REGIONAL CANCER CARE ASSC PHRMC STOP & SHOP PHARMACY WINDSOR PHARMACY PHARMACY SERVICES AT NOVARTIS

(732) 390-7750 (732) 432-0999 (732) 390-0003 (732) 967-8680 (732) 257-3784 (862) 778-7900

J2 BRIER HILL CT 3 LEXINGTON AVE K2 BRIER HILL CT 647 STATE ROUTE 18 722 STATE ROUTE 18 1 HEALTH PLZ, BLDG 125, #184

EAST BRUNSWICK EAST BRUNSWICK EAST BRUNSWICK EAST BRUNSWICK EAST BRUNSWICK EAST HANOVER

NJ NJ NJ NJ NJ NJ

08816-3340 08816-5037 08816-3341 08816-3747 08816-3723 7936

EAST ORANGE PHARMACY & SURGICALS G & G DRUGS LEXANN PHARMACY LLC PARKWAY CENTRAL PHARMACY PROFESSIONAL PRESCRIPTION CENTER RITE CARE PHARMACY

(973) 674-5777 (973) 675-6684 (973) 678-1700 (973) 675-2951 (973) 678-9221 (973) 676-5959

310 CENTRAL AVE STE 111 575 CENTRAL AVE 333 CENTRAL AVE # 335 185 CENTRAL AVE 265 CENTRAL AVE 630 CENTRAL AVE

EAST ORANGE EAST ORANGE EAST ORANGE EAST ORANGE EAST ORANGE EAST ORANGE

NJ NJ NJ NJ NJ NJ

07018-2838 07018-1934 07018-2801 07018-3332 07018-3427 07018-1403

SHEEFA PHARMACY & WELLNESS CENTER WASHINGTON SHOP PHARMACY ALLTOWN PHARMACY OPTION CARE APOGEE BIO PHARM LLC BELL PHARMACY DEVINES PHARMACY EDISON PHARMACY INC FAITHFUL PHARMACY KENNEDY PHARMACY LOVING CARE PHARMACY MIDDLESEX ONCOLOGY OAK TREE PHARMACY STAR PHARMACY CUREXA BERGEN PHARMACY BERT'S PHARMACY BOB'S PHARMACY CAMACHO PHARMACY COMMUNITY PHARMACY CROSS ROADS PHARMACY ELIZABETH PHARMACY ELMORA HEALTHCARE GOETHALS PHARMACY

(973) 673-6800 (973) 676-0800 (732) 542-7773 (800) 373-1995 (732) 902-6575 (732) 985-1211 (732) 549-7117 (732) 985-5110 (732) 287-3999 (732) 515-9500 (732) 832-2862 (908) 757-9696 (732) 902-6434 (732) 777-1717 (609) 927-0390 (908) 994-9700 (908) 351-0644 (908) 351-9300 (908) 355-1784 (908) 469-6363 (908) 354-2060 (908) 994-1525 (908) 352-8808 (908) 527-1112

405 CENTRAL AVE 90 WASHINGTON ST 158 WYCKOFF RD 6 INDUSTRIAL WAY W STE C 180 RARITAN CENTER PKWY #101 1907 STATE ROUTE 27 1949 OAK TREE RD 2303 WOODBRIDGE AVE 511 OLD POST RD STE 6 1 LINCOLN HWY STE 3 1653 STATE ROUTE 27 # 2 34-36 PROGRESS ST STE B2 1700 OAK TREE RD 4 BRUNSWICK AVE 3007 OCEAN HEIGHTS AVE 240 WILLIAMSON ST STE 101 601 ELIZABETH AVE 321 WASHINGTON AVE 509 ELIZABETH AVE 1089 ELIZABETH AVE STE 5 700 EAST JERSEY STREET 1147 E JERSEY ST 162 ELMORA AVE 638 BAY WAY AVE

EAST ORANGE EAST ORANGE EATONTOWN EATONTOWN EDISON EDISON EDISON EDISON EDISON EDISON EDISON EDISON EDISON EDISON EGG HARBOR TOWNSHIP ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07018-2525 07017-1050 07724-1840 07724-2281 8837 08817-3212 08820-2036 08817-5561 08817-4684 8820 08817-3484 08820-1197 08820-2854 08817-2500 08234-7749 07202-3671 07206-1131 7202 07206-1130 07201-2984 7201 7201 07202-1148 7202

HOROWITZ - SPRMO PHCY & SURG SUPLS LEGACY DRUGSTORE

(908) 353-3282 (908) 352-0050

32 GROVE ST 400 S BROAD ST

ELIZABETH ELIZABETH

NJ NJ

07202-2327 07202-3502

NR_0009_10823 10/2017

Page 387 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MABEL'S PHARMACY MORRIS AVENUE PHARMACY SHOPSMART FOOD & PHARMACY SOUTH BROAD PHARMACY STOP & SHOP PHARMACY SUPERIOR PHARMACY TAKE CARE PHARMACY VILLAGE DRUGS WESTMINSTER PHARMACY ELMER PHARMACY BEST HEALTH PHARMACY ELMWOOD DRUGS BUCKLEYS DRUG STORE GENOA-QOL HEALTHCARE HANA GRAND PHARMACY LIBERTY PHARMACY MAIOS PHARMACY UNION HILL SUPREMO PHARMACY COMMUNITY CARE PHARMACY HOME TOWNE RX MEDICAL HOME PHARMACY FAIRLAWN PHARMACY LLC GARDEN PHARMACY JIFFY SCRIPTS RX PLYMOUTH PARK PHARMACY INC HOMECARE RX FAIRVIEW PHARMACY FANWOOD PHARMACY FARMINGDALE PHARMACY WEIS PHARMACY

Provider Name

(908) 353-6900 (908) 353-5200 (908) 355-2400 (908) 469-4061 (908) 820-9301 (908) 282-6300 (908) 351-5768 (908) 353-8200 (908) 352-7111 (856) 521-0710 (201) 794-2222 (201) 796-0400 (201) 569-1345 (201) 627-4407 (201) 568-9378 (201) 568-7868 (732) 536-4705 (732) 972-2333 (609) 896-2700 (609) 323-7503 (609) 403-8994 (201) 773-6090 (201) 797-6888 (201) 590-2884 (201) 797-0006 (877) 920-2090 (201) 840-8049 (908) 680-6936 (732) 938-9051 (973) 598-8913

809 ELIZABETH AVE 333 MORRIS AVE 570 N BROAD ST 605-607 S BROAD ST UNIT A 801 NEWARK AVE 214 2ND ST 182A ELMORA AVE 851 ELIZABETH AVE 577 N BROAD ST 201 FRONT ST 260 BROADWAY 73 BROADWAY 35 E PALISADE AVE 93 W PALISADE AVE RM 128 543 GRAND AVE 113 TENAFLY RD 345 UNION HILL RD 324 ROUTE 9 N 1668 N OLDEN AVENUE 1400 PARKWAY AVE 1440 PENNINGTON RD STE 4 14-25 PLAZA RD 13-38 RIVER RD 3110 PROMENADE BLVD 11-12 SADDLE RIVER RD 695 US HIGHWAY 46 STE 100 151 ANDERSON AVENUE 246 SOUTH AVE UNIT 104 73 MAIN ST 293 US HIGHWAY 206 UNIT 1

ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELIZABETH ELMER ELMWOOD PARK ELMWOOD PARK ENGLEWOOD ENGLEWOOD ENGLEWOOD ENGLEWOOD ENGLISHTOWN ENGLISHTOWN EWING EWING EWING FAIR LAWN FAIR LAWN FAIR LAWN FAIR LAWN FAIRFIELD FAIRVIEW FANWOOD FARMINGDALE FLANDERS

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07201-2708 7208 07208-3314 7202 07208-3514 07206-1901 07202-2114 07201-2755 07208-3364 8318 07407-3522 07407-3007 07631-2901 07631-2611 07631-4934 07631-2231 07726-1875 7726 08638-3209 08628-3021 08618-2669 07410-3546 07410-1813 7410 07410-5722 07004-1561 07022-1754 07023-1271 07727-1326 07836-9580

HUNTERDON HEMATOLOGY ONCOLOGY

(908) 788-6461

2100 WESCOTT DR

FLEMINGTON

NJ

08822-4603

HUNTERDON REGIONAL PHARMACY INC READING RIDGE PHARMACY STOP & SHOP PHARMACY BOYDS PHARMACY AR-EX PHARMACY QUICK CHEK PHARMACY MEDICINE TO GO PHARMACIES AMERICARE PRESCRIPTION SURG CT BERGEN CARE PHARMACY INC

(908) 788-6586 (908) 782-7576 (908) 782-2977 (609) 499-0100 (732) 738-1085 (732) 738-5885 (609) 242-1400 (201) 461-2472 (201) 461-4646

2100 WESCOTT DR FL 1 8 READING RD 334 HWY RTE 31 306 BROAD ST 370 NEW BRUNSWICK AVE 6 EGAN AVE 528 W LACEY RD 511 MAIN ST 1625 LEMOINE AVE STE 1

FLEMINGTON FLEMINGTON FLEMINGTON FLORENCE FORDS FORDS FORKED RIVER FORT LEE FORT LEE

NJ NJ NJ NJ NJ NJ NJ NJ NJ

08822-4603 08822-2081 8822 08518-1912 08863-2141 08863-1911 08731-1502 07024-4504 07024-5651

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 388 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name CENTER PHARMACY DUNN MEADOW PHARMACY FORT LEE PHARMACY & SURGICALS INCLINE HEALTH LLC STAR PHARMACY THE MEDICINE SHOPPE PHARMACY NORTH COUNTRY PHARMACY PLAINS PHARMACY SHOPRITE OF FRANKLIN PHARMACY WEIS PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY ULTRA CARE PHARMACY CENTRASTATE SPECIALTY SCRIPT MONMOUTH MIDDLESEX HEMA ONC POETS SQUARE PHARMACY PROVISION PHARMACY FRENCHTOWN PHARMACY INC ATLANTICARE PHARMACY JERSEY SHORE PHARMACY LTC MEDICAP PHARMACY GARFIELD PHARMACY MIDLAND DRUGS VARIETY DRUG GLEN RIDGE PHARMACY SUN PHARMACY GLEN ROCK MEDICAL PHARMACY ROCK RIDGE PHARMACY ROCK RIDGE PHARMACY GLOUCESTER CITY PHARMACY PHARMACY VALUE SEIFERTS PHARMACY GENOA-QOL HEALTHCARE HACKENSACK PHARMACY HACKENSACK UNIV MED CTR J AND J STATE STREET PHARMACY PLAZA PHARMACY STOP & SHOP PHARMACY YORKSHIRE PHARMACY INC SKYLANDS COMMUNITY PHARMACY WEIS PHARMACY STINES APOTHECARY

NR_0009_10823 10/2017

Provider Phone Number (201) 947-5550 (201) 949-3402 (201) 346-9202 (201) 676-3838 (201) 224-8877 (201) 944-1002 (973) 827-7340 (973) 827-7107 (973) 827-1806 (973) 209-4453 (201) 891-8706 (732) 422-4425 (732) 798-6076 (732) 414-1977 (732) 431-8400 (732) 409-1100 (732) 333-0226 (908) 996-4180 (609) 404-7444 (609) 748-1162 (609) 748-2449 (862) 225-9422 (973) 772-7966 (973) 779-5951 (973) 743-5900 (973) 429-9300 (201) 444-3200 (201) 444-4190 (201) 444-4190 (856) 456-7600 (201) 662-7949 (201) 861-2333 (201) 546-5839 (201) 488-1230 (201) 996-5427 (201) 820-3360 (551) 996-8744 (201) 342-0847 (201) 342-1999 (908) 852-3784 (908) 850-0056 (609) 261-9919

Provider Street 251 MAIN ST 1555 CENTER AVE, FIRST FLOOR 1562 LEMOINE AVE 331 TOM HUNTER RD 1400 ANDERSON AVE 2468 LEMOINE AVE 190 MUNSONHURST RD # 9 66 RT 23 270 STATE RT 23 STE F 140 ROUTE 23 816 FRANKLIN AVE 3391 ROUTE 27 STE 100 3191 STATE ROUTE 27 STE 3 901 W MAIN ST STE 162 326 PROFESSIONAL VIEW DR 10 THOREAU DR 30 W MAIN ST 20 RACE ST 54 W JIMMIE LEEDS RD 236 E JIMMIE LEEDS RD 335 E JIMMIE LEEDS RD 85 OUTWATER LN UNIT 7 600 MIDLAND AVE 50 PASSAIC ST 855 BLOOMFIELD AVE STE 1 989 BLOOMFIELD AVE 210 ROCK RD 191 ROCK RD 191 ROCK RD 520 MONMOUTH ST 7012 PARK AVE 6801 PARK AVE 395 MAIN ST 441 PASSAIC ST 92 2ND ST ROOM 121 298 STATE ST 20 PROSPECT AVE STE 102 380 W PLEASANTVIEW AVE 788 MAIN ST 78 MAIN ST STE 30 2045 RT 57 STE 101 1491 ROUTE 38

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Provider City FORT LEE FORT LEE FORT LEE FORT LEE FORT LEE FORT LEE FRANKLIN FRANKLIN FRANKLIN FRANKLIN FRANKLIN LAKES FRANKLIN PARK FRANKLIN PARK FREEHOLD FREEHOLD FREEHOLD FREEHOLD FRENCHTOWN GALLOWAY GALLOWAY GALLOWAY GARFIELD GARFIELD GARFIELD GLEN RIDGE GLEN RIDGE GLEN ROCK GLEN ROCK GLEN ROCK GLOUCESTER CITY GUTTENBERG GUTTENBERG HACKENSACK HACKENSACK HACKENSACK HACKENSACK HACKENSACK HACKENSACK HACKENSACK HACKETTSTOWN HACKETTSTOWN HAINESPORT

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07024-5709 07024-4612 07024-5635 07024-4608 07024-4405 07024-6206 7416 07416-0000 07416-2160 7416 07417-1311 8823 08823-1356 07728-2537 7728 07728-4666 07728-2210 08825-1012 08205-9401 08205-4134 08205-4127 7026 07026-1665 07026-3159 07028-1307 07028-1301 07452-1707 07452-1706 07452-1706 08030-1548 07093-4708 07093-4405 07601-5806 7601 7601 07601-5515 07601-1997 07601-8005 07601-4811 07840-1361 07840-3533 08036-2967

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FAMILY DRUG SHOPS HALEDON FIRST AID RX MERCERVILLE FAMILY PHARMACY BELLEVUE DRUG COMPANY

Provider Name

(973) 917-3175 (862) 237-7222 (609) 981-7555 (609) 561-0825

183 BELMONT AVENUE UNIT 4 397 HALEDON AVE SUITE # 102 2103 WHITEHORSE MERCERVILLE RD 254 BELLEVUE AVE

HALEDON HALEDON HAMILTON HAMMONTON

NJ NJ NJ NJ

7508 07508-1551 08619-2641 08037-1752

PHARMACY PLUS & SURGICAL SPPLS LLC HEIGHTS SPECIALTY PHARMACY KRESSATYS PHARMACY HAWORTH APOTHECARY OLSSON'S PHCY-TAIBI'S FMLY PHY HAZLET PHARMACY INC THE MEDICINE SHOPPE SAIFF DRUGS & SURGICAL SUPPLY UNITE PHARMACY HIGHTSTOWN PHARMACY WINDSOR PHARMACY WEIS PHARMACY PASCACK PHARMACY CENTER PHARMACY FRANKLYN'S PHARMACY HO-HO-KUS PHARMACY ALBINI PHARMACY AVON PHARMACY CAREPOINT HEALTH PHARMACY HEALTH FAIR PHARMACY HOBOKEN FAMILY PHARMACY

(973) 900-9275 (201) 288-0404 (973) 835-1627 (201) 384-7171 (973) 427-1700 (732) 264-3310 (732) 888-7900 (732) 545-0687 (848) 209-9007 (609) 371-9000 (609) 308-2240 (908) 431-0161 (201) 664-5500 (908) 354-3169 (201) 444-5550 (201) 444-2026 (201) 798-5245 (201) 420-8300 (201) 418-2830 (201) 222-6968 (201) 420-7777

236 HARRISON AVE 450 BOULEVARD 1068 RINGWOOD AVE STE 1 169 TERRACE ST 576 LAFAYETTE AVE 2874 HWY 35 3253 STATE ROUTE 35 325 RARITAN AVE 75 RARITAN AVE 100 MAIN ST 222 DUTCH NECK RD STE 4 315 ROUTE 206 124 BROADWAY 1108 LIBERTY AVE 1 SHERIDAN AVE 622 N MAPLE AVE 401 ADAMS ST 222 JACKSON ST 308 WILLOW AVE 315 WILLOW AVE 307 1ST ST

HARRISON HASBROUCK HEIGHTS HASKELL HAWORTH HAWTHORNE HAZLET HAZLET HIGHLAND PARK HIGHLAND PARK HIGHTSTOWN HIGHTSTOWN HILLSBOROUGH HILLSDALE HILLSIDE HO HO KUS HO HO KUS HOBOKEN HOBOKEN HOBOKEN HOBOKEN HOBOKEN

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07029-1347 07604-1518 07420-1441 07641-1835 07506-2423 07730-1504 07730-1544 08904-2701 08904-2442 8520 08520-2508 08844-4627 07642-2024 07205-2103 07423-1538 07423-1591 07030-2630 7030 07030-3808 07030-3807 07030-2431

MEDICINE MAN PHCY & COMPOUNDING METRO DRUGS MODERN MEDICINE RX PREMIER PHARMACY SHOPRITE OF HOBOKEN TUCKER DRUGS WILLOW PHARMACY BAYSHORE HOMECARE PHARMACY INC HOLMDEL VILLAGE PHARMACY THE MEDICINE SHOPPE HOPEWELL PHARMACY FUTURE PHARMACY PARKWAY PHARMACY QUAIL CREEK PHARMACY RAMTOWN PHARMACY

(201) 942-9777 (201) 253-1100 (201) 420-9000 (201) 683-8647 (201) 792-9652 (201) 659-8492 (201) 659-4992 (732) 888-0303 (732) 946-8700 (973) 398-6066 (609) 466-1960 (732) 431-8170 (866) 355-7797 (732) 785-9711 (732) 840-3100

511 WASHINGTON ST 79 HUDSON ST 33-41 NEWARK ST STE 2B 101 PARK AVE STE 2 900 MADISON ST 1000 WASHINGTON ST 900 WILLOW AVE 733 N BEERS ST STE L1 969 HOLMDEL RD 50 HOPATCHUNG RD 1 W BROAD ST 979 US HIGHWAY 9 3502 US HIGHWAY 9 2 RAMTOWN GREENVILLE RD 145 NEWTONS CORNER RD

HOBOKEN HOBOKEN HOBOKEN HOBOKEN HOBOKEN HOBOKEN HOBOKEN HOLMDEL HOLMDEL HOPATCONG HOPEWELL HOWELL HOWELL HOWELL HOWELL

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

7030 07030-5638 07030-5627 07030-3785 07030-6404 07030-5202 07030-3041 07733-1513 07733-2124 07843-1581 08525-1901 07731-3365 07731-3345 07731-2762 7731

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 390 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SOMA PHARMACY STOP & SHOP PHARMACY ABELS PHARMACY BRIAR HILL PHARMACY CAMP DRUGS INC CARE PLUS PHARMACY CHANCELLOR PHARMACY LYONS PHARMACY SPRINGVIEW PHARMACY WELLNESS PLUS PHARMACY ISELIN PHARMACY ALL WELLNESS PHARMACY CAREL PHARMACY MERIDIAN VILLAGE PHARMACY PHARMAPLUS PHARMACY STOP & SHOP PHARMACY JAMESBURG DRUGS POINT OF CARE PHARMACY A PLUS DRUGS & SURGICAL LLC AHMAR PHARMACY AMERICAN PHARMACY BARNABAS HEALTH RETAIL PHARMACY BERGEN AVE DRUGS BOND DRUGS CAREPOINT HEALTH PHARMACY CENTRAL PHARMACY INC

Provider Name

(732) 987-9969 (732) 901-8882 (973) 373-6038 (973) 374-2001 (973) 375-8812 (973) 849-6563 (973) 399-2700 (973) 926-6496 (973) 372-1300 (973) 399-1150 (732) 283-1111 (732) 987-4209 (732) 364-4040 (732) 994-7387 (732) 370-4777 (732) 905-3050 (732) 521-7777 (732) 641-2664 (201) 451-4944 (201) 332-9333 (201) 333-6663 (201) 915-2166 (201) 521-0545 (201) 656-3900 (201) 217-4720 (201) 876-1100

3420 US HIGHWAY 9 4075 US HIGHWAY 9 635 GROVE ST 50 UNION AVE 850 18TH AVE 3 MARSHALL ST 894 CHANCELLOR AVE 471 LYONS AVE #79 4 ELMWOOD AVE 1076 SPRINGFIELD AVE 1186 GREEN ST 180 N COUNTY LINE RD 2010 W COUNTY LINE RD 27 S COOKS BRIDGE RD SUITE 1 10 S NEW PROSPECT RD 2275 W COUNTY LINE RD 24 W RAILROAD AVE 333 FORSGATE DR STE 104 8 BALDWIN AVE 53 BALDWIN AVE 509 W SIDE AVE 355 GRAND ST 745 BERGEN AVE 371 CENTRAL AVE 176 PALISADE AVE 438 CENTRAL AVE

HOWELL HOWELL IRVINGTON IRVINGTON IRVINGTON IRVINGTON IRVINGTON IRVINGTON IRVINGTON IRVINGTON ISELIN JACKSON JACKSON JACKSON JACKSON JACKSON JAMESBURG JAMESBURG JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07731-3343 07731-3307 07111-3719 07111-3262 07111-2756 07111-3622 07111-1214 7111 07111-1920 07111-2467 08830-2012 08527-4797 8527 8527 08527-1645 08527-2354 08831-1362 8831 07304-3154 07304-3155 07304-1515 07302-4321 7306 07307-2827 07306-1121 07307-2727

COMMUNITY PHARMACY & SURGICAL INC COSMO PHARMACY COURTHOUSE PHARMACY DIRECT MEDS OF JERSEY CITY DOWNTOWN PHARMACY DOWNTOWN PHARMACY EXCEL PHARMACY FAMILY PHARMACY INC FENNY PHARMACY FRIENDLY PHARMACY GARFIELD HEALTHCARE PHARMACY GOODTIME PHARMACY HEALTH AID DRUGS HEALTH CARE PHARMACY HEALTH CARE PHARMACY

(201) 333-4700 (201) 332-7008 (201) 653-4093 (201) 333-3524 (201) 885-2939 (201) 434-2200 (201) 239-5800 (201) 420-7737 (201) 333-2223 (201) 433-6990 (201) 434-6968 (201) 222-6655 (201) 653-1441 (201) 369-6918 (201) 432-6968

79 MONTICELLO AVE 402 PACIFIC AVE 570 NEWARK AVE 26 GREENSVILLE AVE 201 MORRIS BLVD 52 ESSEX ST 612 PAVONIA AVE 291 CENTRAL AVE 135 NEWARK AVE 360 MARTIN LUTHER KING JR DR 935 GARFIELD AVE 324 CENTRAL AVE 212 PALISADE AVE 1825 JOHN F KENNEDY BLVD 119 OCEAN AVE

JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

7304 07304-3748 07306-2330 7305 7302 07302-4508 7306 07307-2912 07302-2811 07305-3739 7304 7307 07306-1116 07305-2106 07305-2500

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 391 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HERBERT'S DRUG & SURGICAL SALES CO. HOME TOWNE RX HOOK PHARMACY HUDSON PHARMACY JERSEY DRUGS JFK PHARMACY MANHATTAN PHARMACY MASTROLIA PHARMACY NEW HORIZON PHARMACY NEWPORT PHARMACY NOBLE PHARMACY INC NORMAN'S PHARMACY PALACE DRUGS PALISADE DRUGS PAVONIA PHARMACY PECKMAN'S PHARMACY PINTOS PHARMACY POMARICO PHARMACY SACHIN PHARMACY INC SAINT MOSES PHARMACY SIP PHARMACY ST MARK PHARMACY SUMMIT CARE PHARMACY SUMMIT HEALTHCARE PHARMACY THE PRESCRIPTION SHOPPE ULTRA CARE PHARMACY VERONA PHARMACY VINALBA GREENVILLE PHCY, INC. VITALIS PHARMACY WELCOME PHARMACY WISDOM PHARMACY DRUGSMART PHARMACY KEANSBURG DRUGS ARLINGTON PHARMACY MIDTOWN PHARMACY FILIPPONES TOWN PHARMACY MORABITO'S PHARMACY SAV-ON DRUGS STOP & SHOP PHARMACY STOP & SHOP PHARMACY HIAWATHA HEALTH MART PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (201) 333-7250 (201) 792-1800 (201) 333-5189 (201) 432-5205 (201) 656-4392 (201) 356-9132 (201) 653-1725 (201) 653-8378 (201) 324-3900 (201) 963-1903 (201) 604-5812 (201) 435-8112 (201) 432-3300 (201) 222-9399 (201) 216-9666 (201) 433-1512 (201) 653-3154 (201) 434-8062 (201) 653-1200 (201) 984-2585 (201) 222-5452 (201) 792-9881 (201) 222-2721 (201) 333-6998 (201) 360-0600 (201) 433-9777 (201) 946-9500 (201) 433-8002 (201) 222-1800 (201) 333-0100 (201) 451-5388 (732) 769-5550 (732) 787-1414 (201) 991-2444 (201) 991-3454 (908) 276-8540 (908) 709-1414 (732) 264-0904 (732) 335-4281 (973) 838-6699 (973) 794-4909

Provider Street 753 BERGEN AVE 267 CENTRAL AVE 204 WASHINGTON ST STE 1B 2260 JOHN F KENNEDY BLVD 286 CENTRAL AVE 2818A JOHN F KENNEDY BLVD 3300 JOHN F KENNEDY BLVD 325 7TH ST 711 BERGEN AVE 165 ERIE ST 47 TONNELE AVE 501 JERSEY AVE 172 NEWARK AVE 338 PALISADE AVE 600 PAVONIA AVE 227 OCEAN AVE 161 PALISADE AVE 239 OLD BERGEN RD 295 CENTRAL AVE 1727 JOHN F KENNEDY BLVD 54 SIP AVE 875 BERGEN AVE 518 SUMMIT AVE 103 SUMMIT AVE 550 NEWARK AVE STE 101 568 W SIDE AVE 741 COMMUNIPAW AVE 1850 JOHN F KENNEDY BLVD 3495 KENNEDY BLVD 770 W SIDE AVE 2717 JOHN F KENNEDY BLVD 300 MAIN ST 199 MAIN ST 434 KEARNY AVE 581 KEARNY AVE 501 BOULEVARD 21 N 20TH ST 16 E FRONT ST 100 ROUTE 36 25 KINNELON RD 84 N BEVERWYCK RD

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Provider City JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY JERSEY CITY KEANSBURG KEANSBURG KEARNY KEARNY KENILWORTH KENILWORTH KEYPORT KEYPORT KINNELON LAKE HIAWATHA

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07306-4705 07307-3012 7302 07304-1462 07307-3013 07306-3942 07307-4212 07302-1802 07306-4801 07302-1717 07306-5412 07302-3457 07302-5827 07307-1753 07306-2929 07305-2613 7306 07305-2620 07307-2910 07305-1920 07306-3107 07306-4405 07306-2915 7304 07306-1362 07304-1741 07304-1707 07305-2122 7307 07306-6602 07306-5712 07734-2033 07734-1734 07032-2604 07032-2737 07033-1637 07033-1613 07735-1524 7735 07405-2337 07034-2607

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name JEFFERSON PHARMACY AMR PHARMACY LLC CTR FOR HLTH ED MED & DEN EMES PHARMACY GENOA-QOL HEALTHCARE LAKEWOOD DRUGS MADISON PHARMACY MEDICINE TO GO PHARMACIES PHARMEX PHARMACY LLC REFUA PHARMACY RIVER PHARMACY TAYLORS PHARMACY TRI-STATE PHARMACEUTICAL LLC WESTGATE PHARMACY MEDICINE SHOPPE SOLUS PHARMACY LLC HOFFMAN PHARMACY PENLAR PHARMACY THE MCGRATH PHARMACY DIRECT MEDS HANA HEALTHMART PHARMACY ARTHUR PHARMACY INC LINDEN PHARMACY PARK DRUGS SOUTHWOOD RITA PHARMACY ST GEORGES PHCY & HEALTHCARE BIENESTAR PHCY & WELLNESS CENTER EXPRESS SAVINGS PHARMACY LITTLE FALLS PHARMACY J T L PHARMACY LITTLE SILVER FAMILY PHARMACY BARNABAS HEALTH RETAIL PHARMACY BARNABAS HEALTH RETAIL PHCY LIVINGSTON PHARMACY MEDICAL CENTER PHARMACY NORTHFIELD PHARMACY ALLSTAR PHARMACY DEPT RIZZO'S PHARMACY ACE PHARMACY BARNABAS HEALTH RETAIL PHCY DIAMOND'S PHARMACY HOMESTEAD PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (973) 663-2550 (844) 267-7427 (732) 534-8559 (732) 942-1212 (732) 886-2999 (848) 245-0997 (732) 370-4200 (732) 367-5222 (732) 730-7700 (732) 942-9987 (732) 860-4000 (732) 363-0144 (888) 475-0761 (732) 370-2500 (609) 397-8889 (856) 282-4410 (732) 566-3304 (609) 895-0444 (609) 882-7777 (201) 585-0616 (201) 592-9888 (908) 583-6989 (908) 583-6665 (908) 486-1875 (908) 862-4444 (908) 925-4567 (856) 805-7991 (856) 566-1100 (973) 638-1561 (201) 641-7200 (732) 741-1121 (973) 322-2445 (973) 322-7315 (973) 597-1200 (973) 535-0900 (973) 992-4050 (973) 473-2243 (973) 473-6141 (732) 222-1481 (732) 923-6111 (732) 222-1299 (732) 222-5400

Provider Street 706 STATE ROUTE 15 S 1195 AIRPORT RD STE 9B 1771 MADISON AVE 415 CEDAR BRIDGE AVE 700 AIRPORT RD 101 PROSPECT ST STE 115 400 MADISON AVE 1000 ROUTE 70 EAST STE 7 1091 RIVER AVE 911 E COUNTY LINE RD 1201 RIVER AVE UNIT 3 123 MADISON AVE 1985 SWARTHMORE AVE STE 3 112 HILLSIDE BLVD 1509 ROUTE 179 805B WEST ATLANTIC AVENUE 1-7 LAURENCE PKWY 160 LAWRENCEVILLE PENNINGTON R 1251 LAWRENCEVILLE RD 345 GRAND AVE 330 BROAD AVE 223 N WOOD AVE 15 N WOOD AVE 1732 E SAINT GEORGES AVE 937 S WOOD AVE 332 W. ST GEORGES AVE 799 EMERSON AVE 593 BLACKWOOD- CLEMENTON RD 75 NEWARK POMPTON TPKE 191 MAIN ST 10 CHURCH ST 94 OLD SHORT HILLS RD, E WING 200 S ORANGE AVE 91 E MOUNT PLEASANT AVE 365 E NORTHFIELD RD 568 S LIVINGSTON AVE 105 TERHUNE AVE 122 S MAIN ST 186 BROADWAY 300 2ND AVE 444 OCEAN BLVD N 601 BROADWAY

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Provider City LAKE HOPATCONG LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAMBERTVILLE LAUREL SPRINGS LAURENCE HARBOR LAWRENCEVILLE LAWRENCEVILLE LEONIA LEONIA LINDEN LINDEN LINDEN LINDEN LINDEN LINDENWOLD LINDENWOLD LITTLE FALLS LITTLE FERRY LITTLE SILVER LIVINGSTON LIVINGSTON LIVINGSTON LIVINGSTON LIVINGSTON LODI LODI LONG BRANCH LONG BRANCH LONG BRANCH LONG BRANCH

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07849-2250 08701-5970 08701-1251 8701 08701-5907 8701 08701-3225 8701 08701-5641 08701-2069 08701-5676 8701 08701-4554 8701 08530-3447 8021 08879-2771 08648-1470 08648-3545 07605-2238 07605-1703 07036-4219 7036 07036-1729 07036-4567 7036 8021 08021-5901 7424 07643-1514 07739-1440 7039 07039-5817 07039-3005 07039-4810 7039 07644-2805 07644-2204 07740-7006 07740-6303 07740-7500 07740-5906

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WEST END FAMILY PHARMACY LONG VALLEY PHARMACY LTC SCRIPTS MT HOLLY PHARMACY LEVYS PHARMACY STOP & SHOP PHARMACY MADISON PHARMACY STOP & SHOP PHARMACY MEDICINE SOLUTIONS STAFFORD PHARMACY INC A PLUS PHARMACY LLC ANDEE PLAZA PHARMACY RX EXPRESS PHARMACY INC. ATLANTIC HEMATOLOGY ONCOLOGY EASY PHARMACY & SURGICALS SMITH BROS. DRUG COMPANY LEXANN PHARMACY & WELLNESS CNTR TOWN AND COUNTRY PHARMACY VAKIL APOTHECARY INC MARLBORO VILLAGE PHARMACY CROPWELL PHARMACY HEALTHVIA PHARMACY MARLTON PHARMACY MEDS N MORE PHARMACY SUCCESS MEDS LLC VILLAGE PHARMACY HALCYON PHARMACY MATAWAN PHARMACY PARK PLAZA PHARMACY STOP & SHOP PHARMACY SIMCARE PHARMACY MAYWOOD PHARMACY BOYD'S PHARMACY OF MEDFORD MEDFORD LEAS PHARMACY OLDE MEDFORD PHARMACY MENDHAM APOTHECARY, INC. ROBINSON DRUG SHOP EPISCOPO'S MERCERVILLE PHCY QUAKERBRIDGE PHARMACY RISOLDIS PHARMACY RYLA COMMUNITY PHARMACY BOYT PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (732) 229-2400 (908) 876-9000 (908) 876-0100 (609) 914-4890 (201) 438-1026 (201) 438-7835 (973) 377-0075 (973) 593-0539 (609) 994-3588 (609) 597-9625 (732) 308-9099 (732) 431-9400 (732) 851-7272 (732) 528-0760 (908) 722-7002 (856) 779-8300 (973) 763-0010 (973) 762-2700 (973) 763-5252 (732) 617-6060 (856) 596-7305 (856) 983-8700 (856) 983-9002 (856) 552-0890 (856) 596-3939 (609) 390-9594 (732) 970-5277 (732) 705-3722 (732) 290-9111 (732) 583-9500 (609) 625-2525 (201) 880-5290 (609) 975-8197 (609) 654-3099 (609) 654-6884 (973) 543-4400 (973) 543-2525 (609) 587-1980 (609) 587-1850 (609) 588-5445 (856) 320-2609 (732) 548-2125

Provider Street 134 BRIGHTON AVE 67 E MILL RD 62 E MILL RD STE B1 1613 ROUTE 38 UNIT 5 299 STUYVESANT AVE 425 LEWANDOWSKI ST 66 MAIN ST 133 MAIN ST 712 E BAY AVE STE 14 24 NAUTILUS DR STE 1 100 US HIGHWAY 9 STE 10 130 HWY ROUTE 33 STE 6 356 ROUTE 9 NORTH 1707 ATLANTIC AVE 931 KENNEDY BLVD 25 W MAIN ST 1885 SPRINGFIELD AVE 747 IRVINGTON AVE 2168 MILLBURN AVE STE 105 12 SCHOOL RD W 527 OLD MARLTON PIKE W 300 GREENTREE RD STE 8 1 EVES DR STE 101 795 ROUTE 70E STE G 9002 LINCOLN DR W STE C 38 TUCKAHOE RD 347E MATAWAN RD 1070 ROUTE 34 STE K 343 STATE ROUTE 34 207 LLOYD RD 8 CENTRAL AVE 102 W PLEASANT AVE 5 WILKINS STATION RD STE 100 1 MEDFORD LEAS 639 STOKES RD STE 101 88 E MAIN ST 2 E MAIN STREET 2427 NOTTINGHAM WAY 94 FLOCK RD 3100 QUAKERBRIDGE RD 4301 MAPLE AVE UNIT A 411 MAIN ST

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Provider City LONG BRANCH LONG VALLEY LONG VALLEY LUMBERTON LYNDHURST LYNDHURST MADISON MADISON MANAHAWKIN MANAHAWKIN MANALAPAN MANALAPAN MANALAPAN MANASQUAN MANVILLE MAPLE SHADE MAPLEWOOD MAPLEWOOD MAPLEWOOD MARLBORO MARLTON MARLTON MARLTON MARLTON MARLTON MARMORA MATAWAN MATAWAN MATAWAN MATAWAN MAYS LANDING MAYWOOD MEDFORD MEDFORD MEDFORD MENDHAM MENDHAM MERCERVILLE MERCERVILLE MERCERVILLE MERCHANTVILLE METUCHEN

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07740-5302 07853-3180 07853-3118 08048-2921 07071-1874 07071-2540 07940-1813 07940-2154 08050-3447 08050-2490 07726-3017 7726 07726-8262 08736-1147 08835-2007 08052-2411 07040-3419 07040-1607 07040-2670 07746-1507 08053-2041 08053-9418 08053-3125 08053-2351 08053-3204 08223-1206 07747-3926 7747 07747-9514 07747-1845 08330-1504 07607-1336 08055-9606 08055-2254 08055-3003 07945-1832 7945 08619-4107 8619 8619 08109-1818 08840-1836

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BORO HALL PHARMACY CRESTVIEW PHARMACY

Provider Name

(732) 968-0414 (732) 747-6833

565 BOUND BROOK RD 525 HIGHWAY 35

MIDDLESEX MIDDLETOWN

NJ NJ

08846-1535 7748

MEMORIAL SLOAN KETTERING MONMOUTH STOP & SHOP PHARMACY SUNRAY DRUGS & MEDICAL BOWKERS PHARMACY HOLLAND CENTER PHARMACY MILLTOWN PHARMACY QUICK MART PHARMACY HEALTH FIRST PHARMACY FRANKLIN PHARMACY MONROE PARK PHARMACY STOP & SHOP PHARMACY TEXAS ROAD PHARMACY GROVE PHARMACY KEIL'S PHARMACY BARRY'S MONTVILLE PHARMACY BARON II DRUG & SURGICAL DELRAN PHARMACY MORRIS PLAINS PHARMACY STOP & SHOP PHARMACY MOLNAR PHARMACY MORRISTOWN MEDICAL CENTER PHCY WHITE'S PHARMACY MOUNT ARLINGTON PHARMACY PINKS PHARMACY HIGH STREET PHARMACY LARCHMONT PHARMACY MT LAUREL PHARMACY CAMPBELLS PHARMACY AT FOODTOWN GARDEN PHARMACY JERSEY SHORE PHARMACY MERIDAN PHARMACY OPTIMAL PHARMACY PARKE WARNER PHARMACY WEST LAKE PHARMACY LAKELAND PHARMACY NEW BRUNSWICK PHCY & SURGICALS ULTRA CARE PHARMACY

(848) 225-6060 (732) 957-9355 (732) 671-0350 (908) 995-0666 (908) 995-0015 (732) 828-0080 (732) 745-7222 (856) 506-8556 (732) 446-5445 (732) 251-3000 (609) 409-0136 (609) 235-9368 (973) 744-5550 (973) 744-2113 (973) 335-6688 (201) 641-1110 (856) 764-5400 (973) 539-3635 (973) 683-9095 (973) 538-5053 (973) 971-6200 (973) 538-1023 (973) 601-3617 (973) 895-4900 (609) 267-6000 (856) 235-8888 (856) 581-0860 (732) 776-7575 (732) 922-4121 (732) 455-8102 (732) 776-4750 (732) 455-5646 (732) 774-3477 (732) 455-5885 (973) 347-0068 (732) 418-1100 (732) 543-1568

480 RED HILL RD STE 1136 850 STATE ROUTE 35 1151 STATE ROUTE 35 46 BRIDGE ST 621 MILFORD WARREN GLEN RD 21 N MAIN ST 100 RYDERS LN 1200 N HIGH ST STE 6 557 ENGLISHTOWN RD STE 14 357 SPOTSWOOD ENGLISHTOWN RD 1600 PERRINEVILLE RD 355 APPLEGARTH RD 123 GROVE ST 732 VALLEY RD 185 CHANGEBRIDGE RD 91 MOONACHIE RD 88 HARTFORD RD STE A 712 SPEEDWELL AVE 245 LITTLETON RD 76 MORRIS ST 100 MADISON AVE 60A SOUTH ST 181 HOWARD BLVD UNIT F-1 1250 SUSSEX TPKE 22 HIGH ST 200 LARCHMONT BLVD STE 5 3131 ROUTE 38 STE 6 116 3RD AVE 2467 STATE ROUTE 33 2040 HWY 33 1945 STATE ROUTE 33 34 ROUTE 35 UNIT 38 1201 STATE ROUTE 33 1828 W LAKE AVE 17 MAPLE AVE 159 FRENCH ST 272 GEORGE ST

MIDDLETOWN MIDDLETOWN MIDDLETOWN MILFORD MILFORD MILLTOWN MILLTOWN MILLVILLE MONROE TOWNSHIP MONROE TOWNSHIP MONROE TOWNSHIP MONROE TOWNSHIP MONTCLAIR MONTCLAIR MONTVILLE MOONACHIE MOORESTOWN MORRIS PLAINS MORRIS PLAINS MORRISTOWN MORRISTOWN MORRISTOWN MOUNT ARLINGTON MOUNT FREEDOM MOUNT HOLLY MOUNT LAUREL MT LAUREL NEPTUNE NEPTUNE NEPTUNE NEPTUNE NEPTUNE NEPTUNE NEPTUNE NETCONG NEW BRUNSWICK NEW BRUNSWICK

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

7748 07748-4203 07748-2605 08848-1224 08848-1631 08850-1518 08850-1254 08332-2588 08831-2947 08831-8600 08831-4923 08831-3733 07042-4021 07043-1521 07045-9563 07074-1016 08057-3736 07950-2231 07950-2921 07960-4108 07960-6136 07960-4136 07856-2314 07970-9001 08060-1702 08054-3379 8054 07753-6400 07753-3762 07753-6103 07753-4859 07753-4743 07753-5006 07753-4663 7857 08901-2341 08901-1314

UNIVERSITY PHARMACY AND SURGICAL

(732) 247-2900

303 GEORGE ST

NEW BRUNSWICK

NJ

08901-2020

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 395 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ZAJAC'S PHARMACY PLUMSTED PHARMACY AMCARE RX PHARMACY ANGELO PHARMACY BARNABAS HEALTH RETAIL PHCY BERGEN PHARMACY BERGEN PHARMACY BERGEN PHARMACY CLINTON AVE BESTCARE PHARMACY BRANCH BROOK PHARMACY BROADWAY HEALTH PHARMACY CAMPUS PHARMACY CITIHEALTH RX CLINTON PHARMACY & HEALTHCARE COLONIAL HEALTH PHARMACY COORDINATED CARE NETWORK PHCY D'ALLEGRO'S PUBLIC SRVCE PHCY DE ROSA PHARMACY FEINSTEINS PHARMACY FOOD DEPOT PHARMACY FOREST HILL PHARMACY FOURTH AVENUE PHARMACY FREEDOM PHARMACY GATEWAY PHARMACY GIANNOTTO PHARMACY GUARDY'S PHARMACY HARRIS PHARMACY INC HELLER PHARMACY JAY'S PHARMACY INC KAYES DRUG STORE KINGS PHARMACY KOMISHANE'S PHARMACY LISS PHARMACY METRO PHARMACY MICHAEL'S PHARMACY NEWARK COMMUNITY PHARMACY NICKS DRUGS NIKKY'S PHARMACY LLC OBENG PHARMACY- PHARMAMAIL OLSHINS PHARMACY PRIME AID PHCY OF NEWARK CORP QUICK STOP PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (732) 545-0582 (609) 758-8829 (973) 412-1000 (973) 589-6530 (973) 926-7422 (973) 926-9701 (973) 972-1960 (973) 273-1100 (973) 596-0060 (973) 412-7300 (973) 485-9150 (973) 824-8664 (862) 772-0442 (973) 375-6003 (973) 824-5010 (862) 237-7297 (973) 344-8663 (973) 482-6753 (973) 372-1894 (862) 240-1444 (973) 485-5094 (973) 483-3872 (973) 824-2627 (973) 732-6900 (973) 482-8220 (973) 482-2648 (973) 482-4968 (973) 482-5353 (973) 371-1325 (973) 926-4100 (973) 482-1556 (973) 399-0900 (973) 483-4749 (973) 424-0045 (973) 558-5940 (973) 481-2400 (973) 596-1800 (973) 374-6480 (862) 237-7601 (973) 344-9000 (973) 643-2400 (973) 639-1900

Provider Street 225 GEORGE ST 28 BRINDLETOWN RD 36 PARK AVE 492 FERRY ST 201 LYONS AVE 178-180 LYONS AVE 90 BERGEN ST STE 1600 194 CLINTON AVE 504 SPRINGFIELD AVE 917 FRANKLIN AVE 57 BROADWAY 195 CENTRAL AVE 23 COURT ST 784 CLINTON AVE 125 AVON AVE 268 MARTIN LUTHER KING JR BLVD 252 WALNUT ST 570 BLOOMFIELD AVE 295 16TH AVE 75 1ST ST 324 MOUNT PROSPECT AVE 329 ROSEVILLE AVE 953 FRELINGHUYSEN AVE 1 GATEWAY CTR 195 1ST AVE W 403-409 BLOOMFIELD AVE 519 BROADWAY 664 MOUNT PROSPECT AVE 850 S ORANGE AVE 1069 BERGEN ST 33 PARK AVE 199 STUYVESANT AVE 794 MOUNT PROSPECT AVE 727 FRELINGHUYSEN AVE 287 S ORANGE AVE 751 BROADWAY 800 BROAD ST 342-344 HAWTHORNE AVE 671 MARTIN LUTHER KING BLVD 114 CONGRESS ST 25B BRANFORD PL 198 MARKET ST

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Provider City NEW BRUNSWICK NEW EGYPT NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

08901-1322 08533-1802 7104 07105-3925 7112 7112 07103-2425 07108-2809 07103-2021 07107-2809 07104-2503 07103-3921 07102-2693 07108-1045 07108-2531 07102-2011 07105-1717 07107-1346 07103-1104 07107-3101 07104-2102 07107-1721 07114-2103 07102-5310 07107-2618 7107 07104-4132 07104-3110 07106-1941 07112-9991 07104-1043 07106-3020 07104-3221 07114-1348 07103-2438 07104-4309 07102-2760 07112-1688 7102 07105-1723 07102-2711 07102-3708

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RACHIT DRUG, INC. REGAL PHARMACY RMC PHARMACY ROSEVILLE PHARMACY ROXY PHARMACY SANFORD PHARMACY ST PETER PHARMACY SUMMER AVENUE PHARMACY TOWN TOTAL HEALTH LLC TRIMAX PHARMACY UNITED DRUGS VALUE PLUS PHARMACY WALTER J LEWIT INC WEISBROD'S PHARMACY LLC

Provider Name

(973) 926-0191 (973) 350-0500 (973) 732-9762 (973) 484-1258 (973) 242-8001 (973) 351-0099 (862) 240-9311 (973) 481-3388 (973) 757-1200 (973) 485-8522 (973) 482-9300 (973) 623-5566 (973) 623-1876 (973) 371-2771

233 LYONS AVE 684 MOUNT PROSPECT AVE 236 S ORANGE AVE 500 ORANGE ST 29 COURT ST 1041 S ORANGE AVE 15-17 ROPES PL. #106 205 SUMMER AVE 393 CENTRAL AVE 1299 MCCARTER HWY 507 CENTRAL AVENUE 563 BROAD ST 124 SPRUCE ST 980 S ORANGE AVE

NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK NEWARK

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07112-1737 07104-3110 07103-2459 07107-2944 07102-2605 07106-1716 7107 07104-2628 7103 07104-3711 7107 07102-4503 07108-3015 07106-1714

NEWTON MEDICAL CENTER COMM PHCY NEWTON RX LLC WEIS PHARMACY H-B DRUGS ST PHILO PHARMACY AMEEN PHARMACY ATLAS DRUG BROADWAY CONTINENTAL DRUGS BROADWAY PHARMACY GIARDINA PHARMACY HARRY'S PHARMACY DEPT. NORTH BERGEN PHARMACY NOVECKS PHARMACY INC. QUICK CHEK PHARMACY AQUAVITA PHARMACY MEDLIFE PHARMACY NORTH BRUNSWICK PHARMACY QUICK AID PHARMACY SMS PHARMACY DEBLIECK'S PHARMACY LANDMARK PHARMACY BUNTING FAMILY PHARMACY NAZHA CANCER CENTER US PHARMACY LAB BURGESS CHEMIST 2 GARYS PHARMACY WHITE OAK PHARMACY

(973) 940-8777 (973) 352-7394 (973) 383-4849 (201) 997-2010 (201) 955-6260 (201) 590-8776 (201) 869-5990 (201) 854-4800 (201) 766-9300 (201) 868-5700 (201) 662-7575 (201) 868-6900 (201) 869-1235 (201) 869-3553 (732) 658-3771 (732) 658-3636 (732) 940-9940 (732) 247-2333 (732) 658-3922 (973) 427-6300 (908) 412-9400 (609) 484-0026 (609) 383-6033 (844) 559-8334 (973) 235-0909 (973) 667-1003 (973) 667-1434

175 HIGH ST 55 MILL ST UNIT 7 121 WATER ST 98 RIDGE RD 38B RIDGE RD 7527 BERGENLINE AVE 8416 KENNEDY BLVD 7200 BROADWAY 7211 BROADWAY 6101 KENNEDY BLVD 7917 KENNEDY BLVD 7126 BERGENLINE AVE 7823 BERGENLINE AVE 7201 BERGENLINE AVE # 11 630 TOWNE CENTRE DR 2000 C ROUTE 27 NORTH 1825 US HIGHWAY 130 569 MILLTOWN RD 1463 FINNEGANS LN UNIT #11 467 HIGH MOUNTAIN RD 345 SOMERSET ST 1337 NEW RD UNIT A 411 NEW RD 130 HAZEL COURT 559 FRANKLIN AVE 349 FRANKLIN AVE 88 UNION AVE

NEWTON NEWTON NEWTON NORTH ARLINGTON NORTH ARLINGTON NORTH BERGEN NORTH BERGEN NORTH BERGEN NORTH BERGEN NORTH BERGEN NORTH BERGEN NORTH BERGEN NORTH BERGEN NORTH BERGEN NORTH BRUNSWICK NORTH BRUNSWICK NORTH BRUNSWICK NORTH BRUNSWICK NORTH BRUNSWICK NORTH HALEDON NORTH PLAINFIELD NORTHFIELD NORTHFIELD NORWOOD NUTLEY NUTLEY NUTLEY

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07860-1004 7860 07860-1420 07031-6318 07031-6339 07047-5459 07047-4265 7047 07047-5736 07047-3441 07047-4137 7047 07047-4942 07047-5416 08902-1236 8902 08902-3079 08902-3321 08902-5025 07508-2603 07060-4774 08225-1249 08225-1648 7648 07110-1746 07110-4004 07110-3374

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 397 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ADLERS OAK PARK PHARMACY OAKHURST PHARMACY OAKLAND DRUGS SHOP RITE PHARMACY WE CARE PHARMACY WICKAPECKO PHCY & MED SUPPLIES OCEANPORT PHARMACY ACE-RX SPECIALTY PHARMACY FUTURE PHARMACY LLC OLD BRIDGE DRUGS & SURGICALS SOUTHWOOD PHARMACY, INC. TEXAS ROAD PHARMACY THE WELLNESS CTR PHCY & SURG WOODLANE PHARMACY WOODS PHARMACY LLC GET RX HELP PHARMACY JAY'S PHARMACY E & M PHARMACY JASVIL PHARMACY VALUE MART PHARMACY WELLCARE PHARMACY ANTHONYS PHARMACY BENJAMINS PHARMACY BROAD PHARMACY INC RICHARD'S PHARMACY RODEO PHARMACY SEROM PHARMACY SOL PHARMACY PALMYRA PHARMACY BERGEN MEDICAL PHARMACY BERGEN REGIONAL MEDICAL CENTER PARAMUS PHARMACY STOP & SHOP PHARMACY VALLEY HEALTH PHARMACY E-Z HEALTHMART PHARMACY PARLIN PHARMACY QUICK MART PHARMACY GENOA-QOL HEALTHCARE GREENHILLS PHARMACY LIVWELL PHARMACY PARSIPPANY PHARMACY BEST PHARMACY & SURGICAL, INC.

NR_0009_10823 10/2017

Provider Phone Number (732) 229-4200 (732) 531-3784 (201) 337-7300 (201) 405-0707 (732) 775-3600 (732) 776-6070 (732) 542-8607 (732) 952-2244 (732) 952-5550 (732) 525-2220 (732) 254-7800 (732) 723-1101 (732) 679-3555 (732) 679-6000 (732) 656-9550 (201) 767-0095 (201) 262-1800 (973) 677-2800 (973) 675-7757 (973) 676-0866 (862) 444-3632 (201) 944-2720 (201) 945-7222 (201) 313-0111 (201) 947-8270 (201) 363-1181 (201) 242-1000 (201) 947-8877 (856) 786-1615 (201) 444-4322 (201) 967-4000 (201) 599-3366 (201) 445-4540 (201) 634-5799 (732) 561-3339 (732) 952-3022 (732) 238-4022 (973) 658-6685 (973) 887-9444 (973) 794-4991 (973) 917-3850 (973) 773-3300

Provider Street 67 MONMOUTH RD 1915 HWY 35 373 RAMAPO VALLEY RD 14 POST RD 3317 SUNSET AVE 1409 WICKAPECKO DR 271 E MAIN ST 2628 HIGHWAY 516 72 STATE ROUTE 34 200 PERRINE RD STE 200B 15 COUNTY ROAD 516 1183 ENGLISHTOWN RD 3117 US HIGHWAY 9 18 THROCKMORTON LN 151 TEXAS RD 173 OLD TAPPAN RD 223 KINDERKAMACK RD 325 HENRY ST 9 MAIN ST 314 MAIN ST 180 SCOTLAND ROAD 341 BROAD AVE 118 BROAD AVE STE N4 17 BROAD AVE 207 BROAD AVE 225 BROAD AVE # 202-203 210 BROAD AVE 450B BROAD AVE 1 E BROAD ST 1 W RIDGEWOOD AVE STE 100 230 E RIDGEWOOD AVE 61B E RIDGEWOOD AVE 859 N STATE RT 17 1 VALLEY HEALTH PLZ 1018 US HWY 9 S 499 ERNSTON RD 777 WASHINGTON RD STE 1 1259 US HIGHWAY 46 STE 100A 164 PARSIPPANY RD 1110 US ROUTE 46 1236 US HIGHWAY 46 919 MAIN AVE

Page 398 of 679

Provider City OAKHURST OAKHURST OAKLAND OAKLAND OCEAN OCEAN OCEANPORT OLD BRIDGE OLD BRIDGE OLD BRIDGE OLD BRIDGE OLD BRIDGE OLD BRIDGE OLD BRIDGE OLD BRIDGE OLD TAPPAN ORADELL ORANGE ORANGE ORANGE ORANGE PALISADES PARK PALISADES PARK PALISADES PARK PALISADES PARK PALISADES PARK PALISADES PARK PALISADES PARK PALMYRA PARAMUS PARAMUS PARAMUS PARAMUS PARAMUS PARLIN PARLIN PARLIN PARSIPPANY PARSIPPANY PARSIPPANY PARSIPPANY PASSAIC

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07755-1630 7755 07436-2704 07436-1614 07712-4554 07712-4201 07757-1145 08857-2306 08857-2879 08857-2836 08857-1402 08857-1319 08857-2690 08857-2570 8857 07675-7042 07649-2129 07050-2517 7050 07050-3613 7050 07650-1656 07650-2718 07650-1403 07650-1508 07650-1588 7650 07650-3631 8065 7652 07652-4142 07652-3609 07652-3103 07652-3619 8859 08859-1406 8859 07054-4913 07054-4708 7054 07054-2159 07055-8529

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FENNY 1 PHARMACY

Provider Name

(973) 928-2230

362 MONROE ST #C

PASSAIC

NJ

07055-4114

GOODMAN PHARMACY & SURGICAL INC GREEN CROSS PHARMACY HEALTH CARE PHARMACY MY FRIEND'S PHARMACY NEW LUCYS PHARMACY INC PASSAIC COMMUNITY PHARMACY INC PHARMACY PLUS & SURGICAL SUPPLIES QUICK CHEK PHARMACY VALUE PHARMACY & SURGICAL INC BARNERT PHARMACY BENGAL PHARMACY BILLSTRA PHARMACY CARMENS PHARMACY & MED SUPPLY CITYRX PHARMACY DOWNTOWN PHARMACY DRUG ZONE PHARMACY LLC FABIO'S PHARMACY FARMACIA DEL PUEBLO FARMACIAS DEL PUEBLO II FLORIDA DRUGS & LIQUOR HAMILTON PHARMACY INTERNATIONAL DRUGS IRVING PHARMACY KAY PHARMACY LA NUEVA MERCEDES PHARMACY MAIN FAIR PHARMACY MCDERMOTT PHARMACY MORT JACOBS PHARMACY PARK AVE PHARMACY PATERSON PHARMACY PHARMACY PLUS & SURGICAL SUPPLIES PRESIDENTIAL PHARMACY SHEEFA PHARMACY SINAI QUICK STOP PHARMACY STEIGNER PHARMACY INC SUSSMANS DRUGS TONY'S PHARMACY TONY'S PHARMACY VITAL PLUS PHARMACY WELLCARE PHARMACY LLC

(973) 777-2727 (973) 473-3727 (973) 473-4444 (973) 470-0566 (973) 778-4495 (973) 471-0160 (973) 471-9100 (973) 773-0055 (973) 916-1111 (973) 925-7200 (973) 595-5434 (973) 279-2200 (973) 279-0200 (973) 247-0786 (973) 742-5347 (973) 684-6991 (862) 257-3300 (973) 523-0500 (973) 523-2070 (973) 742-6313 (973) 345-1012 (973) 345-4900 (973) 742-8186 (973) 942-8296 (973) 279-2800 (973) 279-5510 (973) 790-8486 (973) 279-4600 (973) 928-8888 (973) 278-5808 (862) 257-9990 (973) 782-4955 (973) 345-4242 (973) 742-6556 (973) 278-2207 (973) 345-3991 (973) 742-1235 (973) 742-6655 (862) 267-0385 (973) 653-3077

296 PASSAIC ST 120 MARKET ST 15 BROADWAY 916 MAIN AVE 286-288 MONROE ST 339 PASSAIC ST 625 MAIN AVE 195 MAIN AVE 108 BROADWAY 680 BROADWAY SUITE 108 366 UNION AVE 608 21ST AVE 418 RIVER ST 7 W BROADWAY 127 MAIN ST 75 MARKET ST 88 MARKET ST 992 MADISON AVE # 994 22 MARKET ST 507 BROADWAY 177 MARKET ST 48 PARK AVE 382 MAIN ST 448 CHAMBERLAIN AVE 500 RIVER ST 87 MAIN ST 433 UNION AVE 506 PARK AVE 107 PARK AVE 430 MADISON AVE 900 MAIN ST 121 W BROADWAY 1029 MAIN ST 715 BROADWAY 688 MAIN STREET 422 10TH AVE 357 21ST AVE 534 21ST AVE 10 W. BROADWAY 693 E 18TH ST

PASSAIC PASSAIC PASSAIC PASSAIC PASSAIC PASSAIC PASSAIC PASSAIC PASSAIC PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON PATERSON

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07055-5813 07055-7625 07055-5007 7055 07055-5271 07055-5818 07055-3028 07055-5402 07055-3903 7514 07502-1931 07513-1210 07524-1902 07505-1014 07505-1040 07505-1205 07505-1208 07501-3636 07501-1721 07514-2811 07505-1701 07501-2207 07501-2840 07522-1009 7524 07505-1026 07502-1917 07504-1532 07501-2328 07524-2728 07503-2619 07522-2018 07503-2226 07514-1407 07503-2622 07514-1808 07501-3642 07513-1337 7505 07501-2375

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 399 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WILLIAMS PHARMACY VICTORY DAY PHARMACY,LLC BOYD'S PHARMACY-PEMBERTON INC PENNINGTON APOTHECARY AMERICARE 2 PHARMACY LAN PHARMACY PENNSCARE FAMILY PHARMACY MILLSTONE FAMILY PHARMACY ADVANCED PHARMACY AMBOY PHARMACY BUENA CARE PHARMACY CEDENOS PHARMACY LUDWIG'S PHARMACY MANGER PHARMACY MO'S PHARMACY RARITAN BAY PHARMACY & SURGICAL RENAISSANCE PHARMACY SANTA MARIA PHARMACY SMITH PHARMACY TOWN DRUGS AND SURGICAL MEDIMAX PHARMACY PHILLIPSBURG PHARMACY STOP & SHOP PHARMACY V CARE PHARMACY HEIGHTS PHARMACY STELTON PHARMACY INC STOP & SHOP PHARMACY VISHWAM RX PITMAN PHARMACY FRONT STREET PHARMACY PARK MADISON PHARMACY RAPPS PHARMACY INC SCOTT DRUGS LTD PLAINSBORO PHARMACY BUTLER PHARMACY INC. QUICK CHEK PHARMACY ATLANTICARE COMM PHCY POMONA ORGANIX PHARMACY SHOPPERS PHARMACY GERI SCRIPT SERVICES STOP & SHOP PHARMACY APOTHECO PHARMACY PRINCETON

NR_0009_10823 10/2017

Provider Phone Number (973) 523-0777 (856) 224-9800 (609) 894-8288 (609) 737-9297 (856) 356-2480 (856) 662-2700 (856) 514-2638 (732) 446-5050 (732) 324-4490 (732) 442-2033 (732) 324-5666 (732) 442-4478 (732) 442-6442 (732) 442-5580 (732) 934-5485 (732) 376-1600 (732) 979-2410 (732) 442-0163 (732) 661-6625 (732) 324-4200 (908) 454-4777 (908) 454-4352 (908) 859-8331 (908) 454-0727 (732) 885-1000 (732) 424-8080 (732) 968-4610 (848) 391-9512 (856) 589-2392 (908) 222-7100 (908) 412-1333 (908) 756-0008 (908) 754-1600 (609) 750-0101 (732) 892-4488 (732) 899-3310 (609) 404-4833 (973) 907-7440 (973) 835-9900 (973) 890-7735 (973) 839-5514 (609) 503-7731

Provider Street 305 BROADWAY 43 E BROAD ST 17 FORT DIX RD 6 N MAIN ST 5201 ROUTE 38 UNIT #116 5509 WESTFIELD AVE 182 N BROADWAY 221 MILLSTONE RD # 46 288 SMITH ST 186A SMITH STREET 147 SMITH ST 400 STATE ST 475 BRACE AVE 376 STATE ST 201 NEW BRUNSWICK AVE 501 NEW BRUNSWICK AVE 275 HOBART ST 432 HALL AVE 91 SMITH ST 238 SMITH ST 580 MARSHALL ST 96 BALTIMORE ST 1278 US HIGHWAY 22 362 S MAIN ST 10 PLAINFIELD AVE STE 1 179 STELTON RD 581 STELTON RD 1637 STELTON RD UNIT B6 39 S BROADWAY 204 E FRONT ST 400 W FRONT ST 611 PARK AVE 701 PARK AVE 9 SCHALKS CROSSING RD 2301 BRIDGE AVE 2809 ROUTE 88 65 W JIMMIE LEEDS RD 720 HAMBURG TPKE 750 HAMBURG TPKE 220 W PARKWAY UNIT 4-5 500 STATE RT 23 STE 13-14 10 FORRESTAL RD S STE 102

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Provider City PATERSON PAULSBORO PEMBERTON PENNINGTON PENNSAUKEN PENNSAUKEN PENNSVILLE PERRINEVILLE PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PERTH AMBOY PHILLIPSBURG PHILLIPSBURG PHILLIPSBURG PHILLIPSBURG PISCATAWAY PISCATAWAY PISCATAWAY PISCATAWAY PITMAN PLAINFIELD PLAINFIELD PLAINFIELD PLAINFIELD PLAINSBORO POINT PLEASANT BEACH POINT PLEASANT BEACH POMONA POMPTON LAKES POMPTON LAKES POMPTON PLAINS POMPTON PLAINS PRINCETON

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

07501-2102 08066-1451 08068-1439 08534-2221 8109 08110-1850 8070 08535-1214 08861-4042 8861 8861 8861 08861-3018 08861-3438 08861-4111 08861-3653 08861-3396 8861 8861 08861-4324 08865-2629 8865 08865-4123 8865 08854-4046 08854-3250 08854-3835 8854 08071-1493 07060-1317 7060 07060-1612 07060-1636 08536-1618 08742-4329 08742-2839 08240-9102 7442 07442-1452 7444 07444-1853 8540

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SANTE INTEGRATIVE PHARMACY THE PRINCETON PHARMACY FAMILY PHARMACY LLC SKAFF'S CORNER PHARMACY IRONIA PHARMACY LIVEWELL PHARMACY RANDOLPH PHARMACY GENOA-QOL HEALTHCARE MERIDIAN PHARMACY RIVERVIEW RED BANK FAMILY PHARMACY ANTHONY'S RIDGEFIELD PHARMACY HAN AH REUM PHARMACY STOP & SHOP PHARMACY TOWN & COUNTRY PHARMACY TOWN AND COUNTRY COMP & CONSLT VALLEY HEALTH PHARMACY PARAMOUNT DRUG THE MEDICINE SHOPPE ESSEX PHARMACY GALLO'S HEALTH MART PHCY ROCKAWAY PHCY & COMPOUNDING TENS PHARMACY FRIENDLY PHARMACY ROSELLE PARK RITA PHARMACY RUMSON PHARMACY READYSCRIP ADVANCED PHARMA WEST END PHARMACY THE MEDICINE SHOPPE SALEM PHARMACY MAIN STREET SPECIALTY PHARMACY SAYREVILLE PHARMACY INC QUICK CHEK PHARMACY SCOTCH HILLS PHARMACY CAMPBELL PHARMACY MARRAS DRUG STORE SHORT HILLS PHARMACY JOLIN'S PHARMACY SMILE PHCY & SURGICAL SUPPLIES AKSHAR PHARMACY HEALTHYBENEFITSRX MANDELL'S PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (609) 921-8822 (609) 924-4545 (609) 426-0441 (732) 381-4144 (973) 584-1717 (973) 775-9818 (973) 442-4020 (732) 842-7477 (732) 450-2602 (732) 530-9460 (201) 945-5503 (201) 943-8787 (201) 444-2800 (201) 652-0013 (201) 447-2020 (201) 447-8434 (856) 461-0953 (201) 664-5553 (201) 843-5920 (201) 843-1350 (973) 625-8558 (973) 226-1200 (908) 587-0020 (908) 245-1396 (732) 842-1234 (201) 549-8895 (201) 438-2164 (201) 291-0844 (856) 935-4800 (732) 475-3311 (732) 254-5858 (908) 322-2112 (908) 889-2322 (732) 974-2929 (201) 865-3540 (973) 379-3780 (856) 885-4510 (908) 756-3232 (732) 873-0040 (732) 951-1002 (732) 356-4395

Provider Street 200 NASSAU STREET 36 UNIVERSITY PL 2025 OLD TRENTON RD 1112 SAINT GEORGES AVE 400 DOVER CHESTER RD 477 STATE ROUTE 10 UNIT 13 124 STATE ROUTE 10 STE 4 270 STATE ROUTE 35 1 RIVERVIEW PLAZA 141 BROAD ST 676 SHALER BLVD 321 BROAD AVE 175 FRANKLIN AVE 60 E RIDGEWOOD AVE 106 PROSPECT ST 223 N VAN DIEN AVE 54 E SCOTT ST 653 WESTWOOD AVE 60 ESSEX ST STE 105 192 ROCHELLE AVE 25 W MAIN ST 178 EAGLE ROCK AVE STE 4 570 RARITAN RD 200 CHESTNUT ST 22 W RIVER RD 201 STATE RT 17 FL 11 311 UNION AVE 487 MARKET ST STE 9 228 E BROADWAY 881 MAIN STREET UNIT 4 89 MAIN ST 1928 WESTFIELD AVE 1819 E SECOND ST 2175 HIGHWAY 35 1285 PATERSON PLANK RD 40 CHATHAM RD 412 SICKLERVILLE RD STE 103 1110 HAMILTON BLVD UNIT 1A 225 DEMOTT LN 2013 STATE ROUTE 27 SUITE 1 7 CEDAR GROVE LN

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Provider City PRINCETON PRINCETON PRINCETON JUNCTION RAHWAY RANDOLPH RANDOLPH RANDOLPH RED BANK RED BANK RED BANK RIDGEFIELD RIDGEFIELD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIVERSIDE RIVERVALE ROCHELLE PARK ROCHELLE PARK ROCKAWAY ROSELAND ROSELLE ROSELLE PARK RUMSON RUTHERFORD RUTHERFORD SADDLE BROOK SALEM SAYREVILLE SAYREVILLE SCOTCH PLAINS SCOTCH PLAINS SEA GIRT SECAUCUS SHORT HILLS SICKLERVILLE SO PLAINFIELD SOMERSET SOMERSET SOMERSET

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

8542 08540-5116 08550-2412 07065-2665 07869-3909 07869-2142 07869-2415 07701-5920 07701-1864 07701-1923 07657-1749 7657 07450-3205 07450-3810 07450-4433 07450-2726 08075-3692 7675 07662-4347 07662-4111 07866-3435 07068-1341 07203-2446 07204-2263 7760 07070-2557 07070-1515 07663-5942 08079-1108 8872 08872-1561 07076-1714 7076 08750-1009 07094-3228 07078-2303 08081-2557 07080-2031 08873-4876 08873-3838 08873-1331

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ROBERT FEIN MD & DAVID RICHARDS MD SOMERSET PARK PHARMACY TOWNSHIP PHARMACY VERONICA PHARMACY WALD DRUGS MADURA PHARMACY NEW JERSEY RX LLC EASY PHARMACY AND SURGICALS SOUTH ORANGE PHARMACY STOP & SHOP PHARMACY DRUG MART DURHAM PHARMACY PETER PAN PHARMACY QUALITAS PHARMACY SERVICES TWIN CITY PHARMACY SOUTH RIVER PHARMACY HOMETOWN PHARMACY SPARTA PHARMACY STOP & SHOP PHARMACY MAIN PHARMACY-SPRING LAKE ACOHA DORSI'S PHARMACY KENNEDY PHARMACY VALLEY PHARMACY LISS MEDICAL ARTS PHARMACY LISS PHARMACY-SUMMIT BAKERS PHARMACY ALFORS PHARMACY ALVINS PHARMACY J & J PHARMACY PARKVIEW PHARMACY VILLAGE DRUGS COMMUNITY SURGICAL PHARMACY HC GOOD NEIGHBOR PHARMACY HOLIDAY CITY PHARMACY HORIZON PHARMACY MEDICAL MALL PHARMACY MULE ROAD PHARMACY PERSONAL TOUCH PHARMACY SILVERTON PHARMACY STOP & SHOP PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (732) 246-4882 (732) 846-6666 (732) 545-8800 (732) 227-4994 (908) 725-0585 (732) 721-1732 (732) 479-4349 (732) 667-7007 (973) 821-5414 (973) 762-5044 (908) 561-5300 (908) 548-8224 (908) 754-7607 (908) 851-7420 (908) 755-7696 (732) 257-0069 (609) 859-5633 (973) 512-3131 (973) 729-9161 (732) 449-6157 (973) 379-2111 (908) 647-7878 (856) 346-3535 (973) 584-4200 (908) 522-0111 (908) 277-0399 (973) 875-4141 (609) 268-2235 (201) 836-4586 (201) 836-7003 (201) 837-6368 (732) 542-7455 (732) 349-2990 (732) 503-4111 (732) 349-3999 (866) 635-0061 (732) 244-4747 (732) 244-3737 (848) 223-7300 (732) 255-4788 (732) 341-3620

Provider Street 75 VERONICA AVE STE 201 900 EASTON AVE STE 26 712 HAMILTON ST 84 VERONICA AVE 40 W MAIN ST 115 N BROADWAY 125 NORTH BROADWAY 34 MAIN ST 73 S ORANGE AVE 407 VALLEY ST 1249 W 7TH ST 124 DURHAM AVE UNIT 6 2125 PARK AVE STE A 603 MONTROSE AVE 1708 PARK AVE 54 MAIN ST 1805 ROUTE 206 UNIT 9 61 SPARTA AVE #B 60 SPARTA AVE 1206 3RD AVE 385 MORRIS AVE STE 100 184 CENTRAL AVE 42 LAUREL RD E STE 1900 107 ROUTE 10 E 33 OVERLOOK RD STE 102 407 SPRINGFIELD AVE 3842 MAIN ST 1572 ROUTE 206 115 CEDAR LN 527 CEDAR LN 1430 QUEEN ANNE RD 1201 SYCAMORE AVE STE 110 163 STATE HWY 37 W 1071 ROUTE 37 W UNIT 10 833 ROUTE 37 W 1591 RT 37 WEST UNIT F3 9 HOSPITAL DR STE B3 600 MULE RD UNIT 2 1580 LAKEWOOD RD UNIT 8 1824 HOOPER AVE 353 ROUTE 37 E

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Provider City SOMERSET SOMERSET SOMERSET SOMERSET SOMERVILLE SOUTH AMBOY SOUTH AMBOY SOUTH BOUND BROOK SOUTH ORANGE SOUTH ORANGE SOUTH PLAINFIELD SOUTH PLAINFIELD SOUTH PLAINFIELD SOUTH PLAINFIELD SOUTH PLAINFIELD SOUTH RIVER SOUTHAMPTON SPARTA SPARTA SPRING LAKE SPRINGFIELD STIRLING STRATFORD SUCCASUNNA SUMMIT SUMMIT SUSSEX TABERNACLE TEANECK TEANECK TEANECK TINTON FALLS TOMS RIVER TOMS RIVER TOMS RIVER TOMS RIVER TOMS RIVER TOMS RIVER TOMS RIVER TOMS RIVER TOMS RIVER

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

08873-5002 08873-1760 08873-3202 08873-3529 08876-2203 8879 8879 08880-1466 07079-1715 07079-2807 07080-1732 7080 07080-5401 07080-2601 07080-5519 08882-1225 08088-3558 7871 07871-1821 07762-1331 07081-1100 07980-1233 08084-1354 07876-1430 07901-3561 07901-2603 7461 08088-8882 07666-4442 07666-1710 07666-3518 07724-3208 8755 08755-5026 08755-5038 8755 08755-6425 08757-6461 08755-3287 8753 08753-5562

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name STOP & SHOP PHARMACY BURGIO'S PHARMACY COMMUNITY CARE RX NJ QUICK CHEK PHARMACY ALEXANDERS TWIN PHARMACY EPISCOPO'S PHARMACY INC HAMILTON PHARMACY HEALTH CARE PHARMACY, INC HENRY J. AUSTIN PHARMACY HOME TOWNE RX HOME TOWNE RX KING BOULEVARD PHARMACY MEDICAL HOME PHARMACY MEDICAL HOME PHARMACY OLDEN PHARMACY QUICK CHEK PHARMACY SHOPRITE OF HAMILTON SQUARE SIEGELS PHARMACY THE ROBBINS PHARMACY VIVA PHARMACY VIZZONI'S PHARMACY WESTSIDE PHARMACY IDEAL PHARMACY RESTORATION PHARMACY LLC STOP & SHOP PHARMACY AMERICA'S PHARMACY ANTHONY'S PHARMACY C.F. PARENTINI PHARMACY FARMACIA LATINA FARMACIA SAN JOSE FARMACIA SANTA MARIA GOODWILL PHARMACY HINES PHARMACY KWICKMED FARMACIA MYERSON PHARMACY OSCAR PHARMACY PRESCRIPTION CENTER PHARMACY PRIME AID PHARMACY CORP. TOLEDO PHARMACY TOWN PHARMACY UNION CITY PHARMACY WELLCARE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (732) 905-8180 (973) 790-3711 (973) 837-8044 (973) 790-5005 (609) 585-7222 (609) 393-3017 (609) 393-1776 (609) 695-3525 (609) 278-5931 (609) 695-2000 (609) 571-9820 (609) 396-6288 (609) 858-7560 (609) 989-1400 (609) 586-6661 (609) 883-5724 (609) 890-4160 (609) 394-8111 (609) 882-2404 (609) 337-7152 (609) 394-5784 (609) 394-0600 (908) 688-1801 (908) 688-8866 (908) 729-9082 (201) 867-5153 (201) 863-0631 (201) 863-2700 (201) 766-5526 (201) 864-1809 (201) 864-6307 (201) 758-5159 (201) 348-2667 (201) 758-8982 (201) 865-0844 (201) 751-4984 (201) 864-2004 (201) 864-0100 (201) 867-0297 (201) 766-1900 (201) 250-8290 (201) 590-9040

Provider Street 2360 ROUTE 9 137 UNION BLVD 225 ROUTE 46 W STE 4 79 UNION BLVD 1060 WHITE HORSE MERCERVILLE 1125 CHAMBERS ST 533 HAMILTON AVE 225 E STATE ST 321 N WARREN ST 635 S CLINTON AVE STE 400 359 PENNINGTON AVE STE 8 836 MLK JR BLVD 521 S BROAD ST 828 N OLDEN AVE 930 S OLDEN AVE 1535 PENNINGTON RD 1225 HIGHWAY 33 1201 S BROAD ST 2108 PENNINGTON RD 503 S OLDEN AVE 1616 S BROAD ST 215 N HERMITAGE AVE 2333 MORRIS AVE UNIT B # 101 1385 STUYVESANT AVE 1201 STUYVESANT AVE 1500 SUMMIT AVE 4300 PALISADE AVE 2517 BERGENLINE AVE 216 48TH ST 149 48TH ST 1115 NEW YORK AVE 4313 BERGENLINE AVE 2301 BERGENLINE AVE 4121C NEW YORK AVE 1019 SUMMIT AVE 4505 BERGENLINE AVE 1914 BERGENLINE AVE 3915 BERGENLINE AVE 3808 BERGENLINE AVE 4900 BERGENLINE AVE STE 2 3214 BERGENLINE AVE 3406 BERGENLINE AVE

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Provider City TOMS RIVER TOTOWA TOTOWA TOTOWA TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON TRENTON UNION UNION UNION UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY UNION CITY

State

ZIP code

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

08755-1929 07512-2641 7512 07512-2739 8610 08610-5801 08609-2625 08608-1800 08618-4741 08611-1831 08618-3615 8638 08611-1819 08638-4902 08610-5160 08618-1301 08690-2713 08610-6231 08638-1416 8629 08610-6036 08618-5511 07083-5714 7083 07083-3821 07087-1922 07087-5022 07087-3611 07087-6404 07087-6428 07087-4207 07087-5067 07087-3523 07087-4927 07087-5511 7087 07087-3304 07087-4899 07087-4819 07087-1611 07087-3935 07087-3922

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TERRYS DRUGS

Provider Name

(973) 239-2200

560 BLOOMFIELD AVE

VERONA

NJ

07044-1817

COMPLETECARE COMMUNITY PHARMACY HERNANDO'S HOMETOWN PHARMACY MAIN PHARMACY SOUTHERN ONCOLOGY HEMATOLOGY TRINITY PHARMACY SERVICES MEDILINK RX CARE WALDWICK PHARMACY COLFAX PHARMACY MY WALLINGTON PHARMACY SHIPPEE PHARMACY EDGEWOOD PHARMACY QUICK CHEK PHARMACY PLAINS PHARMACY RIVERVIEW PHARMACY STOP & SHOP PHARMACY VALLEY PHARMACY VALURX PHARMACY WAYNE PHARMACY PARK AVENUE PHARMACY AMES DRUG STORE STEVEN DRUGS, INC. WEST MILFORD PHARMACY BERGENLINE DRUGS CENTRAL PHARMACY CONTINENTAL DRUGS EMPIRE PHARMACY HEALTH CENTER PHARMACY HUDSON PHARMACY MULKAY DRUGS INC

(856) 696-1861 (856) 691-3784 (856) 692-6246 (856) 696-9550 (856) 794-5380 (856) 566-4300 (201) 445-1100 (732) 280-3535 (973) 777-4717 (973) 835-6871 (908) 754-4400 (908) 689-4210 (973) 694-5522 (973) 831-4080 (973) 305-5860 (973) 832-7200 (973) 513-9940 (973) 696-6667 (201) 552-9500 (856) 854-2022 (732) 222-4411 (973) 728-1400 (201) 867-0615 (201) 854-1829 (201) 854-3535 (201) 758-7800 (201) 861-7521 (201) 766-5060 (201) 854-4900

785 WEST SHERMAN AVE 741 E LANDIS AVE 80 S MAIN RD 1505 W SHERMAN AVE STE 101 1667 E LANDIS AVE 709 HADDONFIELD BERLIN RD 16 E PROSPECT ST 2510 BELMAR BLVD STE K-10 25 LOCUST AVE 636 RINGWOOD AVE 62B MOUNTAIN BLVD 30 BELVIDERE AVE 578 VALLEY RD 2405 HAMBURG TPKE STE C 1220 ALPS RD 791 HAMBURG TPKE 2075 HAMBURG TPKE STE 2A 1055 HAMBURG TPKE 3712 PARK AVE 701 COLLINGS AVE 349 MONMOUTH RD 1495 UNION VALLEY RD 5005 BERGENLINE AVE 335 60TH ST 6419 PARK AVE 6509 BERGENLINE AVE 6200 BERGENLINE AVE 5313 HUDSON AVE 6601 BROADWAY

VINELAND VINELAND VINELAND VINELAND VINELAND VOORHEES WALDWICK WALL WALLINGTON WANAQUE WARREN WASHINGTON WAYNE WAYNE WAYNE WAYNE WAYNE WAYNE WEEHAWKEN WEST COLLINGSWOOD WEST LONG BRANCH WEST MILFORD WEST NEW YORK WEST NEW YORK WEST NEW YORK WEST NEW YORK WEST NEW YORK WEST NEW YORK WEST NEW YORK

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

8360 8360 08360-7829 8360 08361-2942 08043-3714 7463 07719-3976 07057-1304 07465-2016 07059-5607 07882-1415 07470-3526 07470-6287 07470-3706 07470-8416 07470-6293 07470-3235 7086 08107-1725 07764-1150 07480-1361 07093-5563 07093-5412 7093 7093 07093-1619 07093-2615 07093-3249

NORTH HUDSON COMMUNITY PHARMACY PAN AMERICAN PHARMACY SINGER PHARMACY THE GALAXY DRUG STORE UNITED PHARMACY WEST ORANGE FAMILY PHARMACY MEDI CENTER PHARMACY WEST TRENTON PHARMACY BARON'S DRUG STORE TIFFANY NATURAL PHARMACY

(201) 520-9364 (201) 861-7966 (201) 864-1168 (201) 453-0555 (201) 758-1415 (973) 325-1020 (973) 256-0144 (609) 882-3131 (908) 232-6680 (908) 233-2200

5301 BROADWAY 232 60TH ST 5532 BERGENLINE AVE 7000 KENNEDY BLVD E 6014 B BERGENLINE AVE 443 MAIN ST 993 MCBRIDE AVE 618 BEAR TAVERN RD 243 E BROAD ST 1115 SOUTH AVE W

WEST NEW YORK WEST NEW YORK WEST NEW YORK WEST NEW YORK WEST NEW YORK WEST ORANGE WEST PATERSON WEST TRENTON WESTFIELD WESTFIELD

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ

7093 07093-2824 07093-4658 07093-4818 07093-1421 07052-5741 07424-2534 08628-2701 07090-2119 07090-1418

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 404 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WHARTON PHARMACY GARDEN STATE UROLOGY LLC THE MEDICINE SHOPPE WHITING PHARMACY EAST PARK PHARMACY DIGINO'S APOTHECARY FAMILY HEALTH & PRESC CENTER THE MEDICINE SHOPPE WOODBURY FAMILY PHARMACY PASSAIC VALLEY MEDICAL PHARMACY MILLERS OF WYCKOFF, INC SICOMAC PHARMACY LOWES PHARMACY #55 ABQ BESTCARE PHARMACY 1 LLC ABQ BESTCARE PHARMACY 2 LLC ALBUQUERQUE INDIAN HEALTH CTR ALBUQUERQUE PHARMACY BEST BUY DRUGS CAREMART DURAN CENTRAL PHARMACY FIRST NATIONS COM HEALTH PHCY GENOA-QOL HEALTHCARE HIGHLAND PHARMACY MENAUL COMPOUNDING PHARMACY NM ONCOLOGY HEMOTOLOGY CONSULTANTS

Provider Name

(862) 397-3133 (973) 240-2170 (732) 350-4535 (732) 849-3141 (609) 877-7600 (201) 365-0344 (609) 861-5124 (732) 636-0011 (856) 251-1900 (973) 256-0222 (201) 891-3333 (201) 891-0822 (575) 434-4130 (505) 836-0600 (505) 268-2030 (505) 248-7640 (505) 262-5739 (505) 299-4496 (505) 268-2411 (505) 247-4141 (505) 998-5520 (505) 585-0577 (505) 243-3777 (505) 291-1600

22 N MAIN ST 16 EDEN LN 63 LACEY RD STE I 200 LACEY RD 1 ROSE ST 255 VALLEY BLVD 621 DEHIRSCH AVE 458 AMBOY AVE 160 N BROAD ST 1225 MCBRIDE AVE STE 112 678 WYCKOFF AVE 300 SICOMAC AVE 675 10TH ST 2929 COORS BLVD NW STE 110 5400 GIBSON BLVD SE 801 VASSAR DR NE 500 LOUISANA BLVD STE A 1445 WYOMING NE 201 SAN PEDRO DR SE STE C 1815 CENTRAL AVE NW 5608 ZUNI RD SE 7850 JEFFERSON ST NE STE 301 717 ENCINO PL NE STE 1 11417 MENAUL BLVD NE

WHARTON WHIPPANY WHITING WHITING WILLINGBORO WOOD RIDGE WOODBINE WOODBRIDGE WOODBURY WOODLAND PARK WYCKOFF WYCKOFF ALAMOGORDO ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE

NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NM NM NM NM NM NM NM NM NM NM NM NM

07885-2220 07981-1402 08759-2966 8759 08046-2537 07075-1201 08270-2338 07095-2948 08096-1720 7424 07481-1430 07481-2132 88310-6769 87120-1272 87108-4729 87106-2725 87108 87112-3849 87108-3009 87104-1143 87108 87109-4315 87102-2611 87112-1794

(505) 822-3911

4901 LANG AVE NE

ALBUQUERQUE

NM

87109-4397

NORTH VALLEY CENTER FOR FAMILY & CO OPTION CARE PHARMACA INTEGRATIVE PHARMACY PHIL'S PHARMACY RX INNOVATIONS SAM'S REGENT PHARMACY SAV-ON DRUGS SAV-ON DRUGS SAV-ON DRUGS SAV-ON DRUGS SAV-ON DRUGS SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SMITHS PHARMACY

(505) 944-5353 (505) 797-8126 (505) 796-0387 (505) 265-6868 (505) 881-4601 (505) 346-0533 (505) 883-8703 (505) 821-1275 (505) 275-9733 (505) 294-1597 (505) 897-3961 (505) 877-2240 (505) 293-5247 (505) 831-4641 (505) 857-9783

3401 4TH ST NW 4374 ALEXANDER BLVD NE STE A-C 8910 HOLLY AVE NE 5510 LOMAS BLVD NE 7215 WASHINGTON ST NE 7120 WYOMING BLVD NE STE B7 4950 MONTGOMERY BLVD NE 7101 WYOMING BLVD NE 12201 ACADEMY RD NE 2801 EUBANK BLVD NE STE A 10131 COORS BLVD NW 1625 RIO BRAVO BLVD SW 11825 LOMAS BLVD NE 6600 CENTRAL AVE SW 8100 WYOMING BLVD NE STE A

ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE

NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM

87107-2423 87107-6818 87122-2947 87110 87109-4518 87109-4869 87109-1306 87109-4868 87111-8051 87112-1300 87114-4045 87105-6057 87112-5613 87121-8800 87113-1946

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 405 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SMITHS PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SOUTHWEST CARE CENTER

Provider Name

(505) 922-4303 (505) 877-4542 (505) 344-3509 (505) 884-0307 (505) 256-9443 (505) 266-7433 (505) 823-4480 (505) 292-5888 (505) 299-7621 (505) 897-1321 (505) 836-5322 (505) 296-9751 (505) 780-4044

4800 MCMAHON BLVD NW 1601 ARENAL RD SW 6125 4TH ST NW 4016 LOUISIANA BLVD NE 3701 CONSTITUTION AVE NE 6001 LOMAS BLVD NE 8040 ACADEMY RD NE 4700 TRAMWAY BLVD NE 5850 EUBANK BLVD NE 8301 GOLF COURSE RD NW 111 COORS BLVD NW 200 TRAMWAY BLVD SE 4710 JEFFERSON STREET SUITE A

ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE

NM NM NM NM NM NM NM NM NM NM NM NM NM

87114-5010 87105-4048 87107-5755 87110-1447 87110-5623 87110-6618 87111-1159 87111-2979 87111-6132 87120-5801 87121-2006 87123-3934 87109-2155

SW MESA CTR FOR FAMILY & COM HLTH THE MEDICINE CHEST THE PILL BOX PHARMACY UNIVERSITY HOSPITAL O/P PHARMACY

(505) 925-6051 (505) 344-2335 (505) 508-4106 (505) 272-0526

301 UNSER BLVD NW STE 106 1123 CANDELARIA RD NW 1010 BRIDGE BLVD SW STE B2 1209 UNIVERSITY BLVD NE

ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE

NM NM NM NM

87121 87107-2414 87105-3765 87102-1727

UNM HOSPITALS OUTPATIENT AND DISCHA

(505) 272-4239

2211 LOMAS BLVD NE # 4ACC

ALBUQUERQUE

NM

87106

UNMH PHARMACY AT SE HEIGHTS CLINIC VICTORS REGENT PHARMACY ZIA PHARMACY BESTCARE PHARMACY ANGEL FIRE BROWN DRUG LOWELL'S PHARMACY, LLC KARE DRUG BUCKLAND PHARMACY SHARE N CARE PHARMACY SHARE N CARE PHARMACY PHARMACY PLUS PHS-IHS SANTA ANA HLTH CLINIC PHCY KARE PHARMACY ADVANCED MEDICATION LA TIENDA PHARMACY SAV-ON PHARMACY SOUTHWEST PHARMACY EZ PHARMACY CITY DRUG PLAINS REGIONAL MED CTR PHCY RODEN SMITH PHARMACY

(505) 272-4563 (505) 877-1620 (505) 639-5857 (575) 208-1616 (575) 746-3591 (575) 746-6681 (505) 334-6411 (505) 864-7434 (505) 864-7471 (505) 864-7471 (505) 867-2336 (505) 867-2497 (505) 632-3324 (575) 885-2979 (575) 628-0637 (575) 885-2165 (575) 887-6611 (575) 824-5242 (575) 374-9121 (575) 769-7680 (575) 762-3848

8200 CENTRAL AVE SE STE 106 1643 ISLETA BLVD SW 2820 BROADBENT PKWY NE STE C UNIT B4, THE INN, HIGHWAY 434 322 W WASHINGTON AVE 612 N 13TH ST STE A 100 LLANO ST 600 DALIES AVE 701 DALIES AVE 701 DALIES AVE STE B 407 W HIGHWAY 550 2C DOVE RD 100 N CHURCH ST STE A 2402 W PIERCE ST STE 2B 1301 S CANAL ST 808 N CANAL ST 2402 W PIERCE ST STE 1A 550 E LISA DR, STE C 7 MAIN ST 2401 W 21ST STREET 601 E LLANO ESTACADO BLVD

ALBUQUERQUE ALBUQUERQUE ALBUQUERQUE ANGEL FIRE ARTESIA ARTESIA AZTEC BELEN BELEN BELEN BERNALILLO BERNALILLO BLOOMFIELD CARLSBAD CARLSBAD CARLSBAD CARLSBAD CHAPARRAL CLAYTON CLOVIS CLOVIS

NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM

87108-2408 87105-4633 87107-1621 87710 88210-2866 88210-1167 87410-2172 87002-3616 87002-3617 87002-3617 87004-5995 87004-5906 87413-5754 88220-3568 88220-6509 88220-2418 88220-3568 88081 88415-3037 88101 88101-3758

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 406 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

COCHITI HEALTH CLINIC PHARMACY CORRALES PHARMACY JICARILLA I.H.S PHARMACY SMITH'S PHARMACY FAIRVIEW PHARMACY SANTA CLARA HEALTH CENTER PHCY MICHAELS PRSCR CORNER EUNICE FOUR CORNERS COMPOUNDING PINON FAMILY PHARMACY SAN JUAN ONCOLOGY ASSOC, PC SMITH'S PHARMACY PARKHUST PHARMACY TRUST PHARMACY MICHAELS RX CORNER NORTE VISTA SAV-ON DRUGS JEMEZ HEALTH CENTER PHARMACY AMERICAN SPECIALTY PHARMACY

Provider Name

(505) 465-2587 (505) 897-3784 (505) 759-3291 (505) 286-9040 (505) 753-2209 (505) 753-9421 (575) 394-2311 (505) 327-4826 (505) 327-4826 (505) 564-6850 (505) 325-1774 (505) 287-4641 (505) 287-3913 (575) 392-2311 (505) 392-4503 (575) 834-0130 (575) 532-8919

255 COCHITI ST 4940 CORRALES RD STE 200 12000 STONE LAKE RD 2B HIGHWAY 344 730 N RIVERSIDE DR ROUTE 5 1024 MAIN STREET 2300-B EAST 30TH SUITE 101 2300 E 30TH ST BLDG B 735 W ANIMAS ST 600 E 20TH ST 1208 BONITA AVE SUITE A 1000 E ROOSEVELT AVE 2410 N FOWLER ST STE A 2402 N GRIMES ST 110 SHEEPSPRINGS RD 4371 E LOHMAN AVE

COCHITI PUEBLO CORRALES DULCE EDGEWOOD ESPANOLA ESPANOLA EUNICE FARMINGTON FARMINGTON FARMINGTON FARMINGTON GRANTS GRANTS HOBBS HOBBS JEMEZ PUEBLO LAS CRUCES

NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM

87072-9998 87048 87528 87015-6849 87532-2525 87532 88231 87401 87401-8991 87401-5616 87401-2108 87020 87020-2118 88240-2312 88240-2109 87024-0000 88011-8255

BEN ARCHER HEALTH CENTER PHARMACY

(575) 382-6812

1600 THORPE RD

LAS CRUCES

NM

88012-9776

BEN ARCHER HLTH CTR PHCY LAS CRUCES HEALTHCARE PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY DEL NORTE LONG TERM CARE PHCY DEL NORTE PHCY & HOME MED PLAZA DRUGS INC NAMBE DRUGS LOS ALAMOS SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY NEWSCRIPTS PHARMACY MICHAEL'S PRESCRIPTION CORNER NOWELL PHARMACY ALAMO NAVAJO PHARMACY MESCALERO PHS INDIAN HOSPITAL MAY PHARMACY MOUNTAINAIR MEDS & MORE LLC PECOS VALLEY MEDICAL CENTER, INC JOE'S PHARMACY CJ'S PILL BOX VILLAGE PHARMACY

(579) 528-7160 (575) 915-1538 (505) 541-1264 (505) 521-9841 (505) 434-6000 (505) 425-6241 (505) 425-5221 (505) 661-9560 (505) 662-4778 (505) 672-9457 (505) 865-3310 (505) 358-7155 (575) 396-2311 (575) 396-4242 (575) 854-2626 (575) 464-3844 (505) 832-9988 (505) 847-0242 (505) 757-7111 (505) 869-3646 (575) 356-4422 (505) 356-8555

1998 MOTEL BLVD 3865 E LOHMAN AVE STE 2 1285 EL PASEO RD 2551 E LOHMAN AVE 602 UNIVERSITY AVE 604 UNIVERSITY AVE 178 BRIDGE ST 111 CENTRAL PARK SQUARE 535 CENTRAL AVE 31 SHERWOOD BLVD 2580 MAIN ST NE 7103 4TH ST NW STE G 123 W AVENUE A 122 W ADAMS AVE HWY 169 MM 30 318 ABALONIE LOOP 600 CENTRAL 111 BROADWAY 199 HIGHWAY 50 3646 HIGHWAY 47 109 W 4TH ST 1719 S AVENUE D

LAS CRUCES LAS CRUCES LAS CRUCES LAS CRUCES LAS VEGAS LAS VEGAS LAS VEGAS LOS ALAMOS LOS ALAMOS LOS ALAMOS LOS LUNAS LOS RANCHOS LOVINGTON LOVINGTON MAGDALENA MESCALERO MORIARITY MOUNTAINAIR PECOS PERALTA PORTALES PORTALES

NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM

88007 88011-8292 88001-6000 88011-8233 87701-4248 87701-4248 87701-3427 87544-4020 87544-3202 87544-3730 87031-6340 87107-6675 88260-4211 88260-4010 87825 88340 87035 87036-0000 87552 87042-8468 88130-6306 88130-7241

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 407 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDICINE SHOPPE PHARMACY MESA PHARMACY SAV-ON DRUGS SMITH'S PHARMACY FARMERS UPTOWN PHARMACY PRIMM DRUG SAV-ON PHARMACY SIERRA BLANCA PHARMACY

Provider Name

(575) 445-0075 (575) 245-6372 (505) 892-2262 (505) 892-1866 (575) 623-0830 (505) 622-6571 (505) 622-7039 (575) 258-2456

1275A S SECOND ST 1279 S 2ND ST 4300 RIDGECREST DR SE 1000 RIO RANCHO DR SE 2800 N MAIN 700 N UNION AVE 1110 S MAIN ST 1206 MECHEM DR

RATON RATON RIO RANCHO RIO RANCHO ROSWELL ROSWELL ROSWELL RUIDOSO

NM NM NM NM NM NM NM NM

87740 87740-2234 87124-5911 87124-1051 88201 88201-3955 88203 88345-7206

ACOMA CANONCITO LAGUNA I.H.S PHCY PHS-IHS ZIA HLTH CLINIC PHCY FORT BAYARD MEDICAL CNT PHCY CHRISTUS ST VINCENT PHCY DEL NORTE PHCY & HOME MED HIGHLAND PHARMACY SANTA FE NAMBE DRUGS PHARMACA INTEGRATIVE PHARMACY SANTA FE IHS PHARMACY SAV-ON PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SOUTHWEST CARE CENTER ROUTE 66 PHARMACY GENOA-QOL HEALTHCARE SAV-ON PHARMACY KELLY'S PHARMACY MESA PHARMACY (SPRINGER) SMITH'S PHARMACY TAOS/PICURIS INDIAN HEALTH CTR DAVIS FLECK UNITED PHARMACY NEW MEXICO VETERAN CENTER PHCY BOB'S BUDGET PHARMACY WELLBORN PHARMACY ZUNI INDIAN HEALTH SERVICE JOLLY'S DRUG STORE - ALAMO SAV-ON PHARMACY JOLLY'S DRUG STORE LLC DAHL'S PHARMACY OF CARSON DAHL'S SPECIALTY PHARMACY RALEY'S DRUG CENTER SAVE MART PHARMACY SAVE MART PHARMACY

(505) 552-5393 (505) 867-5258 (575) 537-8745 (505) 913-5000 (505) 988-9797 (505) 983-7169 (505) 455-2256 (505) 820-1517 (505) 946-9389 (505) 982-4806 (505) 473-5563 (505) 471-7874 (505) 989-8154 (575) 472-5666 (575) 342-8900 (575) 388-0133 (575) 835-2125 (575) 483-2288 (505) 758-4823 (505) 758-4224 (505) 894-3055 (575) 894-4200 (575) 461-1200 (575) 461-2784 (505) 782-7521 (775) 725-3515 (702) 293-7592 (775) 726-3771 (775) 885-8881 (775) 461-3980 (775) 882-3116 (775) 883-1833 (775) 841-4436

I-40 EXIT 102 155 CAPITOL SQUARE DR # B 41 FORT BAYARD RD 465 SAINT MICHAELS DR STE 112 1691 GALISTEO ST 1676 HOSPITAL DR 70 CITIES OF GOLD RD 530 W CORDOVA RD STE B 1700 CERRILLOS RD 600 N GUADALUPE ST 2110 PACHECO 2308 CERRILLOS RD 649 HARKLE RD STE E 1128 HISTORIC ROUTE 66 1007 N POPE ST STE P 1956 HIGHWAY 180 E 312 N CALIFORNIA ST 308 COLBERT AVE 224 PASEO PUEBLO SUR 1090 GOAT SPRINGS ROAD 500 BROADWAY 992 S BROADWAY ST 511 S 2ND ST 315 S 2ND ST RTE 301 NORTH B ST 414 BROADWAY 1008 NEVADA HWY 800 N SPRING STREET 1851 N CARSON ST 1851 N CARSON ST SUITE C 3701 S CARSON ST 4348 S CARSON ST 3620 N CARSON ST

SAN FIDEL SAN YSIDRO SANTA CLARA SANTA FE SANTA FE SANTA FE SANTA FE SANTA FE SANTA FE SANTA FE SANTA FE SANTA FE SANTA FE SANTA ROSA SILVER CITY SILVER CITY SOCORRO SPRINGER TAOS TAOS TRUTH OR CONSEQUENCES TRUTH OR CONSEQUENCES TUCUMCARI TUCUMCARI ZUNI ALAMO BOULDER CITY CALIENTE CARSON CITY CARSON CITY CARSON CITY CARSON CITY CARSON CITY

NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NM NV NV NV NV NV NV NV NV

87049-0130 87053-6013 88026 87505-7621 87505-4780 87505-4754 87506-0938 87505-1844 87505-3554 87501-1456 87505 87505-3264 87505-4765 88435-2712 88061-5161 88061-7781 87801-4207 87747 87571 87571 87901 87901-3198 88401-2861 88401-2821 87327-0000 89001 89005-1825 89008 89701 89701-1216 89701-5534 89701-8500 89706-1925

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 408 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SMITH'S PHARMACY SMITH'S PHARMACY GOLDEN HEALTH PHARMACY RALEY'S DRUG CENTER SMITH'S PHARMACY ECONOMY UNITED DRUGS RIDLEY'S CLINIC PHARMACY RIDLEY'S PHARMACY DAHLS PHARMACY OF FALLON DAHL'S PHARMACY OF FERNLEY RALEY'S DRUG CENTER SMITH'S PHARMACY WASHOE TRIBAL HEALTH CENTER ABACUSRX PHARMACY, LLC ATLAS SPECIALTY PHARMACY DRUG PLUS PHARMACY EVERGREENS DRUGS LAS VEGAS INFUSION PHARMACY NATIONAL SPECIALTY PHCY LLC SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY #3206 SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY WELLNESS PHARMACY LLC RALEY'S DRUG CENTER VILLAGE PHARMACY ABC PHARMACY ADVANCED CARE RX PHCY 1 LLC ADVANCED CARE RX PHCY 2 LLC AEVA SPECIALTY PHARMACY AHF PHARMACY ALL CITY PHARMACY ALL IN ONE PHARMACY ASPCARES AVELLA LAS VEGAS II INC BENZER PHARMACY C&K PHARMACY LLC

NR_0009_10823 10/2017

Provider Phone Number (775) 885-9928 (775) 246-0920 (775) 753-5393 (775) 738-2779 (775) 777-1337 (775) 289-4929 (775) 289-3420 (775) 289-2671 (775) 423-3194 (775) 575-4435 (775) 782-2226 (775) 782-0160 (775) 265-4215 (702) 475-4297 (702) 744-8060 (702) 834-8152 (702) 269-1354 (702) 476-6996 (702) 832-3320 (702) 407-0258 (702) 568-0259 (253) 344-4830 (702) 565-7805 (702) 260-0065 (702) 837-6117 (702) 451-0468 (702) 565-6466 (702) 614-8674 (702) 912-1400 (775) 831-3111 (775) 831-1133 (702) 541-8000 (702) 331-6796 (702) 331-0284 (702) 558-2382 (702) 639-8110 (725) 465-7770 (702) 697-6501 (702) 912-4844 (702) 522-6483 (702) 891-0365 (702) 522-0844

Provider Street 599 E WILLIAM ST 2200 US HIGHWAY 50 E 247 BLUFFS AVE BLDG 1 2511 MOUNTAIN CITY HWY 1740 MOUNTAIN CITY HWY 696 AULTMAN ST 6 STEPTOE CIR 1689 GREAT BASIN BLVD 1870 W WILLIAMS AVE 805 E MAIN ST 1363 US HIGHWAY 395 N 1341 US HIGHWAY 395 N 1559 WATASHEAMU RD 1516 W WARM SPRINGS RD 301 N PECOS RD STE D 1590 W HORIZON RIDGE PKWY #130 10001 S EASTERN AVE STE 105 1510 W SUNSET RD STE 120 2970 SAINT ROSE PKWY #120 201 S STEPHANIE ST 575 COLLEGE DR 2910 BICENTENNIAL PKWY 190 N BOULDER HWY 1000 NO GREEN VALLEY PKWY 55 S VALLE VERDE DR 4602 E SUNSET RD 830 S BOULDER HWY 10616 S EASTERN AVE 80 N PECOS RD STE I 930 TAHOE BLVD 898 TANAGER ST 3050 E BONANZA RD STE 140 7512 WESTCLIFF DR 4161 S EASTERN AVE STE A3 2870 S MARYLAND PKWY STE 110 3201 S MARYLAND PKWY STE 218 821 N LAMB BLVD STE 4 2080 E FLAMINGO RD STE 310 501 S RANCHO DR STE G46 701 SHADOW LN STE 110 3035 S MARYLAND PKWY STE 120 6870 S RAINBOW BLVD STE 106

Page 409 of 679

Provider City CARSON CITY DAYTON ELKO ELKO ELKO ELY ELY ELY FALLON FERNLEY GARDNERVILLE GARDNERVILLE GARDNERVILLE HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON HENDERSON INCLINE VILLAGE INCLINE VILLAGE LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS

State

ZIP code

NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV

89701-4033 89403-7352 89801 89801-4496 89801-2411 89301-1555 89301-2692 89301-3154 89406-2644 89408-0027 89410-5495 89410-5301 89460-7455 89014 89074-1350 89012-3508 89052-3908 89014-6633 89052-4449 89012-4476 89015-7518 89044-4477 89015-5308 89074 89012-3433 89014-2202 89015-7521 89052-2926 89074-3379 89451-9451 89451-9475 89101-3706 89145-5175 89119 89109-1548 89109-2424 89110-5439 89119-5181 89106-4835 89106-4132 89109-2202 89118

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name CARE N HOME INC CENTRX PHARMACY CENTENNIAL HILLS CENTRX PHARMACY DESERT SPRINGS CENTRX PHARMACY SPRING VALLEY CENTRX PHARMACY SUMMERLIN CHOICE LV SPECIALTY PHARMACY CITY PHARMACY CNS SCRIPS LLC DOLCRX DTS PHARMACY & COMPOUNDING FAMILY CARE PHARMACY FIRST CLASS RX PHARMACY #2 FIRST CLASS RX PHARMACY LLC HEALTHCARE PARTNERS TENAYA ONC HUNTRIDGE DRUG KEN'S PHARMACY KIM'S BETTER HEALTH PHCY LLC LAS VEGAS DERMATOLOGY LIFEFIRST PHARMACY MLK PHARMACY NELLIS CARE PHARMACY OK'CARE PHARMACY ONEPOINT PATIENT CARE LLC OPTION CARE PARTELL SPECIALTY PHARMACY PARTELL SPECIALTY PHARMACY PHOENIX PHARMACY PRECISION SPECIALTY PHARMACY PROFESSIONAL RX PHARMACY PROVIDENCE PHARMACY QHR PHARMACY RAXO DRUGS INC REAL CARE PHARMACY RED ROCK PHARMACY REFILL PHARMACY LLC SAV ON PHARMACY SAV-ON DRUGS SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (702) 697-2105 (702) 470-2694 (702) 425-4939 (702) 425-4623 (702) 470-2695 (702) 487-5207 (702) 816-4277 (702) 731-4800 (702) 436-5279 (702) 331-0887 (702) 457-2100 (702) 202-3290 (702) 534-0325 (702) 735-7154 (702) 382-7373 (702) 384-3784 (702) 749-7800 (702) 456-3120 (702) 646-5433 (702) 272-0400 (702) 531-6523 (702) 538-9388 (702) 876-1616 (702) 258-0011 (702) 685-3800 (702) 791-3800 (702) 685-1233 (702) 405-9500 (702) 541-6023 (702) 778-3072 (702) 331-6388 (702) 369-9135 (702) 902-5400 (702) 754-3800 (702) 476-5888 (702) 435-7339 (702) 562-1832 (702) 363-3306 (702) 739-1508 (702) 260-4594 (702) 614-4331 (702) 796-2952

Provider Street 3050 E DESERT INN RD STE 124 6850 N DURANGO DR STE 108 2075 E FLAMINGO RD 5400 S RAINBOW BLVD 653 TOWN CENTER DR STE 100 7915 W SAHARA AVE #103 1131 E TROPICANA AVE # A-1 3370 PINKS PL STE F 801 S RANCHO DR STE A4 2208 E CHARLESTON BLVD STE B 5625 S RAINBOW BLVD STE F 1321 S RAINBOW BLVD STE 102 8846 S EASTERN AVE STE 100 2851 N TENAYA WAY #101 1144 E CHARLESTON BLVD 2202 W CHARLESTON BLVD STE 13 6850 SPRING MOUNTAIN RD #U-3 653 N TOWN CENTER DR STE 414 3233 W CHARLESTON BLVD STE 204 1100 N MARTIN L KING BLVD #E 348 N NELLIS BLVD 4845 S RAINBOW BLVD STE 403 444 E WARM SPRINGS RD 3920 W CHARLESTON BLVD STE X 8751 W CHARLESTON BLVD STE 120 5835 S EASTERN AVE STE 101 6096 S FORT APACHE RD # 100 2775 S JONES BLVD STE 100A 2560 E SUNSET RD STE 120 1729 E CHARLESTON BLVD STE F 765 N. NELLIS BLVD STE 7 3199 S EASTERN AVE 4718 E FLAMINGO RD 5243 W CHARLESTON BLVD STE 4 8536 DEL WEBB BLVD 5500 BOULDER HWY 10140 W FLAMINGO RD 11720 W CHARLESTON BLVD 7350 S RAINBOW BLVD 4800 BLUE DIAMOND RD 7975 BLUE DIAMOND RD 2885 E DESERT INN RD

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Provider City LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS

State

ZIP code

NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV

89121-3873 89149-4596 89119-5188 89118-1859 89144-0515 89117-1996 89119-6601 89102 89106-3870 89104-2049 89118-1855 89146-9047 89123-4829 89128-0453 89104-1558 89102-2229 89146-8820 89144 89102 89106 89110-5313 89103 89119-4200 89102-1633 89117-5481 89119-3031 89148-5585 89146-5655 89120-3517 89104-1986 89110 89169 89121-4709 89146-1304 89134-8676 89122-6010 89147-8385 89135 89139 89139 89178 89121-3603

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SMITHS PHARMACY SMITHS PHARMACY SMITHS PHARMACY SMITHS PHARMACY SMITHS PHARMACY SMITHS PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SOUTHWEST PHARMACY SPRING VALLEY PHARMACY SUN DRUG INC. SUNRISE MEDICAL PHARMACY SUNSET PHARMACY LLC THOMAS DERMATOLOGY INC TRINITY PHARMACY TRUE CARE PHARMACY TRUE CARE PHARMACY UNIQUE CARE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (702) 839-9256 (702) 395-6912 (702) 515-1466 (702) 658-6669 (702) 240-3788 (702) 838-7548 (702) 457-1503 (702) 877-2162 (702) 869-9503 (702) 633-6222 (702) 294-7202 (702) 647-2799 (702) 617-1074 (702) 248-1854 (702) 240-7055 (702) 248-6510 (702) 431-9135 (702) 438-1091 (702) 220-7911 (702) 871-6550 (702) 878-7414 (702) 631-6745 (702) 658-3870 (702) 791-0517 (702) 452-0224 (702) 341-8181 (702) 946-1204 (702) 451-5536 (702) 837-0821 (702) 256-1984 (702) 254-0823 (702) 876-3215 (702) 929-2229 (702) 248-4119 (702) 382-1166 (702) 732-2334 (702) 380-4160 (702) 430-5333 (702) 776-8210 (702) 701-8944 (702) 233-2010 (702) 522-9777

Provider Street 7151 W CRAIG RD 7075 W ANN RD 4850 W CRAIG RD 8410 FARM RD 1940 VILLAGE CENTER CIR 10250 W CHARLESTON BLVD 5881 E CHARLESTON BLVD 1001 S RAINBOW BLVD 4055 S DURANGO DR 2255 E CENTENNIAL PKWY 8050 SOUTH RAINBOW BLVD 7130 N DURANGO DR 9750 S MARYLAND PKWY 4840 W DESERT INN RD 9350 W FLAMINGO RD 4001 S DECATUR BLVD 4965 E SAHARA AVE 3602 E BONANZA RD 10100 WEST TROPICANA AVENUE 6130 W TROPICANA AVE 850 S RANCHO DR 1421 N JONES BLVD 3160 N RAINBOW BLVD 2540 S MARYLAND PKWY 450 N NELLIS BLVD 8555 W SAHARA AVE 9851 W CHARLESTON BLVD 3850 E FLAMINGO RD 2385 E WINDMILL LN 2211 N RAMPART BLVD 10600 SOUTHERN HIGHLANDS PKWY 4015 S BUFFALO DR 4550 E BONANZA RD UNIT C 2725 S JONES BLVD STE 101 2410 E BONANZA RD 3006 S MARYLAND PKWY STE 101 4011 W SAHARA AVE # 8 9097 W POST RD STE 100 2810 W CHARLESTON BLVD STE 44E 2208 S NELLIS BLVD STE 5A 3525 S FORT APACHE RD STE 165 4571 W FLAMINGO RD

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Provider City LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS

State

ZIP code

NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV

89129-6511 89130-1109 89130-2727 89131-8158 89134-6236 89135-1020 89142-1010 89145-6232 89147-4158 89081 89139 89149 89183 89102-9125 89147-6414 89103 89104 89110 89147 89103-4604 89106-3831 89108-1610 89108-4533 89109-1627 89110-5304 89117-1819 89117-7516 89121-6227 89123-2037 89128-7640 89141-4368 89147-7455 89110-6308 89146-5605 89101-3452 89109-2219 89102 89148-2417 89102-1905 89104-6211 89147-3442 89103-3702

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name VESPER SPECIALTY PHARMACY WELCOME PHARMACY WELL CARE DISCOUNT PHARMACY WELL CARE DISCOUNT PHARMACY WELL CARE PHARMACY LOVELOCK PHARMACY SMITH'S PHARMACY CITY CENTRE PHARMACY COMMUNITY CARE PHARMACY CRAIG ROAD PHARMACY SAV-ON PHARMACY SMITHS PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY TANGO PHARMACY LIN'S SUPERMARKETS INC SMITH'S PHARMACY DON'S PHARMACY INC HALE'S PHARMACY NEVADA INFUSION NORTHERN NEVADA HOPES OPTION CARE RALEYS RALEY'S DRUG CENTER RALEY'S DRUG CENTER RALEY'S DRUG CENTER RALEY'S DRUG CENTER RALEY'S DRUG CENTER SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SAVE MART PHARMACY SIERRA COMPOUNDING PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SILVER STAGE PHARMACY RALEY'S DRUG CENTER RALEY'S PHARMACY SAVE MART PHARMACY SMITH'S PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (702) 333-4377 (702) 253-9818 (702) 410-7883 (702) 410-7801 (702) 576-9545 (775) 273-1700 (702) 346-8656 (702) 477-0311 (702) 631-1100 (702) 778-0905 (702) 656-3425 (702) 642-6062 (702) 642-8092 (702) 648-6340 (702) 399-3186 (702) 395-7510 (702) 636-2054 (702) 397-2308 (775) 727-2404 (775) 329-2000 (775) 322-2171 (775) 453-0133 (775) 348-1306 (775) 828-8200 (775) 746-6404 (775) 825-2476 (775) 747-0718 (775) 677-8750 (775) 786-3655 (775) 850-8920 (775) 746-5717 (775) 329-2981 (775) 786-2970 (775) 825-3322 (775) 853-3500 (775) 971-3320 (775) 851-8060 (775) 909-4855 (775) 353-8818 (775) 626-7720 (775) 425-2727 (775) 359-6900

Provider Street 4225 S EASTERN AVE UNIT 16 5115 SPRING MOUNTAIN RD STE 11 3430 E TROPICANA AVE 4235 E CHARLESTON BLVD 4101 WAGON TRAIL AVE 325 11TH STREET STE 2 350 N SANDHILL BLVD 2290 MCDANIEL ST STE 1A 1820 E LAKE MEAD BLVD STE N 3251 W CRAIG RD STE 110 3010 WEST ANN RD 6855 ALIANTE PKWY 2255 N LAS VEGAS BLVD 3013 W CRAIG RD 5564 CAMINO AL NORTE 4700 ANN RD 4090 W CRAIG RD 350 S MOAPA VALLEY BLVD 601 S HIGHWAY 160 501 RALSTON ST 901 E 2ND ST STE 102 5401 LONGLEY LN STE 34 580 W 5TH ST STE 12A 6630 S MCCARRAN BLVD STE B14 1630 ROBB DR 4047 S VIRGINIA ST 701 KEYSTONE AVE 1075 N HILLS BLVD STE 270 1441 MAYBERRY DR 18144 WEDGE PKWY 10500 N MCCARRAN BLVD 525 KEYSTONE AVE 195 W PLUMB LN 4995 KIETZKE LN 9738 S VIRGINIA ST #G 175 LEMMON DR 750 SOUTH MEADOWS PKWY 1250 NEVADA ST STE #2 2895 N MCCARRAN BLVD 2389 WINGFIELD HILLS RD 9750 PYRAMID WAY 1255 BARING BLVD

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Provider City LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LAS VEGAS LOVELOCK MESQUITE NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS NORTH LAS VEGAS OVERTON PAHRUMP RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO RENO SILVER SPRINGS SPARKS SPARKS SPARKS SPARKS

State

ZIP code

NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV NV

89119 89146-8719 89121 89104-6695 89118-4426 89419 89027-4797 89030-6330 89030-7134 89032-0788 89031 89084 89030 89032 89031-0810 89031-3463 89032-2758 89040-0000 89048-2157 89503-4434 89502-1176 89511-1817 89503-4437 89509-6136 89523-3516 89502-6007 89503-4103 89506-5705 89509-2430 89511-8168 89503-1873 89503-4304 89509-3450 89509-6548 89511-8939 89506-6757 89521-4877 89429 89431-1882 89436 89441-7549 89434-8673

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE PILL BOX VALLEY PHARMACY SMITH'S PHARMACY OLSENS CORNER DRUG STORE RIDLEY'S PHARMACY REX UNITED DRUGS KINNEY DRUGS ADDISON'S APOTHECARY INC AKRON PHARMACY CENTRAL AVE PHARMACY CRESTWOOD PHARMACY HOUSE CALLS PHARMACY LINCOLN PHARMACY

Provider Name

(775) 778-3784 (775) 374-4044 (775) 664-3197 (775) 625-2777 (775) 623-2548 (775) 463-2345 (315) 232-4562 (607) 504-4091 (716) 542-6300 (518) 621-7748 (518) 435-2315 (518) 427-0102 (518) 465-2253

568 SPRING VALLEY CT 5055 SUN VALLEY BLVD STE 210 1855 WEST WENDOVER BLVD 1041 GRASS VALLEY RD 1125 W WINNEMUCCA BLVD 24 N MAIN ST 10923 US ROUTE 11 36 MAIN ST 58 MAIN ST 346 CENTRAL AVE 26 PICOTTE DR # A 920 LARK DR 300 MORTON AVE

SPRING CREEK SUN VALLEY WENDOVER WINNEMUCCA WINNEMUCCA YERINGTON ADAMS ADDISON AKRON ALBANY ALBANY ALBANY ALBANY

NV NV NV NV NV NV NY NY NY NY NY NY NY

89815-6821 89433-8299 89883 89445-4205 89445 89447-2278 13605-2109 14801-1210 14001-1240 12206-2347 12208-1710 12207-1300 12209-2220

NY ONCOLOGY HEMA PATIENT PRESCP CTR PARAMOUNT SPECIALTY PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY TOWN TOTAL HEALTH LLC ALBERTSON PHARMACY INC. ALDEN PHARMACY INC KINNEY DRUGS ALFRED PHARMACY DRUG WORLD BAY VILLAGE DRUG & SURGICAL STOP & SHOP PHARMACY PRICE CHOPPER PHARMACY RIVERFRONT PHARMACY APALACHIN PHARMACY COTTRILLS PHARMACY TOWN CENTER PHARMACY HEALTH CENTER PHARMACY R & I RX CENTER INC STOP & SHOP PHARMACY 30TH AVENUE PHARMACY INC AMIN PHARMACY INC ASPCARES PHARMACY ASTOR SURGICAL PHARMACY ASTORIA CHEMISTS INC ASTORIA ORGANIX PHARMACY ASTORIA PHARMACY

(518) 489-0044 (518) 512-5802 (518) 456-0742 (518) 456-9360 (518) 915-7900 (518) 257-7294 (516) 246-9900 (716) 937-9818 (315) 482-6270 (607) 587-9222 (845) 373-8000 (631) 789-4447 (631) 691-0342 (518) 843-8332 (518) 843-0500 (607) 625-2129 (585) 492-2310 (914) 765-0600 (718) 945-2400 (718) 634-5890 (718) 318-6285 (718) 777-8544 (718) 786-6611 (347) 507-1680 (718) 932-9800 (718) 278-8300 (718) 255-1338 (718) 278-3772

400 PATROON CREEK BLVD STE 1 150 NEW SCOTLAND AVE 1706 WESTERN AVE 1892 CENTRAL AVE 475 ALBANY SHAKER RD 350 NORTHERN BLVD STE 328 1028 WILLIS AVE 13203 BROADWAY ST 21 STATE ROUTE 12 36 N MAIN ST 5094 RTE 22 357 BROADWAY 351 MERRICK RD 141 SANFORD FARMS SHOPPING CTR 2490 RIVERFRONT CTR 6845 STATE ROUTE 434 255 MAIN ST 575 MAIN ST 6200 BEACH CHANNEL DR 342 BEACH 54TH ST 7020 ROCKAWAY BEACH BLVD 3506 30TH AVE 2903 36TH AVE 26-20 HOYT AVENUE SOUTH 3518 DITMARS BLVD 2501 30TH AVE 3720 31ST AVE 29-36 30TH AVE

ALBANY ALBANY ALBANY ALBANY ALBANY ALBANY ALBERTSON ALDEN ALEXANDRIA BAY ALFRED AMENIA AMITYVILLE AMITYVILLE AMSTERDAM AMSTERDAM APALACHIN ARCADE ARMONK ARVERNE ARVERNE ARVERNE ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

12206 12208-3423 12203-4484 12205-4200 12211-1581 12204 11507-1331 14004-1312 13607-1520 14802-1011 12501 11701-2748 11701-3447 12010-7535 12010-4612 13732-3503 14009-1214 10504-1891 11692-1409 11692-1782 11692-1272 11103-4623 11106-3107 11102 11105-2107 11102-2447 11103-3822 11102

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 413 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ATHENAS PHARMACY AVENUE CHEMISTS INC BONUS DRUG INC BROADWAY DRUGS INC CITY VIEW PHARMACY CRESCENT APOTHECARY CROWN CHEMISTS DOUBLE G PHARMACY HARPELLS DITMARS PHARMACY HEALTHY RX INC HYATT PHARMACY NEWTOWN PHARMACY OLYMPIA CHEMIST INC ORGANIC CHEMISTS PHARMACARE PLUS INC PHARMACHOICE PHARMACY 2 INC. STEINWAY STREET PHARMACY TRIBORO PHARMACY INC VITAHEALTH PHARMACY WELLNESS CENTER PHARMACY INC XIP PHARMACY YOUR CHOICE PHARMACY ATTICA PHARMACY INC FEEK PHARMACY KINNEY DRUGS KINNEY DRUGS RX CITY PHARMACY INC

Provider Name

(718) 204-7867 (718) 545-1010 (718) 274-9200 (718) 728-0350 (718) 545-2550 (718) 777-1110 (718) 278-6777 (718) 728-3127 (718) 278-5454 (718) 777-2020 (347) 808-7726 (718) 728-9100 (718) 267-2766 (718) 585-3095 (347) 848-0455 (347) 639-0007 (347) 738-6443 (718) 777-7033 (718) 777-8482 (718) 956-0060 (718) 204-6565 (718) 606-8965 (585) 591-1111 (518) 647-8484 (315) 255-0014 (315) 252-9204 (315) 282-0088

3224 STEINWAY ST 45-01 30TH AVE 3104 BROADWAY 3408 BROADWAY 2307 ASTORIA BLVD 2501 DITMARS BLVD 3320 DITMARS BLVD 2282 31ST ST 3308 DITMARS BLVD 3007 31ST AVE 2321 30TH AVE 2804 31ST ST 2318 31ST ST 28-15 STEINWAY ST 2109A 31ST ST 2509 30TH AVE 25-78 STEINWAY ST 37-20 DITMARS BLVD 41-16 30TH AVE 4015 BROADWAY 2134 BROADWAY 4410 31ST AVE 2 MARKET ST 14223 NYS ROUTE 9N 187 STATE ST 62 OWASCO ST 161 GENESEE ST

ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ASTORIA ATTICA AU SABLE FORKS AUBURN AUBURN AUBURN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11103 11103 11106-2649 11106-1112 11102-2942 11105-3120 11105-2106 11105-2714 11105-2106 11106-2404 11102-4183 11102-1719 11105-2892 11103-3331 11105-2601 11102-3587 11103-3774 11105-1841 11103-2968 11103-4030 11106-4603 11103-2251 14011-1024 12912 13021-1803 13021-4059 13021

YOUNGS PHARMACY AND GENERAL STORE VILLAGE PHARMACY & SURGICAL STOP & SHOP PHARMACY KINNEY DRUGS P&C PHARMACY O'BRIEN PHARMACY BARDONIA PHARMACY ALBERTY DRUGS

(518) 674-3663 (631) 482-1160 (914) 628-8942 (315) 635-3155 (315) 635-6013 (518) 885-7330 (845) 507-0555 (585) 344-1570

1636 BURDEN LAKE RD 124 E MAIN ST STE 103 80 ROUTE 6 21 E GENESEE ST 2265 DOWNER STREET 4 FRONT ST 301 ROUTE 304 SUITE 4 81 MAIN ST

AVERILL PARK BABYLON BALDWIN PLACE BALDWINSVILLE BALDWINSVILLE BALLSTON SPA BARDONIA BATAVIA

NY NY NY NY NY NY NY NY

12018-2808 11702-3532 10505-1026 13027-2501 13027-2370 12020-1718 10954-1654 14020

UNITED MEMORIAL MED CNTR OP PHCY VILLAGE PHARMACY BAY PHARMACY GENOA-QOL HEALTHCARE HEALTH MART PHARMACY

(585) 344-5263 (607) 664-9039 (631) 665-2229 (631) 954-2060 (631) 300-4670

127 NORTH ST 7181 STATE ROUTE 54 603 E MAIN ST UNIT C 1444 5TH AVE STE 1 5 CANDLEWOOD RD

BATAVIA BATH BAY SHORE BAY SHORE BAY SHORE

NY NY NY NY NY

14020 14810-9502 11706-8505 11706-4147 11706

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 414 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SALU-MED SHORE DRUGS INC SUN RAY PHARMACY BAYBRIDGE PHARMACY BELL BOULEVARD PHARMACY MJ88 PHARMACY INC NOVO PHARMACY PLUS DRUGS INC ST MARYS HOSP FOR CHILDREN INC STERLING PHARMACY WOORI PHARMACY LLC BAYVILLE PHARMACY INC TWIN HARBOR DRUGS VOGEL PHARMACY BEDFORD PHARMACY BRADDOCK PHARMACY LLC. PHAMCO DRUGS KEE-ZAC PHARMACY PRECISION PHARMACY NICHOLSON PHARMACY BETHPAGE MEDICAL PHARMACY KING KULLEN PHARMACY BLITZ PHARMACY LOURDES PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY THE MEDICINE SHOPPE THE PHARMACY WEIS PHARMACY CASEY'S PRESCRIPTION PAD INC BOICEVILLE PHARMACY KINNEY DRUGS INC BRENTWOOD PHARMACY SALUD Y VIDA FARMACIA SALUMED PHARMACY BRENTWOOD BREWERTON PHARMACY KINNEY DRUGS COMMUNITY PHARMACY INC JNR PHARMACY TRUECARE PHARMACY VALUE DRUGS MANSON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (631) 231-4960 (631) 665-3000 (631) 206-4000 (718) 751-9911 (718) 229-2344 (718) 819-0881 (718) 225-1923 (718) 352-1234 (718) 281-8751 (718) 224-7300 (718) 229-2001 (516) 628-3640 (516) 628-2323 (845) 831-3784 (914) 234-3744 (718) 347-1516 (718) 749-5811 (516) 221-4022 (516) 785-4774 (585) 268-7287 (516) 796-4004 (516) 822-1738 (607) 358-4200 (607) 798-5944 (607) 235-7243 (607) 770-1108 (607) 723-7585 (607) 217-7029 (607) 772-6357 (716) 926-9044 (845) 657-6511 (315) 942-2509 (631) 273-3314 (631) 273-0101 (631) 299-0213 (315) 676-4441 (315) 676-3676 (845) 278-2700 (845) 278-8200 (845) 940-1111 (914) 941-1970 (718) 297-4424

Provider Street 1805 5TH AVE STE B 30 E MAIN ST 1191 SUNRISE HWY 20848 CROSS ISLAND PKWY FL 2 4748 BELL BLVD 6136 SPRINGFIELD BLVD 45-64 BELL BLVD 209-31 NORTHERN BLVD 2901 216TH ST 3801 BELL BLVD 21915B NORTHERN BLVD 253 BAYVILLE AVE 72 BAYVILLE AVE 234 MAIN ST 424 OLD POST RD 236-01A BRADDOCK AVE 24815 UNION TPKE 109 BEDFORD AVE 2711 MERRICK RD 36 SCHUYLER ST 4277 HEMPSTEAD TPKE 598 STEWART AVE 485 MAPLE ST 161 RIVERSIDE DR 33 CHENANGO BRIDGE RD 10 GLENWOOD AVE 1179 VESTAL AVE STE 1 1139 UPPER FRONT ST STE 3 160 ROBINSON ST 4154 MCKINLEY PKWY 4103 STATE ROUTE 28 13187 STATE ROUTE 12 761 SUFFOLK AVE 1077 SUFFOLK AVE 753 COMMACK RD 9679 BREWERTON RD 9543 BREWERTON RD STE 1 100 INDEPENDENT WAY STE G 2505 CARMEL AVE 995 ROUTE 22 89 N STATE RD 137-69 QUEENS BLVD

Page 415 of 679

Provider City BAY SHORE BAY SHORE BAY SHORE BAYSIDE BAYSIDE BAYSIDE BAYSIDE BAYSIDE BAYSIDE BAYSIDE BAYSIDE BAYVILLE BAYVILLE BEACON BEDFORD BELLEROSE BELLEROSE BELLMORE BELLMORE BELMONT BETHPAGE BETHPAGE BIG FLATS BINGHAMTON BINGHAMTON BINGHAMTON BINGHAMTON BINGHAMTON BINGHAMTON BLASDELL BOICEVILLE BOONVILLE BRENTWOOD BRENTWOOD BRENTWOOD BREWERTON BREWERTON BREWSTER BREWSTER BREWSTER BRIARCLIFF MANOR BRIARWOOD

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11706-1761 11706-8301 11706-5911 11360-1187 11361-3334 11364-2336 11361 11361-3134 11360 11361-2058 11361-3525 11709-1670 11709-1656 12508-2732 10506 11426 11426-1836 11710-3526 11710-5719 14813-1015 11714 11714-2702 14814-9701 13905-4176 13901-1233 13905-2568 13903-1606 13905-1131 13904-1547 14219-2995 12412-5200 13309-4962 11717-4409 11717-4503 11717-7407 13029-8738 13029-9426 10509-2368 10509 10509-1526 10510-1415 11435

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KINNEY DRUGS 161 ST PHARMACY INC 167TH ST PHARMACY 1ST AID PHARMACY & SURGICAL SUPP 1ST BRONXCARE PHARMACY INC 3 GEM PHARMACY, INC 3110 CUIDAMED PHARMACY INC

Provider Name

(315) 633-0073 (718) 742-3400 (718) 975-0142 (718) 450-3555 (718) 483-9891 (718) 558-3333 (718) 993-9800

7998 STATE ROUTE 31 275 E 161ST ST 1150 WEBSTER AVE 23 W FORDHAM RD 438 E 149TH ST 1398 GRAND CONCOURSE 3110 3RD AVE

BRIDGEPORT BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY

13030-8438 10451-3504 10456-5205 10468 10455-1304 10456 10451-4606

5 STAR PHARMACY & SURGICAL SUPPLIES 75 BURNSIDE DRUG & SURGICAL INC. A1 HEALTH PHARMACY AAA PHARMACY INC ABC DRUGS ABC DRUGS ABC DRUGS INC ADEE PHARMACY INC AKSHAR PHARMACY AMATO PHARMACY AMBAR PHARMACY ARTHUR AVENUE PHARMACY ASENCIO PHARMACY BAINBRIDGE PHARMACY BARRETTO PHARMACY INC BENJAMIN'S PHARMACY & SURGICAL BIG APPLE PHARMACY INC BLONDELL RX CORP BOCA PHARMACY BOCA PHARMACY BOCA PHARMACY BOCA PHARMACY BOCA PHARMACY BOCA PHARMACY BOSTON ROAD PHARMACY BOSTON ROAD PHARMACY BRIGHT AID PHARMACY BRIGHTPOINT PHARMACY BRONX COMMUNITY PHARMACY BRONX DRUGS BRONX DRUGS INC BRONX EDEN PHARMACY BRONX FAMILY PHARMACY BRONX PHARMACY

(718) 401-6500 (718) 731-8505 (718) 618-7477 (718) 231-2471 (347) 750-5540 (917) 801-4700 (718) 618-0510 (718) 379-1954 (718) 220-2748 (718) 365-8630 (718) 994-4444 (718) 561-4040 (718) 299-2416 (347) 899-8666 (718) 893-2000 (718) 405-9111 (718) 515-5003 (212) 249-8202 (718) 292-2088 (718) 991-3519 (718) 292-7979 (718) 304-7380 (718) 618-7878 (718) 991-6700 (718) 991-4000 (718) 733-4150 (718) 293-0040 (718) 208-2837 (718) 220-1336 (718) 708-5775 (718) 684-5888 (718) 299-4800 (718) 828-3450 (718) 466-5500

2604 THIRD AVE 75 W BURNSIDE AVE 1003 OGDEN AVE 3513 WHITE PLAINS RD 1925 UNIVERSITY AVENUE 470 E FORDHAM RD 1564 E 174TH ST 1427 E GUN HILL RD 2200 GRAND CONCOURSE 619 E 187TH ST 667 ALLERTON AVE 2343 ARTHUR AVE 154 E 174TH ST 3161A BAINBRIDGE AVE 1009 LONGWOOD AVE 987-989 ALLERTON AVE 27 E GUNHILL RD 1642 EASTCHESTER RD 736 E 152ND STREET 872 HUNTS POINT AVE 514 WILLIS AVE 1225 FULTON AVE 1070 SOUTHERN BLVD 904 PROSPECT AVE 1272 BOSTON RD 3456 BOSTON RD 142 E 170TH ST 1543 INWOOD AVE THIRD FLOOR 2404 WEBSTER AVE 586 E 187TH ST 445 E TREMONT AVE 1575 GRAND CONCOURSE 1800 WHITE PLAINS RD 511 E TREMONT AVE

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10454 10453-4015 10452-5104 10467-5705 10453 10458-5108 10472-1203 10469-3063 10457 10458-6706 10467-7405 10458 10457-6904 10467 10459-4506 10469-4336 10467 10461-2316 10455 10474 10455-4028 10456-3401 10459-3268 10459-3929 10456-3621 10469-2512 10452-7021 10452-2001 10458 10458 10457-4301 10452 10462-1408 10457-4515

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 416 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BRONX SPECIALTY PHARMACY INC BRONXWOOD PHARMACY LLC BURKE AVENUE PHARMACY BZ PHARMACY CALLEN-LORDE COMMUNITY PHCY CARE FIRST PHARMACY CORP. CARE PHARMACY CARE PHARMACY CARE WELL RX CAREMORE RX PHARMACY CAREPOINT PHARMACY CASA DE VIDA PHARMACY CASTLE HILL COMMUNITY PHARMACY CASTLE HILL DRUGS CASTLE TOPP PHARMACY CAULDWELL PHARMACY INC CEDRA PHARMACY CEDRA PHARMACY CENTRAL PHARMACY & SURGICALS CHARMAR PHARMACY CHASE PHARMACY INC CHOICE ONE PHARMACY CIRCLE PHARMACY CORP CIR-KORT PHARMACY CITY ISLAND PHARMACY INC CITY LINE PHARMACY COMMUNITY PRESCRIPTIONS COMMUNITY RECETA INC CONCORDIA PHARMACY CONCOURSE PHARMACY CONCOURSE PHARMACY INC CONGRESS PHARMACY CO-OP CITY PHARMACY INC COURTLANDT PHARMACY INC CROTONA PHARMACY CORP CSS PHARMACY INC D.J. DRUGS DANNY'S PHARMACY DE FRANCO PHARMACY DESAI'S PHARMACY DIVINO PHARMACY CORP DRUG DEPOT

NR_0009_10823 10/2017

Provider Phone Number (718) 328-2800 (347) 346-8680 (347) 326-6000 (516) 492-3201 (718) 215-1801 (718) 676-5959 (718) 455-5558 (718) 822-3700 (718) 294-7147 (917) 801-2325 (718) 589-1234 (347) 820-7989 (718) 319-8200 (718) 239-5400 (718) 684-6825 (718) 292-3800 (917) 473-6030 (917) 473-7788 (718) 585-1071 (718) 822-1348 (347) 449-6513 (718) 450-8922 (718) 823-6666 (718) 585-7061 (718) 885-3053 (718) 324-0555 (917) 792-7600 (718) 299-3044 (718) 328-2833 (718) 299-2200 (718) 665-0026 (718) 665-6771 (718) 708-8171 (718) 402-0202 (917) 688-1102 (718) 220-5402 (718) 549-6709 (718) 328-6777 (718) 893-2400 (718) 543-0800 (718) 933-0278 (718) 299-9600

Provider Street 940A SOUTHERN BOULEVARD 3673 BRONXWOOD AVE 759 BURKE AVE 473 WILLIS AVE 3144 3RD AVE 3908A WHITE PLAINS RD 979 WESTCHESTER AVE 313 E 161ST ST 826 E TREMONT AVE 2260 CROTONA AVE 888 HUNTS POINT AVE 52 W BURNSIDE AVE 706 CASTLE HILL AVE 674 CASTLE HILL AVE 1370-A CASTLE HILL AVE 609 WESTCHESTER AVE 724 ELTON AVE 3027 3RD AVE 423 E 138TH ST 781 LYDIG AVE 3632 WHITE PLAINS RD 1550 UNIVERSITY AVENUE 116 HUGH J GRANT CIR 414 WILLIS AVE 290 CITY ISLAND AVE 4704 WHITE PLAINS RD 1030 SHERIDAN AVE 1713 DR MARTIN L KING JR BLVD 898 E TREMONT AVE 1850 GRAND CONCOURSE 767 CONCOURSE VLG W 542 SOUTHERN BLVD 167 EINSTEIN LOOP 680 COURTLANDT AVE 1384 B BOSTON RD 2043 GRAND CONCOURSE 3721 RIVERDALE AVE 1632 BRUCKNER BLVD 1790 RANDALL AVE 228 W 238TH ST 30 E KINGSBRIDGE RD 1588 DR MARTIN L KING JR BLVD

Page 417 of 679

Provider City BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10459-3402 10469-1147 10467-6611 10455-4015 10451-4629 10466-3018 10459 10451-3535 10460 10457-1939 10474 10453 10473-1303 10473-1430 10462 10455-1504 10455-1244 10455-2647 10454-3041 10462-2144 10467 10452 10472-5065 10454-1011 10464-1433 10470-1103 10456-6100 10453-6961 10460-4300 10457 10451-3801 10455-3715 10475-4902 10451-5166 10456 10453-4317 10463-1807 10473-4553 10473-3629 10463-2474 10468 10453-6994

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DRUG DEPOT CORP DRUG RITE PHARMACY DRUG RITE PHARMACY DRUGS R US PHARMACY INC E JEROME PHARMACY INC EAST 174 ST PHARMACY EAST TREMONT PHARMACY EAST TREMONT PHARMACY EASTCHESTER PHARMACY EMERALD PHARMACY

Provider Name

(718) 620-9000 (718) 220-9200 (718) 231-1600 (718) 299-4400 (718) 364-2248 (718) 378-1200 (718) 861-0382 (718) 764-1623 (718) 684-5454 (718) 944-0862

619 E 169TH ST 2426 GRAND CONCOURSE 3432 JEROME AVE 1963 GRAND CONCOURSE 1 E 183RD ST 932 E 174TH ST 1065 E TREMONT AVE 930 E TREMONT AVE 2102 EASTCHESTER RD 4295 KATONAH AVE

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY

10456-2605 10458-5202 10467-1002 10453-4929 10453-1242 10460-5202 10460 10460-4363 10461-2248 10470-2015

EMILIOR PHARMACEUTICAL COMPOUNDING EVERS PHARMACY EXPRESS CARE PHARMACY EXPRESS PHARMACY EZ PHARMACY F & N PHARMACY INC FALAK PHARMACY FAMILY DRUG STORE CORP FAMILY PHARMACY FAMILY PHARMACY FARMACIA APOTEK FARMACIA CENTRAL FEEL GOOD PHARMACY FELICITY PHARMACY FIRO PHARMACY & SURGICALS FIRST AID PHARMACY INC FIRST HEALTH PHARMACY FORDHAM FAMILY PHARMACY FORDHAM ROAD PHARMACY FRIENDLY PHARMACY FRIENDLY PHARMACY FRIENDLY PHARMACY INC FULLER DRUG STORE FULTON CARE PHARMACY GERARD PHARMACY GIG PHARMACY INC GOOD CARE PHARMACY GOOD LIFE PHARMACY INC GOODMAN PLAZA PHARMACY INC GRACE PHARMACY GRAND CONCOURSE PHARMACY INC

(855) 426-6768 (718) 292-0900 (718) 618-7525 (718) 292-7010 (718) 992-1204 (718) 684-2567 (718) 597-5230 (347) 920-2520 (718) 401-3900 (718) 764-1002 (718) 901-4717 (718) 547-6860 (347) 918-9000 (718) 466-5695 (718) 590-4242 (718) 893-5700 (347) 597-7999 (917) 801-1801 (718) 364-3333 (718) 884-2908 (718) 733-8528 (718) 742-0001 (718) 292-4244 (347) 918-8700 (718) 293-2285 (718) 708-5400 (718) 991-1400 (718) 618-7099 (347) 590-9102 (718) 618-7927 (718) 901-3186

2510 WESTCHESTER AVE STE 207 226 E 144TH ST FL 2 15 E TREMONT AVE 273 E 149TH ST 3716 3RD AVE 2309 WESTCHESTER AVE 2730 E TREMONT AVE 2550 BOSTON RD # F 2754 3RD AVE 890 GARRISON AVE STE B317 753 E TREMONT AVE 55A E GUN HILL RD 3058 3RD AVE 621 E TREMONT AVE 1418 WYTHE PL 921 E TREMONT AVE 1229 FRANKLIN AVE 202 W FORDHAM RD 2 E FORDHAM ROAD 223A W 231ST ST 3137 GRAND CONCOURSE 389 E 138TH ST 2688 THIRD AVE 557 E 169TYH ST 903 GERARD AVE 3405 JEROME AVE 1026 E 163RD STREET 2366 GRAND CONCOURSE 3250 3RD AVE 205 E 198TH ST 233 E TREMONT AVE

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10461 10451-5909 10453-5801 10451-5601 10456-2126 10462-5073 10461-2808 10467-9004 10455 10474-5332 10457-5101 10467-2103 10451-4605 10457 10452-6904 10460-4305 10456-3515 10468-5520 10468 10463-5301 10468-1401 10454-3099 10454-1103 10456-2625 10452 10467-1049 10459 10458-6908 10456-6743 10458-3101 10457-5303

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 418 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GRANT PHARMACY GUNHILL PHARMACY HAPPY PHARMACY HEALTH SMART PHARMACY INC HEALTHCARE PHARMACY HIGHBRIDGE PHARMACY HILL PHARMACY HOPEWELL PHARMACY INC HUDSON PARKWAY PHARMACY ICARE PHARMACY IMPERIAL PHARMACY IMPERIAL PHARMACY ISABEL'S PHARMACY INC J & C PHARMACY J & K PHARMACY J & N PHARMACY JEROME DRUGS JJ PHARMACY JOLIN PHARMACY K & G PHARMACY, INC KARNABY DRUGS 2 KING COMMUNITY PHARMACY INC KING-RAJ PHARMACY

Provider Name

(718) 588-3304 (718) 654-4305 (718) 466-1000 (718) 618-7081 (718) 585-1117 (718) 681-3000 (718) 863-0203 (718) 733-6722 (718) 549-8288 (929) 777-9611 (718) 543-0028 (718) 581-0019 (718) 655-4005 (718) 822-7869 (718) 401-7375 (718) 293-2233 (718) 294-5070 (718) 367-2000 (718) 294-5588 (718) 220-2014 (347) 346-5134 (347) 899-8020 (718) 584-8371

1340 EDWARD L GRANT HIGHWAY 83 E GUN HILL RD 1831 GRAND CONCOURSE STE B 760 GRAND CONCOURSE 567 COURTLANDT AVE 1230 OGDEN AVE 2197 WESTCHESTER AVE 251 E 188TH ST 5700 MOSHOLU AVE 2256 E TREMONT AVE 5625 BROADWAY 3050 CORLEAR AVE 338 E GUN HILL RD 1027A MORRIS PARK AVE 440 E 138TH ST 1220 MORRIS AVE 1788 JEROME AVE 332 E 188TH ST 1870 GRAND CONCOURSE 2434 JEROME AVE 662 E 233RD ST 161 DREISER LOOP 58 E KINGSBRIDGE RD

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10452 10467-2103 10453 10451-3048 10451 10452-3522 10462 10458-5301 10471 10462-6303 10463 10463-5180 10467-2208 10461-1410 10454-3026 10456-3117 10453-5708 10458-5406 10457-5401 10468-6401 10466-2802 10475-2703 10468-7504

KINGS CARE PHARMACY AND STORE INC KINGS PHARMACY KINGSBRIDGE PHARMACY KINGSBRIDGE PHARMACY KINGSBRIDGE PHARMACY KRAMER'S PHARMACY LA FARMACIA LA FE PHARMACY LACROSS DRUGS LAFAYETTE FAMILY PHARMACY INC LEFF PRESCRIPTION CENTER LEMED PHARMACY LEROY PHARMACY LEROY PHARMACY LEROY PHARMACY LEROY PHARMACY LEROY PHARMACY II LLC LEROY PHARMACY IV

(718) 684-1595 (718) 992-6881 (718) 933-5150 (718) 432-2240 (718) 708-8665 (718) 993-1488 (917) 962-4444 (917) 473-7810 (718) 665-5474 (718) 618-7204 (718) 665-1163 (718) 231-4040 (718) 991-2266 (718) 823-4344 (718) 882-5614 (718) 842-2777 (718) 220-7600 (718) 933-1154

306 E 149TH ST 545 SAINT PAULS PL 229 E KINGSBRIDGE RD 200C W 231ST ST 145 W KINGSBRIDGE RD 309 SAINT ANNS AVE 709 E TREMONT AVE 754 EAST 151ST 530 E 138TH ST 849 SOUNDVIEW AVE 70 E 161ST ST 159 E GUNHILL RD 901 E TREMONT AVE 1448 METROPOLITAN AVE 314 E 204TH ST 1527 WESTCHESTER AVE 245 E 198TH ST 392 BEDFORD PARK BLVD

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10451-5602 10456-2122 10458-4413 10463-5302 10468-3914 10454-2589 10457-5001 10455 10454-4906 10473-3903 10451-2207 10467 10460-4301 10462-7402 10467-4602 10472-2908 10458-3147 10458-2415

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 419 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LINCOLN CARE DRUGS INC LINCOLN DRUGS INC LISCIO PHARMACY LONGWOOD DRUG & SURGICAL LONGWOOD PHARMACY LUMIT PHARMACY LYDIG PHARMACY M & V PHARMACY INC M.A. FEINBURG'S PROF PHARMACY MAHESH DRUGS MARBLE HILL PHARMACY CORP MARCO FARMACIA MARGA PHARMACY MARION PHARMACY MASON RX MCGRAW PHARMACY INC MED RX MEDI CENTER PHARMACY MEDICAL CENTER PHARMACY

Provider Name

(718) 401-7400 (718) 993-6750 (718) 547-3706 (718) 542-4770 (718) 328-3593 (718) 866-0629 (718) 678-8700 (718) 840-6532 (718) 299-2800 (718) 842-3807 (718) 562-5200 (917) 259-7376 (718) 618-7676 (718) 584-6561 (718) 863-0210 (718) 684-4512 (718) 584-6600 (347) 699-6006 (718) 933-3113

270 E 165TH ST 526 MORRIS AVE 2498 WILLIAMSBRIDGE RD 839B PROSPECT AVE 993 PROSPECT AVE 200 E 167TH ST 742 LYDIG AVE 1663 BOSTON RD 2021 GRAND CONCOURSE 731 WHITE PLAINS RD 5227A BROADWAY 814 E TREMONT AVE 33 WEST BURNSIDE AVE 322 E 194TH ST 1255 CASTLE HILL AVE 2048 MCGRAW AVE 625 E FORDHAM RD 1262 BOSTON RD 571 E 184TH ST

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10456-6078 10451-5537 10469-4897 10459-3912 10459-2903 10456-4004 10462 10460-4921 10453-4304 10473-2631 10463-7636 10460-4146 10453 10458-4304 10462 10462-8003 10458-5049 10456-3602 10458-8039

MEDICINE CABINET II PHCY & SURG SUP MEDICINE CENTER RX LLC MEDISERV PHARMACY

(347) 590-0831 (718) 410-2814 (718) 395-4000

430 E 149TH ST 92 E 167TH ST 2611 WEBSTER AVE

BRONX BRONX BRONX

NY NY NY

10455-1338 10452-8203 10458-4845

MEDSTOP PHCY AND SURGICAL SUPPLIES MEGA PHARMACY MELROSE PHARMACY METCARE RX METCARE RX METCARE PHARMACY METCARE RX METCARE RX METRO PHARMACY MHHC PHARMACY INC. MI CASA RX MID CONCOURSE PHARMACY INC MONTEFIORE MED COMM PHCY AT CH MORRIS AVE PHARMACY MORRIS HEIGHTS PHARMACY MORRIS PHARMACY MORRISSANIA PHARMACY MOSCOSO PHARMACY

(718) 552-2278 (718) 294-7899 (718) 292-1856 (718) 239-9808 (718) 975-7774 (718) 996-3366 (718) 741-9505 (718) 410-4711 (718) 292-1212 (718) 924-2688 (718) 841-9969 (718) 367-4540 (718) 484-5160 (718) 292-2500 (718) 960-4370 (718) 537-0365 (718) 401-8800 (718) 293-5832

1330 JEROME AVE 1560 GRAND CONCOURSE 666 COURTLANDT AVE 1515 BLONDELL AVE 1250 WATERS PL 700 BROOK AVE 1 FORDHAM PLAZA 5TH FL 305 E 161ST ST 342 E 149TH ST 57 W BURNSIDE AVE STE B1 18 EAST 183RD STREET 2106 GRAND CONCOURSE 111 E 210TH ST 675 MORRIS AVE 64 W BURNSIDE AVE 255 E 165TH ST 596 MORRIS AVE 151 E 170TH ST

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10452 10457-8402 10451-5018 10461 10461-2720 10455-1357 10458 10451-3535 10451-5635 10453-4038 10453 10457-2800 10467-2401 10451 10453-4018 10456-6057 10451-4744 10452-7014

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 420 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MOTT HAVEN PHARMACY MT CARMEL PHARMACY NEW CONCOURSE PHARMACY NEW PELHAM PARKWAY PHARMACY NEXMED PHARMACY LLC NICKS DRUG STORE NOVA PHARMACY INC NVR PHARMACY INC OGDEN PHARMACY ONE DRUG CORP ONE STOP PHARMACY OVAL DRUG OVAL PHARMACY OZ PHARMACY PALMVILLE PHARMACY PAPAS PHARMACY PARK PLAZA PHARMACY PARKARE PHARMACY INC

Provider Name

(718) 292-9144 (718) 364-6100 (347) 590-2863 (718) 409-0908 (516) 243-7702 (347) 590-1030 (718) 328-7040 (718) 583-3575 (718) 410-9113 (718) 401-7900 (718) 292-3801 (718) 823-0688 (718) 654-2200 (718) 292-8892 (718) 547-7600 (347) 947-9500 (718) 583-5900 (718) 239-3500

400 E 141ST STREET 705 E 187TH ST 2395 GRAND CONCOURSE 2133 WILLIAMSBRIDGE RD 239 W 238TH ST 3060 BOSTON RD 1521 WATSON AVE 61 E MOUNT EDEN AVE 1071 OGDEN AVE 411 E 138TH ST 176 E 161ST ST 1500 METROPOLITAN AVE 255 E GUN HILL RD 322 E 149TH ST 799 ALLERTON AVE 3979 LACONIA AVE 1773 UNIVERSITY AVE 2158 STARLING AVE

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10454 10458-6803 10468-6823 10461-1601 10463 10469-4038 10472-5329 10452-5806 10452-4601 10454 10451-3508 10462-6801 10467-2109 10451 10467-8909 10466-4916 10453-6997 10462-4303

PARKCHESTER FAMILY PHARMACY & SURGI PARKCHESTER PHARMACY PELHAM PHARMACY INC PENN PHARMACY INC PEOPLE'S PHARMACY & FOOD MART

(347) 851-2688 (347) 398-9006 (917) 708-9700 (718) 484-4280 (347) 346-7600

1445 UNIONPORT RD 1663 METROPOLITAN AVE 2171 WHITE PLAINS RD 1666 BOSTON RD 3176 BAINBRIDGE AVE

BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY

10462-4400 10462-6202 10462-1405 10460-4980 10467-3980

PHARMACY PLUS SURGICAL SUPPLIES INC PHARMCARE RX PHARMACY INC PHARMORE PHARMACY PILGRIM PHARMACY INC PINEBROOK PHARMACY PK PHARMACY INC PLANET PHARMACY PLAZA PHARMACY PORT MORRIS PHARMACY PRAYOSHA PHARMACY CORP PRIME AID PHARMACY CORP PULSE PHARMACY INC QUALITY RX QUICKRX LTC PHARMA INC R AND S PIONEER PHARMACY RAHIMU PHARMACY REAL PHARMACY

(718) 430-0911 (718) 601-6000 (646) 314-7954 (718) 823-1085 (718) 992-8182 (718) 872-7730 (718) 220-2035 (718) 365-8148 (718) 665-6337 (718) 220-1900 (718) 220-2111 (718) 975-4411 (718) 299-4500 (646) 518-5526 (718) 538-8183 (718) 991-7550 (718) 432-3180

1770 WESTCHESTER AVE STE D 5999 BROADWAY 337 E 149TH ST 2941 WESTCHESTER AVE 1183 JEROME AVE 811 SOUTHERN BLVD 2336A GRAND CONCOURSE 2515 WEBSTER AVE 800 E 138TH ST 54 E 183RD ST 373 E FORDHAM RD 7 BEDFORD PARK BLVD E 1611 UNIVERSITY AVE 1646 EASTCHESTER RD 1018 OGDEN AVE 607 SOUNDVIEW AVE FRNT 1 113 W KINGSBRIDGE RD

BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10472-3022 10471-4101 10451-5688 10461-4534 10452 10459 10458-6903 10458-5583 10454-1902 10453-1239 10458-5033 10468-1771 10453-6947 10461-2316 10452-5103 10473-2928 10468-3902

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 421 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name RECETAS PHARMACY INC REGAL PHARMACY RELION PHARMACY RITE CARE PHARMACY RITE CARE PHARMACY RITE CHOICE PHARMACY RITE-WAY PHARMACY, LLC RIVERDALE PHARMACY RJ PHARMACY INC ROSE DRUG STORE INC ROSEDALE PHARMACY LLC RX FOR YOU CORP RX MASTERS INC SAINT HELENA PHARMACY INC SARA PHARMACY SAS PHARMACY SCHEER DRUGS SCRIPTX PHARMACY SECURITY DRUGS SEDGWICK PHARMACY SHAKESPEARE PHARMACY LLC SIMFAROSE PHARMACY SIMPSON PHARMACY,INC SINAI RX PHARMACY SIRISHA PHARMACY SJS PHARMACY INC SOL'S PHARMACY SOUNDVIEW PHARMACY SOUTH BRONX RX INC SPECIALTY CARE PHARMACY SR DRUG CORP ST GABRIEL PHARMACY ST PAUL'S NEIGHBORHOOD STAR DRUG STAR HILL PHARMACY STARLING PHARMACY STAT RX PHARMACY INC STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY STV CHEMISTS 2

NR_0009_10823 10/2017

Provider Phone Number (718) 733-9330 (718) 543-6868 (347) 691-3922 (718) 378-6800 (718) 328-0000 (718) 293-9596 (718) 860-0600 (718) 543-7500 (347) 691-3701 (718) 294-1470 (718) 684-2318 (718) 991-3400 (718) 293-0800 (718) 742-9500 (718) 696-1500 (718) 823-5330 (718) 655-5558 (718) 538-8100 (718) 654-6974 (718) 543-3116 (718) 588-4100 (718) 823-6378 (718) 328-1080 (718) 588-0761 (718) 881-7958 (718) 933-1222 (718) 861-5490 (718) 828-2446 (718) 538-3385 (718) 933-9010 (718) 842-5747 (718) 294-3770 (718) 293-8810 (718) 295-4444 (718) 466-1790 (718) 684-6880 (718) 538-4754 (718) 860-3363 (718) 823-6185 (718) 862-2883 (718) 320-2904 (718) 991-0391

Provider Street 112 E 183RD ST 558 W 235TH ST 1607 WILLIAMSBRIDGE RD 898 E 163RD ST 805 SOUNDVIEW AVE # D 39-41 EAST 170TH STREET 1603 WESTCHESTER AVE 5669 RIVERDALE AVE 2111 WILLIAMSBRIDGE RD 262 E BURNSIDE AVE 1737 E 174TH ST 1767 SOUTHERN BLVD 1437 WEBSTER AVE 755B E 149TH ST 652 E 233RD ST 1481 LELAND AVE 1343 E GUN HILL RD 72 E 167TH ST 3419 BOSTON RD 3887 SEDGWICK AVE 1252 SHAKESPEARE AVE 765 MORRIS PARK AVE 1014A WESTCHESTER AVE 903B SHERIDAN AVE 2901 WHITE PLAINS RD 105 E BURNSIDE AVE # 107 1515 SOUTHERN BLVD 751 WHITE PLAINS RD 1650 GRAND CONCOURSE 4463 3RD AVE 1577A WESTCHESTER AVE 18 W BURNSIDE AVE 3750A 3RD AVE 57 E KINGSBRIDGE RD 115 FEATHERBED LN STE A 2098 STARLING AVE 235 E 167TH ST 961 E 174TH ST 1720 EASTCHESTER RD 691 CO OP CITY BLVD 2136 BARTOW AVE 1401 BRONX RIVER AVE

Page 422 of 679

Provider City BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10453-1237 10463-1709 10461 10459-4108 10473-3900 10452 10472-2914 10471-2105 10461-1601 10457-3724 10472-1801 10460-4801 10456-1831 10455-4525 10466-2802 10460-3901 10469-3010 10452 10469-2501 10463-4401 10452-3012 10462 10459-3309 10451-3305 10467-8129 10453-4142 10460-5957 10473-2631 10457-7606 10457-2501 10472-2912 10453-4004 10456 10468-7503 10452-1615 10462-4304 10456-4024 10460-5060 10461-2322 10475-1673 10475-4615 10472-1001

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name TAKE CARE PHARMACY TAMMY CARE PHARMACY INC THIRD AVENUE PHARMACY THROGGS NECK PHARMACY TONE PHARMACY TOP GRADE PHARMACY TOP VALUE PHARMACY TOTAL CARE PHARMACY TOTAL CARE PHARMACY INC TOWER PHARMACY TREMONT CHEMIST TREMONT DRUGS INC TRI-ROAD PHARMACY TU SALUD LLC TWIN PARKS PHARMACY & SURGICAL V V PHARMACY V&K PHARMACY VALENTINE PHARMACY INC VCARE PHARMACY VICTOR PHARMACY VITAL CARE PHARMACY VITAL PHARMACY WAKEFIELD PHARMACY WASHINGTON PHARMACY CORP WE CARE PHARMACY WEBSTER AVE PHARMACY WECARE RX PLUS, INC. WELL CARE PHARMACY WELL CARE PHARMACY WELLCARE PHARMACY WEST STREET PHARMACY WESTCHESTER AVENUE PHARMACY INC WESTCHESTER PHARMACY WHITE PLAINS RD PHARMACY INC WILLIS PHARMACY WORLD PHARMACY INC YESRX PHARMACY CORP YOGI PHARMACY YOUR FAMILY PHARMACY CORP Z STOP DRUGS ZAMZAM DRUGS INC ZAMZAM PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (347) 281-9221 (718) 933-4000 (718) 665-1410 (718) 823-6353 (718) 562-8100 (718) 822-2905 (718) 325-1355 (718) 823-9300 (718) 933-9900 (718) 450-3313 (718) 822-5900 (917) 801-1000 (917) 570-5169 (718) 993-3096 (718) 618-7436 (718) 538-7600 (718) 293-8777 (718) 329-9721 (718) 824-3745 (718) 823-9115 (718) 882-6337 (929) 222-3333 (718) 547-0040 (718) 466-5555 (718) 708-7960 (718) 618-0802 (718) 684-5070 (718) 590-0853 (718) 329-2000 (718) 450-8759 (718) 364-2800 (718) 684-5127 (718) 829-2348 (718) 409-1338 (718) 585-5300 (718) 378-3530 (718) 367-2105 (718) 716-6299 (718) 872-6060 (718) 409-3537 (347) 899-8930 (718) 401-6799

Provider Street 2134 STARLING AVE 2641 JEROME AVE 2702 3RD AVE 3569 E TREMONT AVE 2268 GRAND CONCOURSE 1903 STORY AVE 3811 DYRE AVE 1721 CROSBY AVE 4531 3RD AVE 1250 WATERS PLACE 3131 E TREMONT AVE 489 E TREMONT AVE 791 WESTCHESTER AVE 615 E 138TH ST 817 E 180 ST 3593 3RD AVE 1227 OGDEN AVE 309 E 181ST ST 1959 WESTCHESTER AVE 662 MORRIS PARK AVE 3958 WHITE PLAINS RD 257 W KINGSBRIDGE RD 4334A WHITE PLAINS RD 484 E TREMONT AVE 764 BURKE AVE 1231 WEBSTER AVE 2405 WESTCHESTER AVENUE 397 E 167TH ST 70 E 184TH ST 906 E 180TH ST 51 W 183RD ST 3227 WESTCHESTER AVENUE 1780 WESTCHESTER AVE 1207 WHITE PLAINS RD 208 WILLIS AVE 1581 WATSON AVE 2492 WEBSTER AVE 1985 UNIVERSITY AVE 1392 OGDEN AVE 2315-17 WESTCHESTER AVE 3105 BAINBRIDGE AVE 524 MORRIS AVE

Page 423 of 679

Provider City BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX BRONX

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10462-4303 10468 10454-1103 10465-2017 10457-1039 10473-2705 10466 10461-4901 10458-7804 10461 10461-5719 10457-4401 10455 10454-2776 10460 10456-3403 10452 10457-2335 10462-4505 10462-3503 10466-3026 10463-7308 10466-3098 10457-4437 10467-6612 10456-3373 10461-3538 10456-4009 10468-6502 10460 10453-1231 10461 10472-3020 10472 10454-4844 10472-5313 10458 10453 10452-2311 10462 10467-3955 10451-5536

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ZIVE PHARMACY VALUE DRUGS BRONXVILLE INC 1 STOP PHARMACY 13TH AVE PHARMACY INC. 1413 RX CORP 1746 PHARMACY CORPORATION 18TH AVE PHARMACY

Provider Name

(718) 824-6060 (914) 337-2520 (718) 336-2244 (718) 871-9777 (718) 221-4860 (718) 774-1656 (718) 331-3600

811 LYDIG AVE 80 PONDFIELD RD 1220 AVENUE P 5211 13TH AVE 1456 FULTON ST 524 CLARKSON AVE 5411 18TH AVE

BRONX BRONXVILLE BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY

10462-2105 10708-3801 11229-1009 11219-3814 11216-2505 11203-2015 11204

21ST AVE PHARMACY & MED SUPPLY INC 353 EMPIRE PHARMACY 39TH STREET PHARMACY 424 NEIGHBORHOOD PHARMACY 4TH AVENUE PHARMACY 59 ST PHARMACY INC 5TH AVENUE PHARMACY INC 7 STAR PHARMACY 7TH AVENUE CHEMIST INC 7TH AVENUE PHARMACY INC 86 PHARMACY INC 86TH STREET COMMUNITY PHARMACY 86TH STREET PHARMACY 888 PHARMACY INC A & G PHARMACY INC A AND F PHARMACY A AND V PHARMACY INC A ONE PHARMACY INC A PLUS PHARMACY INC A STAR PHARMACY INC. A TO Z PHARMACY INC A.M. PHARMACY AA PHARMACY AAUSADH INC ABBY PHARMACY ABC DRUGS ABC PHARMACY 6 CORP ABC PHARMACY INC ABC SOURCE PHARMACY ABIGAIL'S PHARMACY ABO PHARMACY CORP ABSOLUTERX PHARMACY INC. AC PHARMACY CORP ACCURATE PHARMACY LLC

(718) 449-4949 (718) 467-0918 (718) 552-2323 (718) 485-6303 (718) 492-1500 (718) 567-0019 (718) 439-8585 (718) 484-7213 (718) 439-0998 (718) 633-2299 (718) 266-1268 (718) 266-2137 (718) 743-1200 (718) 871-8833 (718) 996-2277 (718) 277-7707 (718) 238-1402 (718) 438-3999 (718) 492-3888 (718) 439-4981 (347) 517-4040 (718) 238-9828 (347) 425-0965 (718) 972-2780 (347) 915-1010 (718) 234-2500 (718) 437-9888 (718) 686-8830 (718) 676-5556 (718) 566-9700 (718) 872-5142 (718) 883-9991 (718) 567-3318 (718) 788-2082

8511 21ST AVE 347B EMPIRE BLVD 3902 16TH AVE 424 SUTTER AVE 5002 4TH AVE 5816 4TH AVE 4818 5TH AVE 596 CLARKSON AVE 679 60TH ST 5412 7TH AVE 2042 86TH ST 2789 86TH ST 203 BRIGHTON BEACH AVE 48-21 8TH AVE 1216 NEPTUNE AVE 2754 PITKIN AVE 8501 4TH AVE 6009 8TH AVE 5605 7TH AVE 757 60TH ST 9407 5TH AVE 5702 8TH AVE 849 57TH ST FLR 1 4615 5TH AVE 812 60TH ST 1942 86TH ST 5304 7TH AVE 5401 8TH AVE STORE A 2309 AVENUE U 9717 KINGS HWY 8003 FLATLANDS AVE 811 54TH ST 762 59TH ST 639 5TH AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11214-3207 11225-3203 11218-5500 11212-8139 11220-1814 11220-3810 11220-1936 11203-2115 11220-4108 11220-3123 11214-3216 11223-4433 11235-7406 11220 11224-2903 11208 11209-4607 11220-4337 11220-3509 11220-4209 11209-7446 11220-3913 11220 11220-1254 11220-4322 11214-3135 11220 11220 11229-4916 11212 11236-3533 11220-3223 11220-3936 11215-8048

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 424 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ADELPHI DRUGS ADVANTAGE PHARMACY AEGIS PHARMACY AHF PHARMACY AI HUA PHARMACY AID PHARMACY AL MEDINA PHARMACY ALBANY PHARMACY ALDAV PHARMACY INC ALL AMERICAN DRUGGISTS INC ALL RX PHARMACY II INC ALMARK PHARMACY AMANI PHARMACY AMERICAN PHARMACY INC AMIABLE PHARMACY AN NOOR PHARMACY INC ANH PHARMACY INC ANTEKA RX INC ANTELIS PHARMACY APPLE DRUGS APTEKA CORP ARCHI-MED PHARMACY INC ATLANTIC PHARMACY AND SURG SUPP AUSTRA-LINE PHARMACY INC AVE J ROYAL CARE PHARMACY LLC AVE M PHARMACY AVE X-DRUGS AVK RX INC AVON PHARMACY & SURGICAL INC AWARD PHARMACY CORP AZE PHARMACY B&T MARLBORO PHARMACY BABA DRUGS BALAJI PHARMACY BALLARD PHARMACY BANGLA PHARMACY BATISH DRUGS BAY PARK PHARMACY CORP BAY PARKWAY PHARMACY BAY PHARMACY BAY PHARMACY BAY RIDGE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (718) 827-9034 (718) 437-4699 (718) 444-5425 (718) 637-2970 (718) 567-8288 (718) 376-3313 (718) 941-2669 (718) 756-6061 (718) 724-2245 (718) 891-2801 (718) 375-7800 (347) 770-8633 (347) 425-1996 (718) 686-1688 (718) 827-7528 (718) 827-4000 (718) 484-8044 (718) 332-4002 (718) 339-4483 (718) 467-6700 (718) 853-7766 (718) 333-1215 (718) 221-2608 (718) 531-6000 (718) 253-1030 (718) 376-2836 (347) 497-7333 (718) 484-9810 (718) 384-0630 (718) 331-1310 (718) 576-3476 (718) 373-4800 (718) 484-4500 (718) 996-9000 (718) 768-1325 (718) 554-1900 (718) 623-8930 (718) 372-2700 (917) 933-9188 (718) 373-2722 (718) 934-3838 (718) 921-2525

Provider Street 3350 FULTON ST 4910 FORT HAMILTON PARKWAY 5425 FLATLANDS AVE 475 ATLANTIC AVE 5724 7TH AVE 807 KINGS HWY 1242 FLATBUSH AVE 178 ALBANY AVE 749 OCEAN PKWY 1101 BRIGHTON BEACH AVE 1231 AVENUE U 2094 LINDEN BLVD 1162 LIBERTY AVE 5524 8TH AVE 1108 LIBERTY AVE 35 101ST AVE 3167 FULTON ST 511 BRIGHTON BEACH AVE 1709 AVENUE M 376 KINGSTON AVE 371 MCDONALD AVE 6 BAY 50TH ST 1706-B ATLANTIC AVE 5916 GLENWOOD RD 1315 AVENUE J 1206 AVENUE M 3050 AVE X 3904 CHURCH AVE 82 GRAHAM AVE 2249 86TH ST 4519 7TH AVE 2845 86TH ST 295 RALPH AVE 1708 MERMAID AVE 226 PROSPECT PARK W 401 CHURCH AVE 378 LAFAYETTE AVE 3355 NEPTUNE AVE 8506A BAY PKWY 2240 86TH ST 1653 SHEEPSHEAD BAY RD 9720 4TH AVE

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Provider City BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11208-2034 11219 11234-2405 11217-1812 11220 11223-2239 11226-7619 11213-2105 11230-7813 11235-5558 11229-4101 11207 11208-3332 11220-3516 11208-2903 11208-3404 11208 11235 11230-5303 11213-4332 11218-2211 11214-6917 11213 11234-1817 11230-3605 11230-5204 11235 11203-2915 11206-3311 11214-4107 11220-1495 11223-4634 11233 11224 11215-5802 11218-3107 11238 11224-1675 11214-4104 11214-4139 11235-3804 11209-8101

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BAY RIDGE RX BAY-CARE PHARMACY LLC BAYRIDGE RX BBRX PHARMACY BEACH HAVEN PHARMACY BED STUY PHARMACY BEHRENS PHARMACY BELL DRUGS INC BELMONT PHARMACY BENNETTS PHARMACY BERKELEY DRUGS BEST CARE PHARMACY BEST QUALITY CARE PHARMACY BETTER HEALTH PHARMACY BOARDWALK RX CORP BOBO PHARMACY INC. BORBAS PHARMACY BOREUM DRUGS CORP BORINQUEN PHARMACY BORO PHARMACY INC BRIDGE APOTHECARY BRIDGE PHARMACY BRIGHT PHCY & MED SUPPLY INC BRIGHTON 11TH PHARMACY INC BRIGHTON CARE PHARMACY BRIGHTON RX BROADMEDS PHARMACY BROADWAY PHARMACY BROADWAY PHARMACY BROOKDALE PHARMACY BROOKLYN APOTHECARY BROOKLYN CENTER PHARMACY BROOKLYN CHEMISTS BROOKLYN CHEMISTS BROOKLYN PHARMACY BROOKLYN PHARMACY INC

Provider Name

(718) 745-7119 (718) 266-6160 (718) 680-3784 (718) 439-0502 (718) 648-5999 (212) 249-8202 (718) 638-4350 (718) 388-4307 (718) 485-3300 (718) 277-0800 (718) 338-3434 (718) 680-9855 (718) 686-8765 (718) 622-4743 (718) 996-7600 (718) 759-6308 (718) 372-5686 (718) 387-8288 (718) 782-7539 (718) 878-7333 (718) 246-4100 (718) 836-1400 (718) 615-1550 (718) 934-0022 (917) 933-9220 (718) 332-8428 (718) 919-8630 (718) 915-9660 (718) 495-1122 (718) 485-0070 (718) 748-2022 (718) 250-0060 (718) 373-3500 (718) 382-3400 (718) 484-8600 (347) 462-4662

7119 5TH AVE 8515 BAY PARKWAY 6910 3RD AVE 6013 7TH AVE UNIT B 589 AVENUE Z 1458 FULTON ST 231 DEKALB AVE 138 GRAHAM AVE 102 BELMONT AVE # A 990 SUTTER AVE 1951 FLATBUSH AVE 8510 3RD AVE 5015 8TH AVENUE 1147 FULTON ST 3100 OCEAN PKWY 6903 18TH AVE 2046 BATH AVE 194 UNION AVE 106 GRAHAM AVE 5027 NEW UTRECHT AVE 104 JAY ST 8912 3RD AVE 227 BRIGHTON BEACH AVE 124 BRIGHTON 11TH ST 1055 BRIGHTON BEACH AVE 277 BRIGHTON BEACH AVE 863 BROADWAY 361 BROADWAY 1538 PITKIN AVE 2568 LINDEN BLVD 7716 3RD AVE 104 DEKALB AVE 121 AVENUE U 2927 AVENUE S 589 SUTTER AVE 1675 FLATBUSH AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11209-1608 11214 11209-1305 11220 11223-6346 11216-2505 11205-4101 11206-2621 11212-7729 11208-3534 11234-2819 11209-4610 11220-6872 11238-2613 11235-8439 11204-5076 11214-4806 11211-7412 11206-3320 11219-3547 11201-1569 11209-5706 11235-7406 11235-5375 11235-5662 11235-7410 11206-5903 11211 11212 11208 11209 11201-5427 11223-3605 11229-3231 11207-4002 11210-3946

BROWNSVILLE COMMUNITY PHARMACY INC BUFFALO DRUGS C & J WELLNESS PHARMACY LLC CARE FAST PHARMACY INC CARE MAX PHARMACY INC

(718) 345-3399 (718) 953-9083 (718) 443-0591 (718) 975-4464 (718) 833-6700

592 ROCKAWAY AVE 183 BUFFALO AVE 1425 BROADWAY 3771 NOSTRAND AVE 6721 FORT HAMILTON PKWY

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY

11212-5539 11213 11221-4202 11235-2041 11219-5847

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 426 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CARE PHARMACY CARE PLUS PHARMACY INC CARELAND PHARMACY CARE-RX PHARMACY CAREWAY PHARMACY

Provider Name

(718) 209-2222 (718) 256-4886 (347) 987-4315 (718) 331-2668 (718) 483-8743

5915 AVENUE N 7010 18TH AVE 84 CLARK ST 8011 18TH AVE 1174 FLATBUSH AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY

11234-4129 11204-5201 11201-2721 11214 11226-7005

CARIBBEAN AMERICAN FAMILY PHARMACY CENTRAL AVE PHARMACY CENTRAL PHARMACY

(718) 484-3300 (718) 942-5855 (929) 234-5500

3424 CHURCH AVE 334B CENTRAL AVE 397 MOTHER GASTON BLVD

BROOKLYN BROOKLYN BROOKLYN

NY NY NY

11203-2714 11221-3819 11212-7736

CENTRAL PHARMACY OF BROOKLYN NY INC CENTURY PHARMACY INC CHEMPLUS PHARMACY CORP CITY CHEMIST CITY CHEMIST CITY DRUGS PHARMACY CITYLINE PHARMACY CLEAR PHARMACY INC COMMUNITY CARE PHARMACY COMMUNITY CHEMISTS COMPASHIONE PHARMACY CONEY ISLAND CHEMIST INC CONEY ISLAND PHARMACY CORNER PHARMACY COUNTY PHARMACY INC CREST PHARMACY LTD CRJ PHARMACY LLC CRYSTAL PHARMACY INC CURE SCRIPT DRUGS & SURGICALS CYPRESS CARE PHARMACY INC DAHILL PHARMACY INC DAVID'S PHARMACY DEAR DRUGS DEKALB DRUGS DERMER PHARMACY AND SURFICAL DITMAS PARK PHARMACY DITMAS PHARMACY CORP DNG PHARMACY CORP DOCS PHARMACY DOLINSKY PHARMACY DOOR TO DOOR PHARMACY DOWNTOWN WELLNESS PHARMACY

(718) 646-2222 (718) 375-4100 (718) 935-1033 (718) 237-2489 (718) 387-0124 (718) 686-2727 (718) 940-0310 (718) 975-7680 (718) 372-5300 (718) 339-8118 (718) 363-1095 (347) 587-7200 (212) 249-8202 (718) 599-2771 (718) 783-1143 (718) 399-8677 (718) 676-0157 (718) 942-5800 (718) 576-6556 (718) 277-3300 (718) 484-8300 (718) 677-8500 (718) 998-8000 (718) 249-0670 (718) 377-4900 (718) 975-4989 (718) 675-0055 (718) 384-6630 (718) 627-1145 (718) 256-8423 (718) 484-7400 (347) 599-1781

252 BRIGHTON BEACH AVE 483 KINGS HWY 222B HOYT ST 129 MONTAGUE ST 335 GRAHAM AVE 422 CHURCH AVE 511 CORTELYOU RD 1707 KINGS HWY 2913 SURF AVE 436 AVE P 621 NOSTRAND AVE 2384 CONEY ISLAND AVE 2720 MERMAID AVE 166 DIVISION AVE 580 NOSTRAND AVE 196 FLATBUSH AVE 1341 FULTON ST 2950 AVENUE X STE B 10317 GLENWOOD RD 1159 BLAKE AVE 73 CHURCH AVE 1408 AVENUE J 490 AVENUE P 886 DEKALB AVE 2064 FLATBUSH AVE 509 RALPH AVE 509 DITMAS AVE 249 GRAHAM AVE 559 KINGS HWY 1678 BATH AVE 259 TROY AVE 135 LAWRENCE ST

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11235 11223-1835 11217-2909 11201-3543 11211-3734 11218-3108 11218-4604 11229-1207 11224-1705 11223-1885 11216 11223-5002 11224-2006 11211-7108 11216-2806 11217-2170 11216-5219 11235-1874 11236-2703 11208-3721 11218-3718 11230-3702 11223-2002 11221-1402 11234-4314 11233-4406 11218-5001 11206-1201 11223-2003 11214-4510 11213-3601 11201

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 427 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DRJ PHARMACY INC DRUG MART PHARMACY CORP DRUGLAND PHARMACY CORP DRUGS CARE CORP DUMONT PHARMACY EAST 16 STREET PHARMACY INC ECHO CARE SPECIALTY PHARMACY EL AZAR PHARMACY ELIYAHU'S PHARMACY INC ELM PHARMACY EMAAN PHARMACY INC EMCON PHARMACY ESTABLISHED DRUGS ESTIS PHARMACY AND SURGICALS EURO CHEMIST EVE AND MIKE PHARMACY EVE III PHARMACY INC EVE PHARMACY

Provider Name

(917) 893-8452 (718) 633-4900 (718) 972-1056 (718) 856-2976 (718) 485-4012 (718) 282-7660 (718) 782-3030 (718) 676-6445 (718) 627-0485 (718) 336-8300 (718) 748-5901 (718) 789-3370 (718) 941-1013 (718) 484-4305 (718) 349-6696 (718) 230-3321 (718) 759-6470 (718) 743-8585

104-10 FLATLANDS AVE 4914 NEW UTRECHT AVE 5806 FORT HAMILTON PKWY 1001 CHURCH AVE 364 JUNIUS ST 1526 CORTELYOU RD 260 BROADWAY 464 AVENUE U 573 KINGS HWY 1651 CONEY ISLAND AVE 7309 5TH AVE 49 5TH AVE 3001 CLARENDON RD 300 TROY AVE 669 MANHATTAN AVE 552 SAINT MARKS AVE 2550 CONEY ISLAND AVE 2836 CONEY ISLAND AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11236 11219-3418 11219-4832 11218-2711 11212-7306 11226-5608 11211-8433 11223-4011 11223-2003 11230-5849 11209-2603 11217-2043 11226 11213-4632 11222-3113 11238 11223-5000 11235-5045

EXPRESS HEALTH MART PHARMACY CORP EXPRESSWAY PHARMACY EXTRA CARE PHARMACY EZ RX PHARMACY INC FAIRFIELD PHARMACY INC FAITH PHARMACY FAITH PHARMACY FAMILY DRUG STORE FAMILY DRUGSTORE FAMILY DRUGSTORE FAMILY FIRST PHARMACY FAMILY PHARMACY FAMILY PHARMACY FAMILY PHARMACY

(347) 221-1100 (718) 439-1570 (718) 462-2273 (347) 560-6560 (718) 395-9400 (718) 643-6300 (718) 827-2250 (718) 769-9600 (718) 759-9500 (718) 373-2300 (718) 633-8388 (718) 703-2440 (718) 342-7368 (718) 382-7700

1173 NOSTRAND AVE 4620 3RD AVE 2036 BEDFORD AVE 8802 4TH AVE 953 PENNSYLVANIA AVE 52 WILLOUGHBY ST 2640 PITKIN AVE 3692 NOSTRAND AVE 8617 5TH AVE 3010 MERMAID AVE 4507 8TH AVE 1101 FLATBUSH AVE 440 ROCKAWAY AVE 1425 KINGS HWY

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11225-5417 11220-1034 11226-1905 11209-5606 11207-8416 11201-5212 11208-2629 11229-5303 11209-5201 11224-1806 11220-1515 11226 11212-5636 11229-2087

FAMILY PHARMACY & SURGICAL SUPPLIES FARMACON PHARMACY-LEGEND FAST & FRIENDLY PHARMACY LLC FAST AID CORP FILL HERE FINE CARE FINE CARE PHARMACY FINE CARE PHARMACY

(718) 331-8877 (718) 238-1090 (718) 484-2300 (718) 646-1109 (718) 968-8600 (718) 438-6555 (718) 942-4842 (718) 676-9976

1757 BATH AVE 8007 5TH AVE 140 EMPIRE BLVD STORE # 1 2807 OCEAN AVE 2116 ROCKAWAY PKWY 4723 13TH AVE 1611 BROADWAY UNIT B 380 KNICKERBOCKER AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY

11214-4517 11209-4003 11225-3316 11229-4707 11236-5802 11219-2602 11207-1002 11237-3702

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 428 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name FINE CARE PHARMACY INC FIRST CARE PHARMACY FIRST CHOICE PHARMACY CORP FIVE STAR PHARMACY INC FIVE-STAR PHARMACY-LEGEND FLATBUSH EXPRESS PHARMACY INC FLATBUSH RX CORP FLATLANDS PHARMACY INC FLUSHING PHARMACY FORTUNE PHARMACY FOSTER MAAZ PHARMACY INC FRANKLIN & CARROLL DRUGS INC. FRIENDLY RX INC FRIENDS PHARMACY INC FULL HEALTHCARE PHARMACY INC FULTON 1ST PHARMACY INC FULTON DRUGS INC FULTON PHARMACY FUTURE PHARMACY INC G & G PHARMACY GARDNER'S PHARMACY INC GATEWAY PHARMACY INC GEM PHARMACY INC GENA CARE PHARMACY GEO PHARMACY INC GET WELL PHARMACY GLOBAL CARE PHARMACY INC GLOBAL DRUGS INC GLOBE DRUG STORE GOLDEN AID PHARMACY GOOD DAY PHARMACY LLC GOOD HEALTH PHARMACY GOOD NEIGHBOR PHARMACY GRAND BUY PHARMACY INC GRANDBROOK PHARMACY, INC GREEN FOREST PHARMACY GREENE COMMUNITY PHARMACY GREENTREE PHARMACY GREENWAY PHARMACY, INC GRISTEDES PHARMACY GS PHARMACY LLC GST PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (718) 857-3499 (718) 859-4100 (718) 439-8077 (718) 686-8900 (718) 398-9000 (718) 282-4777 (718) 677-4067 (718) 975-8200 (718) 260-8999 (718) 836-6337 (718) 421-5533 (718) 221-8678 (718) 732-3399 (718) 753-4900 (347) 599-1088 (718) 484-9100 (718) 735-3784 (718) 235-6394 (718) 376-6563 (718) 646-2800 (718) 384-7509 (347) 587-1771 (718) 676-4006 (718) 484-7166 (718) 703-1888 (718) 686-0812 (718) 851-8998 (929) 337-6738 (718) 745-2233 (718) 693-0888 (718) 851-8826 (718) 618-7425 (718) 375-8900 (718) 853-2845 (718) 484-8690 (929) 333-9669 (718) 834-6368 (718) 768-2700 (718) 462-2029 (718) 834-9003 (718) 421-4068 (718) 963-1018

Provider Street 981 FULTON ST 902 FOSTER AVE 5912 8TH AVE 4125 18TH AVE 1200 FULTON ST 860 FLATBUSH AVE 1855 FLATBUSH AVE 9002 FLATLANDS AVE 414 FLUSHING AVE 6305 8TH AVE 1056 CONEY ISLAND AVE 886 FRANKLIN AVE 651C CONEY ISLAND AVE 342 KINGS HWY 712 60TH STREET 1185 FULTON ST 1548 FULTON ST 2818 FULTON ST 2480 65TH ST 2967 OCEAN AVE 371 BROADWAY 1184 ELTON STREET 10 BRIGHTON 11TH ST 173 CHAUNCEY ST 685 CONEY ISLAND AVE 5218 8TH AVE 5905 8TH AVE 5516 7TH AVENUE 405 86TH ST 882 UTICA AVE 4908 7TH AVE 1379-83 NOSTRAND AVE 1614 AVENUE M 4721A 8TH AVE 642 SUTTER AVE 1520 AVENUE M 702 FULTON ST 291 7TH AVE 644 ROGERS AVE 101 CLARK ST 1932 NOSTRAND AVE 669 GRAND ST

Page 429 of 679

Provider City BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11238-2346 11230-1363 11220-4388 11218-5709 11216-2022 11226-3102 11210-4840 11236-3616 11205 11220-4717 11230-2303 11225-2004 11218-4306 11223-1478 11220 11216-1810 11216-5322 11207 11204-3526 11235 11211-7303 11239 11235-5304 11233-2154 11218-4306 11220-2816 11220-4336 11220 11209-4707 11203-4314 11220-2126 11226 11230-6007 11220-1519 11207-4113 11230-5267 11217-1629 11215-7263 11226-1502 11201-2746 11210-1532 11211-4899

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HAMILTON DRUG HANCOCK PHARMACY INC HAROLDS PHARMACY HARRICO GALLER DRUG CORP HARRICO KNICKERBOCKER DRUG HAVEMEYER PHARMACY INC HAYATT PHARMACY CORP HEALTH CARE PHARMACY HEALTH CARE PHARMACY LLC HEALTH IS WEALTH HEALTH MART PHARMACY INC HEALTH MART PITKIN PHARMACY HEALTH PLUS PHARMACY INC HEALTH POINT DRUGS INC HEALTH STAR PHARMACY INC HEALTH TREASURES PHARMACY INC HEALTHONE PHARMACY INC HEALTHPRO PHARMACY INC

Provider Name

(718) 435-8800 (718) 497-7000 (718) 996-4200 (718) 377-7724 (718) 452-5521 (718) 599-5991 (347) 662-6119 (718) 996-9900 (718) 676-6731 (718) 339-9393 (347) 599-1165 (347) 955-5506 (718) 232-0810 (718) 855-5958 (718) 645-1227 (718) 333-0395 (718) 495-9015 (718) 363-3400

4514 FORT HAMILTON PKWY 715 KNICKERBOCKER AVE 2272 MCDONALD AVE 1409 CONEY ISLAND AVE 214 STANHOPE ST 168 HAVEMEYER ST 6920 5TH AVE 2402 MERMAID AVE 1437 FLATBUSH AVE 1926 KINGS HWY 5603 2ND AVE 2232 PITKIN AVE 6605 BAY PKWY 392 MYRTLE AVE 1422 AVENUE U 8512 20TH AVE 119 PENNSYLVANIA AVE 217 SCHENECTADY AVENUE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11219-2410 11221-5337 11223-3990 11230-4137 11237-4202 11211-5410 11209-1507 11224 11210-2330 11229-1314 11220-3303 11207-3621 11204-3934 11205-2411 11229-3320 11214-3253 11207-2428 11213

HEALTHWAYS PHARMACY & SURGICALS HEALTHY FAMILY PHARMACY INC.

(718) 513-4821 (718) 676-7733

225 NEPTUNE AVE 5901 8TH AVENUE UNIT 1

BROOKLYN BROOKLYN

NY NY

11235-6375 11220

HEMATOLOGY ONCOLOGY ASSOC BROOKLYN HINA DRUGS HOME INFUSION GROUP INC. HOMECREST V&I PHARMACY INC HONG KONG PHARMACY

(718) 382-8500 (718) 778-3900 (718) 676-9070 (718) 872-6655 (929) 292-2326

1660 E 14TH ST STE 401 4 SUTTER AVE 3052 BRIGHTON 1ST ST 3RD FL 1826 GRAVESEND NECK RD 6714 FORT HAMILTON PKWY

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY

11229 11212-3838 11235 11229-4511 11219-5846

HOPEWELL PHARMACY & SURGICALS, INC.

(718) 974-9611

181 MACDOUGAL ST

BROOKLYN

NY

11233-6217

HOYT PHARMACY & SURGICAL SUPPLIES HRITHIKA PHARMACY HUIKANG PHARMACY INC HUMDARD PHARMACY & FOOD MART ICY PHARMACY INC IDEAL CARE PHARMACY IDEAL PHARMACY IMAGE PRESCRIPTION CENTER INTERNATIONAL HOLISTIC PHARMACY IQRA PHARMACY & SURGICALS IRVING PHARMACY ISLAND EXPRESS PHARMACY INC

(718) 277-9160 (718) 443-8787 (718) 333-5654 (718) 703-1800 (718) 455-5080 (718) 382-1990 (718) 439-5900 (718) 686-7343 (718) 975-3733 (347) 305-3100 (718) 484-8510 (347) 533-4606

3024 ATLANTIC AVE 276 MARCUS GARVEY BLVD # 280 6410 8TH AVE UNIT 1A 949 CONEY ISLAND AVE 1383 BUSHWICK AVE 1621 AVENUE U 5409 5TH AVE 119 CHURCH AVE 3078-3080 BRIGHTON 6TH STR 1090 FLATBUSH AVE 115 IRVING AVE 1347 FLATBUSH AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY

11208-1107 11221-1510 11220-4720 11230 11207 11229-3809 11220-3112 11218-3917 11235 11226-6198 11237 11210

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 430 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ISLAND PHARMACY J AND R PHARMACY INC J DRUGS J DRUGS JACOFF PHARMACY JANUS PHARMACY JMJ PHARMACY JNJ PHARMACY CORP. JRSTAT PHARMACY INC JUNCTION PHARMACY JUST IN TIME PHARMACY K & W PHARMACY INC KALA PHARMACY INC KATZ DRUG INC KAY'S PHARMACY KENBY PHARMACY KINETIC PHARMACY INC KINGS BAY CHEMISTS KINGS COURT DRUGS INC

Provider Name

(718) 336-2800 (718) 266-6286 (718) 258-6686 (718) 258-5858 (718) 774-3311 (718) 854-7092 (718) 252-2818 (718) 492-8889 (718) 633-2988 (718) 421-3600 (718) 332-5474 (718) 946-0101 (718) 495-3901 (718) 388-4588 (718) 372-0797 (718) 439-4721 (718) 686-7288 (718) 891-3447 (718) 434-6565

1841 CONEY ISLAND AVE 2302 MERMAID AVE 1205 AVENUE J 3402 AVENUE N 839 EMPIRE BLVD 833 58TH ST 2823 NOSTRAND AVE 761 61ST ST 804 54TH ST 2109 NOSTRAND AVE 2126 KNAPP ST 170 AVE U 9311 CHURCH AVE 76 GRAHAM AVE 2201 BATH AVE 6024 5TH AVE 784 61ST ST 3610 NOSTRAND AVE 610 E 16TH ST

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11230 11224-2208 11230-3603 11234-2607 11213-5653 11220-3609 11229-1816 11220-4211 11220-3209 11210 11229-5609 11223-3740 11212-1645 11206-4017 11214-5603 11220-4012 11220-4212 11229-5203 11226-6585

KINGS HWY PHCY & MEDICAL SUPPLY INC KINGS PHARMACY KINGS PHARMACY KINGS PHARMACY AND SURGICAL KINGSTON PHARMACY KINGSWAY PHARMACY KIRA'S PHARMACY KNAPP PHARMACY KNICKERBOCKER CHEMISTS KONWALER DRUGS KRUTICKS PHARMACY L & A PHARMACY L & S PHARMACY LA RUCHE PHARMACY INC LAGRASS PHARMACY CORP LANE DRUGS LAWRENCE PHARMACY LEMBERGS PHARMACY LERDS PHARMACY INC LEVYS PHARMACY INC LIEB PHARMACY LIFE CARE PHARMACY INC

(718) 375-5757 (718) 499-5200 (718) 230-3535 (718) 363-3300 (718) 221-4805 (718) 946-6899 (718) 676-4343 (718) 513-6178 (718) 483-9102 (718) 438-2565 (718) 277-0573 (718) 339-9532 (718) 332-5881 (718) 485-6923 (718) 377-9400 (718) 435-1118 (718) 649-0180 (718) 368-4336 (718) 332-5330 (718) 633-4377 (718) 633-5770 (718) 564-2356

1671 E 13TH ST 300 7TH AVE 357 FLATBUSH AVE 492 CLARKSON AVE 1106 SAINT JOHN PL 250 KINGS HWY 88 KINGS HWY 2310 KNAPP STREET 360 KNICKERBOCKER AVE 801 CHURCH AVE 589 CRESCENT ST 395 AVENUE X 424 BRIGHTON BEACH AVE 494 ROCKAWAY PKWY 2117 UTICA AVE 4623 13TH AVE 740 NEW LOTS AVE 191 NEPTUNE AVE 1601 GRAVESEND NECK RD 4021-13 AVE 5006 16TH AVE 1337 NOSTRAND AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11229-1101 11215-7251 11238-4378 11203-2013 11213 11223 11214 11229 11237-8053 11218 11208 11223 11235-6457 11212-3248 11234-3844 11219-2631 11207-7319 11235 11229-4430 11234 11204-1404 11226

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 431 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LIFE PHARMACY INC LIFE TOUCH PHARMACY INC. LIGHT PHARMACY INC LINCOLN NEIGHBORHOOD PHARMACY LINCOLN PLACE PHARMACY INC LINDEN PHARMACY LINDENWOOD RX CENTER INC LINKUS PHARMACY INC LINS PHARMACY LIVE GOOD PHARMACY INC LIVINGWORD PHARMACY INC. LIVONIA PHARMACY INC LMD PHARMACY LORVEN PHARMACY LLC LOWENS PHARMACY LUNA PARK PHARMACY INC LUTHERAN PHARMACY M & F PHARMACY M & I PHARMACY M DRUG INC MACRORX PHARMACY MAIN PHARMACY MANER PRESC CTR INC MANIPAL DRUGS INC MANNINGS 8TH AVE PHARMACY MARBEN PHARMACY MARCY PHARMACY INC MARHABA PHARMACY MARINE PHARMACY INC MARINO PHARMACY MARKOWA APTEKA PHARMACY MARLBORO DRUG COMPANY MARTY'S PHARMACY MAURICE PHARMACY INC MAXI CARE PHARMACY INC MAYA PHARMACY MAYFLOWER PHARMACY MEDCAL PHARMACY MEDCARE PHARMACY MEDICINE DEPOT INC MEDICINE PLAZA INC MEDINA PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (718) 438-1421 (347) 529-0500 (718) 872-7668 (718) 284-0083 (718) 756-1717 (718) 342-3131 (718) 277-0898 (718) 837-8282 (347) 221-0914 (718) 221-9300 (347) 461-9555 (718) 484-8100 (718) 627-1616 (718) 349-2255 (718) 238-2444 (718) 946-5444 (718) 492-9800 (718) 467-1000 (718) 493-8118 (718) 252-7334 (718) 633-6337 (718) 372-2144 (718) 748-9300 (718) 623-9533 (718) 238-3850 (718) 649-0200 (718) 384-5917 (929) 333-9306 (718) 332-7155 (718) 497-3104 (718) 389-0389 (718) 373-2600 (718) 251-1313 (347) 462-2877 (718) 774-0600 (718) 566-6292 (718) 645-0999 (718) 331-2200 (718) 513-3322 (718) 963-3923 (718) 627-0800 (718) 439-3500

Provider Street 4301 14TH AVE 361 SUTTER AVE 319 AVENUE X 723 FLATBUSH AVE 1135 EASTERN PKWY 1368 LINDEN BOULEVARD 1380 LORING AVE 7213 18TH AVE 4311 8TH AVE 1025 NOSTRAND AVE 957 UTICA AVE 625A LIVONIA AVE 801 AVENUE U 942 MANHATTAN AVE 6902 3RD AVE 2875 W 8TH ST 5407 2ND AVE 712 NOSTRAND AVE 853 E NEW YORK AVE 405 AVENUE M 5202 7TH AVE 2361 86TH ST 7323 3RD AVE 280 NOSTRAND AVE 6402 8TH AVE # G103 679 STANLEY AVE 170 THROOP AVE 2029 BATH AVE 2758 GERRITSEN AVE 167 WYCKOFF AVE 831 MANHATTAN AVE 2313 STILLWELL AVE 9422 AVENUE L 802 AVE U 1645 BEDFORD AVE 161 WATKINS ST 397 KINGS HWY 6010 BAY PKWY 260 KINGS HWY 86 MANHATTAN AVE 1312 KINGS HWY 5721 5TH AVE

Page 432 of 679

Provider City BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11219-1429 11212-7501 11223-5933 11226-1403 11213-4107 11212 11208-5124 11204-5634 11232-3994 11225-3508 11203 11207-5301 11223-4135 11222-1626 11209 11224-3632 11220-2669 11216-3614 11203 11230-4611 11220-2577 11214-4309 11209-2405 11205-4927 11220-4720 11207-7905 11206-5313 11214-4805 11229-5915 11237-4303 11222-2507 11223-5647 11236 11223 11225-2009 11212-6501 11223-1615 11204 11223-1347 11206-2501 11229-1904 11220

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MED-RX INC MEDWAY PHARMACY INC MEGA AID PHARMACY MEGA AID PHARMACY INC MELLOR DRUG STORE MERCY PHARMACY INC MG PHARMACY INC MICHAELS PHARMACY MILL BASIN PHARMACY, INC MILLENNIUM PHARMACY MISHKIN PHARMACY MITTMAN'S PHARMACY MMC PHARMACY, INC. MODERN CHEMISTS MONICA'S PHARMACY MURAWSKI PHARMACY INC MY CHOICE PHARMACY MYRTLE DRUG CARE MYRTLE DRUGS MYRTLE PHARMACY INC NARROWS PHARMACY NATURES EMPORIUM NAVAR PHARMACY NAZ PHARMACY INC NEERGAARD PHARMACY NEERGAARD PHARMACY NEIGHBOR CARE PHARMACY INC NEVINS DRUGS INC NEW AGE PHARMACY NEW EXPRESS PHARMACY NEW LIFE PHARMACY LLC NEW LOTS CARE PHARMACY NEW LOTS PHARMACY NEW LOTS PHARMACY NEW RONSON DRUG INC NEW TREND PHARMACY NEW UTRECHT PHARMACY NEW VICTORY PHARMACY NEW YORK AVE PHARMACY NEW YORK DRUGS & SURGICALS INC NEWKIRK PHARMACY INC NEXTGEN PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (718) 312-1048 (718) 513-6777 (347) 533-4845 (718) 333-9133 (718) 277-5371 (718) 256-1020 (347) 915-2828 (718) 921-8777 (718) 676-6675 (718) 348-5000 (718) 452-3261 (718) 384-2387 (718) 283-7939 (718) 258-4200 (718) 332-9280 (718) 383-0236 (718) 375-7700 (718) 855-2292 (718) 453-6200 (718) 237-4444 (718) 238-1445 (718) 375-7877 (718) 677-5811 (718) 284-4200 (718) 857-1600 (718) 768-0600 (718) 336-4772 (718) 422-0100 (718) 253-1700 (718) 438-4300 (718) 576-6950 (718) 484-0700 (718) 272-4566 (718) 649-9535 (718) 756-7401 (718) 859-3000 (718) 436-9300 (718) 745-5100 (718) 856-8048 (718) 439-4966 (718) 434-0931 (718) 676-9191

Provider Street 420 MOTHER GASTON BLVD 1914 86TH ST 1013 BROADWAY 3112 MERMAID AVE 3343 FULTON ST 6413 18TH AVE 950 BROADWAY 531 E 7TH ST 5829 AVENUE T 3420 FULTON ST 1153 BROADWAY 167 HAVEMEYER ST 948 48TH ST 1630 CONEY ISLAND AVE 1324 SHEEPSHEAD BAY RD 94 NASSAU AVE # 98 924 KINGS HIGHWAY 355 MYRTLE AVE 1454 MYRTLE AVE 446A MYRTLE AVE 9920 4TH AVE 1601 KINGS HWY 3002 AVENUE M 731 CONEY ISLAND AVE 120 7TH AVE 454 5TH AVE 2315 65TH ST 326 LIVINGSTON ST 2918 AVENUE J 99 CHURCH AVE 5008 AVENUE D 404 NEW LOTS AVE 475 NEW LOTS AVE 739 NEW LOTS AVE 237 UTICA AVE 3401 AVENUE H 4624 NEW UTRECHT AVE 9202 4TH AVE 3307 CHURCH AVE 6112 5TH AVE 1402 NEWKIRK AVE 2483 86TH ST

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Provider City BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11212 11214-3104 11221-2462 11224-1808 11208-2003 11204-3730 11221 11218-4801 11234-4111 11208-1716 11221-3025 11211-5467 11219-2918 11230-4716 11235-3920 11222-3203 11223 11205-3216 11237-5102 11205-2414 11209-8333 11229-1209 11210-4745 11218-4306 11215-1372 11215-4003 11204-4066 11217-1002 11210-3842 11218-2285 11203-5906 11207-6346 11207 11207-7305 11213-3932 11210-3350 11219-2545 11209-6305 11203-2711 11220-4610 11226-6522 11214-4448

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NICK'S PHARMACY NILE RX PHARMACY NORTHSIDE PHARMACY CORP NORWOOD CARE PHARMACY NOSTRAND HOUSES PHARMACY LLC NOTTINGHAM PHARMACY NU-EDGE PHARMACY OAK PARK PHARMACY OCEAN A & R PHARMACY INC. OCEAN PHARMACY OCEAN PHARMACY OCEANIA PHARMACY

Provider Name

(718) 855-1990 (718) 333-5286 (718) 387-6566 (718) 827-1000 (718) 332-0040 (718) 375-2400 (718) 748-4082 (718) 768-6300 (347) 462-9550 (718) 998-9595 (718) 272-2282 (718) 769-5777

111 GOLD ST 6924 4TH AVE 559 DRIGGS AVE 3138 FULTON ST 3031 AVENUE V 1930 AVENUE M 7707 5TH AVE 205 PROSPECT PARK W 2806 OCEAN AVE 1929 KINGS HWY 915 E 107TH ST 415 BRIGHTON BEACH AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY

11201-1551 11209-1502 11211-2911 11208-1916 11229-5448 11230-6202 11209-3311 11215-5706 11229-4708 11229-1313 11236-3013 11235-6401

OCEANSIDE PHARMACY & SUPERMARKET OLYMPE PHARMACY INC OM PHARMACY INC ORGANIC PLANET PHARMACY PAB PHARMACY INC PANACEA PHARMACY PARAS DRUGS PARK CHEMISTS LLC PARK DRUGS PARK DRUGS INC PARK PLACE PHARMACY PARK RX INC PARKAID PHARMACY PARKSHORE HEALTH CARE LLC PARKSIDE CHEMISTS PARKSIDE EXPRESS PHARMACY PARKWAY PHARMACY PARMRX EXPRESS INC PHAMCO DRUGS PHAMCO DRUGS PHARMACIA POPULAR INC PHARMACY 4 U PHARMACY AT THE WAVE INC PHARMACY DEPOT LLC PHARMACY EXPRESS PHARMACY EXPRESS PHARMORE DRUGS PHILLIPS PHARMACY INC PITKIN EXPRESS CARE PHARMACY INC

(718) 996-4949 (718) 484-7070 (718) 453-1003 (347) 799-2213 (718) 649-1111 (718) 382-9616 (718) 372-8795 (718) 393-5555 (718) 953-4548 (347) 987-3380 (718) 857-4000 (718) 388-7228 (718) 875-1505 (718) 688-8755 (718) 462-1111 (347) 529-1843 (718) 436-5501 (718) 627-7070 (718) 604-2585 (646) 285-1545 (718) 218-9346 (718) 676-9770 (718) 891-4300 (718) 646-0001 (718) 493-4199 (718) 648-0002 (718) 282-3600 (718) 435-7790 (347) 627-4778

3206 MERMAID AVE 1665 NOSTRAND AVE 42 THOMAS S BOYLAND ST 205 N 9TH ST 1115 NOSTRAND AVE 1211 AVENUE U 2070 BATH AVE 164 5TH AVE 801 NOSTRAND AVE 693 BROADWAY 160 PARK PLACE 836 BROADWAY 517 PARK AVE STE 102 1222 E 96TH ST 1274 NOSTRAND AVE 685 FLATBUSH AVE 531 CHURCH AVE 1311 GRAVESEND NECK RD 802 NOSTRAND AVE 376 UTICA AVE 17 MARCUS GARVEY BLVD 1919A AVENUE U 104 WEST END AVENUE 317 BRIGHTON BEACH AVE 1081 RUTLAND RD 274 BRIGHTON BEACH AVE 510 OCEAN AVE 3921 9TH AVE 1672 PITKIN AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11224 11226-5515 11233-2028 11211-6919 11225-1502 11229-4108 11214-4904 11217-2696 11225-1507 11206-4404 11217 11206-7305 11205-1631 11236-3903 11226-1504 11225-5689 11218-2409 11229-4328 11216 11213-5551 11206-5305 11229-3905 11235 11235-7412 11212-3503 11235-7411 11226-2886 11232-3207 11212-5605

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 434 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PITKIN PHARMACY & FOOD MART PLUS PHARMACY POLISH AMERICAN PHARMACY POLLINA PHARMACY PREFERRED PHARMACY PREMIUM PHARMACY PRESTIGE CARE PHARMACY INC PRIME CARE DRUG & SURGICALS CORP PRIME HEALTH PHARMACY LLC PRIME INFUSIONS PRIX PHARMACY PROSPECT DRUGS PUNJAB PHARMACY PURE HEALTH PHARMACY PYRAMIDS PHARMACY INC. PYRAMIDS RX PHARMACY INC QUALI MEDS PHARMACY QUENTIN ROAD PHARMACY INC QUICK STOP PHARMACY QUICK SUCCESS PHARMACY INC QWIKMEDS RABINOWITZ PHARMACY RAEES PHARMACY RAFIEH PHARMACY INC RAM DRUGS INC RED HOOK PHARMACY CORP REGAL REMEDIES PHARMACY REGENCY DRUGS REMEDIES PHARMACY REVIVAL PHARMACY LLC RIDGE CHEMISTS, LLC RIGHT CARE PHARMACY RIGHT CHOICE PHARMACY INC RIGHTWAY PHARMACY INC RIMCO PHARMACY RITE CHOICE PHARMACY RITE-CARE PHARMACY RL HEALTH PHARMACY INC ROCKAWAY RX PHARMACY ROCKWAY DRUGS ROSEBLUM PHARMACY ROSS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (717) 484-8730 (718) 851-0817 (718) 389-1500 (718) 331-4300 (718) 872-7717 (718) 484-4628 (718) 676-6691 (718) 513-6644 (718) 676-4405 (718) 443-4000 (718) 513-1585 (718) 783-0890 (718) 434-4000 (718) 236-2747 (718) 513-1114 (718) 748-1400 (718) 872-5737 (718) 998-2588 (718) 256-3400 (718) 376-7600 (718) 443-0500 (718) 332-3708 (718) 856-5998 (718) 387-0021 (718) 852-0269 (718) 797-0200 (718) 265-4646 (718) 238-7488 (718) 855-0214 (718) 298-2222 (718) 333-5979 (718) 975-4535 (718) 676-5522 (718) 891-7900 (718) 919-9131 (718) 773-3700 (718) 499-7410 (718) 333-0410 (718) 975-4666 (718) 462-6527 (718) 388-0745 (718) 693-4138

Provider Street 1601 PITKIN AVE 5223 7TH AVE 566 LEONARD ST 7601 13TH AVE 1771 BROADWAY 829 57TH ST UNIT 1 1190 GRAVESEND NECK RD 1348 CONEY ISLAND AVE 1417 BEDFORD AVE 1624 BROADWAY 3340 NOSTRAND AVE 94 GREENE AVE 1018 CONEY ISLAND AVE 8014 18TH AVENUE 6403 20 AVE 6806 4TH AVE 2272 86TH ST 3109 QUENTIN RD 7210 20TH AVE 1610 AVENUE U 159-161 RALPH AVE 602 BRIGHTON BEACH AVE 750 FLATBUSH AVE 70 LEE AVE 120 RICHARDS ST 376 VAN BRUNT ST 1853 CROPSEY AVE 7115 3RD AVE 711 BEDFORD AVE 5350 KINGS HWY 122 BAY RIDGE AVE 12 NEPTUNE AVE 3609 AVENUE S 2511 AVENUE U 623 WILSON AVE 1484 FULTON ST 677 4TH AVE 2304 86TH ST 1367 ROCKAWAY PKWY 1214 FLATBUSH AVE 255 S 2ND ST 4908 CHURCH AVE

Page 435 of 679

Provider City BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11212-5045 11220-2833 11222-3098 11228-2411 11207 11220-3677 11229-4208 11230-4120 11216-3506 11207-1026 11229-3715 11238-1027 11230 11214 11204-3905 11220-5372 11214-4138 11234-4234 11204-5784 11229-3810 11233 11235-6973 11226-1902 11211-7234 11231-1635 11231-1235 11214 11209-1347 11206-5428 11203 11220-5052 11235-4405 11234-4829 11229-4934 11207-1220 11216-2505 11232-1240 11214-4310 11236-2321 11226-7047 11211-5484 11203-3406

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROSSI PHARMACY ROYAL PHARMACY RUBIN CHEMISTS RUTLAND PHARMACY RX CHOICE PHARMACY INC RX WAREHOUSE PHARMACY RXCIRCLE PHARMACY CORP S & K PHARMACY S & K WARBASSE PHARMACY S AND T PHARMACIE S BROS PHARMACY SAAB PHARMACY SAFE HEALTH PHARMACY SAI APTEKA PHARMACY SALAAM PHARMACY SALDO DRUGS SALUTE PHARMACY SAMS DRUGS SAMS PHARMACY LLC SAUL'S PHARMACY

Provider Name

(718) 346-2506 (718) 941-7722 (718) 493-8833 (718) 774-9613 (718) 368-1190 (718) 236-1212 (718) 686-8280 (718) 743-1600 (718) 449-5177 (718) 756-6026 (718) 855-3070 (718) 332-5577 (718) 632-8299 (718) 349-8989 (718) 484-8157 (718) 389-8015 (718) 517-2272 (718) 453-6866 (718) 676-0697 (718) 265-9108

1891 EASTERN PKWY 2239 CHURCH AVE 828 NOSTRAND AVE 964 RUTLAND RD 1908 AVENUE U 7724 NEW UTRECHT AVE 5001 7TH AVE 371 NEPTUNE AVE 499 NEPTUNE AVE 391 EASTERN PKWY 176 LEE AVE 291 NEPTUNE AVE 5708 7TH AVE STE 1A 151 NASSAU AVE 155 CRYSTAL ST 384 GRAHAM AVE 2113 AVENUE V 1367 BROADWAY 397 SARATOGA AVE 3514 MERMAID AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11233-3290 11226 11216-4403 11212-1544 11229-3906 11214-1014 11220-2127 11235-8025 11224-4003 11216-4103 11211 11235-6975 11220 11222 11208-2624 11211-2471 11229-4848 11221-3618 11233-7076 11224-1509

SCARPA PHARMACY & SURGICAL SUPPLIES SCRIPT DIRECT SDF PHARMACY INC SEA BREEZE PHCY AND MED SUPPLY SHALOM'S PHARMACY INC SHAZIA'S PHARMACY SHEEPSHEAD BAY PHARMACY INC SHIMON'S PHARMACY, INC SHLOMO PHARMACY INC SILVER PHARMACY, INC. SILVER ROD DRUGS SILVER ROD PHARMACY SIMS PHARMACY SISTO PHARMACY SKS PHARMACY LLC SKY PHARMACY SKY PHARMACY LLC SLOPE DRUGS & SURGICAL SUPPLY SMART CHOICE PHARMACY SMART HEALTH RX SMARTHEALTH PHARMACY LLC

(718) 745-5499 (718) 475-1448 (718) 384-1544 (718) 646-0660 (718) 253-4900 (718) 827-6090 (718) 676-4966 (718) 384-0234 (718) 998-4100 (718) 851-7711 (718) 922-3400 (718) 236-5705 (718) 346-7200 (718) 387-2665 (718) 385-6000 (718) 434-4744 (718) 621-0204 (718) 788-8899 (718) 339-3400 (718) 282-9000 (718) 238-2725

6216 11TH AVE 5379 KINGS HWY 302 BROADWAY 1129 BRIGHTON BEACH AVE 1106 AVENUE K 1ST FLOOR 3166 CONEY ISLAND AVE 3558 NOSTRAND AVENUE 115 LEE AVE 2092 CONEY ISLAND AVE 4024 18TH AVENUE 5105 CHURCH AVE 6404 18TH AVE 1711 PITKIN AVE 682 GRAND ST 611 LIVONIA AVE 1100 CONEY ISLAND AVE 7114 BAY PKWY 406 5TH AVE 259 AVENUE X 766 FLATBUSH AVE 551 86TH ST

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11219 11203-6704 11211-7308 11235-5903 11230 11235-6452 11229-5203 11211-7904 11223-2308 11218 11203-3511 11204-3729 11212-6601 11211 11207-5308 11230-2342 11204-6016 11215-3316 11223-5939 11226-1902 11209-4809

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 436 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SOS PHARMACY INC SOUTH SIDE PHARMACY SPECTRUM PHARMACY-LEGEND SPENCER DRUGS LTD SQUARE DEAL PHARMACY ST.JUDE PHARMACY STANLEY PHARMACY STAR DRUGS STARRETT CITY PHARMACY LLC STAYWELL PHARMACY INC STELLA'S PHARMACY STJ RX INC STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY SUMNER AVE PHARMACY SUNRISE FAMILY PHARMACY SUNRISE PHARMACY SUNSET PARK PHARMACY SUNSET RX PHARMACY INC SUNSHINE PHARMACY SUNSHINE PHARMACY OF NY INC SUPERMED SUPREME RX PHARMACY SURE DRUGS SVRH PHARMACY INC T & N PHARMACY INC TEBA PHARMACY TERESA PHARMACY INC. TEVA DRUGS THE LOBBY PHARMACY THE MEDICINE CHEST LLC THE MEDICINE SHOPPE THE MODERN CHEMIST PHARMACY THIS WAY PHARMACY THIS WAY PHARMACY INC THREE P DRUGS THRIFTCARE PHARMACY THRIFTCARE PHARMACY THRIFTCARE PHARMACY THRIFTWAY CHURCH AVE DRUG CORP

NR_0009_10823 10/2017

Provider Phone Number (917) 933-4000 (718) 782-7200 (718) 435-3100 (718) 439-3852 (718) 495-1414 (718) 381-5116 (718) 872-7665 (718) 649-0499 (718) 257-8777 (718) 498-7800 (718) 272-8450 (718) 399-1800 (718) 266-2845 (718) 399-6239 (718) 648-6971 (718) 455-7100 (718) 567-9100 (718) 837-0600 (718) 633-6533 (718) 765-0019 (347) 462-9778 (718) 773-2020 (718) 209-3434 (718) 677-6600 (718) 774-5665 (718) 596-1688 (718) 646-2100 (347) 517-4833 (718) 342-3446 (718) 363-7000 (718) 963-7222 (718) 633-4246 (718) 434-4649 (347) 599-0174 (718) 339-3110 (718) 769-7403 (718) 302-4850 (718) 230-3009 (718) 724-1717 (718) 638-3800 (718) 282-4600

Provider Street 1201 AVENUE Z 432 BEDFORD AVE 952 MCDONALD AVE 5702 7TH AVE 437 MOTHER GASTON BLVD 121 ST NICHOLAS AVE 807 STANLEY AVE 922 PENNSYLVANIA AVE 1110 PENNSYLVANIA AVE 172 WATKINS ST 8722 GLENWOOD ROAD 720 CLASSON AVE 2965 CROPSEY AVE 625 ATLANTIC AVE 1710 AVENUE Y 103 MARCUS GARVEY BLVD 6324 4TH AVE 6725 BAY PKWY 4510 5TH AVE 5805 4TH AVE 1622 VOORHIES AVE 411 KINGSTON AVE 1665 RALPH AVE 3011 AVENUE N 312 RALPH AVE 161 SMITH ST 2570 E 17TH ST 7618 5TH AVE 582 ROCKAWAY AVE 319 KINGSTON AVE 374 STOCKHOLM ST 4407 15TH AVE 1109 CONEY ISLAND AVE 191 4TH AVE 3601 QUENTIN RD 2712 AVENUE U 799 FLUSHING AVE 524 NOSTRAND AVE 1717 FOSTER AVE 759 WASHINGTON AVE 1621 CHURCH AVE

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Provider City BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11235-4301 11249 11218-5612 11220-3903 11212-7617 11237-3407 11207-8103 11207-8402 11207 11212 11236-3412 11238-4231 11214-7216 11217-2169 11235-3534 11206-6940 11220-4909 11204-4735 11220-1206 11220-3836 11235-3914 11225-3171 11236-3317 11210-5410 11233-3023 11201-6337 11235-3505 11209-3304 11212-5625 11213-4329 11237-4006 11219-1604 11230-2305 11217-3124 11234-4203 11229-5052 11206-4107 11216 11230 11238 11226-2615

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

THRIFTWAY FLATBUSH AVE DRUG CORP THRIFTWAY PHARMACY THROOP PHARMACY TIME ONE PHARMACY TOP CARE PHARMACY RX LLC. TRICARE PHARMACY TRUE HEALTH PHARMACY INC U15 PHARMACY INC UHEALTHY PHARMACY INC UMAMAH PITKIN PHARMACY INC UNITED CARE PHARMACY UNITY DRUGS UNZER PHARMACY URGENT CARE RX US PHARMACY & SURGICAL INC. UTICA PHARMACY INC V PHARMACY VALRX PHARMACY INC VAL-U-DRUGS VANDERVEER PHARMACY VIDA PHARMACY VINH HOA LONG CENTRE PHARMACY VISTA PHARMACY VLS ALLEON DRUGS.INC VLS PHARMACY VOORHIES HEALTH PHARMACY INC WALDINGERS PHARMACY WELCARE PHARMACY WELCOME PHARMACY WELCOME RX INC WELLNESS PHARMACY INC WHITMAN PHARMACY

(718) 284-9800 (718) 339-3500 (718) 484-3361 (718) 686-8988 (718) 975-8555 (718) 382-9999 (718) 748-4300 (718) 336-5883 (718) 331-1288 (718) 485-3724 (718) 369-2803 (718) 486-0344 (718) 384-7334 (718) 240-8388 (718) 484-1500 (718) 953-7351 (718) 368-0009 (718) 484-7045 (718) 773-5547 (718) 282-2956 (347) 725-4953 (718) 232-7766 (718) 417-9031 (718) 745-0733 (718) 854-1384 (718) 975-2872 (718) 745-2100 (718) 599-7200 (718) 724-1333 (718) 431-8232 (718) 232-8277 (718) 938-0816

542 FLATBUSH AVE 1909 KINGS HWY 241 THROOP AVE 5415 8TH AVENUE 380 RALPH AVE 1811 KINGS HWY 7524 5TH AVE 1506 AVENUE U 2263 86TH ST 2231 PITKIN AVE 4424 4TH AVE 772 GRAND ST 572 BEDFORD AVE 1235 LINDEN BLVD 1259 FULTON STREET 285 UTICA AVE # 287 2113 AVENUE V 3007 FARRAGUT RD # 1A 822 CLARKSON AVE 1913 NOSTRAND AVE 172 BUSHWICK AVE 87 AVENUE O 236 BUSHWICK AVE 6823 FORT HAMILTON PKWY 4402 5TH AVE 2309 VOORHIES AVE 8318 5TH AVE 54 GRAHAM AVE 1403 FOSTER AVE 128 DITMAS AVE 217 KINGS HWY 329A MYRTLE AVE

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11225-4804 11229-1398 11206-6611 11220 11233 11229-1350 11209-3302 11229-3808 11214-4107 11207-3620 11220-1104 11211-4968 11249 11212-2438 11216 11213-4940 11229-4846 11210-1537 11203-2204 11226 11206-1604 11204-6542 11206-2711 11219-5856 11220-1204 11235 11209 11206-4066 11230-1726 11218-4902 11223-1106 11205

WILLIAMSBURG PHARMACY & SURG SUPPLY WOODHULL DRUGS WOODHULL PRESCRIPTION CENTER WYCKOFF & BLEECKER DRUGS INC WYCKOFF DRUGS WYCKOFF PHARMACY INC WYCKOFFS CORNER PHARMACY Y & Z PHARMACY

(718) 387-9772 (718) 782-9345 (718) 599-1309 (718) 366-3300 (718) 443-1331 (718) 381-6200 (718) 923-1122 (718) 377-1680

244 ROEBLING ST 310 ELLERY ST 755 FLUSHING AVE 235 WYCKOFF AVE 1226 BROADWAY 5 GRAHAM AVE 203 COURT ST 1901 AVENUE M

BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN

NY NY NY NY NY NY NY NY

11211-5664 11206-5312 11206-4419 11237 11221-2906 11206 11201-6420 11230-6201

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name YAFFA PHARMACY INC. YAFIT PHARMACY YMD PHARMACY INC ZOYA PHARMACY INC ZUCKERMAN DRUGS BLACK ROCK PHARMACY CLEVE HILL DRUG DISCOUNT PHARMACY LLC LIFETIME HEALTH MEDICAL GROUP LIFETIME HEALTH MEDICAL GROUP MADINA PHARMACY INC MEDICINE SHOPPE PHARMACY MEDICINE SHOPPE PHARMACY MEDICINE SHOPPE PHARMACY MEDICINE SHOPPE PHARMACY METCARE RX METCARE RX MOBILE PHARMACY SOLUTIONS NIAGARA STREET PHARMACY PARKER PHARMACY PARKSIDE PHARMACY PARKVIEW HEALTH SERVICES PHARMACY AT MATTINA ROSWELL PARK CANCER INSTITUTE THE PHARMACY AT EVERGREEN UNION MEDICAL PHARMACY WEST SIDE PHARMACY INC MILEX DRUG RIVERSIDE REMEDIES RX CORP MAKKI PHARMACY & SURGICALS INC KINNEY DRUGS THE MEDICINE SHOPPE THE MEDICINE SHOPPE CANANDAIGUA THE MEDICINE SHOPPE BEAVER PHARMACY KINNEY DRUGS PRICE CHOPPER PHARMACY CARMAN DRUGS PHARMACENA LABS LLC STOP & SHOP PHARMACY LAKE CARMEL PHARMACY KINNEY DRUGS

NR_0009_10823 10/2017

Provider Phone Number (718) 434-0151 (718) 998-8651 (718) 576-6490 (718) 342-3911 (718) 743-1800 (716) 876-3070 (716) 832-7742 (716) 465-5459 (716) 878-2700 (716) 689-3471 (716) 424-2433 (716) 824-5200 (716) 827-4900 (716) 822-4400 (716) 823-8300 (716) 332-6811 (716) 332-2866 (716) 247-5300 (716) 856-0800 (716) 725-0887 (716) 895-8811 (716) 876-2323 (716) 242-8608 (716) 845-8999 (716) 541-0656 (716) 675-4133 (716) 884-8400 (585) 538-6140 (845) 887-3030 (347) 548-5250 (315) 245-1224 (315) 245-1410 (315) 487-5775 (585) 396-9970 (607) 698-4641 (315) 386-4563 (315) 379-9620 (516) 333-2400 (516) 209-4970 (516) 739-1978 (845) 225-4242 (315) 493-0150

Provider Street 1211 FOSTER AVE 418 AVENUE U 519 UTICA AVE #3 1527 PITKIN AVE 701 BRIGHTON BEACH AVE 431 TONAWANDA ST 1479 KENSINGTON AVE 429 WILLIAM ST. 899 MAIN ST 1185 SWEET HOME RD 1105 BROADWAY STE 8 2032 CLINTON ST 1979 SENECA ST 3038 BAILEY AVE 1791 S PARK AVE 34 BENWOOD AVE 462 GRIDER ST 644 ELLICOTT ST STE 104 469 NIAGARA ST 1388 HERTEL AVE 975 BROADWAY ST 1770 COLVIN BLVD 300 NIAGARA ST ELM AND CARLTON STREETS 206 S ELMWOOD AVE 1769 ORCHARD PARK RD 311 GRANT ST 3130 MAIN ST 39 LOWER MAIN ST 224-04 LINDEN BLVD 2 PRESTON ST 58 MAIN ST 3781 MILTON AVE 66 WEST AVE 7 MAIN ST 40 STATE HIGHWAY 310 111 E MAIN ST 570 WESTBURY AVE 516 MINEOLA AVE 95 OLD COUNTRY RD 511 ROUTE 52 401 STATE ST

Page 439 of 679

Provider City BROOKLYN BROOKLYN BROOKLYN BROOKLYN BROOKLYN BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO BUFFALO CALEDONIA CALLICOON CAMBRIA HEIGHTS CAMDEN CAMDEN CAMILLUS CANANDAIGUA CANISTEO CANTON CANTON CARLE PLACE CARLE PLACE CARLE PLACE CARMEL CARTHAGE

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11230 11223-4099 11203 11212-4516 11235-6493 14207-2625 14215-1436 14204 14203-1109 14226-1018 14212 14206-3312 14210-2352 14215-2814 14220-1411 14214 14215-3021 14203-1221 14201-1740 14216-2825 14212-1317 14223 14201-2135 14203 14201 14224-4624 14213-1423 14423-1218 12723-5000 11411 13316-1216 13316-1338 13031-1557 14424-1521 14823-1125 13617-1459 13617-1445 11514-1747 11514 11514-1800 10512-6064 13619-1413

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PRICE CHOPPER PHARMACY PINE HILL HOMETOWN PHARMACY GREENE MEDICAL ARTS PHARMACY PRICE CHOPPER PHARMACY CORNER DRUG STORE KINNEY DRUGS EZRA PHARMACY GRAND CENTRAL PHARMACY KING KULLEN PHARMACY CENTEREACH PHARMACY SHERON DRUGS VILLAGE PHARMACY CENTRAL VALLEY PHARMACY KINNEY DRUGS PRICE CHOPPER PHARMACY TILE PHARMACY KINNEY DRUGS MEDICINE SHOPPE KINNEY DRUG PRICE CHOPPER CLARENCE PHARMACY KINNEY DRUGS PRICE CHOPPER PHARMACY WAYNE-CLIFTON PHARMACY INC KINNEY DRUGS INC GALENS HEALTH MART PHARMACY PRICE CHOPPER PHARMACY MARRAS PHARMACY DRUG WORLD OPTION CARE PREMIER HEALTH PHARMACY RX EXPRESS PHARMACY OF COMMACK VANCO PHARMACY COMMUNITY CARE PHARMACY CHURCH & SCOTT INC COPIAGUE PHARMACY

Provider Name

(315) 493-6324 (315) 626-3161 (518) 943-1715 (518) 943-3909 (716) 257-3741 (315) 655-3451 (516) 569-7820 (516) 295-8880 (631) 878-9030 (631) 588-8911 (631) 234-6039 (315) 668-2659 (845) 928-1117 (518) 298-5343 (518) 392-5305 (716) 632-4888 (315) 687-6110 (315) 510-3141 (315) 699-0340 (315) 458-2322 (716) 407-3544 (315) 686-5121 (518) 373-8378 (315) 462-6181 (315) 853-3980 (315) 923-2651 (518) 234-2528 (518) 237-2110 (845) 265-6352 (718) 961-1634 (718) 661-0872 (631) 543-3331 (631) 499-1111 (845) 267-5945 (607) 547-1228 (631) 598-0200

60 HIGH ST 2949 STATE ROUTE 370 159 JEFFERSON HTS STE D102 320 W BRIDGE ST 1 WASHINGTON ST 41 ALBANY ST 604 CENTRAL AVE 420 CENTRAL AVE 552 MAIN ST 2155 MIDDLE COUNTRY RD 1629 ISLIP AVE 537 S MAIN ST 228 ROUTE 32 868 STATE ROUTE 11 15 DARDESS DR 1031 CLEVELAND DR 703 E GENESEE ST 1315 STATE ROUTE 5 # A 8150 THOMPSON RD 5701 E CIRCLE DR 9500 MAIN ST STE 600 822 JAMES ST 15 PARK AVE 4 COULTER RD 12 FRANKLIN AVE 17 SODUS ST 105 PLAZA LN 217 REMSEN ST 55 CHESTNUT ST 11402 15TH AVE 2007 127TH ST #312 1163 JERICHO TPKE 30 VANDERBILT MOTOR PKWY 15 SOUTH RT 303 5396 STATE HIGHWAY 28 1733 GREAT NECK RD

CARTHAGE CATO CATSKILL CATSKILL CATTARAUGUS CAZENOVIA CEDARHURST CEDARHURST CENTER MORICHES CENTEREACH CENTRAL ISLIP CENTRAL SQUARE CENTRAL VALLEY CHAMPLAIN CHATHAM CHEEKTOWAGA CHITTENANGO CHITTENANGO CICERO CICERO CLARENCE CLAYTON CLIFTON PARK CLIFTON SPRINGS CLINTON CLYDE COBLESKILL COHOES COLD SPRING COLLEGE POINT COLLEGE POINT COMMACK COMMACK CONGERS COOPERSTOWN COPIAGUE

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

13619-1350 13033 12414-1204 12414-1730 14719 13035-1214 11516-2215 11516-1907 11934-2207 11720-3520 11722-2701 13036-3500 10917-3649 12919-4940 12037-1439 14225-1221 13037-1329 13037-8702 13039-9379 13039-8638 14031-1981 13624-1404 12065-2924 14432-1122 13323-1616 14433-1215 12043-5020 12047-3024 10516-2604 11356-1452 11356-2321 11725 11725-5410 10920 13326-5710 11726-2703

PRESCRIPTION CENTRE AND SURGICALS STOP & SHOP PHARMACY YORE-X DRUGS GEROULDS PHARMACY MARKET STREET APOTHECARY

(631) 698-2868 (631) 736-5168 (631) 698-7788 (607) 936-3233 (607) 936-7023

35 MIDDLE COUNTRY RD STE H 294 MIDDLE COUNTRY RD 3663 RT 112 98 W PULTENEY ST 78 W MARKET ST

CORAM CORAM CORAM CORNING CORNING

NY NY NY NY NY

11727-4478 11727-4428 11727-4130 14830-2260 14830-2527

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 440 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HAZARD'S PHARMACY 21ST CENTURY PHARMACY INC. BEST FIVE STAR PHARMACY BIG APPLE PHARMACY CORONA FARMACIA INC CORONA HEIGHTS PHARMACY FARMACIA CENTRAL FREYA PHARMACY JUNCTION CHEMISTS MGR FARMACIA LATINA INC MY FAMILY PHARMACY NATIONAL PHARMACY NATIONAL RX CORP NORTHERN BLVD PHARMACY PROGRESSIVE PHCY & MED SUPPLY INC SANTIAGO PHARMACY SOL'S PHARMACY VIP PHARMACY CORP KINNEY DRUGS KINNEY DRUGS INC PRICE CHOPPER PHARMACY CROSS RIVER REXALL DRUG WORLD OF CROTON ROBBINS DRUG & SURGICAL CO INC SAVE MOR DRUGS CUBA PHARMACY CUTCHOGUE DRUGS KING KULLEN PHARMACY MAGGY PHARMACY INC NEW ISLAND PHARMACY INC STOP & SHOP PHARMACY FOUR CORNERS PHARMACY TRANSIT HILL PHARMACY

Provider Name

(845) 534-4345 (718) 699-8899 (718) 476-9000 (718) 779-4450 (718) 476-5660 (718) 699-5099 (718) 478-3908 (347) 649-2525 (718) 424-4538 (718) 205-3633 (718) 440-9201 (718) 779-9080 (718) 779-6600 (718) 899-1700 (718) 271-7486 (718) 205-7900 (718) 639-4107 (718) 898-1100 (607) 753-1591 (607) 753-9359 (607) 756-0421 (914) 763-3152 (914) 271-0832 (914) 271-5000 (914) 271-2900 (585) 968-3111 (631) 734-6796 (631) 734-7733 (518) 492-7130 (631) 392-4800 (631) 274-0949 (518) 439-8200 (716) 683-9444

290 MAIN ST 96-05 57TH AVE 10308 ROOSEVELT AVE 37-71 103RD ST 111-19 ROOSEVELT AVE 10607 CORONA AVE 3911 104TH ST 101-19 39TH AVENUE 3504 JUNCTION BLVD 3763 103RD ST 9608 NORTHERN BLVD 40-15 NATIONAL ST 10111 ROOSEVELT AVE 100-16 NORTHERN BLVD 103-22 CORONA AVE 4043 JUNCTION BLVD 37-12 108TH ST 10005 ROOSEVELT AVE 14 CLINTON AVE 3666 STATE ROUTE 281 854 STATE ROUTE 13 20 N SALEM RD 2005 ALBANY POST RD 128 GRAND ST 175 S RIVERSIDE AVE 2 CENTER ST 28195 MAIN RD 31525 MAIN RD 1165 ROUTE 374 1912A DEER PARK AVE 421 COMMACK RD 360 DELAWARE AVE 6344 TRANSIT RD STE 2

CORNWALL CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORONA CORTLAND CORTLAND CORTLAND CROSS RIVER CROTON ON HUDSON CROTON ON HUDSON CROTON ON HUDSON CUBA CUTCHOGUE CUTCHOGUE DANNEMORA DEER PARK DEER PARK DELMAR DEPEW

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

12518-1579 11368-3445 11368-2330 11368 11368 11368-2906 11368-2313 11368-4806 11368-1743 11368-1952 11368-1046 11368-2320 11368-4833 11368-1047 11368 11368 11368 11368-4880 13045-2102 13045-3576 13045-4516 10518-1104 10520 10520-2307 10520-2605 14727-1002 11935-1217 11935-1343 12929 11729 11729-4521 12054-1904 14043-1031

BROWNS RX PHARMACY OF DEPOSIT INC CARY'S PHARMACY KINNEY DRUGS KINNEY DRUGS INC WATER STREET PHARMACY INC PATIENT'S PHARMACY AND MEDICAL BUFFALO PHARMACIES INC. LARWOOD PHARMACY INC

(607) 467-2298 (914) 693-0008 (315) 429-8565 (607) 844-8273 (607) 243-8114 (716) 363-6339 (716) 568-1370 (716) 652-1360

115 FRONT ST 105 MAIN ST 55 N MAIN ST 44 NORTH ST 14 WATER ST 436 CENTRAL AVE 6035 TRANSIT RD 597 OAKWOOD AVE

DEPOSIT DOBBS FERRY DOLGEVILLE DRYDEN DUNDEE DUNKIRK EAST AMHERST EAST AURORA

NY NY NY NY NY NY NY NY

13754-1111 10522-1601 13329-1338 13053-8514 14837-1028 14048-2107 14051-1803 14052-2333

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 441 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DRUG RITE PHARMACY LAGUARDIA PHARMACY INC PARK PLACE CHEMISTS INC WHITES PHARMACY STOP & SHOP PHARMACY UNITY PHARMACY FAMILY RX PHARMACY MEADOW DRUGS AND SURGICAL NUHEALTH PROMED PHARMACY BARTHS PHARMACY ASL INC/TOWN DRUG LIGHT HOUSE PHARMACY SUNRISE PHARMACY BARTHS OF EAST QUOGUE INC BELLE MEAD PHARMACY INC NORTH SHORE HEMATOLOGY ONCOLOGY ASO VILLAGE CHEMISTS OF SETAUKET INC. HOA-THE PATIENT RX CENTER KINNEY DRUGS VALUEDRUGS EAST KINNEY DRUGS KINNEY DRUGS MATTHEWS PHARMACY ELLICOTTVILLE PHARMACY CY'S ELMA PHARMACY BROADWAY CORNER BROADWAY PHARMACY CARE FIRST PHARMACY CEDARS PHARMACY ELMHURST DRUGS CENTER ELMHURST PHARMACY ELMHURST PHCY AND HIF INC ELMWAY II PHARMACY INC ELMWAY PHARMACY EVERGREEN PHARMACY FRANKLIN PHARMACY GETTING WELL RX PHARMACY INC GOGO PHARMACY LLC GRACE PHARMACY HALLMARK PHARMACY

NR_0009_10823 10/2017

Provider Phone Number

State

ZIP code

(718) 728-6878 (718) 478-2576 (631) 324-6660 (631) 324-0082 (631) 859-5120 (631) 581-9620 (516) 280-7474 (516) 785-0120 (516) 542-7670 (516) 307-9200 (631) 874-3784 (631) 266-3999 (631) 654-2444 (631) 569-4245 (631) 653-3784 (631) 444-0784

7702 21ST AVE 10122 ASTORIA BLVD 200 PANTIGO PL STE K 81 MAIN ST 2650 SUNRISE HWY 126 E MAIN ST 621 MERRICK AVE 353 NEWBRIDGE RD 2201 HEMPSTEAD TPKE 537 E MEADOW AVE 94 MONTAUK HWY UNIT A 517A LARKFIELD RD 747 MONTAUK HWY 285 SILLS RD BLDG 8B 424 MONTAUK HWY 196 N BELLE MEAD AVE STE 8

Provider Street

EAST ELMHURST EAST ELMHURST EAST HAMPTON EAST HAMPTON EAST ISLIP EAST ISLIP EAST MEADOW EAST MEADOW EAST MEADOW EAST MEADOW EAST MORICHES EAST NORTHPORT EAST PATCHOGUE EAST PATCHOGUE EAST QUOGUE EAST SETAUKET

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11370-1219 11369-2059 11937-5923 11937-2701 11730-1000 11730 11554-3740 11554-4120 11554-1859 11554 11940-1156 11731-4201 11772-5423 11772-8800 11942 11733-3477

(631) 751-3000 (631) 751-1333 (315) 472-7504 (315) 656-9925 (914) 771-5640 (315) 689-6111 (518) 873-6441 (845) 647-6222 (716) 699-2384 (716) 652-3920 (718) 426-4727 (718) 803-3005 (718) 205-0588 (718) 271-9429 (718) 457-7884 (718) 565-8667 (718) 507-2299 (718) 699-1882 (718) 803-2288 (718) 429-4411 (718) 592-7200 (718) 565-8388 (929) 522-0393 (718) 426-1073 (718) 426-0300

235 N BELLE MEAD AVE 226 MAIN ST 5008 BRITTONFIELD PKWY STE 700 7065 MANLIUS CENTER RD 1 TUCKAHOE AVE 1057 STATE ROUTE 5 7550 COURT STREET 101 CANAL ST 6133 ROUTE 219 S STE 1004 2317 BOWEN RD 4026 75TH ST 88-08 55TH AVE 8330 BROADWAY 9519 57TH AVE 8404 BROADWAY 75-23 BROADWAY 8106 BAXTER AVE 86-07 51ST AVE 8245 BROADWAY 8708 JUSTICE AVE 9431 59TH AVE 8286 BROADWAY 83-09 BROADWAY 9101 43RD AVE 82-85 BROADWAY

EAST SETAUKET EAST SETAUKET EAST SYRACUSE EAST SYRACUSE EASTCHESTER ELBRIDGE ELIZABETHTOWN ELLENVILLE ELLICOTTVILLE ELMA ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11733-3456 11733-2851 13057 13057-2607 10709-2924 13060-8720 12932 12428-1400 14731-9712 14059-9415 11373-1012 11373-4437 11373-5702 11373-4616 11373-5793 11373-5612 11373-1336 11373-3922 11373-3362 11373-4575 11373-5168 11373-3353 11373-5794 11373-2740 11373

Page 442 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HORIZON PHARMACY III LAVIDA PHARMACY NEWCARE PHARMACY INC NEWTOWN PHARMACY QUEENS DRUGS & SURGICAL QUEENS HEALTH PHARMACY RAPID RX PHARMACY RUBEX DRUGS INC SAAD PHARMACY SLV PHARMACY INC STAR PHARMACY STOP & SHOP PHARMACY GEROULD'S PROFESSIONAL PHCY INC. GEROULDS PROFESSIONAL PHCYS WEIS PHARMACY MEACHAM PHARMACY INC MARINELLI'S VILLAGE PHARMACY CORNER DRUG STORE PRICE CHOPPER PHARMACY UNITED HEALTH SERVICES HOSP WEIS PHARMACY FAIRPORT PHARMACY FALCONER PHARMACY, INC. CENTRAL PHARMACY DAWN PHARMACY INC FRIENDLY PHARMACY IDEAL DRUGS MOTT PHARMACY OCEAN PARK DRUGS REDFERN DRUGS RUSSO'S PHARMACY INC SAND CASTLE PHARMACY SMARTSHOP PHARMACY INC

Provider Name

(718) 803-1188 (718) 426-2525 (718) 899-8998 (718) 760-2600 (718) 457-0099 (718) 507-9277 (718) 205-5400 (718) 397-0776 (718) 476-9100 (718) 457-3192 (718) 205-0011 (718) 803-3025 (607) 732-0597 (607) 733-6696 (607) 733-2399 (516) 354-2950 (914) 592-8211 (607) 785-0431 (607) 748-8270 (607) 754-2474 (607) 785-1756 (585) 678-4258 (716) 665-1188 (718) 327-2293 (718) 327-1700 (718) 337-1900 (718) 868-4860 (718) 327-2511 (718) 471-2500 (718) 471-3090 (718) 327-7027 (718) 327-4300 (718) 868-2200

81-14 BROADWAY 4020 82ND ST 8406 QUEENS BLVD 86-15 JUSTICE AVE 8004 BAXTER AVE 7611 BROADWAY # A 9330 43RD AVE 8119 41ST AVE 8737 BRITTON AVE 8652 QUEENS BLVD 8941 ELMHURST AVE 7417 GRAND AVE 215 HOFFMAN ST 130 S MAIN ST 401 N MAIN ST 107 MEACHAM AVE 31 E MAIN ST 101 W MAIN ST 1001 NORTH ST STE 12 1302 E MAIN ST 412 DAY HOLLOW RD 122 VILLAGE LANDING 202 W MAIN ST 1338 CENTRAL AVE 1288 CENTRAL AVE 495 BEACH 20TH ST 1901 MOTT AVE 2119 MOTT AVE 1727 SEAGIRT BLVD 1485 BEACH CHANNEL DR 1909 CORNAGA AVE 711B SEAGIRT AVE 3217 BEACH CHANNEL DR STE A

ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMHURST ELMIRA ELMIRA ELMIRA ELMONT ELMSFORD ENDICOTT ENDICOTT ENDICOTT ENDICOTT FAIRPORT FALCONER FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY FAR ROCKAWAY

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11373 11373 11373-4239 11373 11373-1313 11373-1032 11373-5626 11373-1300 11373-1435 11373-4428 11373-1537 11373-4178 14905-2423 14904-1309 14901-2103 11003-2630 10523-2608 13760-4773 13760-5258 13760-5430 13760-2050 14450-1804 14733-1616 11691-3909 11691-3909 11691-3621 11691-4104 11691-3215 11691-4513 11691 11691-4303 11691-5730 11691-1502

THRIFTWAY FAR ROCKAWAY DRUG CORP VISTA PHARMACY COUNTY LINE PHARMACY MOBY DRUGS STOP & SHOP PHARMACY TRANSCRIPT PHARMACY STOP & SHOP PHARMACY FILLMORE & FISHER PHARMACY INC

(718) 327-2559 (718) 327-0600 (631) 249-6400 (516) 249-0268 (631) 756-5134 (516) 777-7040 (631) 451-1821 (585) 567-2228

2102 MOTT AVE 529 BEACH 20TH ST 1111 BROADHOLLOW RD 226 MAIN ST 55 MOTOR AVE 87 HEMPSTEAD TURNPIKE 2350 N OCEAN AVE 10560 ROUTE 19

FAR ROCKAWAY FAR ROCKAWAY FARMINGDALE FARMINGDALE FARMINGDALE FARMINGDALE FARMINGVILLE FILLMORE

NY NY NY NY NY NY NY NY

11691-3302 11691-3645 11735-4820 11735-2618 11735-4021 11735 11738-2909 14735-8703

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 443 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MEDICAP PHARMACY LEE'S DRUGS RAINDEW COVERT LTD TOWER DRUGS FLORIDA PHARMACY 41 AVENUE PHARMACY LLC 88 PHARMACY AC NORTHERN PHARMACY AE2 PHARMACY INC AGUILAR WELLNESS PLUS PHARMACY ALL RX PHARMACY ALLSTAR DRUG INC ALLSTAR PHARMACY INC APPLE PHARMACY ARCADIA PHARMACY ART PHARMACY CORP AUBURNDALE PHARMACY INC AVONORA PHARMACY BIO PLUS PHARMACY INC BOLING PHARMACY INC. BOWNE CHEMISTS BUY RITE PHARMACY III C K PHARMACY INC CITY PHARMACY COMFORT DRUGS CONCORD PHARMACY CORNER PHARMACY DONG SEO PHARMACY LLC ELIZABETH PHARMACY INC ELMCARE PHARMACY INC EQUAL CARE III LLC EQUAL CARE PHARMACY EVEREST DRUG FAMILY CARE DRUGS FIRST HEALTH SPECIALTY PHCY INC FIRST PHARMACY FLUSHING FAMILY PHARMACY FLUSHING RX H2 PHARMACY CORP HARPELL PHARMACY HEALTHY HAPPY PHARMACY INC HK PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (845) 897-0636 (516) 354-2000 (516) 354-1227 (718) 631-9300 (845) 651-7878 (718) 353-8600 (718) 461-1234 (718) 886-0060 (718) 961-8001 (718) 380-2700 (718) 460-0666 (718) 886-6638 (718) 886-6618 (718) 939-3335 (718) 878-6999 (718) 263-9400 (718) 352-3200 (718) 969-3300 (718) 359-6333 (718) 321-9876 (718) 767-2400 (718) 353-5737 (718) 539-8999 (718) 888-9483 (718) 762-6119 (929) 329-0421 (718) 460-3825 (718) 888-7811 (718) 353-5948 (718) 661-1122 (718) 888-9338 (718) 321-7117 (718) 461-4452 (718) 886-9136 (347) 783-7070 (718) 463-0333 (718) 888-1108 (718) 353-3160 (718) 762-1168 (718) 423-0300 (718) 321-8381 (718) 886-0866

Provider Street 1004 MAIN ST BLDG 554 160 TULIP AVE 73 COVERT AVE 272-68 GRAND CENTRAL PKWY 162 N MAIN ST 136-33 37TH AVE #1A 13619 37TH AVE 15416 NORTHERN BLVD 3657 MAIN ST 15615 AGUILAR AVE 40-22 MAIN ST 13620 38TH AVE STE 3A 142-41 ROOSEVELT AVE 13221 41ST AVE UNIT 1B 4235 MAIN ST UNIT 1L 7060 KISSENA BLVD 19215 47TH AVE 149-01 UNION TURNPIKE 13502 ROOSEVELT AVE 133-37 41 ROAD 16103 29TH AVE 136-10/12 38TH AVE 4213 MAIN ST 13358 41ST RD 13523 ROOSEVELT AVE 143-03 45TH AVENUE 4103 UNION ST 36-22A UNION ST 13231 41ST AVE FL 1 3902 UNION ST # 2 40-59 COLLEGE POINT BLVD 133-42 39TH AVE UNIT 208 14410 45TH AVE 136-18 39TH AVE 2619 FRANCIS LEWIS BLVD 4167 BOWNE ST 43-67 147TH ST 146-01 45TH AVE 3809 MAIN ST 2577 FRANCIS LEWIS BLVD 43-13 MAIN ST 3711 MAIN ST UNIT A10

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Provider City FISHKILL FLORAL PARK FLORAL PARK FLORAL PARK FLORIDA FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

12524-3509 11001-2788 11001-3218 11005 10921-1020 11354-4110 11354-4110 11354-5030 11354-4104 11367-2727 11354 11354 11354 11355-5854 11355-4721 11367-2245 11358-3906 11367-3849 11354-5313 11355 11358-1049 11363 11355-3855 11355-3632 11354-5305 11355 11355-2452 11354 11355-3627 11354-5514 11354-5108 11354-4433 11355-2232 11354 11358 11355-2642 11355 11355-2200 11354-5517 11358-1142 11355 11354-4106

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HORIZON PHARMACY HORIZON PHARMACY IV HORIZON PHARMACY V ICON PHARMACY JANGSU PHARMACY JD DRUGSTORE INC JEWEL PHARMACY JW PHARMACY LLC KANEDA PHARMACY LLC KIOSK PHARMACY KISSENA DRUGS KM PHARMACY LINDENVIEW RAINDEW CORP LUCKY CARE PHARMACY MAIN CARE PHARMACY INC MAIN PHARMACY MERLIN DRUG INC MORAMI PHARMACY MY HOPE PHARMACY LLC NEW FLUSHING PHARMACY NEW YORK FLUSHING PHARMACY LLC NEW YORK-PRESBYTERIAN-QUEENS NORDEN DRUGS NORTHERN PHARMACY NY FAMILY PHARMACY NY HEALTH PHARMACY INC. O & K PHARMACY INC OK PHARMACY & SURGICAL LLC PARSONS PHARMACY PHD PHARMACY PMC PHARMACY INC PREMIUM PHARMACY PRIMACARE PHARMACY INC PRIMACARE PLUS PHARMACY INC. PRINCE PHARMACY INC RAINDEW PHARMACY ROOSEVELT PHARMACY INC RX & BEYOND INC. S & M PHARMACY INC SALZMAN CHEMISTS SANFORD PHARMACY SIMCO PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (718) 888-1918 (718) 359-8881 (718) 539-8989 (718) 899-0033 (718) 886-1121 (718) 888-1517 (718) 591-1040 (718) 762-3784 (718) 888-1489 (718) 463-2261 (718) 793-7658 (718) 888-0110 (718) 762-8041 (718) 358-7000 (718) 886-0205 (718) 261-5608 (718) 762-2883 (718) 886-9100 (718) 353-8202 (347) 368-6681 (718) 461-7200 (718) 670-1728 (718) 969-3314 (718) 445-2470 (718) 888-0808 (718) 661-4440 (718) 544-8500 (718) 886-2227 (718) 888-7817 (718) 359-5605 (718) 321-2922 (718) 886-7128 (718) 886-8968 (718) 886-5683 (718) 888-9596 (718) 539-7559 (718) 888-1500 (718) 353-0060 (718) 544-4656 (718) 380-5440 (718) 460-8329 (718) 939-2898

Provider Street 4630 KISSENA BLVD 4146 MAIN ST 4404 KISSENA BLVD 4173B BOWNE ST 42-23 162ND ST 1ST FL 4170 MAIN ST STE A1 70-35 PARSONS BLVD 14102 NORTHERN BLVD 4032 UNION ST 41-01 KISSENA BLVD 72-63 KISSENA BLVD 4135 KISSENA BLVD 2539 PARSONS BLVD 37-20 PRINCE STREET #1A 3718 MAIN ST 72-71 MAIN ST 13338 41ST RD STE CS2 14473 NORTHERN BLVD 14114 NORTHERN BLVD 4207 KISSENA BLVD 157-10 NORTHERN BLVD 5645 MAIN ST 7901 MAIN ST 16416 NORTHERN BLVD 14246 ROOSEVELT AVE 156-44 NORTHERN BLVD.#C1 7248 MAIN ST 34-04 UNION ST 144-14 NORTHERN BLVD 13532 ROOSEVELT AVE 41-42 MAIN ST 4110A MAIN ST 4128 MAIN ST # 5 3703 MAIN ST 39-07 PRINCE ST STE 1E 3515 FRANCIS LEWIS BLVD 133-55 ROOSEVELT AVENUE 42-69 MAIN ST 6850 MAIN ST 14919 UNION TPKE 13347 SANFORD AVE STE C1D 5925 KISSENA BLVD

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Provider City FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11355-3421 11355 11355-3054 11355 11358 11355 11365-3097 11354-4239 11354 11355 11367 11355-3127 11354 11354 11354-4107 11367-2407 11355-3697 11354-4230 11354-4239 11355-3275 11354 11355-5045 11367-3712 11358-2647 11354-6042 11354 11367-2408 11354-3053 11354-4231 11354-5306 11355 11355-3167 11355-3134 11354-4106 11354-5399 11358-1955 11354 11355-4721 11367-1325 11367-3849 11355-5870 11355-5547

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SMILE PHARMACY INC SOLOMON PHARMACY CORP STARSIDE DRUGS STARSIDE DRUGS STARSIDE DRUGS STARSIDE DRUGS STOP & SHOP PHARMACY SUPER CARE PHARMACY SUPER VALUE DRUGS SUPERIOR DRUGMART TEE PHARMACY INC. TOP CARE PHARMACY CORP UNION ST. PHARMACY INC VICTORIA PHARMACY VITAL MED PHARMACY VITAMIN PHARMACY INC WELL CARE PHARMACY WELLMING PHARMACY WORLD PHARMACY WORLDS FAIR PHARMACY YS PHARMACY INC ASCAN PHARMACY INC BJS DRUGS CAROL RX PHARMACY CHRONICARE LTC RX, LLC COLONY DRUGS AND SURGICALS CORT PHARMACY INC CUSTOM RX PHARMACY LLC FAMILY PHARMACY FOREST HILLS ORGANICS PHARMACY FOREST HILLS PHARMACY HEALTHY CORNER PHARMACY INC J & D PHARMACY L & M PHARMACY & SURG SUPP LLC MB PHARMACY LLC METROPOLITAN PHARMACY II NEIGHBORHOOD RX CORP NEW CENTURY PHARMACY INC. QUEENS CENTRAL PHARMACY INC TRAYMORE CHEMISTS INC MARKET 32 THE MEDICINE SHOPPE

NR_0009_10823 10/2017

Provider Phone Number (718) 358-3800 (718) 321-2526 (718) 321-1716 (718) 358-8801 (718) 886-1031 (718) 888-0893 (718) 886-6262 (917) 563-1730 (718) 359-3373 (718) 445-8450 (718) 939-1001 (718) 886-8833 (718) 321-8830 (718) 886-6200 (718) 544-0700 (718) 888-0851 (718) 353-1350 (718) 321-3978 (718) 358-4800 (718) 358-1300 (917) 285-2100 (718) 793-6747 (718) 793-1616 (718) 459-7711 (718) 590-5999 (718) 897-4888 (718) 897-2569 (718) 830-4500 (718) 268-2151 (718) 487-3570 (718) 275-6555 (718) 261-6699 (718) 544-7182 (718) 880-1418 (718) 268-1900 (718) 263-6151 (718) 997-6700 (917) 832-6494 (718) 268-8060 (718) 261-8440 (518) 832-6238 (518) 993-3003

Provider Street 150-07 NORTHERN BLVD 136-89 37TH AVE 13636 39TH AVE 13685 ROOSEVELT AVE 4116 MAIN ST 4115 KISSENA BLVD 3106 FARRINGTON ST 41-70 MAIN ST 2926 UNION ST 6010A KISSENA BLVD 3333 FRANCIS LEWIS BLVD 13604 NORTHERN BLVD UNIT CU1 4170 MAIN ST STE A2 4445 KISSENA BLVD 6942 MAIN ST 15015 NORTHERN BLVD 4283 MAIN STREET 13343 41ST RD 14901 41ST AVE 5737 MAIN ST 3614 UNION ST # 1FL 10121 METROPOLITAN AVE 6860 AUSTIN ST STE 113 6428 108TH ST 68-54 AUSTIN ST STE 201 10319 QUEENS BLVD 6425 108TH ST 10203A QUEENS BLVD 9622 METROPOLITAN AVE 117-12 QUEENS BLVD 6414 108TH ST 116 65 QUEENS BLVD 7168 YELLOWSTONE BLVD 11062 QUEENS BLVD 11101 QUEENS BLVD 10311 METROPOLITAN AVE 100-23 QUEENS BLVD 6352 108TH ST 116-08 QUEENS BLVD 11080 QUEENS BLVD 354 BROADWAY 30 CANAL ST

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Provider City FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FLUSHING FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FOREST HILLS FORT EDWARD FORT PLAIN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11354 11354 11354-5516 11354-5521 11355-3133 11355-3138 11354-1906 11355 11354-2201 11355-5548 11358-1928 11354-6515 11355 11355-3055 11367-1723 11354-3885 11355 11355-3787 11355-1025 11355-5332 11354-4317 11375-6647 11375-4245 11375-1611 11375-4242 11375-3447 11375-1603 11375-2857 11375-6625 11375-7052 11375-1609 11375 11375 11375 11375-5553 11375-6733 11375 11375-1350 11375 11375-6345 12828-1207 13339-1101

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name CUREWELL PHARMACY FRANKLIN SQUARE PHCY-LEGEND JAYSON PHARMACY STOP & SHOP PHARMACY BARTHOLOMEWS PHARMACY CONCORD PHARMACY BERNHARDS PHARMACY CANNON PHARMACY CHUBBUKS DRUG STORE FREEPORT PHARMACY HEALTH MART PHARMACY XTRA CARE PHARMACY ALL IN ONE PHARMACY ILANA'S PHARMACY NYC DRUG STORE INC PRIME HEALTH PHARMACY QUEENS MEDICAL ASSOCIATES P C SPECIALTY CHEMIST CORP TRUE-CARE PHARMACY CORP FREWSBURG PHARMACY FRIENDSHIP PHARMACY FULTON MEDICINE PLACE HARGRAVES PHARMACY KINNEY DRUGS INC PRICE CHOPPER PHARMACY 520 FRANKLIN AVENUE PHARMACY TWIN PARKS PHARMACY & SURGICALS RAILROAD RX INC DBA SCHULTZ NORTH STREET PHARMACY, INC. THE PHARMACY AT GENEVA COM HTH GLEN COVE CHEMISTS GLEN HEAD PHARMACY A & M PHCY AND SURGICAL SUPPLIES VITALITY DRUG AND SURGICAL FAMILY PHARMACY INC MYRTLE DRUGMART RX PLUS PHARMACY TOP CHOICE PHARMACY CORP TRINITY RX CORP PRICE CHOPPER PHARMACY HOUSECALLS PHARMACY GLOVERSVILLE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (516) 872-8700 (516) 328-7777 (516) 354-5641 (516) 352-4667 (716) 676-3350 (716) 672-8400 (516) 378-0008 (516) 623-2222 (516) 379-3333 (516) 377-8500 (516) 377-4050 (516) 208-7432 (718) 487-4939 (718) 969-9500 (718) 380-0999 (718) 969-1600 (718) 460-2300 (718) 353-2595 (718) 380-3330 (716) 569-2221 (585) 973-3496 (315) 593-8378 (315) 592-4335 (315) 593-2158 (315) 598-1018 (516) 280-7960 (516) 873-8600 (845) 429-5075 (315) 787-5388 (315) 759-5946 (516) 676-9111 (516) 676-1004 (718) 343-5900 (718) 343-0070 (718) 821-3330 (347) 227-8188 (718) 456-0100 (718) 381-5100 (718) 366-2109 (518) 433-4711 (518) 798-3700 (518) 725-4400

Provider Street 757 FRANKLIN AVE 925 HEMPSTEAD TPKE 197 FRANKLIN AVE 40 FRANKLIN AVE 2 ELM ST 10220 ROUTE 60 34 W MERRICK RD 23 S MAIN ST 51 S MAIN ST 82 GUY LOMBARDO AVE 179 ATLANTIC AVE 75 S MAIN ST 75-68 187TH ST 18030 UNION TPKE 15916 UNION TPKE 6921 164TH ST 17660 UNION TPKE STE 360 65-60 FRESH MEADOWS LN 16406 69TH AVE 26 W MAIN ST 9 W MAIN ST 360 W 1ST ST S 113 W BROADWAY 115 ONEIDA ST 12 W 1ST ST S 520 FRANKLIN AVE STE 103 2226 JERICHO TPKE 150 W RAILROAD AVE 200 NORTH ST 601B W WASHINGTON ST 20 FOREST AVE 699 GLEN COVE AVE 25617 HILLSIDE AVE 25707 UNION TPKE 6702 MYRTLE AVE 65-62 MYRTLE AVE 7130 MYRTLE AVE 65-05 MYRTLE AVENUE 7521 MYRTLE AVE 329 GLENMONT RD 100 BROAD ST 42 N MAIN ST

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Provider City FRANKLIN SQUARE FRANKLIN SQUARE FRANKLIN SQUARE FRANKLIN SQUARE FRANKLINVILLE FREDONIA FREEPORT FREEPORT FREEPORT FREEPORT FREEPORT FREEPORT FRESH MEADOWS FRESH MEADOWS FRESH MEADOWS FRESH MEADOWS FRESH MEADOWS FRESH MEADOWS FRESH MEADOWS FREWSBURG FRIENDSHIP FULTON FULTON FULTON FULTON GARDEN CITY GARDEN CITY PARK GARNERVILLE GENEVA GENEVA GLEN COVE GLEN HEAD GLEN OAKS GLEN OAKS GLENDALE GLENDALE GLENDALE GLENDALE GLENDALE GLENMONT GLENS FALLS GLOVERSVILLE

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11010 11010-3636 11010-1441 11010-2527 14737-1004 14063-1420 11520-3827 11520-3606 11520-3854 11520-3715 11520-4922 11520-3841 11366 11366-1620 11366-1938 11365-3159 11366-1531 11365 11365-3202 14738 14739-8701 13069-2441 13069-2215 13069-1227 13069-1635 11530-5814 11040-4708 10923-1243 14456 14456-2119 11542-2106 11545-1602 11004-1617 11004-1250 11385-7058 11385 11385-7260 11385 11385-7419 12077-3468 12801-4349 12078-3004

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

NATHAN LITTAUER HOSPL N NURSING HME TOM'S FAMILY PHARMACY INC KINNEY DRUGS KINNEY DRUGS

(518) 773-5577 (518) 725-0615 (315) 287-4012 (315) 287-2900

99 E STATE ST 45-47 SOUTH MAIN ST 17 CLINTON ST 371 E MAIN ST

GLOVERSVILLE GLOVERSVILLE GOUVERNEUR GOUVERNEUR

NY NY NY NY

12078-1203 12078 13642-1012 13642-1547

VALLEY PHARMACY & MED SUPPLIES INC ISLAND PRESCRIPTION CENTER FREDS GRANVILLE PHARMACY COLONY PHARMACY INC GREAT NECK CHEMISTS INC H PLAZA PHARMACY INC. MIDDLE NECK PHARMACY NATURE'S REMEDY PHARMACY TOWN PHARMACY MID VILLAGE PHARMACY VALUE DRUGS GREENLAWN INC GREENPORT DRUGS LLC PHAMCO INC GREENVALE PHARMACY-LEGEND HALSEY DRUGS & SURGICALS STOP & SHOP PHARMACY KELLY'S PHARMACY INC. CUTIE PHARMA-CARE INC MARKET 32 PHARMACY #28 BROOKS PHARMACY HAMBURG PHARMACY INC LIFETIME HEALTH MEDICAL GROUP SOUTHTOWNS MEDICAL PHARM LLP WANAKAH PHARMACY DOUGHERTY PHARMACY KINNEY DRUGS PARK PHARMACY HAMPTON LIGGETT DRUG - LEGEND HANNIBAL PHARMACY TROTTA'S WEST STREET PHARMACY BONAPARTE PHARMACY HARTSDALE PHARMACY INC GREENLEAF PHARMACY CARE RX PHARMACY MILLERS DRUG STORE-LEGEND ACARIAHEALTH PHARMACY #12, INC.

(716) 532-1700 (716) 773-5599 (518) 642-3733 (516) 439-5556 (516) 482-0004 (516) 441-5400 (516) 482-4880 (516) 439-4911 (516) 439-5380 (631) 261-2233 (631) 754-0532 (631) 477-1222 (631) 477-1111 (516) 621-2260 (516) 801-4413 (516) 484-1414 (518) 966-4800 (518) 692-8500 (518) 724-6752 (716) 627-3060 (716) 646-3147 (716) 648-3040 (716) 649-1500 (716) 627-3232 (315) 825-9800 (315) 824-2200 (607) 569-2800 (631) 728-4030 (315) 564-6464 (914) 835-1125 (315) 537-5032 (914) 723-0390 (914) 478-0004 (845) 553-9900 (845) 429-2400 (800) 511-5144

31 W MAIN ST 1728 GRAND ISLAND BLVD 75 QUAKER ST 481 MIDDLE NECK RD 665 MIDDLE NECK RD 485 GREAT NECK RD UNIT 1 531 MIDDLE NECK RD 72N MIDDLE NECK RD 96 HORACE HARDING BLVD 51 BROADWAY 106 BROADWAY 74825A MAIN ROAD 100 FRONT ST 5 NORTHERN BLVD 82-14 GLEN COVE RD 130 WHEATLEY PLZ 4852 STATE ROUTE 81 114 MAIN ST 2080 WESTERN AVENUE 4481 LAKE SHORE RD 206 LAKE ST 151 ELMVIEW AVE 4855 CAMP RD # 600 4923 LAKE SHORE RD 1017 MADISON MARKETPLACE 103 UTICA ST 27 SHETHER ST 39 W MONTAUK HWY STE 4 450 FULTON ST STE 300 15 HALSTEAD AVE 8210 MAIN STREET 211 E HARTSDALE AVE 544 WARBURTON AVE 2 MAIN ST 10 BROADWAY 5 SKYLINE DR STE 240

GOWANDA GRAND ISLAND GRANVILLE GREAT NECK GREAT NECK GREAT NECK GREAT NECK GREAT NECK GREAT NECK GREENLAWN GREENLAWN GREENPORT GREENPORT GREENVALE GREENVALE GREENVALE GREENVILLE GREENWICH GUILDERLAND HAMBURG HAMBURG HAMBURG HAMBURG HAMBURG HAMILTON HAMILTON HAMMONDSPORT HAMPTON BAYS HANNIBAL HARRISON HARRISVILLE HARTSDALE HASTINGS ON HUDSON HAVERSTRAW HAVERSTRAW HAWTHORNE

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

14070 14072-2122 12832 11023-1470 11023-1216 11021-4306 11023 11021-2357 11020-1106 11740-1322 11740-1310 11944 11944-1616 11548-1204 11548 11548-1344 12083-3904 12834-1215 12084 14075-2404 14075-4471 14075-3762 14075-2600 14075-5662 13346-2343 13346-1100 14840 11946-4094 13074 10528-4002 13648 10530-3502 10706-1549 10927-1966 10927-1606 10532-2166

NR_0009_10823 10/2017

Page 448 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUPERIOR BIOLOGICS NY, INC ANEDDONA PHARMACY BEST CHOICE PHARMACY D'S PHARMACY FRANKLIN RX INC HEALTH & WELLNESS FARMACIA INC HEMPSTEAD DRUGS MIRAJ PHARMACY INC PREFFERED PHARMACY INC

Provider Name

(914) 747-1150 (516) 292-2155 (516) 307-8430 (516) 280-4100 (516) 292-0222 (516) 280-2260 (516) 483-3000 (516) 489-9500 (516) 483-5000

200 SAW MILL RIVER RD 224 S FRANKLIN ST 510 FULTON AVE 391 PENINSULA BLVD STE E 98B N FRANKLIN ST 634 FULTON AVE 397 FULTON AVE 362 FULTON AVE 175 FULTON AVE

HAWTHORNE HEMPSTEAD HEMPSTEAD HEMPSTEAD HEMPSTEAD HEMPSTEAD HEMPSTEAD HEMPSTEAD HEMPSTEAD

NY NY NY NY NY NY NY NY NY

10532-1523 11550-6115 11550-4364 11550-4914 11550-3029 11550 11550-4127 11550-3908 11550-3718

PRESCRIPTION CENTER OF LONG ISLAND SHIPMAN'S PHARMACY STOP & SHOP PHARMACY ERIE PHARMACY HEWLETT NEIGHBORHOOD PHARMACY ACUTUS RX FREEPORT PHARMACY LLC HARRY'S PHARMACY & SURGICALS PERFECT PHARMACY PRO PHARMACY SMITHS PHARMACY STOP & SHOP PHARMACY HILTON FAMILY PHARMACY FRIENDLY DRUGS HOLBROOK PHCY & SURGICAL STOP & SHOP PHARMACY HOLLAND PHARMACY INC HOLLAND PATENT PHARMACY HOLLEY PHARMACY FRANHILL PHARMACY LLC HOLLIS PHARMACY HOLLIS PRESCRIPTION CENTER,INC PRESCRIPTION & VITAMIN WHS SUPER PHARMACY RX INC HONEOYE FALLS PHARMACY THORPE'S PHARMACY INC HOPEWELL DRUGSTORE INC TUMINARO PHARMACY GEROULD'S PROFESSIONAL PHCY CROSSBAY CHEMISTS HOWARD BEACH APOTHECARY LINDEN PARK PHARMACY

(516) 483-2800 (516) 483-1767 (516) 539-2031 (585) 486-4807 (516) 791-2400 (855) 830-6666 (516) 433-4437 (516) 933-3322 (516) 433-7115 (516) 719-5919 (516) 931-1099 (516) 937-7172 (585) 392-7979 (631) 585-8585 (631) 585-7092 (631) 218-8636 (716) 537-2822 (315) 865-8141 (585) 638-5499 (718) 465-2121 (718) 776-8505 (718) 776-2329 (718) 464-2400 (718) 465-5200 (585) 624-2000 (518) 686-5711 (845) 592-1717 (845) 223-7858 (607) 796-2193 (718) 659-9500 (718) 738-4343 (718) 848-7778

126 JACKSON ST 210 S FRANKLIN ST 150 FULTON AVE 60 FINN RD SUITE B 1181 BROADWAY 385 W JOHN ST 478 PLAINVIEW RD 333 S. BROADWAY 524 S BROADWAY 71 E OLD COUNTRY RD 53 N BROADWAY 530 OLD COUNTRY RD 32 MAIN ST 1036 MAIN ST 233 UNION AVE 5701 SUNRISE HWY 19 N MAIN ST MAIN AND STEUBEN ST 3 GEDDES ST EXTENSION 20419 HILLSIDE AVE 18806 JAMAICA AVE # A 20511 JAMAICA AVE 19718 HILLSIDE AVE 20520 JAMAICA AVE 166 WEST MAIN STREET 24 CHURCH ST 410 ROUTE 376 STE 3 800 ROUTE 82 STE A BLDG 5 2887 WESTINGHOUSE RD 15814 CROSSBAY BLVD 15840 CROSSBAY BLVD 8243 153RD AVE

HEMPSTEAD HEMPSTEAD HEMPSTEAD HENRIETTA HEWLETT HICKSVILLE HICKSVILLE HICKSVILLE HICKSVILLE HICKSVILLE HICKSVILLE HICKSVILLE HILTON HOLBROOK HOLBROOK HOLBROOK HOLLAND HOLLAND PATENT HOLLEY HOLLIS HOLLIS HOLLIS HOLLIS HOLLIS HONEOYE FALLS HOOSICK FALLS HOPEWELL JUNCTION HOPEWELL JUNCTION HORSEHEADS HOWARD BEACH HOWARD BEACH HOWARD BEACH

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11550-2413 11550-5613 11550-3719 14467 11557 11801 11801-4372 11801 11801-5013 11801-4200 11801-2901 11803-4998 14468-1211 11741 11741-1820 11741-4801 14080-9509 13354-0000 14470 11423-2213 11423-2512 11423-3039 11423-2127 11423-3021 14472 12090-1600 12533-4008 12533-7372 14845-8110 11414-3136 11414-3136 11414-1751

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 449 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STOP & SHOP PHARMACY PRICE CHOPPER PHARMACY MCCANNS PHARMACY 701 RX INC ATRIUM PHARMACY CORDANT PHARMACY SOLUTIONS KING KULLEN PHARMACY NORTH SHORE PHARMACY RX EXPRESS PHCY OF EAST NORTHPORT STOP & SHOP PHARMACY VALUE DRUG STORES INC HUNTINGTON DRUGS KINNEY DRUGS THE MEDICINE SHOPPE

Provider Name

(718) 641-9853 (518) 822-0076 (518) 747-4732 (212) 249-8202 (631) 784-7777 (516) 806-5943 (631) 385-7320 (631) 427-6262 (631) 462-2233 (631) 421-0134 (631) 427-2919 (631) 271-2271 (315) 894-2381 (315) 894-7283

15601 CROSSBAY BLVD 351 FAIRVIEW AVE 166 MAIN ST 241 E MAIN ST 775 PARK AVE STE 155 789 PARK AVE 50 NEW YORK AVE 25 SOUTHDOWN RD 1842 E JERICHO TPKE 60 WALL ST 349 NEW YORK AVE 180 E PULASKI RD 50 CENTRAL PLZ 10 CENTRAL AVE

HOWARD BEACH HUDSON HUDSON FALLS HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON STATION ILION ILION

NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11414-2746 12534-1211 12839-1814 11743-2924 11743 11743-3912 11743-2199 11743-2538 11743-5796 11743-2065 11743-3342 11746-1915 13357-1701 13357-1822

INWOOD PHARMACY & SURGICAL SUPPLY NATURALFIT PHARMACY CONRADS-HALJAY PHARMACY INTEGRATED MEDICAL STOP & SHOP PHARMACY ISLIP PHARMACY AND SURGICAL RAAN PHARMACY TERRACE PHARMACY CAYUGA EMPLOYEE PHARMACY GREEN STREET PHARMACY KINNEY DRUGS KINNEY DRUGS INC 37TH AVE. PHARMACY INC ADVANCED RX INC AL KOSTO PHARMACY APNA PHARMACY INC B AND B PHARMACY, INC BANGLADESH FARMACIA CITY PHARMACY COMFORT PHARMACY DIVINA PHARMACY FEEL BETTER PHARMACY FRANK'S PHARMACY GEMINI PHARMACY GUARDIOLA PHARMACY INC HEALTH CHOICE PHARMACY INC IMAGE HEIGHTS PHCY INC

(516) 371-4113 (914) 478-7822 (516) 431-1991 (631) 963-7730 (631) 348-2558 (631) 581-8077 (631) 581-4285 (631) 416-5577 (607) 274-4385 (607) 882-9500 (607) 330-5692 (607) 272-8333 (718) 424-8684 (718) 803-0500 (718) 446-2068 (718) 779-4694 (718) 533-6623 (718) 406-9393 (718) 255-1065 (718) 446-2705 (718) 457-0193 (718) 898-1001 (718) 899-2600 (718) 803-3888 (718) 672-9700 (718) 898-1548 (718) 424-0100

115 DOUGHTY BLVD 104 MAIN ST 333 LONG BEACH RD 1324 MOTOR PKWY 1730 VETERANS MEMORIAL HWY 437 MAIN ST 48 LOWELL AVE 64 CARLETON AVE STE B 101 DATES DR SECOND FLOOR 131 E GREEN ST STE 2 2255 N TRIPHAMMER RD 513 N CAYUGA ST 9507 37TH AVE 7612 ROOSEVELT AVE 3765 90TH ST 7106 37TH AVE 7908 37TH AVE 73-21 37TH RD 7918 ROOSEVELT AVE 7228 BROADWAY 8513 NORTHERN BLVD 87-10 NORTHERN BLVD SUITE 104 7701 37TH AVE 86-12 37TH AVE 93-12 ROOSEVELT AVE 8610 ROOSEVELT AVE STE 29-30 7501 37TH AVE

INWOOD IRVINGTON ISLAND PARK ISLANDIA ISLANDIA ISLIP ISLIP TERRACE ISLIP TERRACE ITHACA ITHACA ITHACA ITHACA JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11096-2003 10533-1717 11558-1509 11749-5262 11749 11751-3536 11752-1415 11752-1500 14850-1342 14850-5661 14850-1576 14850-3663 11372-8024 11372-6636 11372-7829 11372-3938 11372 11372-6328 11372-6717 11372-6331 11372-1537 11372-1641 11372-6607 11372 11372 11372 11372-6537

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 450 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name JAC PHARMACY & SURGICAL SUP JANNAT PHARMACY INC. JUNCTION BLVD PHARMACY MEDRITE PHARMACY MI FARMACIA NAIMA PHARMACY NUESTRA FARMACIA INC NUEVA LUZ PHARMACY NUEVA VIDA PHARMACY INC OPTIMA DRUGS QUEENS EXPRESS PHARMACY CORP ROOSEVELT PHARMACY AND SURGICAL SANTA FE PHARMACY SANTO DOMINGO PHARMACY ST. MICHAEL'S PHARMACY STANDARD PHARMACY SUPER PHARMACY UNICA SUPERIOR PHARMACY THREE J'S PHARMACY TRISTATE PHARMACY ULISES PHARMACY INC VITALSCRIPT VIVA PHARMACY & WELLNESS WESTERN DRUGS INC AHF PHARMACY AL-MAMOOR PHARMACY INC ALY-MARC PHARMACY APEX PHARMACY APL PHARMACY INC APNAR PHARMACY INC AS-SALAM PHARMACY INC BEST CHOICE PHARMACY BRIARWOOD PHARMACY COMMUNITY PHARMACY CONCORD DRUG ESTATES PHCY & SURGICAL SUPPLIES EVERS PHARMACY FAMILY CARE RX PHARMACY FUSIONCARE PHARMACY INC GBB WELLNESS INC GLOBAL UNITED PHARMACY INC GUY BREWER PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (718) 478-6863 (718) 732-4288 (718) 396-4030 (917) 832-6035 (718) 429-7666 (718) 205-5001 (718) 424-3333 (718) 406-9040 (718) 899-0200 (718) 424-9275 (718) 565-1005 (718) 424-1291 (718) 651-7400 (718) 424-8798 (718) 803-3330 (718) 899-8900 (718) 651-1400 (718) 478-1135 (718) 899-0499 (718) 565-1900 (718) 458-4500 (718) 424-1101 (718) 450-9595 (718) 899-6520 (929) 421-4620 (718) 374-3406 (718) 291-1845 (718) 848-4900 (718) 206-1776 (347) 561-6520 (718) 291-0717 (718) 558-0008 (718) 526-0310 (718) 925-9259 (718) 739-9099 (718) 739-0311 (718) 323-8377 (718) 297-1927 (347) 644-1886 (718) 978-0001 (718) 206-0271 (718) 525-5005

Provider Street 93-15 ROOSEVELT AVE 7203 35TH AVE 9553 ROOSEVELT AVE 7316 ROOSEVELT AVE 9015 ROOSEVELT AVE 8210 37TH AVE 8524 37TH AVE 8009 37TH AVE 8125 37TH AVE 91-01, 37TH AVE 3454 JUNCTION BLVD 7419 ROOSEVELT AVE 8831 37TH AVE 90-09 37TH AVENUE 3705 83RD ST 37-51 73RD ST 7617 37TH AVE 8005 ROOSEVELT AVE 9012 ELMHURST AVE 89-24 37TH AVE 9108 37TH AVE 8317 37TH AVE 80-14 NORTHERN BOULEVARD 8120 ROOSEVELT AVE 16121 JAMAICA AVE # 7 169-18 HILLSIDE AVE 17941 HILLSIDE AVE 11449 SUTPHIN BLVD 8750 PARSONS BLVD 16801 HILLSIDE AVE 147-26 HILLSIDE AVE 13838 86TH AVE 14303 HILLSIDE AVE 11434 SUTPHIN BLVD 137-61 QUEENS BLVD 16901 HILLSIDE AVE 14202 ROCKAWAY BLVD 17004 HILLSIDE AVE 18723 HILLSIDE AVE 1ST FLR 13742 GUY R BREWER BLVD 17942 HILLSIDE AVE 11717 GUY R BREWER BLVD

Page 451 of 679

Provider City JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JACKSON HEIGHTS JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11372-7943 11372-4005 11372-8028 11372-6336 11372-7938 11372-7023 11372 11372-6719 11372-6718 11372-7919 11372-3829 11372-6529 11372-7736 11372-7902 11372-7141 11372 11372 11372 11372-7936 11372 11372-7920 11372-7320 11372 11372-6746 11432-6113 11432-4435 11432-4631 11434-1022 11432-3317 11432-4340 11435-3329 11435-2634 11435-3230 11434-1021 11435-1845 11432 11436-1419 11432-4547 11432 11434-3733 11432-4653 11434-2148

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HEAL THE WORLD PHARMACY INC HEALTH AND COMFORT RX HEALTHY CHOICE PHARMACY HEARTLAND PHARMACY CORP. HILLSIDE DHAKA PHARMACY HILLSIDE PHARMACY MED SCRIPT PHARMACY MEDICINE CABINET PHARMACY MERRICK BLVD PHARMACY MERRICK DRUGS METRO PHARMACY NEW PARSONS PHARMACY NEW YORK BOULEVARD PHARMACY PRIMARY CARE PHARMACY INC QUEENS COMMUNITY EXPRESS PHCY QUEENS DRUGS & SURGICAL QUEENS PHARMACY CENTER READY RX PHARMACY S&A SUPERDRUGS II INC. SAFA PHARMACY INC STAR CARE PHARMACY SUTPHIN PHARMACY TOWER PHARMACY & SURGICAL TRIUMPH PHARMACY LLC VALUECARE PHARMACY INC VARIETY DRUGS ZAHIR'S PHARMACY INC BARTHS OF JAMESPORT INC PHARMACY INNOVATIONS SOUTHSIDE PHARMACY INC JEFFERSON VALLEY PHARMACY TACONIC PHARMACY JEFFERSON PHARMACY INC ISLAND DRUGS LLC THE PHARMACY UNITED HEALTH SVCS HOSPITALS INC PALMER PHARMACY PRICE CHOPPER PHARMACY KATONAH PHARMACY WEINSTEIN PHARMACY KEESEVILLE PHARMACY IVYLEA PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (718) 276-4325 (718) 262-8777 (347) 454-9032 (718) 285-9940 (718) 526-2300 (718) 658-7800 (718) 658-9300 (718) 297-1345 (718) 528-0505 (347) 561-9686 (718) 523-5800 (718) 291-1114 (718) 297-6500 (718) 291-4747 (718) 206-9096 (718) 297-0099 (718) 380-1261 (718) 297-4500 (718) 949-2122 (718) 739-0940 (718) 262-8789 (718) 291-9500 (718) 526-1121 (718) 529-0300 (718) 380-2600 (718) 723-2100 (718) 739-7777 (631) 722-3900 (716) 484-1586 (716) 487-0133 (914) 962-6553 (914) 245-3334 (845) 482-5720 (516) 490-5595 (607) 798-0343 (607) 763-6775 (518) 762-8319 (518) 736-2426 (914) 232-2300 (914) 232-5166 (518) 834-6090 (716) 873-1444

Provider Street 161-45 BAISLEY BLVD 147-16 JAMAICA AVE 163-06 HILLSIDE AVENUE 178-27 HILLSIDE AVE 17014 HILLSIDE AVE 18420 HILLSIDE AVE 83-42 PARSONS BLVD 88-28 PARSONS BLVD 126-13 MERRICK BLVD. 109-50 MERRICK BLVD 17217 JAMAICA AVE 88-01 PARSONS BLVD 10745 GUY R BREWER BLVD 9020 SUTPHIN BLVD 168-12 HILLSIDE AVE 14614 JAMAICA AVE 8235 164TH ST 144-05 JAMAICA AVE 138-10 FARMERS BLVD 165-23 HILLSIDE AVENUE 175-20 HILLSIDE AVE 8780A SUTPHIN BLVD 18512 HILLSIDE AVE 11112 SUTPHIN BLVD STORE # 2 82-69 PARSONS BLVD 16933 137TH AVE 15922 HILLSIDE AVE 1491 MAIN ROAD 863 FAIRMOUNT AVE 766 FOOTE AVE 3663 HILL BLVD 3659 LEE RD 4892 STATE ROUTE 52 336 N BROADWAY 711 MAIN ST 52 HARRISON ST 2 E MAIN ST 241 N COMRIE AVE 202 KATONAH AVE 101 KATONAH AVE 1730 FRONT ST 2446 ELMWOOD AVE

Page 452 of 679

Provider City JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMAICA JAMESPORT JAMESTOWN JAMESTOWN JEFFERSON VALLEY JEFFERSON VALLEY JEFFERSONVILLE JERICHO JOHNSON CITY JOHNSON CITY JOHNSTOWN JOHNSTOWN KATONAH KATONAH KEESEVILLE KENMORE

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11434 11435 11432 11432-4624 11432-4547 11432-4858 11432 11432-3841 11434 11433 11432-5562 11432-3841 11433-2351 11435-3636 11432 11435-3628 11432-1120 11435-3623 11434-4732 11432 11432 11435-3342 11432-4860 11435-5829 11432-1048 11434-4517 11432-3936 11947 14701-2521 14701-8201 10535-1501 10535 12748-5617 11753-2031 13790-1743 13790 12095-2623 12095-1501 10536-2110 10536-2136 12944-3618 14217-2244

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KENMORE PRESCRIPTION CENTER CATSKILL PHARMACY, INC HEALTH SOURCE PLUS PHCY LLC IDEAL PHARMACY N & B PHARMACY, INC REO CHEMISTS INC KINGS PARK PHARMACY NEKOS-DEDRICK'S PHARMACY CARE MORE PHARMACY LLC SOUTH PARK PHARMACY LAGRANGE PHARMACY INC STONE'S PHARMACY INC KINNEY DRUGS INC SLATER'S PHARMACY INC VIVO HEALTH PHARMACY AT CFAM LIVONIA PHARMACY

Provider Name

(716) 874-6360 (845) 626-0900 (718) 849-6700 (718) 441-5474 (718) 487-8100 (718) 849-4661 (631) 663-3800 (845) 338-8000 (716) 235-8185 (716) 823-0440 (845) 447-1343 (518) 696-3214 (518) 523-2011 (631) 588-1590 (516) 734-7780 (585) 346-5615

2818 DELAWARE AVE 6401 ROUTE 209 11807 METROPOLITAN AVE 8548 118TH ST 118-29A METROPOLITAN AVE 8112 LEFFERTS BLVD 64 INDIAN HEAD RD 86 N FRONT ST 319 RIDGE RD 2707 S PARK AVE 1520 ROUTE 55 UNIT 16 1 MAIN ST 1954 SARANAC AVE 407 HAWKINS AVE 450 LAKEVILLE RD 5975 BIG TREE RD

KENMORE KERHONKSON KEW GARDENS KEW GARDENS KEW GARDENS KEW GARDENS KINGS PARK KINGSTON LACKAWANNA LACKAWANNA LAGRANGEVILLE LAKE LUZERNE LAKE PLACID LAKE RONKONKOMA LAKE SUCCESS LAKEVILLE

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

14217-1325 12446-3033 11415-2020 11415-2908 11415-2020 11415-1729 11754-3703 12401-3832 14218-1228 14218-1511 12540-5236 12846 12946-1171 11779-4239 11042 14480-9722

LAKEWOOD APOTH NATUR HLTH CARE INC LARCHMONT PHARMACY FALLON WELLNESS PHARMACY PRICE CHOPPER PHARMACY LAURELTON PHARMACY KING KULLEN PHARMACY K & K PHARMACY SULLIVAN PHARMACY INC THE MEDICINE SHOPPE LIMA VILLAGE PHARMACY CARE+ PHARMACY THE MEDICINE CENTER KINNEY DRUGS DANA PHARMACY INC LITTLE NECK DRUG STORE INC KINNEY DRUGS KINNEY DRUGS PRICE CHOPPER PHARMACY MANOR PHARMACY LLC FAMILY PHARMACY PLUS LOCKPORT APOTHECARY PENDLETON STAR PHARMACY INC QUALITY PHARMACY LOCUST VALLEY CHEMISTS KINGS PHARMACY

(716) 763-0016 (914) 341-1900 (518) 220-2005 (518) 782-0227 (718) 977-0700 (516) 579-2111 (845) 292-3430 (845) 295-5456 (845) 292-8200 (585) 624-9777 (631) 450-4404 (631) 957-9723 (315) 823-0016 (718) 224-3233 (718) 631-8787 (315) 453-1750 (315) 652-6584 (315) 622-6020 (845) 439-1188 (716) 433-3733 (716) 438-3990 (716) 210-3152 (716) 434-5731 (516) 656-9090 (516) 431-4455

130 CHAUTAUQUA AVE 2141 PALMER AVE 1057 TROY SCHENECTADY RD 873 NEW LOUDON RD 224-12 MERRICK BLVD 3284 HEMPSTEAD TPKE 187 MILL ST 267 N MAIN ST 1987 STATE ROUTE 52 7298 W. MAIN ST 602 WELLWOOD AVE 178 MONTAUK HWY 530 ALBANY ST 24812 NORTHERN BLVD STE 1C 252-11 NORTHERN BLVD 437 ELECTRONICS PKWY 7608 OSWEGO RD STE 19 3863 STATE ROUTE 31 43A MAIN ST 320 S TRANSIT ST 6606 LINCOLN AVE 6503 CAMPBELL BLVD 7134 ROCHESTER RD 60 FOREST AVE 1054 W BEECH ST

LAKEWOOD LARCHMONT LATHAM LATHAM LAURELTON LEVITTOWN LIBERTY LIBERTY LIBERTY LIMA LINDENHURST LINDENHURST LITTLE FALLS LITTLE NECK LITTLE NECK LIVERPOOL LIVERPOOL LIVERPOOL LIVINGSTON MANOR LOCKPORT LOCKPORT LOCKPORT LOCKPORT LOCUST VALLEY LONG BEACH

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

14750-1241 10538-2406 12110-1002 12110-2150 11413-2023 11756-1345 12754-2000 12754-1850 12754-8316 14485 11757-2001 11757-5951 13365-1439 11362-1207 11362-1355 13088-6001 13090-2948 13090-1309 12758-5145 14094-4848 14094-6109 14094-9210 14094-1626 11560-1714 11561-1140

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 453 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LONG BEACH CHEMISTS PRECISION PHCY INC OF LONG BEACH STOP & SHOP PHARMACY AGUSTIN PHARMACY INC BRIOVARX OF NEW YORK INC CRESCENT CHEMIST LONG ISLAND CITY CHEMISTS NATURE'S PRESCRIPTIONS LLC

Provider Name

(516) 431-0611 (516) 889-8899 (516) 889-6704 (718) 937-8160 (866) 903-4466 (718) 383-3882 (718) 392-8049 (718) 786-8555

170 W PARK AVE 629 E PARK AVE 85 LONG BEACH PLZ 3920 29TH ST 3950 CRESCENT ST 2412 34TH AVE 3012 36TH AVE 5-29 50TH AVE

LONG BEACH LONG BEACH LONG BEACH LONG ISLAND CITY LONG ISLAND CITY LONG ISLAND CITY LONG ISLAND CITY LONG ISLAND CITY

NY NY NY NY NY NY NY NY

11561-3317 11561 11561-3597 11101-3708 11101-3802 11106-4320 11106-2315 11101

QUEENSBRIDGE PLAZA PHARMACY CORP RAVENSVIEW PHARMACY INC THE CHEMIST SHOP VERNON BOULEVARD PHARMACY KINNEY DRUGS LAKEVIEW PHARMACY NEEMA PHARMACY INC NEW YORK PHARMACY NETWORK LLC VALUE PHARMACY DOBBINS DRUGS KINNEY DRUGS FALLS PHARMACY

(718) 707-0705 (718) 729-5199 (718) 472-0900 (718) 361-7390 (315) 376-7551 (516) 599-4646 (516) 599-0079 (516) 531-5000 (718) 271-1997 (315) 946-6691 (315) 946-6699 (315) 348-8121

1037 41ST AVE 3449 21ST ST 30-15 38TH AVE 4815 VERNON BLVD 7395 UTICA BLVD 133 LAKEVIEW AVE 18 ATLANTIC AVE 444 MERRICK RD # LL5 257 BROADWAY 52 WILLIAM ST 20 FORGHAM ST 6805 MCALPINE ST

LONG ISLAND CITY LONG ISLAND CITY LONG ISLAND CITY LONG ISLAND CITY LOWVILLE LYNBROOK LYNBROOK LYNBROOK LYNBROOK LYONS LYONS LYONS FALLS

NY NY NY NY NY NY NY NY NY NY NY NY

11101-7346 11106-4721 11101-2609 11101-5616 13367-1705 11563-1742 11563-3024 11563-2461 11563-3243 14489-1545 14489-1308 13368

LAKE MAHOPAC PHARMACY & SURGICAL KINNEY DRUGS KINNEY DRUGS PRICE CHOPPER PHARMACY

(845) 208-0424 (518) 483-3371 (518) 483-4110 (518) 899-6063

559 ROUTE 6 485 E MAIN ST 3400 STATE ROUTE 11 ONE KENDALL WAY

MAHOPAC MALONE MALONE MALTA

NY NY NY NY

10541-4712 12953-2126 12953-4714 12020-4439

FGL DRUG CORP D/B/A/ NORDON DRUG RED JACKET PHARMACY MANHASSET PARK DRUG RAINDEW PLANDOME PHARMACY

(516) 593-8663 (585) 289-3002 (516) 869-0101 (516) 627-8666

247 HEMPSTEAD AVE 113 S MAIN ST 290 PLANDOME RD 465 PLANDOME RD

MALVERNE MANCHESTER MANHASSET MANHASSET

NY NY NY NY

11565-2034 14504 11030-2327 11030-1942

VIVO HEALTH PHARMACY AT MANHASSET KINNEY DRUGS KING KULLEN PHARMACY MAIN STREET PHCY OF MARCELLUS MARGARETVILLE HOSPITAL PHARMACY HILL PHARMACY STOP & SHOP PHARMACY STUARTS PHARMACY-LEGEND ARLO DRUG STORE KINNEY DRUGS

(516) 562-8486 (315) 692-9000 (631) 399-0346 (315) 673-2410 (845) 586-2631 (718) 429-4646 (516) 797-8365 (516) 799-5858 (516) 798-9444 (315) 764-0559

300 COMMUNITY DR 7660 HIGHBRIDGE RD 460 COUNTY ROAD 111 11 E MAIN ST 42084 STATE HIGHWAY RT 28 5301 65TH PL 702 HICKSVILLE RD 681 BROADWAY 1022 PARK BLVD 300 MAIN ST

MANHASSET MANLIUS MANORVILLE MARCELLUS MARGARETVILLE MASPETH MASSAPEQUA MASSAPEQUA MASSAPEQUA PARK MASSENA

NY NY NY NY NY NY NY NY NY NY

11030-3816 13104-1639 11949-3372 13108-1224 12455 11378-1656 11758-1260 11758-2361 11762-2711 13662-1901

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 454 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JOHNSONS VILLAGE PHARMACY INC HAVEN DRUGS MEDFORD CHEMISTS PHARMACY 112 INC STOP & SHOP PHARMACY ROSENKRANS PHARMACY THE MEDICINE SHOPPE 110 PHARMACY & SURGICAL ISLAND CARE PHARMACY MOMS PHARMACY

Provider Name

(716) 753-3200 (631) 289-6888 (631) 475-4476 (631) 438-0530 (631) 345-0255 (585) 798-1650 (716) 798-1212 (631) 421-5454 (516) 822-6300 (631) 547-6520

99 E CHAUTAUQUA ST 76 SOUTHAVEN AVE 2608 ROUTE 112 2608 ROUTE 112 # B 700 PATCHOGUE YAPHANK RD 526 MAIN ST 142 E CENTER ST 459 WALT WHITMAN RD 1860 WALT WHITMAN RD STE 700 45 MELVILLE PARK RD

MAYVILLE MEDFORD MEDFORD MEDFORD MEDFORD MEDINA MEDINA MELVILLE MELVILLE MELVILLE

NY NY NY NY NY NY NY NY NY NY

14757-1017 11763-3738 11763-2551 11763-2551 11763-2206 14103-1421 14103-1621 11747 11747-3098 11747-3109

TOWN TOTAL COMPOUNDING CNTRS LLC MENDON PHARMACY GARFIELD PHARMACY, INC. SAVALL DRUG INC KINNEY DRUGS KING KULLEN PHARMACY AJ'S VILLAGE CHEMIST ARTIS DRUG CORPORATION COLOMBOS PHARMACY LLC VALLEY PHARMACY MIDDLEPORT FAMILY HLTH CTR PHY ACCUCARE PHARMACY CRYSTAL RUN PHCY HUDSON REGIONAL LTC PHARMACY MIDDLETOWN PHARMACY NEIGHBORX PHARMACY NEIGHBORX PHARMACY AT ORMC PRESTIGE PHARMACY INC PRICE CHOPPER PHARMACY MILLBROOK PHARMACY LLC ECHO PHARMACY STOP & SHOP PHARMACY DRUG MART OF MILLWOOD FRANWIN PHCY MINEOLA SURGICAL MINEOLA FAMILY PHARMACY BLOOMING GROVE PHARMACY HEALTH MART PHARMACY KIRYAS JOEL PHARMACY INC MONROE PHARMACY STOP & SHOP PHARMACY GREENBAUM'S PHARMACY INC

(516) 249-7436 (585) 624-8010 (516) 378-5521 (516) 379-3722 (315) 963-0601 (631) 924-0684 (718) 894-9000 (718) 429-6611 (718) 418-9700 (518) 702-4176 (716) 735-3261 (845) 341-2750 (845) 692-7628 (845) 341-2700 (845) 342-5566 (845) 343-6666 (845) 333-7250 (845) 344-4433 (845) 344-0327 (845) 677-3131 (631) 642-8175 (631) 642-3232 (914) 923-9200 (516) 746-4720 (516) 427-5573 (845) 782-2260 (845) 774-1464 (845) 783-3399 (845) 395-0909 (845) 774-8118 (845) 356-9300

532 BROADHOLLOW RD STE 104 51 ASSEMBLY DR 1760 MERRICK AVE 393 MERRICK AVE 3318 MAIN ST 1235 MIDDLE COUNTRY RD 74-05 METROPOLITAN AVE 8002 ELIOT AVE 7551 METROPOLITAN AVE 312 MAIN ST 81 TELEGRAPH RD 67 COUNTY HIGHWAY 108 390 CRYSTAL RUN RD # 111 280 ROUTE 211 E BLDG 2 STE 112 149 WICKHAM AVE 331 ROUTE 211 E 707 EAST MAIN STREET 36 JAMES ST # 42 511 SCHUTT ROAD EXT 3272 FRANKLIN AVE 56 ECHO AVE 385 ROUTE 25A 230 SAW MILL RIVER RD 127 MINEOLA BLVD 182 2ND ST 1200 STATE ROUTE 208 STE 1 48 BAKERTOWN RD UNIT 101 51 FOREST RD STE 211 581 STATE ROUTE 17M 475 STATE ROUTE 17M 42 MAIN ST

MELVILLE MENDON MERRICK MERRICK MEXICO MIDDLE ISLAND MIDDLE VILLAGE MIDDLE VILLAGE MIDDLE VILLAGE MIDDLEBURGH MIDDLEPORT MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MIDDLETOWN MILLBROOK MILLER PLACE MILLER PLACE MILLWOOD MINEOLA MINEOLA MONROE MONROE MONROE MONROE MONROE MONSEY

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11747-3609 14506 11566-2728 11566-2723 13114-3002 11953-2515 11379 11379-1409 11379-2638 12122-6523 14105-9638 10940-6948 10941-4013 10940-3109 10940-3721 10940-2121 10940-2650 10940-5729 10940-2569 12545-0557 11764-2401 11764-2525 10546-1139 11501-3999 11501-4021 10950-4649 10950-8429 10950-2936 10950-3456 10950-4169 10952-3000

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 455 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MEDEX MEDICINE EXPRESS MONSEY FAMILY DRUGSTORE LLC ROCKLAND PHARMACY WHITE'S DRUG & DEPARTMENT ST MONTGOMERY VILLAGE PHARMACY FAMILY DRUG STORE QUINLANS PHARMACY INC KINNEY DRUGS INC DOUGHERTY PHARMACY NO. WESTCHESTER PRESC CTR-LEGEND ROBERT JACOBSON SURGICAL PHCY HERITAGE CHEMISTS KING KULLEN PHARMACY 32 PROCTOR PHARMACY INC ANKERSON PHARMACY DBA CIRCLE RX FLEETWOOD PHARMACY MEDSPLUS PHCY & SURGICAL SPLY MT. VERNON PHARMACY PHILIP PHARMACY RL MT. VERNON PHARMACY INC SOUND SHORE PHARMACY INC SOUTH FULTON PHARMACY INC. VERNON PHARMACY REDI PHARMACY STOP & SHOP PHARMACY NAPLES APOTHECARY NASSAU PHARMACY INC CHINATOWN PHARMACY CORP SERVICE PHARMACY CLARKSTOWN PHARMACY II LLC PHARMACEUTICAL CONSULTANTS PRICE CHOPPER PHARMACY THE MEDICINE SHOPPE LAKEVILLE PHARMACY SORKIN'S RX LTD TARUN WASIL PHYSICIAN, PC UNION SPECIALTY PHARMACY INC VIVO HEALTH PHARMACY AT LIJ VIVO HEALTH SPECIALTY PHARMACY DEDRICKS PHCY OF NEW PALTZ MAIN STREET PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (845) 425-3400 (845) 371-6464 (845) 356-3045 (631) 668-2994 (845) 457-4020 (845) 794-2345 (607) 210-4262 (315) 497-9600 (315) 684-3171 (914) 666-4467 (914) 241-4887 (631) 509-4545 (631) 474-0012 (914) 668-8500 (914) 668-9300 (914) 665-5555 (914) 665-5556 (914) 664-6600 (914) 363-3675 (914) 668-6688 (914) 699-0235 (914) 664-0015 (914) 667-7772 (914) 664-0300 (845) 507-0630 (845) 624-0659 (585) 374-5040 (518) 766-2707 (212) 226-8988 (607) 847-8100 (845) 634-6100 (845) 425-1131 (315) 736-5178 (315) 735-7979 (516) 354-3545 (516) 355-2273 (516) 354-2200 (718) 749-5961 (718) 470-8486 (516) 465-5250 (845) 255-0310 (914) 235-1000

Provider Street 59 ROUTE 59 108 B RTE 59 27 ORCHARD ST 95 CARL FISHER PLZ 105 WARD ST 524 BROADWAY 336 WEST MAIN STREET 130 MAIN ST 14 E MAIN ST 19 E MAIN ST 359 E MAIN ST 150 ROUTE 25A 5507-200 NESCONSET HWY 32 GRAMATAN AVE 11 S 4TH AVE 120 GRAMATAN AVE 505 GRAMATAN AVE 531 GRAMATAN AVE 1 PATHMARK PLZ 100 STEVENS AVE 107 W 4TH ST 12 N 7TH AVE 301 S FULTON AVE 105 STEVENS AVE 250 W ROUTE 59 STE 5 32 S MIDDLETOWN RD 129 S MAIN ST 1 ALBANY AVE 111 MOTT ST 12 S MAIN ST 174 S MAIN ST 200 E ECKERSON RD 4535 COMMERCIAL DR 18 KELLOGG RD 749 HILLSIDE AVE 1981 MARCUS AVE STE 225 1575 HILLSIDE AVE STE 301 265-01 UNION TURNPIKE 270-05 76TH AVE 410 LAKEVILLE RD 190 MAIN ST 761 MAIN ST

Page 456 of 679

Provider City MONSEY MONSEY MONSEY MONTAUK MONTGOMERY MONTICELLO MONTOUR FALLS MORAVIA MORRISVILLE MOUNT KISCO MOUNT KISCO MOUNT SINAI MOUNT SINAI MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON NANUET NANUET NAPLES NASSAU NEW YORK NEW BERLIN NEW CITY NEW CITY NEW HARTFORD NEW HARTFORD NEW HYDE PARK NEW HYDE PARK NEW HYDE PARK NEW HYDE PARK NEW HYDE PARK NEW HYDE PARK NEW PALTZ NEW ROCHELLE

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10952 10952-0000 10952-3047 11954 12549-1110 12701-1154 14865 13118-3689 13408 10549-2218 10549-3028 11766-2002 11766-2019 10550-1306 10550 10550-1206 10552-3008 10552-2103 10550-3518 10550-2600 10550-4002 10550-2026 10553-1715 10550-2686 10954-2221 10954-2801 14512-9574 12123-3300 10013 13411-2900 10956-3380 10956-7164 13413-6208 13413-2825 11040-2515 11042-1055 11040-2501 11040 11040 11042-1101 12561-1211 10805-1511

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name NEW ROCHELLE PHARMACY NEW ROCHELLE PRESCRIPTION CENTER SOUND SHORE PHARMACY, INC STARLING PHARMACY STOP & SHOP PHARMACY MEDICINE CHEST PHARMACY NEW WINDSOR PHARMACY PRICE CHOPPER PHARMACY 103 PHARMACY INC 133RD ST PHARMACY INC 139 CENTER PHARMACY LLC 139 PHARMACY INC 145TH ST PHARMACY 1699 FANCY PHARMACY INC 18 PHARMACY 1875 LEXINGTON AVE CORP OF NY 2000 NINOS PHARMACY 2355 2ND AVE CORP 27 AUDUBON PHARMACY CORP 278 PHARMACY 523 PHARMACY CORP 678 PHARMACY INC. 79TH STREET PHARMACY INC 88 STREET PHARMACY 8TH AVE PHARMACY 909 COLUMBUS RX CORP 90TH STREET PHARMACY 92 PHARMACY INC 96TH STREET RX CORP A.M. PHARMACY II INC ABACUS PHARMACY ABC DRUGS ABC PHARMACY ABC PHARMACY A-CLASS PHARMACY AHF PHARMACY AID PHARMACY NY CORP ALISONS PHARMACY INC ALL HEALTH PHARMACY CORP ALLEN STREET PHARMACY INC ALRITE PHARMACY INC AMERICAN EAST PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (914) 654-1222 (914) 636-2225 (914) 365-3986 (914) 278-9733 (914) 632-7148 (845) 561-5555 (845) 568-3000 (845) 565-3314 (212) 410-4410 (212) 491-4911 (646) 838-6388 (212) 283-6623 (212) 281-3480 (212) 529-4532 (212) 571-0027 (212) 249-8202 (212) 491-2910 (212) 249-8202 (212) 249-8202 (212) 227-7666 (212) 281-7408 (646) 870-9996 (646) 370-5978 (212) 348-8900 (212) 234-3900 (212) 249-8202 (212) 289-9168 (212) 426-6484 (646) 979-2900 (212) 226-8832 (212) 477-6400 (212) 491-2501 (212) 965-8882 (212) 966-7588 (212) 431-0333 (212) 284-0060 (212) 965-9688 (212) 227-7065 (212) 431-4398 (212) 966-8287 (212) 965-8868 (212) 925-1900

Provider Street 110 LOCKWOOD AVE 551 MAIN ST 16 GUION PL 378 NORTH AVE 2425 PALMER AVE 408 BLOOMING GROVE TPKE 215 QUASSAICK AVE 115 TEMPLE HILL RD 2002 2ND AVE 1473 AMSTERDAM AVE 139 CENTRE STREET STORE #105 3415 BROADWAY 300 W 145TH ST 131 ESSEX ST 18 ELIZABETH ST 1875 LEXINGTON AVE 3663 BROADWAY 2355 2ND AVE 27 AUDUBON AVE 27 E BROADWAY FL 1 523 MALCOLM X BLVD 139 CENTRE ST SUITE 201 215 W 79TH ST 1695 FIRST AVE 2830 8TH AVE 909 COLUMBUS AVE 1260 MADISON AVE 1938 2ND AVE 175 E 96TH ST 219 GRAND STREET 168 2ND AVE 2095 MADISON AVE 17 E BROADWAY 53 ELIZABETH ST 85 ELIZABETH ST 365A W 28TH ST 139 CENTRE ST STORE #8 12 BOWERY 118 MOTT ST 2 ALLEN ST STE 1C/1D 161 HESTER ST 23 DIVISION ST

Page 457 of 679

Provider City NEW ROCHELLE NEW ROCHELLE NEW ROCHELLE NEW ROCHELLE NEW ROCHELLE NEW WINDSOR NEW WINDSOR NEW WINDSOR NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10801-5028 10801-7214 10801-5503 10801 10801-4400 12553-7841 12553-4501 12553-6812 10029-5445 10027-7472 10013 10031-7414 10039 10002-2370 10013-4802 10035-4733 10031 10035-3107 10032-2241 10002-6804 10037-1808 10013-4553 10024-6242 10128-4804 10039-2115 10025-4041 10128-0516 10029-6303 10128-6200 10013 10003-5754 10037-3449 10002-6994 10013-4617 10013-4770 10001-4703 10013 10013 10013-4709 10002 10013 10002-6707

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ANDY PHARMACY ANDY PHARMACY II ANSONIA PHARMACY APICHA HEALTH CENTER PHARMACY APOLLO PHARMACY APOTHECO PHARMACY MANHATTAN APTHORP PHARMACY INC ARCELY PHARMACY INC ARROW PHARMACY INC ASBELL PHARMACY AVALON CHEMISTS AVENUE A PHARMACY AVENUE C PHARMACY BAC AI PHARMACY BATTERY PARK PHARMACY BAYARD L. C. PHARMACY BELLEPLAINE PHARMACY INC BEST CARE PHARMACY CORP BETTER HEALTH RX CORP BIO CARE PHARMACY INC BJ'S PHARMACY BLAKE PHARMACY BLISS PHARMACY BOWEN PHARMACY INC BOWERY PHARMACY BROADWAY CHEMISTS BROADWAY DOWNTOWN PHARMACY BROADWAY FAMILY PHARMACY BROADWAY PHARMACY BROADWAY PHARMACY BROADWAY PHARMACY III BROADWAY RX ENTERPRISES INC. BUY RITE PHARMACY BUY RITE PHARMACY IV BUY-RITE PHARMACY V BUY-RITE PHARMACYII C O BIGELOW CHEMISTS INC CALIGOR PHARMACY RX CALLEN-LORDE COMMUNITY PHCY CAMBRIDGE CHEMISTS CANAL PHARMACY INC CANAL STREET PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (212) 368-5511 (212) 795-3033 (212) 477-0762 (212) 334-7958 (212) 862-7700 (212) 889-0022 (212) 877-3480 (212) 923-2412 (212) 245-8469 (212) 927-5994 (212) 260-3131 (212) 260-4878 (212) 228-0764 (212) 513-1344 (212) 912-0555 (212) 219-8116 (212) 234-0300 (212) 334-0086 (212) 222-8600 (212) 255-3100 (212) 348-7788 (212) 369-1350 (212) 427-4382 (212) 956-9111 (212) 219-0449 (212) 877-0888 (212) 925-4888 (212) 724-1950 (212) 926-9800 (212) 740-8500 (212) 927-0999 (212) 926-9200 (212) 925-7698 (212) 625-9505 (212) 343-1919 (212) 966-9239 (212) 533-2700 (212) 369-6000 (212) 271-7260 (212) 734-5678 (212) 608-1668 (212) 748-4900

Provider Street 3750 BROADWAY 1341 SAINT NICHOLAS AVE 446 AVENUE OF THE AMERICAS 400 BROADWAY 3569 BROADWAY 462 2ND AVE 2201 BROADWAY 1603 SAINT NICHOLAS AVE 883 9TH AVE 1600 SAINT NICHOLAS AVE 7 2ND AVE 41 AVENUE A 178 AVE C 216 CANAL ST 327 S END AVE 62 BAYARD ST 2703 FREDERICK DOUGLASS BLVD 28 E BROADWAY 503 W 125TH ST 222 8TH AVE 80 E 116TH ST 1868 3RD AVE 1590 MADISON AVE 881 10TH AVE 95 BOWERY 2345 BROADWAY 373 BROADWAY 2330 BROADWAY 3621 BROADWAY 4329 BROADWAY 629 W 185TH ST 3489 BROADWAY 11 CHATHAM SQ 215 GRAND ST FL 7 139 CENTRE ST 106 LAFAYETTE ST 414 AVENUE OF THE AMERICAS 1226 LEXINGTON AVE 356 W 18TH ST 855 LEXINGTON AVE 196 CANAL ST 210 CANAL ST

Page 458 of 679

Provider City NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10032 10033-7236 10011-8424 10013-3698 10031 10016-9104 10024-6203 10040-3303 10019-1704 10040-3311 10003-8674 10009-7628 10009 10013-4122 10280-1002 10013-4938 10030-1246 10002-6803 10027-3402 10011-1610 10029-1128 10029-5432 10029-3816 10019-1044 10002-4901 10024-3213 10013-3906 10024-4342 10031-2518 10033-2408 10033-3102 10031-5612 10038-1028 10013-4290 10013-4552 10013-4111 10011-8416 10028-1406 10011 10065 10013-4516 10013-4155

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CANALBERRY CORP CAPITOL CHEMISTS CAPSULE PHARMACY CARE PHARMACY & SURGICALS CARIBE PHARMACY CARNEGIE HILL PARAPHARMACIE CARNEGIE HILL PHARMACY CEDRA PHARMACY CEDRA PHARMACY CENTER PHARMACY INC

Provider Name

(212) 619-6190 (212) 772-3337 (212) 675-3900 (212) 281-2345 (212) 304-0649 (212) 534-1300 (212) 246-0020 (212) 877-5000 (212) 758-1199 (212) 222-7922

84 MULBERRY ST 1639 1ST AVE 113 W 25TH ST 565 LENOX AVE 146 NAGLE AVE 1331 MADISON AVE 1721 BROADWAY 2268 BROADWAY 1207 2ND AVE 1290 AMSTERDAM AVE

NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

NY NY NY NY NY NY NY NY NY NY

10013-4471 10028-4646 10001-7243 10037-1742 10040-1437 10128-1304 10019-5214 10024-5403 10065-7402 10027

CENTRAL PARK HEMATOLOGY & ONCOLOGY CENTRE CARE PHARMACY LLC CENTURY PHARMACY CENTURY PHARMACY CENTURY PHARMACY CHARLIE PHARMACY INC CHELSEA MOBILITY CIBAO PHARMACY CITY DRUG & SURGICAL CITY DRUGS CITYDRUG & SURGICAL INC CLYDE CHEMISTS LTD COLUMBIA PHARMACY COLUMBUS AVENUE PHARMACY COMFORT CARE PHARMACY INC CONFUCIUS PHARMACY & SURGICAL CORBY CHEMISTS CORDETTE PHARMACY CT HEALTH CASTLE CORP CUREWAYS CUREWELL DRUGS DALIZA PHARMACY DICHTER PHARMACY DOWNTOWN PHARMACY INC DRUG LOFT PHARMACY DRUG MART DRUG MART II LLC DRUG SHOPPE DRUG STOP CORP DRUG WORX DUNBAR PHARMACY

(212) 861-6660 (212) 226-0988 (212) 925-3838 (212) 227-7262 (212) 227-5227 (646) 596-7028 (212) 255-5522 (212) 543-1900 (212) 781-0707 (212) 988-4500 (212) 781-1011 (212) 288-6966 (212) 928-6342 (212) 663-7440 (212) 410-4200 (212) 966-4420 (212) 755-6632 (212) 398-9999 (212) 966-6039 (646) 559-1515 (212) 568-1020 (212) 281-9410 (212) 569-1230 (212) 233-0333 (212) 996-9499 (212) 737-8800 (212) 569-4400 (212) 222-3652 (212) 410-0509 (212) 795-7455 (212) 234-4493

12 E 86TH ST STE 4 187 CENTRE ST 302A GRAND ST 159 E BROADWAY 225 MADISON ST 2034 2ND AVE 327 8TH AVE 1303 SAINT NICHOLAS AVE 719 W 181ST ST 1752 FIRST AVE 2039 AMSTERDAM AVE 926 MADISON AVE 3921 BROADWAY 916 COLUMBUS AVE 1990 LEXINGTON AVE STE C 25 BOWERY 988 1ST AVE 55 W 39TH ST 86 BOWERY 2201-A AMSTERDAM AVE 4157 BROADWAY 3481 BROADWAY 4953 BROADWAY 165 WILLIAM ST 1412 MADISON AVE 1631 YORK AVE 4873 BROADWAY 2074 FREDERICK DOUGLASS BLVD 2062 2ND AVE 4197 BROADWAY 2580 ADAM CLAYTON POWELL JR BL

NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10028-0517 10013-3610 10002 10002-6301 10002-7505 10029-4701 10001-4807 10033-7210 10033-4731 10128 10032-5007 10021 10032-1538 10025-4040 10035-2902 10002-6702 10022-4150 10018 10013-4615 10032-2512 10033 10031-5612 10034-2303 10038-2605 10029-6941 10028-6202 10034-3134 10026-3375 10029-4704 10033-3735 10039

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 459 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DYCKMAN PHARMACY E CARE PHARMACY CORP EAST END PHARMACY EAST HARLEM PHARMACY ECOGREEN PHARMACY ELM DRUGS EMBASSY PHARMACY EQUAL CARE PHARMACY ERINS PHARMACY ERXCITY CORP ESCO DRUG INC ESQUIRE PHARMACY EXPRESS DRUGS & SURGICALS EZ CARE PHARMACY LLC FAIRVIEW PHARMACY FAITH PHARMACY FAMILY CHOICE PHARMACY CORP FAMILY PLUS PHARMACY CORP FARMACIA CENTRAL FARMACIA SAN RAFAEL FEIN'S ETHICAL PHARMACY FIRST CHOICE PHARMACY FOREVER HEALTH PHARMACY FOREVER HEALTH PHARMACY FULTON FAMILY PHARMACY FUSION APOTHECARY FUZHOU PHARMACY GAGA PHARMACY INC GALLERY DRUG GENERATION PHARMACY LLC GIDEONS DRUGS INC GOLDBERGERS PHARMACY GOOD HEALTH FAMILY PHARMACY GOTHAM PHARMACY INC GRAMERCY DRUGS INC GRAND HEALTH PHARMACY INC GRISTEDES PHARMACY GROVE DRUGS H & C CHEMISTS INC HABITAT PHARMACY INC HALPERN PHARMACY HAMILTON PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (212) 567-1331 (212) 962-3388 (212) 831-1730 (212) 987-3600 (212) 369-3084 (212) 255-6100 (212) 690-1331 (212) 228-6137 (212) 677-7335 (212) 625-8339 (212) 246-8169 (212) 228-2260 (212) 749-6626 (212) 343-8899 (212) 567-3384 (212) 387-8800 (212) 925-6088 (212) 732-3388 (212) 942-5050 (212) 923-4190 (212) 862-3315 (212) 348-6700 (212) 219-3692 (212) 966-7887 (212) 431-6688 (917) 472-7895 (212) 693-8866 (212) 226-2668 (212) 838-6765 (212) 227-9129 (212) 575-6868 (212) 734-6998 (212) 665-6007 (212) 289-7800 (212) 532-0022 (212) 228-0068 (212) 373-8448 (212) 242-6193 (212) 535-1700 (212) 685-8600 (212) 683-0148 (212) 281-0488

Provider Street 199 DYCKMAN ST 48 MOTT ST 210 E 116TH ST 2371 2ND AVE 1600 MADISON AVE 56 7TH AVE 1873 AMSTERDAM AVE 753 E 5TH ST 360 E 4TH ST 185 CANAL ST STE 201 687 9TH AVE 277 1ST AVE 2381 FREDERICK DOUGLASS BLVD 87 ELIZABETH ST 4478 BROADWAY 743 E 9TH ST 13 ELIZABETH ST UNIT 10 14-18 ELIZABETH ST ARCADE #15 102 NAGLE AVE 1479 SAINT NICHOLAS AVE 3586 BROADWAY 245 E 124TH ST 244 GRAND ST 2 E BROADWAY 98 E BROADWAY FL 1 1158 2ND AVE 96 E BROADWAY 115 MOTT STREET 131 E 60TH ST 31-33 OLIVER ST STORE #3 1385 BROADWAY 1200 1ST AVE 449 W 125TH ST 2258 3RD AVE 1938 3RD AVE 349 GRAND ST 227 9TH AVE 302 W 12TH ST 1299 FIRST AVE 525 3RD AVE 333 E 23RD ST 3293 BROADWAY

Page 460 of 679

Provider City NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10040-1069 10013-5011 10029-1401 10035-3109 10029-3823 10011-6672 10031-1716 10009-1274 10009-8501 10013-4537 10036-3630 10003-2994 10027-1822 10013-4992 10040-2606 10009-5335 10013-4803 10013 10040-1401 10033-4002 10031-3201 10035-2093 10002 10038-1073 10002-7015 10065-8504 10002 10013 10022-1102 10038 10018-6001 10065-7105 10027 10035-2208 10029-4006 10002-4628 10011-4934 10014-6025 10021-5503 10016-4168 10010-4710 10027-7909

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HAMILTON PRESCRIPTIONS HARLEM CARE PHARMACY HARLEM COMMUNITY PHARMACY HARLEM PHARMACY HARLEM PHARMACY & SURGICALS HARLEM RX INC HARLEM SUPER PHARMACY, INC. HARMONY PHARMACY INC. HARTLEY PHARMACY HARVARD PHARMACY HEALTH CITY PHARMACY HEALTH RITE PHARMACY INC HEALTHSOURCE PHARMACY HEALTHSOURCE PHARMACY HEALTHSOURCE PHARMACY INC HEALTHY PHARMACY INC HEIDI PHARMACY HERITAGE PHCY & SURGICAL SUPPLIES HILLTOP PHARMACY HUDSON SQUARE PHARMACY I & S PHARMACY INWOOD PHARMACY IVAN PHARMACY JANIK PHARMACY JAROS DRUGS INC JMC PHARMACY INC JORGE PHARMACY JOSE PHARMACY JOSEPH PHARMACY JULIE PHARMACY CORP JVJ PHARMACY KARNABY DRUGS KINGS PHARMACY KINGS THIRD AVE PHARMACY LA FE PHARMACY LC PHARMACY INC LENDA PHARMACY INC LENOX PHARMACY LENOX TERRACE PHARMACY INC LEVITT PHARMACY LEX DRUGS INC LEXCARE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (212) 281-7121 (212) 666-3600 (212) 926-7500 (212) 831-0200 (212) 368-7900 (212) 666-8100 (212) 316-1100 (212) 226-2881 (212) 749-8480 (212) 410-6470 (212) 267-8882 (212) 781-8888 (212) 481-6600 (212) 310-0111 (212) 794-8700 (212) 966-8682 (212) 740-3737 (212) 694-8050 (212) 568-5510 (212) 989-1400 (212) 427-7123 (212) 304-4646 (212) 222-4400 (212) 567-1350 (212) 247-8080 (212) 795-4909 (212) 567-2753 (212) 304-0101 (212) 875-1718 (646) 791-5237 (212) 473-0277 (212) 928-7700 (212) 791-3100 (212) 534-6000 (212) 321-0083 (212) 513-1177 (212) 368-3130 (212) 678-9722 (212) 234-2050 (212) 475-5760 (212) 426-0402 (212) 722-5222

Provider Street 5 HAMILTON PLACE 165 W 127TH ST 67 W 137TH ST 17 WEST 125TH ST 531 LENOX AVE 102 W 116TH ST 2046 7TH AVENUE 128 MOTT STREET UNIT 102B 1219 AMSTERDAM AVE 2118 3RD AVE 137 MOTT ST 1988 AMSTERDAM AVE 120 E 34TH ST 1000 1ST AVE 1302 2ND AVE 108 BOWERY 522 WEST 181ST ST 2258 ADAM CLAYTON POWELL JR BL 593 FORT WASHINGTON AVE 345 HUDSON ST 1994 3RD AVE 4915 BROADWAY 691 COLUMBUS AVE 520 W 207TH ST 25 CENTRAL PARK W 3875 BROADWAY UNIT A 101 SHERMAN AVE 506 W 207TH ST 216 W 72ND ST 4121 BROADWAY 74 UNIVERSITY PL 3851 BROADWAY 5 HUDSON ST 1619 3RD AVE 4220 BROADWAY 75 E BROADWAY 3397 BROADWAY 27 LENOX AVE 20 W 135TH ST 407 GRAND ST 1797 LEXINGTON AVE 1570 LEXINGTON AVE

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Provider City NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10031-6801 10027-3720 10037-1953 10027 10037 10026-2500 10027 10013 10027-7007 10029 10013-4718 10032-5141 10016-4609 10022-4105 10065 10013-4788 10033 10027 10033-1908 10014-4502 10029-3644 10034-3119 10025-7002 10034-2646 10023-7253 10032-1510 10034-5626 10034-2609 10023-2805 10033-3734 10003-4504 10032-1540 10013-3825 10128-3459 10033-3737 10002-6007 10031-7416 10026 10037-2534 10002-3951 10029-2830 10029

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LEXINGTON AVENUE PHARMACY LEXINGTON CHEMISTS INC LIFE PHARMACY LOISAIDA DRUGS AND SURGICAL LUCKY HEALTH PHARMACY INC. MADISON AVENUE PHARMACY MADISON DRUGS INC MADISON RX PHARMACY INC MAGNOLIA PHARMACY MALCOLM PHARMACY INC MANNINGS PHARMACY MARCIA PHARMACY MARIN PHARMACY MAXWELL PHARMACY INC MCP RX MEDIEXPRESS PHARMACY CORP MEDILANE DRUGS MEDILANE PHARMACY MEDPHARM DRUG & TRADING INC MELBRAN PHARMACY MEMORIAL HOSPITAL FOR CANCER METRO DRUGS 3RD AVE CORP METROPHARM INC METRORX

Provider Name

(212) 426-5555 (212) 838-2500 (212) 694-5700 (212) 254-7307 (212) 625-8988 (212) 722-3200 (212) 385-6775 (646) 918-7225 (212) 369-6075 (212) 722-1550 (212) 941-6480 (212) 534-1939 (212) 795-1795 (212) 534-7700 (212) 233-2833 (212) 388-9886 (212) 505-1788 (212) 571-2888 (212) 267-5670 (212) 568-1300 (646) 888-7020 (212) 794-7200 (212) 219-8668 (212) 831-1222

2056 LEXINGTON AVE 806 LEXINGTON AVE 471 LENOX AVE 273 E 3RD ST 224A CANAL ST 1407 MADISON AVE 36 GOUVERNEUR ST 203 MADISON ST 2032 3RD AVE 160 MALCOLM X BLVD 13 ELIZABETH ST RM 118 217 E 106TH ST 1576 SAINT NICHOLAS AVE 234 E 106TH ST 156 CANAL ST 78 CLINTON ST 227 AVENUE B 204 CLINTON ST 61 CATHERINE ST 605 W 168TH ST 1133 YORK AVE ROOM 1005 931 LEXINGTON AVE 92 BAXTER ST 1976 2ND AVE

NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10035-1732 10065 10037 10009-7800 10013 10029-6930 10002-5763 10002-7581 10029-3602 10026-1319 10013-4803 10029-4005 10040-4351 10029-7604 10013-4501 10002-3487 10009-3358 10002-7576 10038-1307 10032-3705 10065 10065-5771 10013-4407 10029-6314

MIDTOWN EAST PHCY AND SURGICAL LLC MILENA PHARMACY MISHKINS PHARMACY MOTT ST PHARMACY INC MULBERRY PHARMACY INC NAGLE PHARMACY NATES PHARMACY NATURES CURE PHARMACY INC NATURES FIRST NEERGAARD PHARMACY NEW AMSTERDAM DRUG MART INC NEW DRUG LOFT NEW HEALTH RX NEW LONDON PHCY NEW LONDON SPECIALTY PHARMACY NEW YORK CHEMISTS NEW YORK CITY PHARMACY

(212) 213-2444 (212) 543-2333 (212) 926-2801 (212) 732-3888 (212) 693-6688 (212) 942-0202 (212) 995-9400 (212) 545-9393 (212) 228-7900 (212) 327-4700 (212) 865-9700 (212) 879-0910 (212) 281-1100 (212) 243-4987 (212) 414-9755 (212) 255-2525 (212) 253-8686

161 MADISON AVE 4407 BROADWAY 1714 AMSTERDAM AVE 11 MOTT ST 87 MULBERRY ST 210-220 NAGLE AVE 205 3RD AVE 324 E 34TH ST 313 1ST AVENUE 1520 1ST AVE 698 AMSTERDAM AVE 1103 LEXINGTON AVE 127 W 135TH ST 246 8TH AVE 246 8TH AVE 2ND FL STE A 77 CHRISTOPHER ST 206 1ST AVE

NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10016-5421 10040-4014 10031-4602 10013-5020 10013-4452 10034 10003-2506 10016-4991 10003 10075-1024 10025-6902 10075-0411 10030-2926 10011-1646 10011 10014 10009-3720

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 462 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name NEWGEN PHARMACY INC NOLITA CHEMISTS NORWOOD PHARMACY NUCARE PHARMACY & SURGICAL NUCARE PHARMACY AND SURGICAL NYC CHELSEA PHARMACY NYPRES PHARMACY INC NYU HOSPITALS CENTER PHARMACY OVAL PHARMACY PALACE PHARMACY PANCARE PHARMACY INC PARK WEST PHARMACY PASTEUR PHARMACY PAYLESS RX PHARMACY INC PEOPLES CHOICE PHARMACY PEOPLES PHARMACY PETERS PHARMACY AND VITAMINS INC PHARMAX INC DBA MINH PHARMACY PREFERRED PHARMACY PRESCRIPTIONS EXCLUSIVE PRIME ESSENTIALS RX PROHEALTH PHARMACY PROHEALTH PHARMACY QUISQUEYA PHARMACY RAYSOL DRUGS INC REDWOOD APOTHECARY RELIANCE PHARMACY RITE HEALTH PHARMACY RITE HOPE PHARMACY INC RITE WAY DRUGS & SURGICAL RIVERSIDE PHARMACY RIVERTON PHARMACY INC ROSALISE PHARMACY CORP ROYAL PHARMACY RX CENTER SAINT MARIA PHARMACY SAN JUAN PHARMACY SAN NICHOLAS PHARMACY SAN PEDRO PHARMACY SANTA BARBARA DRUGS SANTA ISABEL PHARMACY INC SB PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (212) 349-1857 (212) 226-1415 (212) 234-6611 (212) 462-2525 (212) 426-9300 (212) 776-4444 (646) 918-6640 (212) 263-7319 (212) 234-1800 (212) 283-2136 (212) 240-2312 (212) 721-3883 (212) 683-3838 (212) 544-0020 (212) 388-0888 (212) 285-0977 (212) 873-8838 (212) 343-1252 (212) 722-0000 (212) 249-1050 (212) 941-7900 (212) 684-8300 (212) 286-8400 (212) 795-1604 (212) 348-2117 (212) 928-8082 (212) 234-8800 (646) 861-2533 (212) 348-3341 (212) 777-6864 (212) 491-5500 (212) 283-8300 (212) 690-6502 (212) 567-9800 (212) 289-8839 (212) 568-1383 (212) 222-4650 (212) 781-4214 (212) 928-7263 (212) 795-4080 (212) 567-1444 (212) 534-2849

Provider Street 12A PELL ST 208 MOTT ST 2490 FREDERICK DOUGLASS BLVD 250 9TH AVE 1789 1ST AVE 215 W 14TH ST 1083 SAINT NICHOLAS AVE 530 1ST AVE 11 EDWARD M MORGAN PL 543 LENOX AVE 22 BOWERY 463 COLUMBUS AVE 53 E 34TH ST 567 W 207TH ST 527 GRAND ST 77 MOTT ST 652 AMSTERDAM AVE 207 GRAND ST 3 E 115TH ST 1229 3RD AVE 345 BROADWAY 385 2ND AVE 370 LEXINGTON AVE 174 AUDUBON AVE 1870 LEXINGTON AVE 1280 SAINT NICHOLAS AVE 480A MALCOLM X BLVD 3885-3897 BROADWAY 1793A MADISON AVE 369 1ST AVE 2920 FREDERICK DOUGLASS BLVD 2085 LEXINGTON AVE 3350 BROADWAY 5030 BROADWAY 2325 1ST AVE 1328 SAINT NICHOLAS AVE 960 AMSTERDAM AVE 1265 ST NICHOLAS AVE 1381 SAINT NICHOLAS AVE 120 AUDUBON AVE 145 SHERMAN AVE 27 E 124TH ST # 29

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Provider City NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10013-5105 10012-4102 10030-2792 10001-6602 10128-6901 10011-7108 10032-3829 10016-6402 10032-7105 10037 10013-5102 10024-5147 10016-4332 10034-2607 10002-4103 10013-4862 10025-7458 10013-4276 10029-1088 10021-5105 10013 10010-4617 10017-6503 10033 10029-2003 10033-7204 10037-2420 10032 10035 10010-6504 10039-1610 10035-1746 10031 10034-1609 10035-3604 10033-7213 10025-3002 10033 10033-4001 10032-2109 10034-4604 10035-2731

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SECOND AVE PHARMACY INC SEVENTH AVENUE PHARMACY SHERMAN PHARMACY SKYLINE PHARMACY, INC. SMART AID PHARMACY ST ANTHONY PHARMACY ST JESUS PHARMACY ST. TERESA PHARMACY STANLEY'S PHARMACY SUBA PHARMACEUTICAL, INC. SUGAR HILL PHARMACY TAINO PHARMACY TAINO TOWERS PHARMACY THE CHEMIST SHOP THE CURE PHARMACY THE PHARMACY@, LLC THERESA PHARMACY THERESA PHARMACY INC THOMAS DRUGS INC THOMPSON CHEMIST INC THRIFTWAY PHARMACY TISANE PHARMACY TOWER CHEMISTS INC TOWN DRUG TOWN DRUG & SURGICAL TOWN DRUG AT BROADWAY TRIBECA PHARMACY INC TU QUYNH PHARMACY TULSI PHARMACY TWINS PHARMACY TWINS PHARMACY 2 TYKA PHARMACY UN PLAZA PHARMACY UNITED HEALTH PHARMACY INC UNO PHARMACY UPPER MANHATTAN PHARMACY UPTOWN CARE PHARMACY UPTOWN CHEMIST V.L.V. MED PHARMACY INC VALLEY DRUGS VALUE CITY PHARMACY VALUE DRUGS ROCK INC

NR_0009_10823 10/2017

Provider Phone Number (212) 876-8300 (212) 862-0505 (212) 567-1115 (212) 996-5929 (212) 234-4299 (212) 923-6111 (212) 923-5733 (212) 304-4541 (646) 476-9622 (212) 866-6700 (212) 281-8300 (212) 289-2000 (212) 426-6200 (212) 684-5125 (212) 750-4100 (212) 491-7900 (212) 923-7617 (212) 304-3949 (212) 877-7340 (212) 598-9790 (212) 956-1100 (212) 517-0037 (212) 628-1900 (212) 678-0636 (212) 333-7330 (212) 304-9582 (212) 219-2788 (212) 219-8998 (212) 543-2616 (212) 927-5570 (212) 927-3100 (212) 343-1517 (646) 918-7363 (212) 766-3773 (212) 795-5004 (212) 694-6666 (212) 221-8355 (212) 923-6000 (212) 923-7530 (212) 678-0084 (212) 961-9500 (212) 757-9335

Provider Street 249 E 115TH ST 2454 ADAM CLAYTON POWELL BLVD 232A SHERMAN AVE 2123 2ND AVE 708 SAINT NICHOLAS AVE 3860 BROADWAY 4180 BROADWAY 3849 10TH AVE 31 LUDLOW ST 2721 BROADWAY 752 SAINT NICHOLAS AVE 2403 2ND AVE 2253 3RD AVE 1ST FLOOR 30 E 40TH ST 1025 A 3RD AVE 2541 7TH AVENUE 3901 BROADWAY 66 NAGLE AVE 171 COLUMBUS AVE 137 THOMPSON ST 646 10TH AVE 340 E 86TH ST 1292 FIRST AVE 501 W 113TH ST 428 W 59TH ST 4785 BROADWAY 19 6TH AVE 230 GRAND ST # A1-2 565 W 181ST ST 1538 SAINT NICHOLAS AVE 4073-4075 BROADWAY 173 CANAL ST 800 2ND AVE 4 ELIZABETH ST 1544A SAINT NICHOLAS AVE 1728 AMSTERDAM AVE 2254 2ND AVE 4027 BROADWAY 4085 BROADWAY 850 AMSTERDAM AVE 2578 BROADWAY 30 ROCKEFELLER PLZ

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Provider City NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10029-2130 10030 10034-2501 10029 10031-4002 10032-1545 10033-3736 10034-1850 10002-6304 10025-3940 10031-4002 10035-2102 10035 10016-1201 10065 10039-3502 10032-1503 10040 10023-5907 10012-3174 10036-2929 10028-4661 10021 10025-8073 10019-1105 10034-4915 10013 10013-4241 10033-5004 10033-2605 10032 10013-4510 10017 10013-4802 10040-4506 10031-4604 10029 10032 10032-1535 10025-5170 10025-5642 10112-0002

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

VALUE PRICE PHARMACY VCARE PHARMACY VENUS PHCY AND BEAUTY SUPPLY VIDA PHARMACY VILLAGE APOTHECARY VILLY PHARMACY VIM DRUGS VIM PHARMACY VITAHEALTH APOTHECARY VITAHEALTH APOTHECARY INC VIVA PHARMACY WELL GREEN PHARMACY INC WELLNESS RX PHARMACY INC WEST 14TH ST PRESCRIPTION CTR WEST SIDE PHARMACY WHITNEY CHEMIST WINHEALTH PHARMACY XPRESS LANE PHARMACY Z CHEMISTS ZITOMER PHARMACY INC ACE DRUGS HARINAM RX INC HUDSON VIEW PHARMACY MEDICAL ARTS PHARMACY NEWBURGH PHARMACY INC PRICE CHOPPER PHARMACY ROUTE 300 PHARMACY STOP & SHOP PHARMACY MEDICINE SHOPPE PHARMACY COMMUNITY MEDICAL PHARMACY MACLEOD'S PHARMACY NIAGARA APOTHECARY PINE PHARMACY NIAGRA FALLS LLC SUMMIT PARK PHARMACY INC

Provider Name

(212) 535-4710 (212) 234-7400 (212) 666-4800 (212) 923-3524 (212) 807-7566 (212) 226-8971 (212) 927-0220 (212) 567-5533 (212) 628-1110 (212) 772-1110 (212) 923-0077 (212) 491-7700 (212) 226-8873 (212) 727-7979 (212) 362-9171 (212) 473-4166 (212) 694-1200 (212) 962-4900 (212) 956-6000 (212) 737-5560 (845) 561-5253 (845) 569-4100 (845) 561-4370 (845) 561-3784 (845) 561-1771 (845) 565-0140 (845) 275-0816 (845) 566-4266 (716) 778-0600 (716) 282-1292 (716) 283-8704 (716) 297-3530 (716) 282-1112 (716) 731-3500

1475 2ND AVE 1743 AMSTERDAM AVE 972 AMSTERDAM AVE 1620 ST NICHOLAS AVE 346 BLEECKER ST 179 GRAND ST 3835 BROADWAY 39 SHERMAN AVE 1235 1ST AVE 1609 2ND AVE 1494 SAINT NICHOLAS AVE 1969 AMSTERDAM AVE 95B ELIZABETH ST 312 W 14TH ST 255 COLUMBUS AVE 50 UNIVERSITY PL 3500 BROADWAY 99 NASSAU ST # 111 40 W 57TH ST 969 MADISON AVE 194 BROADWAY 313 S WILLIAM ST STE 3 147 LAKE ST STE 101 39 N PLANK RD 600 BROADWAY 39 N PLANK RD 1208 ROUTE 300 STE 103 1429 ROUTE 300 2780 MAIN ST 918 MICHIGAN AVE 8672 BUFFALO AVE 8745 NIAGARA FALLS BLVD 1806 PINE AVE 2578 NIAGARA FALLS BLVD #100

NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEW YORK NEWBURGH NEWBURGH NEWBURGH NEWBURGH NEWBURGH NEWBURGH NEWBURGH NEWBURGH NEWFANE NIAGARA FALLS NIAGARA FALLS NIAGARA FALLS NIAGARA FALLS NIAGARA FALLS

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10075-2292 10031-4614 10025 10040 10014-2980 10013-3762 10032-1510 10040-1701 10065 10028-4153 10033-4022 10032-5041 10013 10014-5002 10023-3330 10003-4511 10031 10038-2703 10019-4001 10021-2763 12550-5415 12550-5300 12550 12550-2118 12550-5157 12550-2118 12550-5003 12550-2908 14108-1237 14305-2608 14304-4365 14304-1947 14301-2234 14304-4683

UPSTATE HEMATOLOGY ONCOLOGY PLLC DEER PARK PHARMACY STOP & SHOP PHARMACY NORTH COLLINS PHARMACY VILLAGE PHARMACY WELLNESS PARK PHARMACY INC WURLITZER FAMILY PHARMACY

(518) 836-3030 (631) 940-9472 (516) 826-0057 (716) 337-2992 (315) 458-0500 (716) 260-1918 (716) 260-1131

2125 RIVER RD STE 100 1155 DEER PARK AVE 2450 JERUSALEM AVE 10504 MAIN ST 792 N MAIN ST STE 200C 624 RIVER RD STE 5A 521 DIVISION ST

NISKAYUNA NORTH BABYLON NORTH BELLMORE NORTH COLLINS NORTH SYRACUSE NORTH TONAWANDA NORTH TONAWANDA

NY NY NY NY NY NY NY

12309 11703-3105 11710-1827 14111 13212-1673 14120-6563 14120-4403

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 465 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name JONES DRUG STORE STOP & SHOP PHARMACY PRICE CHOPPER PHARMACY SERVICE PHARMACY NUNDA FAMILY PHARMACY LLC KOBLINS PHARMACY MCMANUS PHARMACY OAKFIELD FAMILY PHARMACY BAYSIDE PHARMACY INC PRIME DRUGS WINDSOR PHARMACY & SURGICALS LEVIN'S PHARMACY OCEAN CHEMISTS KIMROS MEDICINE PLACE KINNEY DRUGS PRICE CHOPPER PHARMACY DIAMOND DRUGS KINNEY DRUGS DAN HORN PHCY AND HEALTH SERV PRIZEL'S PHARMACY VIC VENA PHARMACY PRICE CHOPPER PHARMACY THE MEDICINE SHOPPE FOXCARE PHARMACY PRICE CHOPPER PHARMACY ANTHONY-BROWN PHARMACY INC. OPTION CARE HEALTHSMART PHARMACY OSSINING HUDSON PHARMACY PRESCRIPTION CENTER PRESCRIPTION PLUS KINNEY DRUGS PRICE CHOPPER PHARMACY WAYNE DRUG OSWEGO CORP KINNEY DRUGS INC THE OWEGO PHARMACY BARTLE'S PHARMACY INC AL-HAQQ PHARMACY INC CORP CARE SCRIPT PHARMACY CLOCK TOWER PHARMACY CROSS BAY CHEMIST ELITE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (631) 261-7070 (631) 757-4832 (607) 336-2588 (607) 334-2431 (585) 468-2416 (845) 358-0688 (845) 358-0205 (585) 948-5283 (718) 224-1234 (718) 749-5021 (718) 428-8200 (516) 766-2288 (516) 764-9600 (315) 393-6290 (315) 393-2440 (315) 393-7153 (516) 586-8733 (315) 369-6044 (716) 376-6337 (716) 373-8383 (716) 372-7761 (315) 363-7856 (315) 363-1750 (607) 431-5959 (607) 432-9315 (716) 662-3800 (800) 499-2168 (914) 923-3000 (914) 941-4476 (914) 941-1660 (914) 945-0500 (315) 342-6800 (315) 343-3180 (315) 343-5722 (607) 869-5033 (607) 687-8779 (607) 843-2841 (718) 738-3333 (718) 487-3677 (718) 322-1580 (718) 880-1644 (877) 577-1447

Provider Street 100 MAIN ST 454 FORT SALONGA RD 5631 STATE HIGHWAY 12 38 S BROAD ST 12 N STATE ST 96 MAIN ST 114 MAIN ST 40 MAIN ST 22136 HORACE HARDING EXPY 224-17A UNION TPKE 21519 73RD AVE 364 LONG BEACH RD 3124 LONG BEACH RD 511 STATE ST 700 CANTON ST 2981 FORD STREET EXT STE 9 724 OLD BETHPAGE RD 2964 STATE ROUTE 28 111 E GREEN ST 535 MAIN ST 1322 W STATE ST 142 GENESEE ST 507 LENOX AVE 1 FOXCARE DR STE 215 5626 STATE HIGHWAY 7 4328 S BUFFALO ST 40 CENTRE DR 203 MAIN ST 40 SPRING ST 162 CROTON AVE 105 CROTON AVE 174 W BRIDGE ST 137 STATE ROUTE 104 24 W BRIDGE ST 7115 N MAIN ST 1135 STATE ROUTE 17C 10 LAFAYETTE PARK 75-07 101ST AVE 9605 ROCKAWAY BLVD 9120 ATLANTIC AVE 96-05 101ST AVE 10210 101ST AVE

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Provider City NORTHPORT NORTHPORT NORWICH NORWICH NUNDA NYACK NYACK OAKFIELD OAKLAND GARDENS OAKLAND GARDENS OAKLAND GARDENS OCEANSIDE OCEANSIDE OGDENSBURG OGDENSBURG OGDENSBURG OLD BETHPAGE OLD FORGE OLEAN OLEAN OLEAN ONEIDA ONEIDA ONEONTA ONEONTA ORCHARD PARK ORCHARD PARK OSSINING OSSINING OSSINING OSSINING OSWEGO OSWEGO OSWEGO OVID OWEGO OXFORD OZONE PARK OZONE PARK OZONE PARK OZONE PARK OZONE PARK

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11768-1723 11768-3047 13815-3205 13815-1620 14517 10960-3196 10960-3112 14125-1043 11364-2333 11364-3631 11364-2928 11572-2230 11572-3299 13669-2672 13669-3836 13669-4455 11804-1240 13420 14760-3641 14760-1513 14760-2036 13421-2704 13421-1521 13820-2086 13820-2050 14127-2638 14127-4100 10562-4704 10562-4716 10562-4430 10562-4215 13126-1443 13126-2937 13126-2051 14521-9716 13827-4823 13830-0000 11416 11417-1612 11416-1527 11416-2521 11416-2622

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KALISH PHARMACY MAXWELL DRUGS MEDAID PHARMACY OZONE PARK PHARMACY S & I RIGHT CHOICE PHARMACY INC STOP & SHOP PHARMACY SYLHET PHARMACY LLC PRICE CHOPPER PHARMACY PALMYRA PHARMACY LLC 112 PHARMACY & SURGICAL KING KULLEN PHARMACY POPULAR PHARMACY SALUMED PHARMACY PATCHOGUE RESOLUTION RX INC

Provider Name

(718) 641-5648 (718) 641-5010 (718) 880-1038 (718) 296-7777 (718) 845-0042 (718) 835-7903 (718) 641-3938 (518) 673-2366 (315) 502-0038 (631) 289-2468 (516) 733-7196 (631) 475-6666 (631) 438-8100 (866) 639-0542

9320 LIBERTY AVE 150-29 CROSS BAY BLVD STORE 1 7708 101ST AVENUE 74-01 101 AVENUE 84-01 101ST AVE 9210 ATLANTIC AVE 78-06 101 AVE SUITE C 6025 STATE HIGHWAY 5 214 E. MAIN ST. 689 MEDFORD AVE 440 SUNRISE HWY 350-8 E MAIN ST 176 W MAIN ST 11 E MAIN ST

OZONE PARK OZONE PARK OZONE PARK OZONE PARK OZONE PARK OZONE PARK OZONE PARK PALATINE BRIDGE PALMYRA PATCHOGUE PATCHOGUE PATCHOGUE PATCHOGUE PAWLING

NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11417-1528 11417 11416 11416-1026 11416 11416-1517 11416 13428-2807 14522 11772-1347 11772 11772-3100 11772-3004 12564-1404

NEIGHBORX PHARMACY AT PEARL RIVER SHOP RITE PHARMACY BAXTER'S PHARMACY KLEIN PHARMACY VILLAGE DRUG PERU PHARMACY INC PHELPS HOMETOWN PHARMACY, LLC THE MEDICINE PLACE PINE BUSH PHARMACY INC PINE PLAINS PHARMACY LIFETIME HEALTH MEDICAL GROUP DIAMOND DRUGS INC ISLAND PROFESSIONAL PHARMACY MEDISOURCE PHARMACY PLAINVIEW FAMILY PHARMACY CONDO PHARMACY CVPH OUTPATIENT PHARMACY KINNEY DRUGS KINNEY DRUGS KINNEY DRUGS KINNEY DRUGS INC PRICE CHOPPER PHARMACY NEIGHBORX PHCY AT PLEASANT VALLEY PLEASANTVILLE PHARMACY STOP & SHOP PHARMACY TRUCARE PHARMACY HERBST PHARMACY INC

(845) 731-7777 (845) 735-4868 (914) 737-3076 (914) 738-3333 (315) 536-0100 (518) 643-2318 (315) 548-9454 (315) 695-4200 (845) 744-4221 (518) 398-5588 (585) 248-8340 (516) 932-3900 (516) 597-5550 (516) 605-0080 (516) 932-7077 (518) 563-3400 (518) 324-3784 (518) 561-3510 (518) 561-1680 (518) 562-3380 (518) 561-8667 (518) 562-3565 (845) 635-2222 (914) 769-0002 (845) 354-8980 (845) 364-5300 (315) 776-4372

139 N MIDDLETOWN RD 26 N MIDDLETOWN RD 950 MAIN ST 123 FIFTH AVE 126 MAIN ST 3 GORMAN WAY 110 MAIN ST 464 MAIN ST 2412 STATE ROUTE 52 2965 CHURCH ST 77 SULLYS TRL 550 WOODBURY RD 100 MANETTO HILL RD STE 104 720 OLD COUNTRY RD 142 MANETTO HILL RD STE A 28 MONTCALM AVE 214 CORNELIA ST STE 101-01 288 CORNELIA ST 1588 MILITARY TPKE 112 NEW YORK RD 6 VETERANS LN 19 CENTRE DR 13 NORTH AVE STE 1 62 WHEELER AVE 1581 ROUTE 202 358 ROUTE 202 1 CHURCH ST

PEARL RIVER PEARL RIVER PEEKSKILL PELHAM PENN YAN PERU PHELPS PHOENIX PINE BUSH PINE PLAINS PITTSFORD PLAINVIEW PLAINVIEW PLAINVIEW PLAINVIEW PLATTSBURGH PLATTSBURGH PLATTSBURGH PLATTSBURGH PLATTSBURGH PLATTSBURGH PLATTSBURGH PLEASANT VALLEY PLEASANTVILLE POMONA POMONA PORT BYRON

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10965-2029 10965-2014 10566-2904 10803-1503 14527-1219 12972-3060 14532-1017 13135-2243 12566-7037 12567-5547 14534-3754 11803-1006 11803-1311 11803-4929 11803-1310 12901-1533 12901 12901-2303 12901-7458 12903-3933 12901-1257 12901-6553 12569-7943 10570-3010 10970-2901 10970-3107 13140

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 467 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CAMMARATO'S ECONOMY PHARMACY PORT EWEN PHARMACY MORIAH PHARMACY

Provider Name

(914) 939-3911 (845) 331-4229 (518) 546-7244

220 WESTCHESTER AVE 177 BROADWAY 4315 MAIN ST

PORT CHESTER PORT EWEN PORT HENRY

NY NY NY

10573-4557 12466 12974-1339

FAIRVIEW PHCY AND HOMECARE SUPPLY ALITONS MANAGED CARE PHARMACY ALITON'S PHCY HOME HLTHCARE CTR THE MEDICINE SHOPPE BEACON PHARMACY HUNOLD PHARMACY-LEGEND SALEM DRUGS INC STOP & SHOP PHARMACY KINNEY DRUGS KINNEY DRUGS CITY DRUG HUDSON VALLEY H-O ASSOCIATES MOLLOY MEDICAL ARTS PHARMACY PREMIER MED GRP OF HUDSON VLY PRICE CHOPPER PHARMACY SMITH STREET PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY BEEKMAN PHARMACY KINNEY DRUGS PUTNAM VALLEY PHARMACY INC BENGAL PHARMACY INC. BOCA PHARMACY CASSON PHARMACY EDELSIE PHARMACY INC HOLLIS DRUGS & SURGICALS KASSELPHARMACY LTD NUTRACARE PHARMACY QV PHARMACY VILLAGE PHARMACY WELLMART RX INC KINNEY DRUGS INC PRICE CHOPPER PHARMACY INKLEY PHARMACY AJO GROUP INC CITY RX PHARMACY LEVINS DRUGS INC LOCAL RX PHARMACY LLC

(631) 474-7828 (845) 856-4120 (845) 856-8314 (845) 856-6681 (516) 883-1155 (516) 767-0007 (516) 944-8668 (516) 767-6914 (315) 262-0529 (315) 265-2770 (845) 471-2320 (845) 454-1942 (845) 471-7455 (845) 437-5000 (845) 790-0150 (845) 471-6440 (845) 483-9003 (845) 471-4526 (845) 724-3200 (315) 298-2024 (845) 528-6400 (718) 291-0740 (718) 465-5196 (718) 464-7777 (718) 736-0036 (718) 464-1556 (718) 464-0200 (718) 264-2222 (718) 465-5400 (718) 464-4844 (718) 704-0808 (518) 480-0011 (518) 798-0622 (716) 358-3201 (718) 899-2001 (718) 459-4880 (718) 459-1500 (718) 275-5300

4747 NESCONSET HWY UNIT 10 34-38 BALL ST 10-12 SUSSEX ST 15 JERSEY AVE 103 MAIN ST 94 MAIN ST 370 PORT WASHINGTON BLVD 65 SHORE RD 48 MAPLE ST 200 MARKET ST 324 MAIN ST 19 BAKER AVE STE 100 19 BAKER AVE 1 COLUMBIA ST STE 390 2585 SOUTH RD 269 MANSION ST #3 2540 SOUTH RD 59 BURNETT BLVD 2540 ROUTE 55 3873 STATE ROUTE 13 11 PEEKSKILL HOLLOW RD 8781 PARSONS BLVD 221 21 JAMAICA AVE 11210 SPRINGFIELD BLVD 11228 FRANCIS LEWIS BLVD 20608 HOLLIS AVE 21811 JAMAICA AVE 220-36 HILLSIDE AVE 214-09 JAMAICA AVE 9037 SPRINGFIELD BLVD 219-13 JAMAICA AVE 161 CAREY RD 677 GLEN ST 113 MAIN ST 6204B WOODHAVEN BLVD 95-25 QUEENS BOULEVARD 98-90A QUEENS BLVD 95-16 QUEENS BLVD

PORT JEFFERSON STATION PORT JERVIS PORT JERVIS PORT JERVIS PORT WASHINGTON PORT WASHINGTON PORT WASHINGTON PORT WASHINGTON POTSDAM POTSDAM POUGHKEEPSIE POUGHKEEPSIE POUGHKEEPSIE POUGHKEEPSIE POUGHKEEPSIE POUGHKEEPSIE POUGHKEEPSIE POUGHKEEPSIE POUGHQUAG PULASKI PUTNAM VALLEY QUEENS QUEENS VILLAGE QUEENS VILLAGE QUEENS VILLAGE QUEENS VILLAGE QUEENS VILLAGE QUEENS VILLAGE QUEENS VILLAGE QUEENS VILLAGE QUEENS VILLAGE QUEENSBURY QUEENSBURY RANDOLPH REGO PARK REGO PARK REGO PARK REGO PARK

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11776-2866 12771-2460 12771 12771-2436 11050-2822 11050-2821 11050-4212 11050-2227 13676-1124 13676-1217 12601-3110 12601 12601 12601-3930 12601-7000 12601-2699 12601-5468 12603-6446 12570-5115 13142-2488 10579-3200 11432 11428-2097 11429-2650 11429-2224 11429-1428 11428-2124 11427-2020 11428 11428-1352 11428-2126 12804-7821 12804-2014 14772-1131 11374 11374 11374 11374

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 468 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MED RX PHARMACY INC PARK CITY DRUGS REFILL RX PHARMACY INC VERA I PHARMACY VNS PHARMACY PRICE CHOPPER PHARMACY KINNEY DRUGS A & P PHARMACY CHOICE PHARMACY CPW PHARMACY DALE PHARMACY AND SURGICAL INC ESSENTIAL RX JAMAICA RX INC MEERAJ PHARMACY METRO DRUGS METROPOLITAN PHARMACY RDS PHARMACY SHARONAS PHARMACY SUPER SCRIPT PHARMACY SUREDRUGS PHARMACY THE J APOTHECARY INC TRIANGLE PHARMACY VAN WYCK PRESCRIPTION CTR WISE DRUGS AJ'S RIDGEWOOD CHEMIST ARD PHARMACY CATALPA CHEMISTS CORP GRANDVIEW PHARMACY J RX PHARMACY MANAV PHARMACY METROHEALTH PHARMACY LLC MIL RUE CHEMISTS INC MYRTLE DRUGS INC NATURE'S WAY PHARMACY INC RIDGEWOOD CITY PHARMACY RIDGEWOOD PHARMACY RIDGEWOOD PHARMACY EXPRESS INC RITE MED PHARMACY SHAWN PHARMACY SHERMAN PHARMACY 2 BARTH'S DRUG STORE MARTIN DRUGS

NR_0009_10823 10/2017

Provider Phone Number (718) 897-8500 (718) 459-0911 (718) 275-2948 (718) 997-1777 (718) 997-6900 (518) 479-4388 (315) 858-3229 (718) 880-1008 (718) 845-0200 (718) 322-4900 (718) 441-7711 (718) 441-7414 (718) 206-8515 (718) 641-4400 (718) 206-4653 (718) 441-2345 (718) 849-9800 (718) 441-4693 (718) 374-3939 (718) 880-2500 (718) 846-8600 (718) 847-9850 (718) 658-0012 (718) 441-3222 (718) 456-4400 (718) 417-4154 (718) 366-3871 (718) 456-2200 (718) 366-0626 (718) 366-6700 (347) 889-7086 (718) 821-3271 (718) 366-6171 (347) 987-3585 (718) 381-7766 (718) 381-3622 (718) 366-6900 (718) 366-2268 (718) 417-0200 (718) 628-8190 (631) 727-2125 (631) 727-0550

Provider Street 9727 QUEENS BLVD 6320 99TH ST 6324 AUSTIN ST 94-02A 63 DR 9305 63RD DR 501 COLUMBIA TPKE 10 MAIN ST 11709 JAMAICA AVE 124-01 LIBERTY AVE 121-16 LIBERTY AVE 10813 JAMAICA AVE 115-07 JAMAICA AVE 8936 VAN WYCK EXPY 115-17 LIBERTY AVE 13402 JAMAICA AVE 11607 METROPOLITAN AVE 121-17 JAMAICA AVE 102-05 JAMAICA AVE 13506 JAMAICA AVE 118-06 101 AVE 101-21 JAMAICA AVE 11901 JAMAICA AVE 8820B VAN WYCK EXPY 11105 JAMAICA AVE 68-19 FRESH POND ROAD 6061 MYRTLE AVE 5701 CATALPA AVE 590 GRANDVIEW AVE 6515 FRESH POND RD 917 WYCKOFF AVE 55-43 MYRTLE AVE 6687 FRESH POND RD 5518 MYRTLE AVE 60-27 MYRTLE AVE 775 SENECA AVE 389 ONDERDONK AVE 5456A MYRTLE AVE 311 ST. NICHOLAS AVE 321 WYCKOFF AVE 5810 MYRTLE AVE 32 E MAIN ST 849 OLD COUNTRY RD

Page 469 of 679

Provider City REGO PARK REGO PARK REGO PARK REGO PARK REGO PARK RENSSELAER RICHFIELD SPRINGS RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RICHMOND HILL RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIDGEWOOD RIVERHEAD RIVERHEAD

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11374-2103 11374-1941 11374-2923 11374 11374-2924 12144-4542 13439-2535 11418-2435 11419 11419 11418-2243 11418-2431 11418-2897 11419 11418-2654 11418-1018 11418 11418 11418-1957 11419 11418-2008 11418-2512 11418-2831 11418-2323 11385 11385-5908 11385-4902 11385-2452 11385-3332 11385-5353 11385-3503 11385-3948 11385-3551 11385 11385-4127 11385-1336 11385-3453 11385 11385-2720 11385 11901-2491 11901-2106

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENESEE CAMPUS APOTHECARY HIGHLAND APOTHECARY

Provider Name

(585) 368-3928 (585) 279-4790

89 GENESEE ST 777 S CLINTON AVE

ROCHESTER ROCHESTER

NY NY

14611-3201 14620-1401

HIGHLAND HOSPITAL OUTPATIENT PHCY HIGHLAND PHARMACY AT JORDAN LIFETIME HEALTH MEDICAL GROUP LIFETIME PHARMACY LLC METCARE RX METCARE RX NEW CLINTON PHARMACY OUTPT PHARMACY AMBULATORY SURG PARK RIDGE APOTHECARY INC R DRUGS ETC SARATOGA PHARMACY ST ANNS HOME PHARMACY STRONG MEMORIAL HOSPITAL PHCY STRONG TIES PHARMACY THE PHARMACY AT TRILLIUM HLTH UNIV OF ROCHESTER STRONG LTC UPSTATE HOMECARE ROCK HILL HEALTHMART PHARMACY ROCK DRUGS SMK PHARMACY CORP BELLE HARBOR CHEMISTS BELLE HARBOR DRUGS KINGS PHARMACY HANNA'S MARKET PHARMACY DAVIS ETHICAL PHARMACY MEDSCRIPT EXPRESS PHARMACY ROCKVILLE CENTRE PHARMACY RYAN MEDICAL PHARMACY ROCKY POINT PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY RMH RETAIL THE MEDICINE SHOPPE STOP & SHOP PHARMACY ROOSEVELT PHARMACY GRISTEDES PHARMACY MEDICINE SHOPPE AAA DRUGS INC MERRICK PHARMACY

(585) 341-0699 (585) 423-5802 (585) 338-4973 (585) 461-1314 (585) 254-6480 (585) 235-2370 (585) 413-3292 (585) 785-5193 (585) 723-7340 (585) 262-3760 (585) 458-2326 (585) 697-6450 (585) 275-4931 (585) 279-4950 (585) 241-9000 (585) 271-3164 (585) 423-9580 (845) 791-1515 (718) 945-4300 (718) 474-1600 (718) 634-0001 (718) 318-5000 (718) 318-0300 (718) 634-0273 (516) 764-3200 (917) 476-6817 (516) 764-6161 (516) 362-2422 (631) 744-1681 (315) 339-0648 (315) 337-3559 (315) 338-7690 (315) 339-0400 (631) 737-1736 (516) 442-4995 (212) 644-4125 (607) 498-4111 (718) 528-5299 (718) 997-8700

1000 SOUTH AVE 82 HOLLAND ST 800 CARTER ST 2975 BRTN HNT TWN LN RD STE230 322 LAKE AVE 480 GENESEE ST 1415 N CLINTON AVE UNIT 11B 180 SAWGRASS DR STE 100 1561 LONG POND RD 222 ALEXANDER ST 192 LYELL AVE 1500 PORTLAND AVE 601 ELMWOOD AVE 2613 W HENRIETTA RD 259 MONROE AVE 5901 LAC DE VILLE BLVD 200 AIRPARK DR STE 100 253 ROCK HILL DR 8818 ROCKAWAY BEACH BLVD 8702 ROCKAWAY BEACH BLVD 412 BEACH 129TH ST 115-14 BEACH CHANNEL DR 194 BEACH 116TH ST 20220 ROCKAWAY POINT BLVD 124 N LONG BEACH RD 180 SUNRISE HWY 30 HEMPSTEAD AVE STE 156 2000 N VILLAGE AVE STE 107 245 ROUTE 25A 1717 BLACK RIVER BLVD N 1790 BLACK RIVER BLVD N 1500 N JAMES ST 823 BLACK RIVER BLVD N 425 PORTION RD 348 NASSAU RD 686 MAIN ST 47 STEWART AVE 14373 243RD ST 23428 MERRICK BLVD

ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCHESTER ROCK HILL ROCKAWAY BEACH ROCKAWAY BEACH ROCKAWAY PARK ROCKAWAY PARK ROCKAWAY PARK ROCKAWAY POINT ROCKVILLE CENTRE ROCKVILLE CENTRE ROCKVILLE CENTRE ROCKVILLE CENTRE ROCKY POINT ROME ROME ROME ROME RONKONKOMA ROOSEVELT ROOSEVELT ISLAND ROSCOE ROSEDALE ROSEDALE

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

14620-2733 14605-2131 14621-2604 14623 14608 14611 14621-3354 14620-4648 14626-4117 14607-4039 14608-1317 14621-3065 14642-0001 14623-2327 14607-3632 14618-5600 14624-5716 12775-6620 11693-1608 11693-1610 11694-1517 11694-2206 11694-2417 11697-1113 11570-4415 11570-4704 11570-4038 11570-1075 11778-8803 13440-2425 13440-2454 13440-2844 13440-3549 11779-4579 11575-1343 10044-0021 12776-0146 11422-2339 11422-1320

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 470 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ROSLYN PHARMACY INC EAST HILLS PHARMACY HARBOR HILL PHARMACY LLC CORNERSTONE DRUG & GIFT INC RYE BEACH PHARMACY RYE BEACH PHARMACY-LEGEND RYE RIDGE PHARMACY ABRIN PHARMACY FAMILY CARE SPECIALTY PHARMACY SAG HARBOR PHARMACY BAKERS DRUGS LLC PHARMACY WORLD INC WISE PHARMACY RELY RX INC SPAGES PHARMACY KINNEY DRUGS KINNEY DRUGS POST OFFICE PHARMACY PRICE CHOPPER PHARMACY SARATOGA HOSP PHCY WESLEY HEALTH CARE CENTER INC SAUGERTIES PHARMACY ARIAHEALTH AT VALUE DRUGS SCARSDALE SPENCER PHARMACY STRATTON PHARMACY WILMONT PHARMACY AUMILLERS PHARMACY INC COLLEGE HOMETOWN PHARMACY ELLIS HOSPITAL MCCLELLAN ST PHARM HOUSE CALLS PHARMACY LANGES PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY SCHROON LAKE PHARMACY PRICE CHOPPER PHARMACY BESSCRIPTION INC CHARLIE'S FAMILY PHARMACY STOP & SHOP PHARMACY PRESCRIPTION DEN PHCY QUALITY PHARMACY SELDEN PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (516) 621-3363 (516) 621-7373 (516) 621-1185 (518) 297-3784 (914) 848-8740 (914) 967-0856 (914) 937-4444 (718) 529-1130 (929) 244-7540 (631) 725-0074 (718) 749-5988 (718) 217-8230 (718) 978-3901 (631) 656-8900 (631) 584-6460 (518) 568-2400 (518) 891-3132 (518) 891-2233 (518) 583-3697 (518) 583-8382 (518) 691-1461 (845) 246-5649 (631) 319-6877 (914) 723-2808 (914) 723-8558 (914) 725-1827 (518) 393-2173 (518) 579-8100 (518) 347-5315 (518) 356-2968 (518) 374-3324 (518) 357-4297 (518) 346-6218 (518) 372-0340 (518) 532-7575 (518) 399-6474 (866) 237-9419 (516) 783-7979 (516) 826-6767 (631) 698-5444 (631) 732-7373 (631) 732-1223

Provider Street 1314 OLD NORTHERN BLVD 310 ROSLYN RD 300 GLEN COVE RD # 310 72 CHAMPLAIN ST 1 THEALL RD STE 102 464 FOREST AVE STE 1 146 S RIDGE ST 131-13 ROCKAWAY BLVD 126-14 101ST AVE 120 MAIN ST 20543 LINDEN BLVD 20011 HOLILIS AVE 18901 LINDEN BLVD 731 MIDDLE COUNTRY RD 471 LAKE AVE 3 PARK PL 277 BROADWAY 61 MAIN ST # 587 3049 ROUTE 50 211 CHURCH ST 131 LAWRENCE ST 250 MAIN ST 270 W MAIN ST 23 SPENCER PL 1467 WEAVER ST 824 POST RD 1340 STATE ST 1044 STATE STREET 600 MCCLELLAN ST. 521 DUANESBURG RD 2205 NOTT ST 1879 ALTAMONT AVE 442 BALLTOWN RD 1640 EASTERN PKWY 1081 US ROUTE 9 290 SARATOGA RD 460 GLEN COVE AVE STE A 3931 MERRICK RD 4055 MERRICK RD 239 BOYLE RD 249 MIDDLE COUNTRY RD 1224 MIDDLE COUNTRY RD

Page 471 of 679

Provider City ROSLYN ROSLYN HEIGHTS ROSLYN HEIGHTS ROUSES POINT RYE RYE RYE BROOK S OZONE PARK S RICHMOND HILL SAG HARBOR SAINT ALBANS SAINT ALBANS SAINT ALBANS SAINT JAMES SAINT JAMES SAINT JOHNSVILLE SARANAC LAKE SARANAC LAKE SARATOGA SPRINGS SARATOGA SPRINGS SARATOGA SPRINGS SAUGERTIES SAYVILLE SCARSDALE SCARSDALE SCARSDALE SCHENECTADY SCHENECTADY SCHENECTADY SCHENECTADY SCHENECTADY SCHENECTADY SCHENECTADY SCHENECTADY SCHROON LAKE SCOTIA SEA CLIFF SEAFORD SEAFORD SELDEN SELDEN SELDEN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11576-2244 11577-2214 11577-1846 12979-1505 10580-1404 10580-3645 10573 11420-2992 11419-1546 11963 11412-2925 11412 11412-3330 11780-3211 11780-2209 13452-1333 12983-1132 12983-1710 12866-2919 12866-1046 12866-1346 12477 11782-2554 10583-4110 10583-7018 10583-5007 12304-2721 12307 12304 12306-1054 12309-4346 12303-3851 12304-2245 12309-6012 12870-2426 12302-5019 11579-2135 11783-2823 11783-2830 11784-1955 11784-2516 11784-2524

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KINNEY DRUGS STOP & SHOP PHARMACY SHELTER ISLAND HGTS PHARMACY BIGELOW'S PHARMACY SHERMAN AREA PHARMACY P&C PHARMACY SHIRLEY PHARMACY AND SURGICALS STOP & SHOP PHARMACY SHOREHAM DRUG KINNEY DRUGS INC VERNAK FARMS COUNTRY STORE SLATE HILL NEIGHBORX PHARMACY PHELPS COMMUNITY PHARMACY SLEEPY HOLLOW PHARMACY PRICE CHOPPER PHARMACY HAAS PHARMACY INC MAPLE PHARMACY SMITHTOWN PRESCRIPTION CENTER SNYDER PHARMACY INC SOMERS PHARMACY & SURGICAL SOUTH DAYTON PHARMACY REFUAH HEALTH CENTER KIDSRX N-GROWN-UPS-TOO PARK HEALTH PHARMACY REX PHARMACY CPW PHARMACY

Provider Name

(315) 568-4300 (631) 751-5612 (631) 749-0445 (607) 674-9691 (716) 761-6876 (315) 361-4090 (631) 281-8101 (631) 281-8924 (631) 821-0707 (315) 685-2393 (315) 673-9327 (845) 355-5555 (914) 366-1400 (914) 366-4000 (518) 478-0597 (845) 753-9675 (631) 265-4040 (631) 979-7575 (716) 839-3050 (914) 276-2121 (716) 988-3410 (845) 354-9300 (718) 323-6666 (718) 322-3261 (718) 843-8000 (718) 322-5000

2085 US ROUTE 5 & 20 158 ROUTE 25A 19 GRAND AVE 6 N MAIN ST 105 W MAIN ST 87 E STATE ST 464 WILLIAM FLOYD PKWY 999 MONTAUK HWY 99-1 RTE 25A 23 FENNELL ST 1889 E LAKE RD 2904 ROUTE 6 STE 8-9 777 N BROADWAY STE 101 95 BEEKMAN AVE # 4 1395 NEW SCOTLAND RD 62 ORANGE TPKE 304 MAPLE AVE 260 E MAIN ST STE 105 4536 MAIN ST 336 ROUTE 202 303 PINE ST 36 LAUREL AVE 125-20 111TH AVE 13124 ROCKAWAY BLVD 119-01 ROCKAWAY BLVD 131-07 ROCKAWAY BLVD

SENECA FALLS SETAUKET SHELTER ISLAND SHERBURNE SHERMAN SHERRILL SHIRLEY SHIRLEY SHOREHAM SKANEATELES SKANEATELES SLATE HILL SLEEPY HOLLOW SLEEPY HOLLOW SLINGERLANDS SLOATSBURG SMITHTOWN SMITHTOWN SNYDER SOMERS SOUTH DAYTON SOUTH FALLSBURG SOUTH OZONE PARK SOUTH OZONE PARK SOUTH OZONE PARK SOUTH OZONE PK

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

13148-8740 11733-2849 11964 13460-9545 14781 13461-1231 11967-3468 11967-2130 11786-0000 13152-1117 13152-8695 10973-3810 10591-1019 10591-2549 12159-7206 10974-2317 11787-4913 11787-2923 14226-3828 10589-3220 14138-0000 12779-5804 11420-1537 11420-2932 11420-2494 11420

DREAM PHARM & SURGICAL SUPPLY INC LIBERTY PHARMACY NEW MOON PHARMACY INC. RICHMOND HILL PHARMACY RICHMOND RX CENTER RX SPRESS PHARMACY PAULS PHARMACY STOP & SHOP PHARMACY SOUTHRIFTY DRUG INC WHITES APOTHECARY SOUTHOLD PHARMACY SPENCERPORT FAMILY APOTHECARY ECKERSON DRUGS HILLCREST PHARMACY LLC MEDWIZ PHARMACY LLC

(718) 441-3800 (718) 738-1500 (718) 738-0302 (718) 849-7300 (718) 845-3540 (718) 322-7158 (914) 533-5679 (631) 585-4469 (631) 283-1506 (631) 287-2900 (631) 765-3434 (585) 349-3562 (845) 352-1800 (845) 356-7300 (845) 624-5200

112-04 101 AVE 12402 LIBERTY AVE # A 109-14 LIBERTY AVE 12501 101ST AVE 11212 LIBERTY AVE 12307 LIBERTY AVE 222 OAKRIDGE DR 250 POND PATH 54 JAGGER LN 18 HAMPTON RD 53895 ROUTE 25 42 NICHOLS ST STE 11 287 N MAIN ST 1 HILLCREST CENTER DR STE 110 240 N MAIN ST

SOUTH RICHMOND HILL SOUTH RICHMOND HILL SOUTH RICHMOND HILL SOUTH RICHMOND HILL SOUTH RICHMOND HILL SOUTH RICHMOND HILL SOUTH SALEM SOUTH SETAUKET SOUTHAMPTON SOUTHAMPTON SOUTHOLD SPENCERPORT SPRING VALLEY SPRING VALLEY SPRING VALLEY

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

11419-1124 11419-2232 11419 11419-1411 11419-1814 11419-2115 10590-2426 11720-2006 11968-4822 11968-4930 11971-4644 14559-2180 10977 10977 10977-4020

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 472 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RX CONSULTANT PHARMACY SPRING VALLEY DRUG VALLEY PHARMACY V-CARE PHARMACY STOP & SHOP PHARMACY SPRINGCREEK PHARMACY INC MCCARTHY'S PHARMACY MCCARTHY'S PHARMACY ADIRONDACK PHARMACY ANNADALE FAMILY PHARMACY ARROCHAR PHARMACY B & T PHARMACY BALAJI TARGEE PHARMACY CORP BEST RX PHARMACY BRIGHTON COMMUNITY PHARMACY CLASSIC PHARMACY INC DELCO DRUGS DONGAN HILLS PHARMACY FOREST PHARMACY GLOBAL HEALTH PHARMACY CORP HEALTH AID PHARMACY II INC HYLAN MEDICINE CABINET INC LIVING WELL PHARMACY MIDLAND PHCY & HLTHCARE PRDUCT MILLERS PHARMACY NATES PHARMACY NATE'S PHARMACY NATES SPECIALTY PHARMACY NEW DORP PHARMACY OCEAN BREEZE HEALTHCARE OCEAN BREEZE PHARMACY PRO CARE PHARMACY QUICK DRUGS INC

Provider Name

(845) 354-9320 (845) 352-0490 (845) 414-9966 (845) 371-2018 (718) 525-2422 (716) 592-9065 (845) 868-1010 (845) 868-1010 (315) 848-3784 (718) 227-0710 (718) 447-3117 (718) 273-7200 (718) 720-7205 (718) 351-2400 (718) 273-6606 (718) 727-0022 (718) 984-6600 (718) 667-7733 (718) 447-5900 (718) 370-1220 (718) 668-1090 (718) 667-4300 (718) 477-5483 (718) 351-1689 (718) 447-4127 (718) 984-0477 (718) 556-3330 (718) 720-5600 (718) 667-6668 (718) 979-5326 (718) 987-2525 (718) 554-4016 (718) 447-2050

728 N MAIN ST STE C 180 ROUTE 59 45 KENNEDY DR 59 E ECKERSON RD 13440 SPRINGFIELD BLVD 227 W MAIN ST RT 82 6032 RT. 82 4057 STATE HWY 3 831 ANNADALE RD 121 MCCLEAN AVE 702 CASTLETON AVE 519 TARGEE ST 325 NEW DORP LN 280 BROADWAY 1300 CLOVE RD 3833 RICHMOND AVE 1560 RICHMOND RD 2236 FOREST AVE 1424 RICHMOND AVE 1781 RICHMOND RD 1988 HYLAN BLVD 3555 VICTORY BLVD 606 MIDLAND AVE 173 BROAD ST 877 HUGUENOT AVE 307 SAND LN 252 PORT RICHMOND AVE STE B 62 NEW DORP PLZ S 235 DONGAN HILLS AVE STE 2B 1817 HYLAN BLVD 3927 AMBOY RD 52 VICTORY BLVD

SPRING VALLEY SPRING VALLEY SPRING VALLEY SPRING VALLEY SPRINGFIELD GARDENS SPRINGVILLE STANFORDVILLE STANFORDVILLE STAR LAKE STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10977-8917 10977-5227 10977-5319 10977-3014 11413-1403 14141-1017 12581-0000 12581-5953 13690-0000 10312-3133 10305-4655 10310-1802 10304-3501 10306-3005 10310-2055 10301-4302 10312-3828 10304-2301 10303-1747 10314-1527 10306 10306-3526 10314-6764 10306-5926 10304-2049 10312 10305-4500 10302-1740 10306-2920 10305-1224 10305-1918 10308-2421 10301-2941

RANDALL MANOR PHARMACY & SURGICAL REGAL REMEDIES RX RICHMOND PHARMACY RICHMOND PHARMACY & SURGICAL RICHMOND VALLEY PHARMACY INC ROSEBANK PHARMACY SA PHARMACY INC SEAVIEW PHARMACY

(718) 720-2324 (718) 442-2222 (718) 818-2178 (718) 447-1206 (718) 967-9607 (718) 727-0426 (917) 830-1499 (718) 667-6777

395 FOREST AVE 19A OLYMPIA BLVD 355 BARD AVE 1796 CLOVE RD 4888 ARTHUR KILL RD 500 TOMPKINS AVE 2062 CLOVE RD 1756 HYLAN BLVD

STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND

NY NY NY NY NY NY NY NY

10301-2622 10305-4309 10310-1664 10304-1672 10309-2633 10305-1743 10304-1650 10305-1932

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 473 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SOUTHSHORE PHARMACY CORP ST GEORGE PHARMACY STATEN ISLAND PHARMACY INC STOP & SHOP PHARMACY STOP & SHOP PHARMACY SUPER HEALTH PHARMACY LLC TODT HILL PHARMACY TOMPKINSVILLE PHARMACY INC VITACARE PHARMACY YOUR PHARMACY INC STONY POINT PHARMACY DRUG MART OF TALLMAN INC SUFFERN PHARMACY AMAZON PHARMACY BLISS DRUGS INC FAMILY PHARMACY PLATINUM PHARMACY ROCKWAY COMMUNITY PHARMACY SUNNY PHARMACY UNITED DHAKA PHARMACY JERICHO PHARMACY CORP KING KULLEN PHARMACY SPECIALTY HOME RX VILLAGE PHARMACY OF SYOSSET WINDSOR PHARMACY BURNET PHARMACY C AND JS NORTHSIDE PHARMACY INC FOCUSED CARE PHARMACY INC GIFFORD & WEST PHARMACY HARVEY'S MEDICAL CENTER PHCY KINNEY DRUGS KINNEY DRUGS KINNEY DRUGS AT FRANCISCAN KINNEY DRUGS INC KINNEY DRUGS INC KINNEY DRUGS INC KINNEY DRUGS INC KINNEY DRUGS INC NOBLE HEALTH SERVICES INC PRICE CHOPPER PHARMACY PRICE CHOPPER PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (718) 948-4848 (718) 447-0333 (718) 448-5200 (718) 448-6758 (718) 980-2059 (718) 967-4600 (718) 351-7363 (718) 727-0430 (718) 720-5604 (718) 524-1100 (845) 942-1373 (845) 357-5200 (845) 547-2331 (718) 786-0707 (718) 482-8900 (718) 349-6767 (718) 472-2100 (718) 937-0890 (718) 433-3091 (917) 396-4944 (516) 864-0020 (516) 496-9452 (516) 921-1507 (516) 921-0880 (516) 864-0522 (315) 437-0102 (315) 455-6677 (315) 433-2371 (315) 471-4139 (315) 476-9246 (315) 883-3333 (315) 487-0326 (315) 474-8851 (315) 476-7921 (315) 492-0248 (315) 703-3356 (315) 464-5172 (315) 445-8790 (888) 843-2040 (315) 472-3832 (315) 449-1016

Provider Street 4020 HYLAN BLVD 99 STUYVESANT PL 1807 VICTORY BLVD 1351 FOREST AVE 2754 HYLAN BLVD 6400 AMBOY RD 2110 RICHMOND RD # G 45 VICTORY BLVD 252 PORT RICHMOND AVE STE A 684A BAY ST 69 S LIBERTY DR 200 ROUTE 59 24 LAFAYETTE AVE 4310 QUEENS BLVD 4701 QUEENS BLVD 45-60 43RD ST 4621 QUEENS BLVD 43-20 43RD AVE 4202 GREENPOINT AVE 4504 GREENPOINT AVE 340 JERICHO TPKE 271 JERICHO TPKE 575 UNDERHILL BLVD STE 110 38 COLD SPRING RD 123 EILEEN WAY 3056 BURNET AVE STE 8 2301 TEALL AVE 6040 TARBELL RD STE 106 300 GIFFORD STREET 833 E GENESEE ST 5221 W TAFT RD 4202 W GENESEE ST 101 UNION AVE STE 201 819 S SALINA ST 104 LAFAYETTE RD 2912 JAMES ST 750 E ADAMS ST 307 NOTTINGHAM RD 6040 TARBELL RD 4713 ONONDAGA BLVD 2515 ERIE BLVD E

Page 474 of 679

Provider City STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STATEN ISLAND STONY POINT SUFFERN SUFFERN SUNNYSIDE SUNNYSIDE SUNNYSIDE SUNNYSIDE SUNNYSIDE SUNNYSIDE SUNNYSIDE SYOSSET SYOSSET SYOSSET SYOSSET SYOSSET SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE SYRACUSE

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

10308-3331 10301-1930 10314-3515 10302-2049 10306-4658 10309-3121 10306-2572 10301-2937 10302-1740 10304-3830 10980-2321 10901-5009 10901-5406 11104-4610 11104-1600 11104 11104-1711 11104 11104-3004 11104 11791-4507 11791-4502 11791-3416 11791-3132 11791-5302 13206-2466 13206-1683 13206-1314 13204 13210-1507 13212-2703 13219-1936 13203-2761 13202-3527 13205-2907 13206-2241 13210-2342 13210-3453 13206-1314 13219-3330 13224-1109

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

UNIVERSITY PHYSCN HEMATOLOGY ONCOLO DIABETIC & PRESCRIPTION CTR WELLNESS RX LLC BRIGHTON EGGERT PHARMACY INC LINDSAY DRUG CO.,INC PRICE CHOPPER PHARMACY KINNEY DRUGS INC CENTURY DRUG KINNEY DRUGS INC KINNEY DRUGS BROWNS PHARMACY LLC GARRO DRUGS PARKWAY DRUGS PARKWAY DRUGS INC PARKWAY DRUGS SOUTH PRICE CHOPPER PHARMACY BRADHURST PHARMACY INC AFFORDABLE SCRIPT DALE DRUG PARKDALE PHARMACY VALLEY STREAM PHARMACY INC U AND I PHARMACY LOURDES PHARMACY UNITED HEALTH SERVICES HOSP WEIS PHARMACY MEAD SQUARE PHARMACY NICHOLS SHOP N SAVE BDRN PHARMACY, LLC THE MEDICINE SHOPPE DELAWARE VALLEY HOSPITAL INC COMMUNITY CARE PHARMACY HOUSECALLS PHARMACY SINCLAIR PHARMACY WYOMING REXALL DRUG AKINS DRUG STORE APPLE VALLEY PHARMACY PRICE CHOPPER PHARMACY WASHINGTONVILLE PHARMACY VALLEY PHARMACY BOLTON'S PHARMACY II INC BOLTON'S PHARMACY INC

(315) 464-2933 (845) 368-9700 (518) 589-9500 (716) 835-6778 (518) 235-2522 (518) 266-9947 (607) 387-6661 (914) 395-1234 (315) 696-8796 (518) 359-9173 (607) 369-2131 (315) 732-6915 (315) 624-9980 (315) 735-3525 (315) 792-4669 (315) 732-1499 (914) 345-3838 (516) 561-6480 (516) 561-1222 (516) 791-6500 (516) 442-0200 (315) 829-4035 (607) 251-2191 (607) 770-7358 (607) 798-8878 (585) 924-7970 (518) 765-4399 (845) 778-2620 (845) 778-6661 (607) 865-2781 (845) 223-8003 (518) 623-2993 (585) 786-2330 (585) 786-2100 (845) 986-4581 (845) 988-5805 (845) 987-6340 (845) 496-8001 (315) 539-9323 (315) 782-1992 (315) 782-5961

NR_0009_10823 10/2017

Provider Street 1000 E GENESEE ST STE 403 296 ROUTE 59 5980 MAIN ST 935 BRIGHTON RD 416 5TH AVE 716 HOOSICK RD 15 EAST MAIN STREET 6 FISHER AVE 596 US ROUTE 11 94 DEMARS BLVD STE 4 225 MAIN ST 704 BLEECKER ST 350 LELAND AVE 1256 ALBANY ST 485 FRENCH RD 1917 GENESEE ST 95 GRASSLANDS RD BLDG 1 177 ROCKAWAY AVE, 2ND FLOOR 531 W MERRICK RD 945 ROSEDALE RD 42 ROCKAWAY AVE 5236 W SENECA ST 3101 SHIPPERS RD STE 104 4417 VESTAL PKWY E 100 RANO BLVD 53 W MAIN ST 5 MAPLE AVE 108 ORANGE AVE 38 GRANT ST 121 STOCKTON AVE 900 ROUTE 376 STE Q 3761 MAIN ST 75 N MAIN ST 91 N MAIN ST 33 MAIN ST 44 RONALD REAGAN BLVD 142 STATE ROUTE 94 S 6 DEPOT ST STE 105 12 W MAIN ST 1320 WASHINGTON ST 128 W MAIN ST

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Provider City SYRACUSE TALLMAN TANNERSVILLE TONAWANDA TROY TROY TRUMANSBURG TUCKAHOE TULLY TUPPER LAKE UNADILLA UTICA UTICA UTICA UTICA UTICA VALHALLA VALLEY STREAM VALLEY STREAM VALLEY STREAM VALLEY STREAM VERNON VESTAL VESTAL VESTAL VICTOR VOORHEESVILLE WALDEN WALDEN WALTON WAPPINGERS FALLS WARRENSBURG WARSAW WARSAW WARWICK WARWICK WARWICK WASHINGTONVILLE WATERLOO WATERTOWN WATERTOWN

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

13210-1840 10982-0000 12485-7719 14150-8194 12182-3007 12180-8850 14886 10707-2604 13159-9410 12986-1443 13849-2245 13501-1406 13502-2327 13501-4252 13502-5932 13501-5615 10595-1638 11580-5823 11580-5125 11581-2318 11580-5809 13476-3635 13850-2003 13850-3556 13850-2798 14564-1106 12186-9301 12586 12586-1850 13856 12590-6465 12885-1837 14569-1343 14569-1343 10990-1332 10990-4118 10990-3663 10992-1519 13165-1329 13601-4532 13601-1989

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name KINNEY DRUGS KINNEY DRUGS KINNEY DRUGS KINNEY DRUGS PRICE CHOPPER PHARMACY HOMETOWN HEALTHCARE INC WAVERLY PHARMACY QUINLAN'S PHARMACY A & J PHARMACY DANWINS PHARMACY HILL HAVEN LONG TERM CARE PHCY KINNEY DRUGS FISHER'S PHARMACY BUONADONNA SHOPRITE II LLC KENSINGTON PHARMACY & SURGICALS PATH PHARMACY-LEGEND STOP & SHOP PHARMACY STOP & SHOP PHARMACY HOERNING PHARMACY KELLY'S PHARMACY MSK OPD PHCY AT HARRISON PRESCRIPTION PLUS NATIONAL RX PHARMACY INC WEST HEMPSTEAD PHARMACY MILLERS PHARMACY STE 1 STOP & SHOP PHARMACY CLARKSTOWN PHARMACY INC SAV-RITE PHARMACY LLC SOUTHGATE MEDICAL PHARMACY INC CARMAN DRUGS IPPC OF NEW YORK NU CASSEL PHARMACY POST AVENUE PHARMACY INC WESTFIELD COMMUNITY PHARMACY HOSPITAL ROAD PHARMACY MEDICAL CENTER PHARMACY ROSEDALE PHARMACY SAXON PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY SUNSHINE PHARMACY VALUABLE DRUGS

NR_0009_10823 10/2017

Provider Phone Number (315) 788-9366 (315) 788-3570 (315) 782-5700 (315) 782-6530 (315) 786-2947 (518) 273-1402 (607) 565-2390 (585) 728-2250 (585) 872-7575 (585) 236-4020 (585) 922-2394 (315) 834-9020 (585) 593-2611 (631) 587-3150 (347) 533-6619 (631) 888-0750 (631) 587-9455 (631) 321-9055 (518) 731-2400 (518) 731-4800 (914) 367-7016 (914) 949-3800 (516) 539-7540 (516) 292-6161 (585) 889-3510 (631) 669-4666 (845) 358-3588 (716) 675-0000 (716) 712-0630 (516) 333-4545 (516) 544-4311 (516) 280-9674 (516) 334-1444 (716) 326-5959 (914) 287-2414 (914) 949-7000 (914) 948-4818 (914) 948-1900 (914) 997-1530 (914) 682-0743 (914) 607-3939 (914) 948-4141

Provider Street 905 COFFEEN ST 1729 STATE ST 1304 WASHINGTON ST 22056 US ROUTE 11 1283 ARSENAL ST 601 19TH ST 316 BROAD ST 107 N MAIN ST 45 WEBSTER COMMONS BLVD 2186 EMPIRE BLVD 1550 EMPIRE BLVD 2783 STATE ROUTE 31 138 N MAIN ST 50 ROUTE 109 # 110 419 GREAT EAST NECK RD 1035 STRAIGHT PATH 365 ROUTE 109 575 W MONTAUK HWY 34 HOPE PLAZA 12183 ROUTE 9W 500 WESTCHESTER AVE 23 TAYLOR SQUARE 111 HEMPSTEAD TPKE 490 HEMPSTEAD AVE 201 SCOTTSVILLE W HENRIETTA RD 400 UNION BLVD 719 W NYACK RD 290 CENTER RD 1026 UNION RD 829B CARMAN AVE 275 GRAND BLVD FLOOR 2 821 PROSPECT AVE 173 POST AVE 55-57 EAST MAIN ST 44 E POST RD 170 MAPLE AVE 1215 MAMARONECK AVE 460 MAMARONECK AVE 154 WESTCHESTER AVE 670 N BROADWAY 276 MAIN ST 417 TARRYTOWN RD

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Provider City WATERTOWN WATERTOWN WATERTOWN WATERTOWN WATERTOWN WATERVLIET WAVERLY WAYLAND WEBSTER WEBSTER WEBSTER WEEDSPORT WELLSVILLE WEST BABYLON WEST BABYLON WEST BABYLON WEST BABYLON WEST BABYLON WEST COXSACKIE WEST COXSACKIE WEST HARRISON WEST HARRISON WEST HEMPSTEAD WEST HEMPSTEAD WEST HENRIETTA WEST ISLIP WEST NYACK WEST SENECA WEST SENECA WESTBURY WESTBURY WESTBURY WESTBURY WESTFIELD WHITE PLAINS WHITE PLAINS WHITE PLAINS WHITE PLAINS WHITE PLAINS WHITE PLAINS WHITE PLAINS WHITE PLAINS

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

13601-1816 13601-3101 13601-4532 13601-5192 13601-2252 12189-2002 14892-1326 14572-1033 14580-3813 14580-2000 14580-2104 13166-9415 14895-1151 11704-6208 11704-7623 11704-3246 11704-6213 11704-8308 12192-9740 12192 10604 10604 11552-2155 11552-2700 14586-9596 11795-3104 10994-2240 14224-1945 14224-3449 11590-6429 11590-3570 11590-3777 11590-3100 14787 10601-4606 10601-4710 10605-4807 10605-1802 10601-4512 10603-2409 10601-2443 10607-1313

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name KINNEY DRUGS INC HARPELL CHEMISTS-LEGEND WHITESTONE PHARMACY CCS ONCOLOGY FAMILY MEDICAL PHARMACY PINE PHARMACY WILLSBORO PHARMACY WINDHAM PHARMACY WOLCOTT PHARMACY AUREUS PHARMACY COTTAGE PHARMACY & SURGICAL STOP & SHOP PHARMACY ATLAS PHARMACY LLC GOOD HEALTH PHARMACY INC HEALTHMAX PHARMACY MEDEX PHARMACY PRIME RX PHARMACY INC QUEENSCARE PHARMACY CORP SUNSHINE PHARMACY INC TS FRIENDS PHARMACY BROADWAY REMEDIES CORP BIG SIX PHARMACY HOPKINS DRUGS HUDSON PHARMACY CORP JMD PHARMACY INC. MERCY PHCY & SURGICAL SUPPLIES INC MIND & BODY PHARMACY SKILLMAN AVENUE PHARMACY CORP TAZMI PHARMACY VARELA PHARMACY INC WOODSIDE CHEMISTS INC WOODSIDE PHARMACY WOODSTOCK APOTHECARY WURTSBORO PHARMACY MEDICAL CTR PHCY OF WYANDANCH WYANDANCH DRUGS ASHBURTON AVE. PHARMACY, INC. BEN FAMILY PHARMACY, INC ESTHER PHARMACY INC FEDCO CHEMIST PHARMACY GRASSY SPRAIN LONGTERM CARE GRASSY SPRAIN PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (315) 292-1374 (718) 767-7868 (718) 767-0618 (716) 565-0355 (716) 568-0800 (716) 332-2288 (518) 963-8946 (518) 734-3033 (315) 594-2222 (516) 249-7400 (516) 367-9030 (516) 692-8447 (718) 577-0200 (718) 296-7000 (718) 296-0400 (718) 805-7000 (718) 296-0202 (718) 480-6597 (718) 296-1900 (718) 374-3265 (516) 295-6070 (718) 606-0422 (718) 429-2140 (347) 448-6965 (929) 522-0858 (718) 204-0026 (718) 255-6355 (718) 565-5454 (718) 205-8880 (917) 832-6095 (929) 522-0324 (718) 205-0550 (845) 679-0790 (845) 888-2614 (631) 643-4354 (631) 253-4552 (914) 963-4525 (914) 375-9222 (914) 965-2661 (914) 294-0501 (800) 547-2779 (914) 779-5133

Provider Street 40 ORISKANY BLVD 1265 150TH ST 15043 14TH AVE STE B 45 SPINDRIFT DR STE 100 120 PLAZA DR 5110 MAIN ST 3932 NYS ROUTE 22 RT 296 AND SOUTH ST 12042 E MAIN ST 415 CROSSWAYS PARK DR STE A 8285 JERICHO TPKE 8101 JERICHO TPKE 9213 JAMAICA AVE 7928 JAMAICA AVE 8007 JAMAICA AVE 9602 JAMAICA AVE 7517 JAMAICA AVE 8446 JAMAICA AVE 80-03 ATLANTIC AVE 8720 JAMAICA AVE 1034 BROADWAY 6110 QUEENS BLVD 6319 ROOSEVELT AVE 65-08 ROOSEVELT AVE 5809 WOODSIDE AVE 30100 51ST ST 5311 ROOSEVELT AVE 5006 SKILLMAN AVE 5905 ROOSEVELT AVE 5314 ROOSEVELT AVE 5801 WOODSIDE AVE #3 4902 QUEENS BLVD 79 TINKER ST 2930 STATE ROUTE 209 1537 STRAIGHT PATH 323 MERRITT AVE 180 ASHBURTON AVE 102 PARK AVE 71 S BROADWAY 512 S BROADWAY 1567 CENTRAL PARK AVE 640 TUCKAHOE RD

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Provider City WHITESBORO WHITESTONE WHITESTONE WILLIAMSVILLE WILLIAMSVILLE WILLIAMSVILLE WILLSBORO WINDHAM WOLCOTT WOODBURY WOODBURY WOODBURY WOODHAVEN WOODHAVEN WOODHAVEN WOODHAVEN WOODHAVEN WOODHAVEN WOODHAVEN WOODHAVEN WOODMERE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSIDE WOODSTOCK WURTSBORO WYANDANCH WYANDANCH YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS

State

ZIP code

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

13492-1318 11357-1752 11357-1817 14221-7889 14221-2345 14221-5256 12996-4507 12496-5513 14590-1022 11797-2061 11797-1886 11797-1234 11421-2108 11421-1801 11421-1902 11421-2209 11421-1849 11421 11421-2924 11421-2036 11598-1228 11377-5776 11377 11377 11377-3437 11377 11377-4238 11377-4156 11377-3546 11377-4239 11377 11377-4444 12498-1238 12790-4031 11798-3414 11798-2328 10701-3201 10703-2934 10701-4004 10705-3253 10710-6002 10710-5704

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HEALTH RX JANIS PHARMACY INC LAKE AVENUE PHARMACY INC LE MAC PHARMACY MCLEAN AVE PHARMACY CORP MERK CHEMISTS MILE SQUARE PHARMACY INC OAKS PHARMACY RIVERDALE PHARMACY ROBERT JACOBSON PHARMACY LTD SCRIPTX PHARMACY SOUTH BROADWAY PHARMACY STANLEY PHARMACY STOP & SHOP PHARMACY SUNRISE PHARMACY THE MEDICINE CABINET PHARMACY THE MEDICINE CABINET PHARMACY 3 TRUST PHARMACY YONKERS PHARMACY YORKTOWN PHARMACY MEDICINE SHOPPE PHARMACY AKRON HEALTH MART PHARMACY

Provider Name

(914) 751-5432 (914) 963-3565 (914) 965-3034 (914) 965-6100 (914) 327-4888 (914) 237-8821 (914) 965-1878 (914) 327-3555 (914) 327-3344 (914) 965-3049 (914) 969-5880 (914) 965-1000 (914) 476-6060 (914) 378-9314 (914) 964-1010 (914) 377-2334 (914) 327-4400 (914) 963-1062 (914) 963-8800 (914) 962-2600 (315) 768-3347 (330) 375-5040

984 N BROADWAY 455 S BROADWAY 130 LAKE AVE 623 MCLEAN AVE 211 MCLEAN AVE 973 MCLEAN AVE 855 MIDLAND AVE 417 RIVERDALE AVE 77 RIVERDALE AVE 231 ASHBURTON AVE 14 N BROADWAY 314 S BROADWAY 2 S BROADWAY 111 VREDENBURGH AVE 2 PARK AVE 266 NEW MAIN ST 45 LUDLOW ST 201 ELM ST 944 N BROADWAY 1905 COMMERCE ST 200 ORISKANY BLVD 879 E EXCHANGE ST

YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YONKERS YORKTOWN HEIGHTS YORKVILLE AKRON

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY OH

10701-1318 10705-2338 10703-2713 10705-4734 10705 10704-4108 10704-1024 10705-2918 10701 10701-3227 10701-2793 10705-2049 10701-3702 10704-2167 10703-3402 10701-4168 10705-1947 10701-8901 10701-1304 10598-4409 13495-1330 44306

AMBULATORY CARE CENTER PHARMACY AXESSPOINTE PHARMACY COPE PHARMACY GENOA-QOL HEALTHCARE HIGHLAND SQUARE PHARMACY

(330) 543-8322 (330) 724-5471 (330) 882-6767 (330) 253-3600 (330) 535-3153

300 LOCUST ST STE 300 1400 S ARLINGTON ST UNIT 38 941 W NIMISILA RD 340 S BROADWAY ST FL 1 786 W MARKET ST

AKRON AKRON AKRON AKRON AKRON

OH OH OH OH OH

44302-1803 44306-3771 44319-4624 44308-1529 44303-1048

KLEINS COMMUNITY HEALTH CENTER PHCY KLEINS PHARMACY MARCS MARCS MED-DOSE SERVICES RITZMAN PHARMACY RITZMAN PHARMACY SAND RUN PHARMACY EASTERDAY PHARMACY MARCS GENOA-QOL HEALTHCARE THE PILL BOX HERBERTS PHARMACY

(330) 253-0963 (330) 926-5945 (330) 628-0781 (330) 773-5554 (330) 535-2001 (330) 376-1771 (330) 867-8780 (330) 864-2138 (330) 823-2266 (330) 829-2110 (513) 685-6033 (513) 753-4700 (440) 293-6358

676 S BROADWAY ST 150 CROSS ST STE 100 2891 E WATERLOO RD 360 E WATERLOO RD 2743 GILCHRIST RD STE 100 95 ARCH ST STE G15 1323 COPLEY RD 40 SAND RUN RD 1696 S ARCH AVE 2444 W STATE ST 43 E MAIN ST # 113 1400 SR 125 270 E MAIN ST

AKRON AKRON AKRON AKRON AKRON AKRON AKRON AKRON ALLIANCE ALLIANCE AMELIA AMELIA ANDOVER

OH OH OH OH OH OH OH OH OH OH OH OH OH

44311-1059 44311-1026 44312-4076 44319-1260 44305-4413 44304-1461 44320-2653 44313-6200 44601-4317 44601-5601 45102-1993 45102-1328 44003-9480

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 478 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ANTWERP PHARMACY WEYRAUCH'S PHARMACY KAUP PHARMACY KLINGER PHARMACY ARLINGTON PHARMACY RITZMAN PHARMACY SAMARITAN PHARMACY TOWNE PHARMACY ACMC HEALTHCARE SYSTEM PHCY GENOA-QOL HEALTHCARE HOFFMANS PHARMACY SIGNATURE HEALTH PHARMACY ASHVILLE APOTHECARY INC DRUGSTORE AT OU FRUTH PHARMACY HOLZER FAMILY PHARMACY THE DRUGSTORE AT O'BLENESS MARCS MARC'S CLEVELAND CLINIC AVON AMB PHCY MCFADDEN PHARMACY THE MEDICINE SHOPPE RITZMAN PHARMACY CHEFFY DRUGS CORNER PHARMACY BATAVIA COMMUNITY PHARMACY HEALTHSOURCE OF OHIO BATAVIA PCY COLONIAL PHARMACY BARRON PHARMACY CLEVELAND CLINIC BEACHWOOD CLEVELAND CLINIC CENTRAL FILL PHCY PARKWAY PHARMACY CLARK'S RX PHARMACY HOME TOWN PHARMACY KHN PHARMACY - SOIN METROHEALTH BEDFORD PHARMACY BELMONT COMMUNITY HEALTH CTR SAVE RITE PHARMACY COMMUNITY MARKET 710 PHARMACY MARY RUTAN HOSP RETAIL PHCY MY PHARMACY THE MEDICINE SHOPPE

NR_0009_10823 10/2017

Provider Phone Number (419) 258-2068 (330) 857-0115 (937) 692-5406 (567) 444-4898 (419) 365-5202 (419) 282-9600 (419) 289-9636 (419) 281-4040 (440) 997-6679 (440) 261-4511 (440) 992-3000 (440) 261-9200 (740) 983-2501 (740) 593-4738 (740) 594-3092 (740) 589-3181 (740) 566-4690 (330) 995-9260 (330) 792-4875 (440) 695-4100 (740) 634-3231 (740) 862-4240 (330) 745-0018 (740) 425-1582 (740) 425-2651 (513) 732-0356 (513) 576-7700 (330) 666-3569 (216) 360-0500 (216) 839-3270 (216) 448-4200 (216) 464-7633 (937) 426-6431 (937) 320-1500 (937) 702-4900 (216) 957-5190 (740) 676-4623 (740) 676-3433 (937) 593-3600 (937) 651-6780 (937) 292-7902 (419) 483-3784

Provider Street 109 S MAIN ST 4959 KIDRON RD 605 N MAIN ST 1260 S DEFIANCE ST 106 N MAIN ST 1055 SUGARBUSH DR 1025 CENTER ST 849 SMITH RD 2420 LAKE AVE 2801 C CT 2323 LAKE AVE 4726 MAIN AVE 3400 ST RT 752 2 HEALTH CENTER DR 8972 UNITED LN 2131 E STATE ST 75 HOSPITAL DR STE 130 300 AURORA COMMONS CIR 4755 MAHONING AVE 33100 CLEVELAND CLINIC BLVD 115 E MAIN ST 114 N MAIN ST 390 ROBINSON AVE STE A 148 E MAIN ST 102 W MAIN ST 2234 BAUER RD STE A 2055 HOSPITAL DR STE 320 1915 N CLEVELAND MASSILLON RD 23632 MERCANTILE RD STE F 26900 CEDAR RD 3175 SCIENCE PARK DR # AC4-B10 23350 MERCANTILE RD 3197 RODENBECK DR 3899 INDIAN RIPPLE RD STE A 3535 PENTAGON BLVD 19999 ROCKSIDE ROAD 3000 GUERNSEY ST 3235 BELMONT ST 878 E SANDUSKY AVE 205 E PALMER RD 932 E SANDUSKY AVE 234 W MAIN ST

Page 479 of 679

Provider City ANTWERP APPLE CREEK ARCANUM ARCHBOLD ARLINGTON ASHLAND ASHLAND ASHLAND ASHTABULA ASHTABULA ASHTABULA ASHTABULA ASHVILLE ATHENS ATHENS ATHENS ATHENS AURORA AUSTINTOWN AVON BAINBRIDGE BALTIMORE BARBERTON BARNESVILLE BARNESVILLE BATAVIA BATAVIA BATH BEACHWOOD BEACHWOOD BEACHWOOD BEACHWOOD BEAVERCREEK BEAVERCREEK BEAVERCREEK BEDFORD BELLAIRE BELLAIRE BELLEFONTAINE BELLEFONTAINE BELLEFONTAINE BELLEVUE

State

ZIP code

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

45813 44606-8819 45304-1401 43502-1620 45814 44805 44805-4011 44805-3644 44004 44004-4577 44004-3439 44004 43103 45701-2907 45701-3668 45701-2138 45701-2858 44202-8828 44515 44011 45612 43105-1210 44203-4204 43713-1004 43713-1066 45103-1996 45103-1978 44210 44122-5916 44122-1191 44122-7327 44122-5921 45432 45440-3410 45431 44146 43906-1540 43906-1520 43311-2884 43311-2281 43311-2856 44811-1330

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HURSH BELLVILLE DRUGS INC MORRISTOWN PHARMACY INC FRUTH PHARMACY FITZGERALD'S PHARMACY B & W PHARMACY MAIN STREET PHARMACY GREG'S PHARMACY ACCUDOSE PHARMACY MD COMPOUNDING PHARMACY FALCON HEALTH CENTER PHARMACY JAKS PUBLIC PHARMACY WOOD COUNTY CHC WOOD COUNTY HOSPITAL PHARMACY CSI INFUSION SERVICES METROHEALTH BRECKSVILLE PHCY BREWSTER FAMILY PHARMACY RIESBECKS PHCY MEDICINE SHOPPE BUKMIRS PHARMACY MARCS SKILLED CARE PHARMACY CLEVELAND QUALITY CMPNDNG & SPECIALTY RX THE HOMETOWN PHARMACY MARCS MR. PRESCRIPTION - BROOKVILLE MARCS THE MEDICINE SHOPPE CUSTER PHARMACY DAVIS DRUG GILLESPIES DRUGS NORTHSIDE CAMBRIDGE PHARMACY RIESBECKS PHCY MEDICINE SHOPPE CAMDEN VILLAGE PHARMACY HERITAGE SQUARE PHARMACY BLOOD & CANCER CENTER AULTMAN EMPLOYEE PHARMACY DARTMOUTH PHARMACY INC DAVIES PHARMACY FULTON DRUGS GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE MARCS

NR_0009_10823 10/2017

Provider Phone Number (419) 886-2561 (740) 782-1230 (740) 423-9561 (513) 734-3784 (740) 984-2305 (937) 783-3999 (937) 428-7970 (888) 222-6185 (330) 726-6337 (419) 372-7443 (419) 352-6423 (419) 354-9052 (419) 354-8937 (440) 717-1700 (216) 957-9050 (330) 767-3436 (740) 633-3368 (740) 598-4755 (440) 746-1015 (330) 405-7040 (330) 505-1064 (330) 448-8009 (216) 398-1464 (937) 833-1552 (330) 273-3232 (419) 562-4222 (740) 942-2726 (740) 732-4503 (740) 732-2356 (740) 255-5844 (740) 432-3810 (937) 452-1263 (330) 854-4949 (330) 533-3040 (330) 363-5489 (330) 454-9045 (330) 454-5151 (330) 456-2476 (234) 360-0363 (234) 203-1825 (412) 931-3131 (330) 492-2963

Provider Street 86 MAIN ST 66840 BELMONT MORRISTOWN RD 1401 WASHINGTON BLVD 697 W PLANE ST 501 DIETZ LANE 601 W MAIN ST 126 N MAIN STREET 685 BOARDMAN-CANFIELD RD STE 3 721 BOARDMAN CANFIELD RD STE 2 838 EAST WOOSTER STREET 970 W WOOSTER ST RM 121 1840 E GYPSY LANE RD 950 W WOOSTER ST 6955 TREELINE DR 9200 TREEWORTH BOULEVARD 360 WABASH AVE N 56130 NATIONAL RD 908 3RD ST 8003 BROADVIEW RD 9299 MARKET PL 7160 WARREN SHARON RD 7160 WARREN SHARON RD 7359 NORTHCLIFF AVE 430 ARLINGTON RD 3303 CENTER RD 345 N SANDUSKY AVE 241 S MAIN ST 109 WEST ST 44523 MARIETTA RD 1300 CLARK STREET SUITE 4 55 S 23RD ST 75 W CENTRAL AVE 977 CHERRY ST E 3695 BOARDMAN CANFIELD RD 2600 6TH ST SW 2801 TUSCARAWAS ST W 2915 TUSCARAWAS ST W 1657 25TH ST NW 624 MARKET AVE N STE 140 625 CLEVELAND AVE NW STE 30 400 TUSCARAWAS ST W STE 200 3014 CROMER AVE NW

Page 480 of 679

Provider City BELLVILLE BELMONT BELPRE BETHEL BEVERLY BLANCHESTER BLUFFTON BOARDMAN BOARDMAN BOWLING GREEN BOWLING GREEN BOWLING GREEN BOWLING GREEN BRECKSVILLE BRECKSVILLE BREWSTER BRIDGEPORT BRILLIANT BROADVIEW HEIGHTS BROADVIEW HTS BROOKFIELD BROOKFIELD BROOKLYN BROOKVILLE BRUNSWICK BUCYRUS CADIZ CALDWELL CALDWELL CAMBRIDGE CAMBRIDGE CAMDEN CANAL FULTON CANFIELD CANTON CANTON CANTON CANTON CANTON CANTON CANTON CANTON

State

ZIP code

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

44813-1021 43718-9665 45714-2201 45106-9573 45715 45107-1141 45817 44512-4711 44512-4386 43402 43402-2651 43402-9173 43402-2603 44141-3393 44141 44613-1042 43912-1529 43913-1049 44147 44147 44403-9657 44403 44144 45309 44212 44820-1806 43907-1131 43724-1359 43724-9209 43725 43725-2180 45311-1007 44614-9609 44406-9009 44710-1702 44708-4640 44708-4607 44709-3421 44702-1017 44702-1805 44702-2044 44709-2908

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MARCS MARC'S MEDICINE CENTER PHARMACY MEDTIME PHARMACY MERCY PROFESSIONAL PHARMACY

Provider Name

(330) 493-3530 (330) 477-8862 (330) 455-5422 (234) 410-3366 (330) 489-1400

4304 BELDEN VILLAGE AVE 5123 TUSCARAWAS ST W 2526 TUSCARAWAS ST W 400 12TH ST NW 1330 MERCY DR NW

CANTON CANTON CANTON CANTON CANTON

OH OH OH OH OH

44718-2506 44708 44708-4702 44703-1809 44708-2626

N CANTON MED FOUNDATION CANCER CTR RITZMAN PHARMACY HARRYS PHARMACY CLARK'S RX PHARMACY SCHWIETERMAN PHARMACY FOSTERS CENTERBURG VALUE RITE CENTERVILLE LTC PHARMACY GENOA-QOL HEALTHCARE

(330) 438-6333 (330) 834-3400 (419) 396-7977 (937) 766-9900 (419) 586-8875 (740) 625-7626 (937) 435-5751 (440) 226-3380

2600 6TH ST SW 7138 FULTON DR NW 101 E FINDLAY ST 9 S MAIN ST 510 E MARKET ST 4584 COLUMBUS RD 9352 DAYTON LEBANON PIKE 12557 RAVENWOOD DR STE 112

CANTON CANTON CAREY CEDARVILLE CELINA CENTERBURG CENTERVILLE CHARDON

OH OH OH OH OH OH OH OH

44710-1702 44718 43316-1247 45314-9765 45822-1824 43011-9401 45458 44024-9009

UNIV HOSP GEAUGA MED CNTR OP PHCY ADENA CANCER CENTER PHARMACY ADENA PHARMACY LLC ALLEN'S MEDICAL PHARMACY INC ANDERSON DRUG STORE GLATFELTER FAMILY PHARMACY HENDERSON PHARMACY SERVICES KNISLEY PHARMACY ADRIEN PHARMACY BERNENS PHARMACY BETHESDA NORTH APOTHECARY BRAXTON CANN MED CTR PHCY CHRIST HOSPITAL APOTHECARY COMMUNITY PHARMACY DAY'S MIAMI HEIGHTS PHARMACY DIPLOMAT SPEC INFUSION GRP ECONO PHARMACY ELM STREET HLTH CTR PHARMACY

(440) 285-6015 (740) 542-3080 (740) 779-8761 (740) 772-5180 (740) 774-2670 (740) 775-6242 (740) 702-1181 (740) 779-6226 (513) 561-7700 (513) 471-7575 (513) 865-1184 (513) 263-8760 (513) 585-0050 (513) 241-3444 (513) 941-4011 (513) 792-7080 (513) 899-6469 (513) 352-3094

13207 RAVENNA RD 4435 STATE ROUTE 159 4439 STATE RT 159 STE 6-40 215 EASTERN AVE 160 E MAIN ST 311 CALDWELL ST 186 W MAIN ST 2535 WESTERN AVE 7023 MIAMI AVE 5053 GLENWAY AVE 10500 MONTGOMERY RD 5818 MADISON RD 2123 AUBURN AVE STE 101 1019 LINN ST 7567 BRIDGETOWN RD 7167 E KEMPER RD 11534 SPRINGFIELD PIKE 1525 ELM ST

CHARDON CHILLICOTHE CHILLICOTHE CHILLICOTHE CHILLICOTHE CHILLICOTHE CHILLICOTHE CHILLICOTHE CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

44024-7032 45601-8620 45601 45601-3462 45601-2506 45601-3332 45601-3106 45601-1094 45243-2636 45238-3903 45242-4402 45227-1708 45219-2906 45203-1314 45248-2014 45249-1028 45246-3516 45202-6957

GE FAMILY WELLNESS CENTER PHARMACY GEHRING PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE

(513) 853-8999 (513) 771-7350 (513) 221-1650 (513) 337-9995

1 NEUMANN WAY BLDG 750 210 E SHARON RD 526 MAXWELL AVE 4966 GLENWAY AVE STE 101

CINCINNATI CINCINNATI CINCINNATI CINCINNATI

OH OH OH OH

45215-1915 45246-4529 45219-2408 45238-3915

GOOD SAMARITAN HOSP O/P PHARMACY GROUP HEALTH PHARMACY GROUP HEALTH PHARMACY

(513) 862-1559 (513) 872-2006 (513) 624-5535

375 DIXMYTH AVE 379 DIXMYTH AVE 7810 5 MILE RD

CINCINNATI CINCINNATI CINCINNATI

OH OH OH

45220-2475 45220-2475 45230-2356

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 481 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GROUP HEALTH PHARMACY GROUP HEALTH PHARMACY HART PHARMACY IHS PHCY & WELLNESS CENTER JEWISH HOSPITAL PHARMACY MED MART PHARMACY MERCY ANDERSON OUTPATIENT PHCY MERCY HEALTH WEST RETAIL PHCY MILLVALE AT HOPPLE HLTH CTR PH MULLANEYS PHARMACY NORTHSIDE HEALTH CENTER PHCY OAK APOTHECARY

Provider Name

(513) 745-4777 (513) 922-1645 (513) 471-1605 (513) 769-3784 (513) 686-5678 (513) 429-5424 (513) 624-4669 (513) 215-1880 (513) 352-3195 (513) 587-1474 (513) 357-7622 (513) 569-6071

8240 NORTHCREEK DR 2001 ANDERSON FERRY RD 4861 GLENWAY AVE 9400 READING RD STE 1 4777 E GALBRAITH RD 5045 CROOKSHANK RD STE 100 7500 STATE ROAD 3300 MERCY HEALTH BLVD 2750 BEEKMAN ST 5907 CHEVIOT RD 3917 SPRING GROVE AVE 629 OAK ST

CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI

OH OH OH OH OH OH OH OH OH OH OH OH

45236-2283 45238-3325 45238-4456 45215-3401 45236-2725 45238-3301 45255 45211-1103 45225-2049 45247-6226 45223-3302 45206-1666

ONCOLOGY HEMATOLOGY CARE PHCY LLC PHARMACY OVER THE RHINE PRICE HILL HEALTH CTR PHARMACY ROHE PHARMACY INC ROSELAWN PHARMACY SCHAEPER'S NORTHSIDE PHARMACY SHARONVILLE PHARMACY TISCHBEIN APOTHECARY TRI STATE COMPOUNDING PHCY LLC UC HEALTH PHARMACY UCMC HOLMES DIVISION PHARMACY UCMC HOXWORTH PHARMACY CIRCLEVILLE APOTHECARY

(513) 891-4800 (513) 579-0900 (513) 357-2705 (513) 661-0480 (513) 761-1212 (513) 541-0354 (513) 242-5700 (513) 321-9282 (513) 624-7333 (513) 585-9700 (513) 584-8820 (513) 584-8828 (740) 420-3784

4350 MALSBARY RD 5 E LIBERTY ST 2136 W 8TH ST 4047 HARRISON AVE 7601 READING RD 4187 HAMILTON AVE 5275 WINNESTE AVE STE A 3500 ERIE AVE 7715 BEECHMONT AVE 3200 BURNET AVE EDEN AND ALBERT SABIN WAY 3130 HIGHLAND AVE RM G200 1200 N COURT ST

CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CINCINNATI CIRCLEVILLE

OH OH OH OH OH OH OH OH OH OH OH OH OH

45242-5665 45202-8202 45204-2052 45211-4639 45237-3203 45223-2245 45232-1130 45208-1717 45255 45229-3019 45219 45219-2333 43113-1000

SCHIEBER FAMILY PHCY MEDICINE SHOPP AHF PHARMACY AMERIWELL PHARMACY AMERIWELL PHARMACY ASIA PLAZA PHARMACY BROADWAY PHARMACY BUCKHEAD PHARMACY CARE ALLIANCE PHARMACY CHURCH SQUARE PHARMACY CLARK LOWCOST PHARMACY CLEVELAND CLINIC FAIRVIEW CLEVELAND CLINIC LUTHERAN

(740) 474-1971 (216) 357-3327 (216) 283-3860 (216) 283-3865 (216) 862-9688 (216) 465-2333 (440) 605-0303 (216) 781-6228 (216) 721-1772 (216) 651-8685 (216) 476-7119 (216) 696-7055

212 LANCASTER PIKE 2829 EUCLID AVE 13422 KINSMAN RD 3167 FULTON RD STE 111 2999 PAYNE AVE # 130 6630 BROADWAY AVE 730 SOM CENTER RD STE 100 2916 CENTRAL AVE 7905 EUCLID AVE 3107 CLARK AVE 18101 LORAIN AVE 1730 W 25TH ST

CIRCLEVILLE CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND

OH OH OH OH OH OH OH OH OH OH OH OH

43113-1507 44115-2413 44120 44109-1465 44114-4400 44105-1310 44143-2364 44115 44103-4226 44109-1145 44111-5612 44113-3108

CLEVELAND CLINIC MARYMOUNT HOSPITAL CLEVELAND CLINIC PHARMACY II

(216) 587-8124 (216) 636-0761

12300 MCCRACKEN RD 2049 E 100TH ST

CLEVELAND CLEVELAND

OH OH

44125-2914 44106-2108

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 482 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CLEVELAND CLINIC PHARMACY INC

Provider Name

(216) 445-6337

9211 EUCLID AVE

CLEVELAND

OH

44106

CLEVELAND CLINIC SURGERY CTR PHARM CLEVELAND CLINIC TAUSSIG CLEVELAND LOWCOST PHARMACY CRP PHARMACY LLC DAVES PHARMACY DAVES PHARMACY DAVES PHARMACY DAVE'S PHARMACY MAG PHARMACY MARCS MARCS MARYMOUNT FAMILY PHARMACY METROHLTH MIDDLEBRG HGHTS PHCY OHIOGUIDESTONE PHARMACY OLD BROOKLYN PHARMACY PRIJATEL'S PHARMACY SEVERANCE PHARMACY SHELIGA DRUG ST VINCENT CHARITY MEDICAL CTR ST. LUKE'S LOWCOST PHARMACY THE CNTRS FOR FAMILIES & CHILD TONYS PHARMACY METRO HLTH CLEVELAND HGTS PHCY BROSSART PHARMACY SCHWIETERMANS DRUG STORE INC FAMILY DRUGS WALGREEN AGENCY THE HOMETOWN PHARMACY ARENA DISTRICT PHARMACY AVELLA OF COLUMBUS INC BUCKEYE PHARMACY CENTRAL OHIO COMPOUNDING PHCY CENTRAL POINT PHARMACY CHARITABLE PHCY OF CENTRAL OH INC CLINIC PHARMACY COLUMBUS AREA PHARMACY CROSBYS DRUGS CSI INFUSION SERVICES COLUMBUS DANE DRUGS EDWARDS DRUGS EQUITAS HEALTH PHARMACY

(216) 444-9525 (216) 445-2124 (216) 476-1400 (216) 291-7555 (216) 961-2005 (216) 291-8881 (216) 991-8648 (216) 361-0735 (216) 373-2383 (216) 252-4747 (216) 398-7943 (216) 587-8822 (216) 957-9657 (440) 260-8892 (216) 957-2150 (216) 361-4212 (216) 691-2369 (216) 431-1035 (216) 592-2853 (216) 795-4000 (216) 623-6555 (216) 651-5700 (216) 297-2400 (513) 941-0428 (419) 678-3435 (330) 482-3816 (330) 482-9080 (614) 569-4479 (614) 360-2800 (614) 465-7070 (614) 847-0109 (614) 272-7000 (614) 227-0301 (614) 252-4348 (614) 251-7791 (614) 263-9424 (614) 798-5943 (614) 866-9338 (614) 258-9527 (614) 340-6776

2070 E 90TH ST 2010 E 90TH ST 14529 PURITAS AVE 10567 ST CLAIR AVENUE 3565 RIDGE RD 3628 MAYFIELD RD 16820 HARVARD AVE 3301 PAYNE AVE 18325 EUCLID AVE STE HH 17400 LORAIN AVE 1650 SNOW RD 12000 MCCRACKEN RD 7800 PEARL RD 3500 CARNEGIE AVE 4229 PEARL RD RM SM 6718 SAINT CLAIR AVE 4127 E 131ST ST 6025 SAINT CLAIR AVE 2351 E 22ND ST 11201 SHAKER BLVD STE 126 1744 PAYNE AVE 3114 CLARK AVE 10 SEVERANCE CIRCLE 45 S MIAMI AVE 404 W NORTH ST 120 S VINE ST 1108 VILLAGE PLZ 262 NEIL AVE STE 130 4830 KNIGHTSBRIDGE BLVD STE C 27 NORTON RD 7870 OLENTANGY RIVER RD #202 699 HARRISBURG PIKE STE L 200 E LIVINGSTON AVE 1000 E BROAD ST 1515 E BROAD ST 2609 N HIGH ST 7654 CROSSWOODS DR 6495 E BROAD ST 1083 MOUNT VERNON AVE 1033 N HIGH ST

CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND HEIGHTS CLEVES COLDWATER COLUMBIANA COLUMBIANA COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

44106-2971 44106-2971 44135-2813 44108 44102-5443 44118-1403 44128-2208 44114-4313 44112 44111-4028 44134-2719 44125-2962 44130-6552 44115-2641 44109-4218 44103-1744 44105-5563 44103-1449 44115-3111 44104-3833 44114 44109-1146 44118 45002-1216 45828-1230 44408-2206 44408-8479 43215-7319 43214-2300 43228-1711 43235-1300 43223-2141 43215-5715 43205-1333 43205-1550 43202-2555 43235-4621 43213-1541 43203-1520 43201

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

EQUITAS HEALTH PHARMACY FRIENDS PHARMACY, INC GENOA-QOL HEALTHCARE GLOBAL RX PHARMACY HAPPY DRUGGIST PHARMACY-KRD HEALTHLAND PHARMACY HEMATOLOGY ONCOLOGY CONSULTANTS INC HOPE PHARMACY LTD LOWER LIGHTS PHARMACY MAPLE LEAF PHARMACY WEST MEDICAL ARTS PHARMACY

Provider Name

(614) 300-2334 (614) 279-9550 (614) 297-8766 (614) 209-8187 (614) 847-3784 (614) 299-9669

750 E LONG ST STE 3100 2872 W BROAD ST STE 101 1301 N HIGH ST 881 EAST MAIN ST SUITE 201 5770 KARL RD 1979 CLEVELAND AVENUE

COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS

OH OH OH OH OH OH

43203-1874 43204 43201-2460 43205-1713 43229 43211

(614) 223-9135 (614) 426-4160 (614) 274-1455 (614) 274-5890 (614) 262-8970

340 E TOWN ST STE 8-200 5791 CLEVELAND AVE 1160 W BROAD ST 491 GEORGESVILLE RD 3350 CLEVELAND AVE

COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS

OH OH OH OH OH

43215-4662 43231-2831 43222 43228-2420 43224-3677

MID OHIO ONCOLOGY & HEMATOLOGY PHCY MVP PHARMACY OLD VILLAGE PHARMACY PHILLIPS PHARMACY INC R M B PRESCRIPTION PHARMACY REFILL RX RITEWAY PHARMACY ROYAL PHARMACY SARAGA PHARMACY THE DRUG STORE PHARMACY THE OHIO ST UNIVERSITY OUT PHCY

(614) 383-6168 (614) 449-8000 (614) 853-3498 (614) 253-2344 (614) 566-5115 (614) 476-6336 (614) 261-0700 (614) 547-0707 (614) 869-5032 (614) 491-3446 (614) 685-1672

3100 PLAZA PROPERTIES BLVD 1931 PARSONS AVE 50 OLD VILLAGE RD STE 103A 1017 MOUNT VERNON AVE 3545 OLENTANGY RIVER RD 3433 AGLER RD STE 1150 1969 MORSE ROAD 2575 S HAMILTON RD 1265 MORSE RD 2940 GROVEPORT RD 460 W 10TH AVE ROOM L012

COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS

OH OH OH OH OH OH OH OH OH OH OH

43219-1531 43207 43228-1583 43203-1517 43214-3907 43219-3387 43229 43232-4964 43229-6320 43207-3255 43210

THE OHIO STATE UNIV OUTPATIENT PHCY THOMPSONS COMMUNITY PHARMACY

(614) 685-1672 (614) 362-6888

600 ACKERMAN RD STE E1014 2800 W BROAD ST

COLUMBUS COLUMBUS

OH OH

43202-4500 43204-2654

THOMPSON'S NEIGHBORHOOD PHARMACY TREMONT PHARMACY TRIO PHARMACY WESTLAND PHARMACY LLC WHITEHALL PHARMACY WHITES PHARMACY HAWKEYS PHARMACY LAKE HEALTH PHARMACY - TRIPOINT GERDES PHARMACY INC OKULEY'S PHARMACY TMMG PHARMACY SHRIVERS PHARMACY KLEIN PHARMACY KLEIN'S ASSUREMED SOLUTIONS

(614) 388-8088 (614) 488-2625 (614) 298-8180 (614) 853-9000 (614) 547-7766 (614) 237-7677 (419) 659-2366 (440) 375-8791 (440) 593-2578 (419) 596-3898 (330) 372-8841 (740) 982-3081 (330) 929-9183 (330) 926-5941

2343 CLEVELAND AVE 2144 TREMONT CTR 1570 CLEVELAND AVE 100 N MURRAY HILL RD 4770 INDIANOLA AVE #208 4057 E LIVINGSTON AVE 114 NORTH HIGH ST 7580 AUBURN RD STE 2 245 MAIN ST 102 S MAIN ST 2600 STATE ROUTE 5 120 S BUCKEYE ST 2015 STATE RD STE 1 2015 STATE RD

COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS COLUMBUS GROVE CONCORD TOWNSHIP CONNEAUT CONTINENTAL CORTLAND CROOKSVILLE CUYAHOGA FALLS CUYAHOGA FALLS

OH OH OH OH OH OH OH OH OH OH OH OH OH OH

43211-1611 43221-3110 43211-2755 43228 43214-1876 43227-2307 45830-1239 44077-9616 44030-2653 45831-9151 44410-9393 43731-1015 44223-1425 44223-1425

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 484 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MARCS #9 NEW CHOICE PHARMACY LONSINGER PHARMACY ACCESS RX PHARMACY, LLC. BEST PHARMACY CLARK'S RX EQUITAS HEALTH PHARMACY FIRST CARE PHARMACY LLC GENOA-QOL HEALTHCARE INFINITY PHARMACY KHN PHARMACY BEAVERCREEK KHN PHARMACY CASSANO KHN PHARMACY GRANDVIEW KHN PHARMACY HUBER KHN PHARMACY KETTERING KHN PHARMACY SOUTHVIEW KMG PHARMACY LLC MIAMI VALLEY PHARMACY PHARMA MEDICAL SALEM PHARMACY ST ELIZABETHS PHARMACY WOODMAN PHARMACY INC ZIKS FAMILY PHARMACY ZIKS FAMILY PHARMACY MERCY DEFIANCE CLINIC PHARMACY OKULEYS PHCY & HOME MEDICAL GALE'S PHARMACY DELPHOS DISCOUNT DRUGS COMMUNITY MARKETS PHARMACY SCARBROUGH PHARMACY DILLONVALE PHARMACY RITZMAN PHARMACY UNION HOSPITAL PROFESSIONAL PHCY LAWLER'S PHARMACY DECILLION HEALTHCARE GENOA-QOL HEALTHCARE HEALTH AND WELLNESS PHARMACY SOLEO HEALTH INC.

Provider Name

(330) 928-8611 (330) 971-7393 (740) 599-6744 (937) 640-3045 (937) 274-5500 (937) 433-6661 (937) 424-1440 (937) 898-3313 (937) 401-0849 (614) 860-5101 (937) 558-3030 (937) 558-0199 (937) 723-3530 (937) 558-3333 (937) 395-8171 (937) 438-1333 (937) 529-4433 (937) 208-4848 (937) 262-7725 (937) 276-2173 (937) 424-4599 (937) 252-9100 (937) 225-9350 (937) 278-9457 (419) 783-3376 (419) 784-4800 (740) 369-5449 (419) 692-3784 (419) 822-0306 (419) 278-1851 (740) 769-7332 (330) 364-2301 (330) 365-3845 (740) 754-3434 (614) 367-7828 (614) 943-4055 (888) 661-4497 (614) 467-8200

470 HOWE AVE 1900 23RD ST 10 E MAIN ST 2611 WAYNE AVE 2800 SALEM AVE 5901 FAR HILLS AVE 1222 S PATTERSON BLVD STE 230B 8353 N MAIN ST 1520 GERMANTOWN ST 3129 E 3RD ST 2510 COMMONS BLVD 165 S EDWIN C MOSES BLVD 405 W GRAND AVE 8701 TROY PIKE 3535 SOUTHERN BLVD 1997 MIAMISBURG CENTERVILLE RD 846 E MAIN ST 1 WYOMING ST FL 1 687 MIAMISBURG CENTERVILLE RD 1100 SALEM AVE 1 ELIZABETH PL # 150 1010 WOODMAN DR STE 100 1130 W 3RD ST 4140 SALEM AVE 1400 E 2ND ST 1245 E 2ND ST 16 TROY RD 660 ELIDA AVE 702 MAIN ST 139 W MAIN ST 74 MAIN ST 3000 N WOOSTER AVE 659 BOULEVARD 817 MAIN ST 270 CRAMER CREEK CT 525 METRO PL N STE 150 5050 BLAZER PKWY STE 202 6185 SHAMROCK CT STE A

CUYAHOGA FALLS CUYAHOGA FALLS DANVILLE DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DAYTON DEFIANCE DEFIANCE DELAWARE DELPHOS DELTA DESHLER DILLONVALE DOVER DOVER DRESDEN DUBLIN DUBLIN DUBLIN DUBLIN

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

44221 44223-1404 43014-9610 45420-1833 45406-2750 45429-2211 45402-2643 45415-1602 45417-3318 45403-2139 45431-3820 45402-8472 45405-4720 45424-1066 45429-1221 45459-3811 45426-2911 45409-2722 45459-6519 45406-5144 45417 45432-1429 45402-6812 45416-1703 43512-2440 43512-2405 43015 45833-1735 43515-1420 43516-1159 43917-0000 44622-9469 44622 43821 43017-2584 43017-7310 43017-3376 43016-1275

CLEVELAND CL HURON CM HLTH CTR PHCY BUCKEYE PHARMACY HERCHE & BLOORS PHARMACY

(216) 767-4200 (330) 382-7726 (330) 385-0825

13944 EUCLID AVE 15549 STATE ROUTE 170 STE 1 104 E 5TH ST

EAST CLEVELAND EAST LIVERPOOL EAST LIVERPOOL

OH OH OH

44112 43920 43920-3031

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 485 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MARTY'S FAMILY PHARMACY KHN PHARMACY EATON PILLS 'N' PACKAGES GATES PHARMACY HEMATOLOGY ONCOLOGY CENTER INC. CLV CLINIC EUCLID HOSP PHCY EUCLID FAMILY PHARMACY MARCS FAIRFIELD PHARMACY MILLS PHARMACY PATIENT CARE PHARMACY MARCS # 7

Provider Name

(330) 386-5521 (937) 456-8388 (419) 862-2982 (440) 329-7300 (440) 324-0415 (216) 445-2357 (216) 732-5860 (216) 731-7474 (513) 863-3350 (513) 868-6397 (513) 874-5868 (330) 869-0426

2249 LISBON ST 450B WASHINGTON JACKSON RD 350 RICE ST 125 E BROAD ST STE 109 41201 SCHADDEN RD 18901 LAKESHORE BLVD 26300 EUCLID AVE 22840 LAKE SHORE BLVD 765 NILLES RD STE A 640 WESSEL DR 5502 DIXIE HWY 2753 W MARKET ST

EAST LIVERPOOL EATON ELMORE ELYRIA ELYRIA EUCLID EUCLID EUCLID FAIRFIELD FAIRFIELD FAIRFIELD FAIRLAWN

OH OH OH OH OH OH OH OH OH OH OH OH

43920-1024 45320-7600 43416-9513 44035-6429 44035-2220 44119 44132-3708 44123-1321 45014 45014-3600 45014 44333

CNTR FR MDCT MGMT/ BLANCHARD VALLEY ORION CANCER CARE PRESCRIPTION SOLUTIONS KAUP PHARMACY FCH PHARMACY CARLISLE PHARMACY FRANKLIN FURNACE PHARMACY JOHNSTONS PHARMACY GRUND DRUG CO CENTRAL OHIO UROLOGY GROUP INC QUAY DRUGS INC FRUTH PHARMACY FRUTH PHARMACY HOLZER FAMILY PHARMACY SIGNATURE HEALTH INC PHARMACY MARCS GARRETTSVILLE FAMILY PHARMACY DONOHOO PHARMACY GERMANTOWN PRESCRIPTION CTR GIBSONBURG PHARMACY BRINE PHARMACY MIDVIEW DRUG CORNER PHARMACY LLC STEWARTS PHARMACY FAMILY HEALTH PHARMACY MEDICINE AND MORE COMMUNITY FIRST PHARMACY HAWTHORNE PHARMACY LLC HEALINGSPRINGS PHARMACY

(419) 429-7002 (419) 429-1300 (419) 423-1513 (419) 375-2323 (419) 435-6560 (937) 806-8470 (740) 354-9983 (740) 828-2601 (419) 332-5585 (614) 396-2684 (419) 468-3044 (740) 441-0781 (740) 446-6620 (740) 446-5236 (216) 395-1060 (216) 475-2568 (330) 527-4349 (937) 378-4844 (937) 855-2055 (419) 637-7441 (330) 545-5025 (440) 748-2137 (937) 981-2454 (937) 981-3245 (937) 548-2953 (937) 547-1642 (513) 785-4755 (513) 299-7967 (513) 863-8000

1900 S MAIN ST 3949 N MAIN ST STE C 1809 S MAIN ST 102 NORTH WAYNE 501 VAN BUREN ST # 101 771 CENTRAL AVE 561 NORWICH AVE 26 E 3RD ST 227 S FRONT ST 701 TECH CENTER DR 2 PUBLIC SQ 204 2ND AVE 2991 STATE ROUTE 160 90 JACKSON PIKE 5410 TRANSPORTATION BLVD #4 12650 ROCKSIDE RD 8295 WINDHAM ST 114 S MAIN ST 28 N MAIN ST 241 W MADISON ST 906 N STATE ST 35053 ROYALTON RD 259 JEFFERSON ST 1013 JEFFERSON ST 5735 MEEKER RD 100 FORT JEFFERSON AVE 210 S 2ND ST 3320 TYLERSVILLE RD 2449 ROSS MILLVILLE RD STE 185

FINDLAY FINDLAY FINDLAY FORT RECOVERY FOSTORIA FRANKLIN FRANKLIN FURNACE FRAZEYSBURG FREMONT GAHANNA GALION GALLIPOLIS GALLIPOLIS GALLIPOLIS GARFIELD HEIGHTS GARFIELD HTS GARRETTSVILLE GEORGETOWN GERMANTOWN GIBSONBURG GIRARD GRAFTON GREENFIELD GREENFIELD GREENVILLE GREENVILLE HAMILTON HAMILTON HAMILTON

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

45840-1214 45840-4208 45840-1311 45846 44830-1593 45005-3318 45629-8892 43822-9651 43420-3023 43230-1987 44833-1926 45631-1022 45631-8441 45631-1560 44125 44125 44231-9406 45121-1221 45327-1350 43431-1319 44420-1736 44044-9539 45123-1345 45123-1283 45331-1180 45331-1012 45011-2811 45011-7714 45013-8952

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 486 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HUGHES DRUG STORE KHN PHARMACY - FORT HAMILTON HARRISON PHARMACY & WELLNESS VILLAGE PHARMACY MARCS #42 HOMETOWN PHARMACY ARENSBERG PHARMACY HICKSVILLE PHCY AND HOME MEDICAL DOWNTOWN DRUG OF HILLSBORO EZ SCRIPTS HOLLAND DISCOUNT PHARMACY CLARKS RX HUBER HEIGHTS CC INDEPENDENCE AMBULATORY PHY CLEVELAND CLINIC HOMECARE SER COAL GROVE PHARMACY INC FRUTH PHARMACY KING'S DAUGHTERS FAMILY PHCY HOLZER FAMILY PHARMACY - JACKSON JACKSON PHCY & WELLNESS CENTER IHS PHARMACY- JAMESTOWN THORNES PHARMACY JEFFERSON VINZE PHARMACARE INC. MILLER'S PHARMACY & GIFTS, LLC GENOA-QOL HEALTHCARE KSU HEALTH CENTER PHARMACY DAYTON PHYSICIANS NETWORK HEARTLAND PHARMACY LLC KHN SPECIALTY PHARMACY WELLNESS 1 PHARMACY C & B MAIN DISC DRUG CTR INC MARCS CARNIVAL FOODS PHARMACY RISCH DRUG STORE #7 INC RISCH DRUG STORE INC THE MEDICINE SHOPPE YOUNG'S PHARMACY ARROW SPRINGS PHARMACY BRYAN'S FAMILY PHARMACY BRYANS PHARMACY SOLUTIONS HUTCHESON HOMECARE PHARMACY CAREPOINT PHARMACY GENOA-QOL HEALTHCARE

NR_0009_10823 10/2017

Provider Phone Number (513) 868-1199 (513) 867-4490 (513) 202-9600 (513) 367-4836 (330) 877-4018 (740) 522-8565 (740) 928-3455 (419) 542-6218 (614) 562-6896 (855) 729-3939 (419) 865-7777 (937) 723-2880 (216) 445-2357 (216) 636-8816 (740) 533-2479 (740) 533-9215 (740) 237-4923 (740) 395-8870 (937) 596-8100 (937) 675-6500 (440) 576-6258 (740) 967-2233 (419) 532-3489 (330) 673-8750 (330) 672-8221 (937) 288-8036 (937) 723-9075 (937) 281-3883 (937) 256-4000 (330) 876-1228 (216) 521-2191 (740) 687-1130 (740) 653-1814 (740) 653-1324 (740) 653-7779 (740) 332-1833 (513) 282-7020 (513) 228-0800 (513) 228-1930 (513) 228-0812 (855) 237-9112 (419) 371-2081

Provider Street 302 MAIN ST 1010 CEREAL AVE 620 RING RD 114 HARRISON AVE 900 W MAPLE 963 HEBRON RD 137 W MAIN ST UNIT D 116 EAST HIGH ST 119 S HIGH ST 6920 HALL ST 909 S MCCORD RD STE 1 7415 OLD TROY PIKE 5001 ROCKSIDE RD 6801 BRECKSVILLE RD STE 10 600 MARION PIKE 1848 STATE ROUTE 141 912 PARK AVE STE 105 280 PATTONSVILLE RD 101 E PIKE ST STE B 4940 COTTONVILLE RD 344 S CHESTNUT ST 267 N MAIN ST 101 S BROAD ST 5982 RHODES RD 1500 EASTWAY DRIVE 3120 GOVERNORS PLACE BLVD 3000 FAR HILLS AVE 3700 SOUTHERN BLVD STE 105 2420 S.SMITHVILLE RD 8507 MAIN ST 14861 DETROIT 1215 N MEMORIAL DR 803 W FAIR AVE 533 N COLUMBUS ST 900 E MAIN ST 15986 STATE ROUTE 56 E 100 ARROW SPRINGS BLVD 726 E MAIN ST 975B KINGSVIEW DR 726 E MAIN ST STE 28 REAR 1313 CAMERON AVE 799 S MAIN ST

Page 487 of 679

Provider City HAMILTON HAMILTON HARRISON HARRISON HARTVILLE HEATH HEBRON HICKSVILLE HILLSBORO HOLLAND HOLLAND HUBER HEIGHTS INDEPENDENCE INDEPENDENCE IRONTON IRONTON IRONTON JACKSON JACKSON CENTER JAMESTOWN JEFFERSON JOHNSTOWN KALIDA KENT KENT KETTERING KETTERING KETTERING KETTERING KINSMAN LAKEWOOD LANCASTER LANCASTER LANCASTER LANCASTER LAURELVILLE LEBANON LEBANON LEBANON LEBANON LEWIS CENTER LIMA

State

ZIP code

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

45013-4762 45013-2784 45030-2764 45030-1328 44632 43056-1184 43025 43526 45133-1442 43528 43528 45424 44131 44131-5057 45638-2963 45638 45638-1596 45640-9452 45334-6000 45335 44047-1317 43031-1018 45853-0000 44240-4128 44243 45409 45429-2510 45429-1226 45420 44428-9333 44107-3909 43130-1626 43130-2346 43130-3036 43130-4048 43135-9741 45036 45036-1900 45036-9562 45036 43035-9662 45804-1519

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LIMA MEMORIAL HEALTH SYSTEM QUICK CARE PHARMACY MORGANS DRUG STORE SHRIVERS PHARMACY MEDICINE SHOPPE MARC'S NORD CENTER'S PHARMACY SOUTHSIDE PHARMACY OF LORAIN DANNER DRUGS

Provider Name

(419) 221-6142 (419) 812-2170 (330) 424-7287 (740) 452-7685 (740) 852-5131 (440) 233-7874 (440) 204-4307 (440) 277-0655 (419) 994-3221

1001 BELLEFONTAINE AVE. 1550 N MAIN ST 118 E LINCOLN WAY 21 HOCKING MALL 54 W HIGH ST STE A 170 SHEFFIELD CTR 6140 S BROADWAY 2811 FULTON RD STE B 202 W MAIN ST

LIMA LIMA LISBON LOGAN LONDON LORAIN LORAIN LORAIN LOUDONVILLE

OH OH OH OH OH OH OH OH OH

45804 45801-2823 44432-1406 43138 43140-1075 44055 44053-3821 44055 44842-1134

MEDICINE CENTER INSTITUTIONAL PHCY MEDICINE CTR PHCY-LOUISVILLE GAHM'S PHARMACY HOLBROOK'S HOMETOWN PHARMACY LUKAS PHARMACY VALLEY VIEW PHARMACY AVITA ONTARIO PHARMACY CLV CLINIC MANSFIELD CANCER CTR GENOA-QOL HEALTHCARE HURSH DRUG INC THE MEDICINE SHOPPE ESSENTRA PHARMACY MARION PRESCRIPTION MGH AMBULATORY PHARMACY EAST OHIO REGIONAL HOSPITAL JUST MEDS LLC DAVE'S PHARMACY ADVANCED DERM & DERMATOPATHOLOGY IN GROUP HEALTH PHARMACY SKILLED CARE PHARMACY INC YOST PHARMACY INC BALTZLY DRUG WEST INC MARC'S PHARMACY MEDICAP PHARMACY THORNCHERRY

(330) 875-9090 (330) 875-5525 (740) 259-2442 (740) 259-0041 (937) 364-2150 (330) 866-3380 (567) 307-7570 (419) 774-3121 (567) 307-4600 (419) 524-0521 (419) 756-6032 (419) 253-0632 (740) 382-5746 (740) 383-8424 (740) 633-4297 (740) 633-2676 (937) 644-1322

700 W MAIN ST STE A 700 W MAIN ST 50A CENTER ST 37C LUCASVILLE MINFORD RD 134 S MAIN ST 11141 STATE ROUTE 800 NE 715 RICHLAND MALL STE J 1125 ASPIRA CT 741 SCHOLL RD STE P1 90 N DIAMOND ST 283 CLINE AVE 73 SPORTSMAN'S DR STE B 544 E CENTER ST 1000 MCKINLEY PARK DR 90 N 4TH ST 1103 S ZANE HWY 411 W 5TH ST

LOUISVILLE LOUISVILLE LUCASVILLE LUCASVILLE LYNCHBURG MAGNOLIA MANSFIELD MANSFIELD MANSFIELD MANSFIELD MANSFIELD MARENGO MARION MARION MARTINS FERRY MARTINS FERRY MARYSVILLE

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

44641-1338 44641-1338 45648-7826 45648-9023 45142 44643-8321 44906-3802 44906 44907-1571 44902-1325 44907-1019 43334-1800 43302-4234 43302-6399 43935-1648 43935-1967 43040-1019

(513) 770-4212 (513) 229-6060 (513) 459-7455 (513) 398-5010 (330) 833-4113 (330) 830-2600 (330) 832-2226 (330) 413-1509

5184 SOCIALVILLE-FOSTER RD 6010 MASON-MONTGOMERY RD 6175 HI TEK CT 120 W MAIN ST 2208 LINCOLN WAY NW 1413 AMHERST RD NE 2012 LINCOLN WAY NW 1607 AMHERST RD NE

MASON MASON MASON MASON MASSILLON MASSILLON MASSILLON MASSILLON

OH OH OH OH OH OH OH OH

45040 45040 45040-2603 45040-1708 44647-6144 44646 44647-6140 44646-4183

TRI COUNTY HEMO AND ONCOLOGY ASSOC DRUGSTORE SOLUTIONS MAUMEE DISCOUNT PHARMACY MARCS #2 CLEVELAND CLINIC HILLCREST AMB

(330) 478-0001 (419) 819-8955 (419) 887-0101 (440) 449-2681 (440) 312-5854

7337 CARITAS CIR NW STE 150 1605 HOLLAND RD STE B5 1398 CONANT ST STE C 6695 EASTGATE DR 6770 MAYFIELD ROAD

MASSILLON MAUMEE MAUMEE MAYFIELD HEIGHTS MAYFIELD HGTS

OH OH OH OH OH

44646 43537-1630 43537-1640 44124 44124

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SHRIVERS PHARMACY SHRIVERS PHARMACY VILLAGE PHARMACY CLEVELAND CL MEDINA AMB PHCY GENTRY HEALTH SERVICES MARC'S RITZMAN PHARMACY RITZMAN PHARMACY GENOA-QOL HEALTHCARE GREAT LAKES PHARMACY LAKE HLTH UNV HOSP SIEDMAN CC MARCS DAYTON CHILDRENS SOUTH CAMPUS KHN PHARMACY SYCAMORE MARC'S PHARMACY SOUTHWEST COMMUNITY PHARMACY SOUTHWEST UROLOGY GENOA-QOL HEALTHCARE MIDDLETOWN PHARMACY THE MEDICINE SHOPPE

Provider Name

(740) 596-2566 (740) 962-2552 (937) 834-2270 (330) 721-5490 (844) 443-6879 (330) 722-3662 (330) 722-8118 (330) 725-2255 (440) 497-4168 (440) 352-2500 (440) 205-5711 (440) 951-1721 (937) 641-5080 (937) 384-3868 (440) 884-4171 (440) 816-8410 (440) 887-2271 (513) 727-0471 (513) 705-6252 (513) 424-8180

530 N MARKET ST 105 N KENNEBEC AVE 26 S MAIN ST 1000 E WASHINGTON ST 1090 ENTERPRISE DR 1041 N COURT ST 275 FOREST MEADOWS DR 3626 MEDINA RD 9220 MENTOR AVE 9500 MENTOR AVE STE 110 9485 MENTOR AVE STE 3 7353 MENTOR AVE 3333 W TECH BLVD 4000 MIAMISBURG CENTERVILLE RD 6849 SOUTHLAND DR 18697 BAGLEY RD 6900 PEARL RD 2ND FLOOR 1036 S VERITY PKWY 4421 ROOSEVELT BLVD STE H 1971 CENTRAL AVE

MC ARTHUR MCCONNELSVILLE MECHANICSBURG MEDINA MEDINA MEDINA MEDINA MEDINA MENTOR MENTOR MENTOR MENTOR MIAMISBURG MIAMISBURG MIDDLEBURG HEIGHTS MIDDLEBURG HEIGHTS MIDDLEBURG HGTS MIDDLETOWN MIDDLETOWN MIDDLETOWN

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

45651-1131 43756 43044-1111 44256-2170 44256-1328 44256 44256 44256-8100 44060-6412 44060-8712 44060 44060-7523 45342-0817 45342-7615 44130 44130-3417 44130 45044-5513 45044-9024 45044-4401

MILFORD PHARMACY AND WELLNESS CNTR OPTION CARE PHARMAKEIA LLC RITZMAN PHARMACY RITZMAN PHARMACY MILLERSPORT PHARMACY MEDICINE CENTER PHARMACY MINFORD PHARMACY MINGO PHARMACY

(513) 831-8211 (513) 576-8400 (513) 239-5955 (330) 674-1891 (330) 893-3179 (740) 467-2232 (330) 868-6200 (740) 820-2163 (740) 535-8068

931 STATE HIGHWAY 28 STE 205 25 WHITNEY DR STE 114 5724 SIGNAL HILL CT 2105 GLEN DR 4900 OAK STREET 12075 LANCASTER ST 251 EAST ST 8746 STATE ROUTE 335 116 MCLISTER AVE

MILFORD MILFORD MILFORD MILLERSBURG MILLERSBURG MILLERSPORT MINERVA MINFORD MINGO JUNCTION

OH OH OH OH OH OH OH OH OH

45150 45150-8400 45150-1483 44654 44654 43046-9787 44657 45653-8698 43938-1259

SCHWIETERMANS MINSTER PHARMACY RINGS PHARMACY INC GENOA-QOL HEALTHCARE HEARTLAND PHARMACY 2 WHISTON PHARMACY HEALTHSOURCE OF OHIO MT ORAB P MT ORAB PHARMACY STERLING PHARMACY FOSTERS EASTSIDE PHARMACY FOSTER'S PHARMACY SCRIPTSHOP

(419) 628-2305 (419) 485-5115 (937) 294-1000 (937) 395-3690 (419) 946-5911 (937) 444-2515 (937) 444-0133 (740) 869-3784 (740) 397-1420 (740) 392-0911 (330) 879-5626

324 N MAIN ST 221 W MAIN ST 3095 KETTERING BLVD 2749 W ALEX BELL RD 25 S MAIN ST 150 HEALTH PARTNERS CIR 155 N POINT DR 283 YANKEETOWN ST 1451 YAUGER RD # 1H 207 W HIGH ST 4254 ERIE AVE SW

MINSTER MONTPELIER MORAINE MORAINE MOUNT GILEAD MOUNT ORAB MOUNT ORAB MOUNT STERLING MOUNT VERNON MOUNT VERNON NAVARRE

OH OH OH OH OH OH OH OH OH OH OH

45865-9560 43543-1015 45439-1983 45459 43338-1445 45154-8610 45154-8366 43143-9410 43050-9046 43050-2427 44662-9664

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FRUTH PHARMACY SHRIVERS PHARMACY BLACKBURNS PHARMACY LLC SCHWIETERMANS DRUG STORE INC

Provider Name

(740) 753-5676 (740) 753-2484 (740) 456-4500 (419) 925-4950

10 W WASHINGTON ST 40 WATKINS ST 3520 RHODES AVE 2 N WASHINGTON ST

NELSONVILLE NELSONVILLE NEW BOSTON NEW BREMEN

OH OH OH OH

45764-1178 45764-1452 45662-4975 45869-1113

NORTHSIDE NEW CONCORD PHARMACY NEW LEBANON MR PRESCRIPTION REED'S PHARMACY VILLAGE PHARMACY DUSINI DRUGS MED SHOPPE MEDICINE CENTER PHARMACY BERRY PHARMACY CO INC ARENSBERG PHARMACY ARENSBERG PHARMACY ARENSBERG PHARMACY GENOA-QOL HEALTHCARE REM SMART PAC MEDI-WISE PHARMACY NEWTON FALLS PHARMACY INC TROUTMAN DRUG COMPANY GREAT SCOT 90 PHARMACY DAVIES DRUG ENVISIONPHARMACIES MARCS MARCS #4 OHLIGER DRUG OF N.O. INC MARCS RITZMAN PHARMACY THE MEDICINE SHOPPE KAISER COMMUNITY PHARMACY IGA COMMUNITY MARKETS PHARMACY ST CHARLES OUTPAIENT PHARMACY THE PHARMACY COUNTER LLC MAIN ST PHCY & WELLNESS CENTER RITZMAN PHARMACY GRAND VALLEY DRUG TUCKERS PHARMACY RILEY CREEK PHARMACY MARCS METROHEALTH PARMA PHARMACY VILLAGE APOTHECARY PEMBERVILLE DRUG STORE

(740) 826-4000 (937) 687-9711 (937) 687-6081 (330) 542-2802 (330) 364-5519 (330) 339-4466 (513) 553-4131 (740) 522-9761 (740) 344-2191 (740) 345-9761 (740) 522-0716 (740) 915-4771 (740) 498-6337 (330) 872-6400 (330) 652-1435 (419) 257-2221 (330) 305-9075 (866) 909-5170 (330) 244-1042 (440) 777-2521 (440) 777-6200 (440) 353-1601 (330) 825-3400 (330) 825-7676 (419) 668-1078 (419) 898-0954 (419) 696-7575 (419) 698-5408 (330) 682-2905 (330) 684-1501 (440) 437-5151 (419) 523-6122 (419) 384-3303 (440) 843-5495 (216) 563-6300 (419) 399-9780 (419) 287-3238

10 E MAIN ST 605 W MAIN ST 675 W MAIN ST 10395 MAIN ST 315 E HIGH AVE 551 W HIGH AVE 1041 B OLD US 52 70 S CHALFANT RD 1650 W CHURCH ST 57 W MAIN ST 1445 W MAIN ST 1563 W MAIN ST 245 W STATE ST 37 RIDGE RD 501 ROBBINS AVE 13710 DESHLER RD 6046 WHIPPLE AVE NW 7835 FREEDOM AVE 1664 N MAIN ST 26393 GREAT NORTHERN SC 25300 LORAIN RD 34800 CENTER RIDGE RD 4047 S CLEVE-MASS RD 3300 GREENWICH RD STE 14 251 BENEDICT AVE 279 W WATER ST 2600 NAVARRE AVE 2701 NAVARRE AVE 120 N MAIN ST 1114 W HIGH ST 11 N MAPLE ST 1831 E MAIN ST 112 E MAIN ST 7511 W RIDGEWOOD 12301 SNOW ROAD 104 N WILLIAMS ST 143 E FRONT ST

NEW CONCORD NEW LEBANON NEW LEBANON NEW MIDDLETOWN NEW PHILADELPHIA NEW PHILADELPHIA NEW RICHMOND NEWARK NEWARK NEWARK NEWARK NEWARK NEWCOMERSTOWN NEWTON FALLS NILES NORTH BALTIMORE NORTH CANTON NORTH CANTON NORTH CANTON NORTH OLMSTED NORTH OLMSTED NORTH RIDGEVILLE NORTON NORTON NORWALK OAK HARBOR OREGON OREGON ORRVILLE ORRVILLE ORWELL OTTAWA PANDORA PARMA PARMA PAULDING PEMBERVILLE

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

43762-1286 45345-9173 45345-9173 44442-9717 44663-2566 44663-2005 45157-8537 43055-1369 43055-1540 43055-5005 43055-1989 43055-1826 43832-1411 44444-1232 44446-2411 45872-9794 44720-7616 44720-6907 44720-8606 44070 44070-2083 44039-3160 44203-5603 44203-5714 44857-2346 43449-1335 43616-3207 43616-3225 44667-1638 44667-1499 44076-9516 45875-1649 45877-8706 44129-5536 44130 45879-1281 43450-7032

NR_0009_10823 10/2017

Provider Phone Number

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Page 490 of 679

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ANSON PHARMACY THE DRUG STORE OF PERRYSBURG

Provider Name

(419) 874-8878 (419) 873-9100

25684 DIXIE HWY 580 CRAIG DR STE 2

PERRYSBURG PERRYSBURG

OH OH

43551-2019 43551-1772

WALT CHURCHILLS MARKET AND PHARMACY PICKERINGTON PHARMACY

(419) 872-6904 (614) 837-2112

26625 DIXIE HWY 641 HILL RD N

PERRYSBURG PICKERINGTON

OH OH

43551-1712 43147-9346

BOSTICK PRESCRIPTION PHARMACY INC MEDICINE SHOPPE PHARMACY PLAIN CITY DRUGGIST PLAIN CITY DRUGGIST COMMUNITY MARKET 320 PHARMACY FRUTH PHARMACY FRUTH PHARMACY SWISHER & LOHSE PHARMACY BASSETT'S MARKET PHARMACY GREEN'S PHARMACY INC

(740) 289-2269 (937) 773-1778 (614) 873-0880 (614) 873-0020 (419) 687-9491 (740) 992-1536 (740) 992-6491 (740) 992-2955 (419) 732-6300 (419) 732-3151

549 S WEST ST 649 W HIGH ST 480 S JEFFERSON AVE 480 S JEFFERSON AVE 262 SANDUSKY ST 700 E MAIN ST 706 W MAIN ST 112 E MAIN ST 3994 E HARBOR RD 200 MADISON ST

PIKETON PIQUA PLAIN CITY PLAIN CITY PLYMOUTH POMEROY POMEROY POMEROY PORT CLINTON PORT CLINTON

OH OH OH OH OH OH OH OH OH OH

45661-8042 45356-2149 43064-4137 43064-4137 44865-1151 45769-1115 45769-1224 45769-1021 43452-2671 43452-1143

THE PHARMACY AT MAGRUDER HOSPITAL COMPASS PHARMACY GENOA-QOL HEALTHCARE KING'S DAUGHTERS FAMILY PHCY#2 MEDI-MART PHARMACY MORTON'S HILLTOP PHARMACY SMITH DRUG COMPANY SOMC PHARMACY SOUTH CAMPUS SOUTHERN OH MEDICAL CENTER PHCY STAKERS SERVICE DRUGS INC POWHATAN HEALTH CENTER FRUTH PHARMACY PROSPECT PHARMACY MARC'S PHARMACY SPEIDEL'S MEDICAL ARTS PHCY TRIANGLE PHARMACY INC ANTHONYS PHARMACY INC RICHWOOD PHARMACY BRISTOW PHARMACY RITZMAN PHARMACY MARCS PHARMACY SPECIALTY GROUP LLC ROSEVILLE PHARMACY INC ARIES PHARMACY TOWN DRUG

(419) 732-4009 (740) 355-7102 (740) 370-0759 (740) 991-1201 (740) 354-3291 (740) 353-1147 (740) 354-5622 (740) 356-7958 (740) 356-8101 (740) 353-1135 (740) 795-4837 (740) 886-7685 (740) 494-2663 (330) 298-3654 (330) 296-6014 (330) 296-8508 (614) 501-4410 (740) 943-2233 (937) 392-4020 (330) 927-3175 (440) 356-6240 (440) 623-7100 (740) 697-0348 (937) 843-3700 (937) 584-2424

615 FULTON ST 1634 11TH ST 901 WASHINGTON ST RM 135 1901 ARGONNE RD 902 4TH ST 1865 COLES BLVD 745 2ND ST 1248 KINNEYS LN 1805 27TH ST 826 CHILLICOTHE ST 63 HIGHWAY 7 S 259 STATE ST 171 S MAIN ST 1145 E MAIN ST 6693 N CHESTNUT ST 219 W MAIN ST 1719 BRICE RD 24 W OTTAWA ST 100 MAIN ST 234 N MAIN ST 21661 CENTER RIDGE RD 1250 LINDA ST #101 157 S MAIN ST 8200 STATE ROUTE 366 12459 EAST US RT 22 & 3

PORT CLINTON PORTSMOUTH PORTSMOUTH PORTSMOUTH PORTSMOUTH PORTSMOUTH PORTSMOUTH PORTSMOUTH PORTSMOUTH PORTSMOUTH POWHATAN POINT PROCTORVILLE PROSPECT RAVENNA RAVENNA RAVENNA REYNOLDSBURG RICHWOOD RIPLEY RITTMAN ROCKY RIVER ROCKY RIVER ROSEVILLE RUSSELLS POINT SABINA

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

43452-2001 45662-4526 45662-3944 45662 45662-4314 45662-2643 45662-4001 45662-2927 45662-2640 45662-4028 43942-1143 45669 43342-9569 44266 44266-3922 44266-2741 43068-2705 43344 45167-1232 44270-1163 44116-3917 44116-1854 43777-1238 43348-9670 45169

NR_0009_10823 10/2017

Provider Phone Number

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Page 491 of 679

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MARCS JUST MEDS LLC SCHWIETERMAN'S PHARMACY SAINT PARIS PHARMACY FREDS FAMILY PHARMACY LEASE DRUG COMPANY MARCS CLEVELAND CLINIC NORTH COAST

Provider Name

(330) 468-4868 (740) 296-5718 (419) 394-3219 (937) 663-6001 (330) 332-9919 (330) 337-8727 (330) 337-7358 (216) 445-2357

550 W AURORA RD 51520 NATIONAL RD E 1052 E SPRING ST 122 S SPRINGFIELD ST 1136 E STATE ST 229 N ELLSWORTH AVE 2487 E STATE ST 417 QUARRY LAKES DR

SAGAMORE HILLS SAINT CLAIRSVILLE SAINT MARYS SAINT PARIS SALEM SALEM SALEM SANDUSKY

OH OH OH OH OH OH OH OH

44067 43950 45885-2446 43072-7704 44460-2230 44460-2803 44460-2586 44870-8635

FIRELANDS REGIONAL MED CTR OP PHCY SARDINIA PHARMACY INC NEIMAYER PHARMACY INC FITZGERALD'S SEAMAN PHARMACY

(419) 557-7473 (937) 446-2545 (740) 945-8005 (937) 386-0701

1111 HAYES AVE 7110 BACHMAN RD 112 E MAIN ST 17860 A STATE RTE 247

SANDUSKY SARDINIA SCIO SEAMAN

OH OH OH OH

44870-3323 45171-9495 43988-8744 45679

HEALTHSOURCE OF OHIO SEAMAN PHCY GROMOLL DRUG STORE INC RITZMAN PHARMACY RIESBECKS PHCY MEDICINE SHOPPE THE SHADYSIDE PHARMACY RITZMAN PHARMACY BUNNYS PHARMACY INC SIDNEY HOMETOWN PHARMACY MARCS NORTHSIDE SOMERSET PHARMACY CHARLESTON PHARMACY MARCS #40 MCMEANS PHARMACY

(937) 386-0049 (330) 938-6670 (330) 769-2995 (740) 676-2325 (740) 676-4782 (330) 567-2823 (937) 492-4550 (937) 498-4846 (440) 248-9239 (740) 743-2185 (937) 462-8331 (216) 691-8990 (740) 377-2677

218 STERN RD 227 N 15TH ST 255 CENTER ST 4595 CENTRAL AVE 3948 CENTRAL AVE 119 N MARKET ST 112 N MAIN AVE 130 W RUSSELL RD 6231 SOM CENTER RD 110 W MAIN ST 127 S CHILLICOTHE ST 4499 MAYFIELD RD 708 4TH ST E

SEAMAN SEBRING SEVILLE SHADYSIDE SHADYSIDE SHREVE SIDNEY SIDNEY SOLON SOMERSET SOUTH CHARLESTON SOUTH EUCLID SOUTH POINT

OH OH OH OH OH OH OH OH OH OH OH OH OH

45679-9607 44672-1301 44273-8864 43947-1279 43947-1310 44676 45365-2731 45365-1754 44139-2912 43783-9588 45368-9786 44121 45680-7111

SMITH PHARMACY AND HOME MEDICAL RIESBECKS PHCY MEDICINE SHOPPE CANAL PHARMACY KHN PHARMACY-SPRINGBORO THE MEDICINE SHOPPE CARSONS NORTHRIDGE PHARMACY HARDING ROAD PHARMACY MADISON AVENUE PHARMACY MERCY HLTH OP PHCY SPRINGFIELD WHITACRE PHARMACY WHITACRE PHARMACY WHITACRE PHARMACY RIESBECKS PHCY MEDICINE SHOPPE A & B SUNSET PHARMACY

(740) 354-5622 (740) 450-7859 (419) 647-4584 (937) 762-5090 (513) 748-0555 (937) 504-7700 (937) 399-8531 (937) 323-1841 (937) 523-6000 (937) 325-6444 (937) 323-2551 (937) 322-1925 (740) 695-0274 (740) 264-5711

10550 MAIN ST 2200 JUNE PKWY 102 S BROADWAY ST 825 N MAIN ST 268 W CENTRAL AVE 4923 SECURITY DR 400 W HARDING RD 640 N FOUNTAIN AVE 100 MEDICAL CENTER DR 1574 LAGONDA AVE 1578 E MAIN ST 1816 S LIMESTONE ST 104 PLAZA DR 4201 SUNSET BLVD

SOUTH WEBSTER SOUTH ZANESVILLE SPENCERVILLE SPRINGBORO SPRINGBORO SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD ST CLAIRSVILLE STEUBENVILLE

OH OH OH OH OH OH OH OH OH OH OH OH OH OH

45682-8922 43701-6377 45887-1267 45066 45066-1104 45503 45504-1707 45504-2202 45504 45503-3912 45503-4634 45505-4016 43950-8736 43952-3617

NR_0009_10823 10/2017

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The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROSS PARK PHARMACY INC ROSS PARK PHARMACY WEST MARCS CLEVELAND CLINIC O/P PHARMACY MARCS #41 THE HOMETOWN PHARMACY RITZMAN PHARMACY SWISS VILLAGE PHARMACY SWANTON PHARMACY FILLMORE PHARMACY PROMEDICA PHARMACY COUNTER SYLVANIA PHARMACY THORNVILLE PHARMACY LLC THE MEDICINE SHOPPE HOCKS TIPP CITY PHARMACY ARINGS COMPOUND CORNER INC COMMUNITY PHARMACY PARTNERS ERIE DRUG GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE JAMES PHARMACY KAHLER PHARMACY LAGRANGE SAV-MOR DRUGS LIFECARE PHARMACY LIFECARE PHARMACY MEDICAL COLLEGE OF OHIO PHCY MERCY OUT PATIENT PHARMACY MONROE PHARMACY PROMEDICA PHARMACY COUNTER RYAN PHARMACY SEAWAY PHARMACY SHAFFER PHARMACY INC

Provider Name

(740) 283-7272 (740) 264-8222 (330) 686-5285 (440) 878-3125 (440) 846-5535 (330) 750-0006 (330) 852-2445 (330) 852-6033 (419) 825-5050 (419) 927-2691 (567) 585-0025 (419) 842-1531 (740) 246-6511 (419) 447-0282 (937) 667-5803 (419) 841-3833 (419) 244-1809 (419) 476-4322 (567) 694-8570 (419) 517-1317 (419) 243-9161 (419) 382-2911 (419) 241-8065 (419) 720-1116 (419) 720-0055 (419) 383-3750 (419) 251-1359 (419) 473-1531 (419) 291-4466 (419) 531-2836 (419) 214-5197 (419) 473-0891

ONE ROSS PARK SUITE 100 4100 JOHNSON RD STE 105 3732 DARROW RD 16761 SOUTHPARK CTR # 1009 16224 PEARL RD 655 CREED ST 126 N BROADWAY 309 S BROADWAY ST 151 E AIRPORT HWY 119 S SYCAMORE AVE 5700 MONROE ST UNIT 112 7640 SYLVANIA AVE STE C1 2 MAIN ST N 465 W PERRY ST 5175 S COUNTY ROAD 25A 6725 W CENTRAL AVE STE N 1910 COLLINGWOOD BLVD 4502 LEWIS AVE 905 NEBRASKA AVE STE Q 5151 MONROE ST 623 LAGRANGE ST 1941 AIRPORT HWY 3103 LAGRANGE ST 2011 STARR AVE 4730 N SUMMIT ST 3000 ARLINGTON AVE 2200 JEFFERSON AVE 4122 MONROE ST 2100 W CENTRAL AVE 3340 DORR ST 1707 CHERRY ST 3900 SUNFOREST CT

STEUBENVILLE STEUBENVILLE STOW STRONGSVILLE STRONGSVILLE STRUTHERS SUGARCREEK SUGARCREEK SWANTON SYCAMORE SYLVANIA SYLVANIA THORNVILLE TIFFIN TIPP CITY TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

43952-2671 43952 44224-4050 44136-9302 44136 44471-1256 44681-0246 44681-9381 43558 44882-9751 43560-2737 43560-9740 43076-9442 44883-1958 45371 43617-1154 43604 43612-2335 43607-4222 43623-3462 43604-1768 43609-1803 43608-1801 43605 43611-2856 43614-2595 43604-7101 43606-2062 43606-3834 43607-2717 43608-2857 43623-4475

ST ANNE MERCY OUTPATIENT PHARMACY ST VINCENT FAMILY CARE PHCY

(419) 407-1777 (419) 251-2485

3404 W SYLVANIA AVE 2213 FRANKLIN AVE

TOLEDO TOLEDO

OH OH

43623-4467 43620-1402

ST. VINCENT MERCY AMBLTRY CARE PHCY THE CLINIC PHARMACY THE PHARMACY COUNTER LLC THE PHARMACY COUNTER LLC THE PHARMACY COUNTER LLC TOLEDO CLINIC CANCER CENTER

(419) 251-2545 (419) 479-5800 (419) 720-2170 (419) 473-1493 (419) 382-3475 (419) 479-5605

2213 CHERRY ST 4235 SECOR RD 3144 W CENTRAL AVE 2655 W CENTRAL AVE 1515 S BYRNE RD 4126 N HOLLAND SYLVANIA RD

TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO TOLEDO

OH OH OH OH OH OH

43608-2603 43623-4231 43606-2920 43606-3550 43614-3458 43623

NR_0009_10823 10/2017

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State

ZIP code

TOLEDO FAMILY PHARMACY TOLEDO FAMILY PHARMACY TOLEDO FAMILY PHARMACY LTC TOLEDO HOSP OUTPATIENT PHCY

Provider Name

(419) 930-5830 (419) 470-0700 (419) 386-0534 (419) 291-5418

324 MAIN ST 1601 W SYLVANIA AVE 1601 W SYLVANIA AVE 2142 N COVE BLVD

TOLEDO TOLEDO TOLEDO TOLEDO

OH OH OH OH

43605-2038 43612-1532 43612-1532 43606-3895

TOLEDO LUCAS COUNTY HLTH DEPT PHCY UNIV OF TOLEDO STUDENT MED CEN UT CARE PHARMACY WESTGATE FAMILY PHARMACY

(419) 213-4049 (419) 530-3471 (419) 383-3355 (419) 531-0000

635 N ERIE ST 2801 W BANCROFT ST 3125 TRAVERSE DR RM 1341 STE M 3147 W CENTRAL AVE

TOLEDO TOLEDO TOLEDO TOLEDO

OH OH OH OH

43604-5317 43606-3328 43614-8008 43606

TORONTO APOTHECARY, MEDICINE SHOPPE UVMC PHARMACY CLE CLINIC TWINSBURG AMB PHCY

(740) 537-2600 (937) 440-4262 (330) 888-4200

1361 FRANKLIN ST 3130 N COUNTY ROAD 25A 8701 DARROW RD

TORONTO TROY TWINSBURG

OH OH OH

43964-1025 45373-1337 44087

TWINSBURG HEALTH MART PHARMACY MAKO'S PHARMACY COMPOUNDING PHARMACY OF GREEN RITZMAN PHARMACY KOEHLER DRUG MEDICINE SHOPPE LTC PHARMACY THE MEDICINE SHOPPE LONSINGER PHARMACY METROHEALTH CENTRAL FILL PHCY RXPEDITE PHARMACY HOCKS VANDALIA PHARMACY KENS PHARMACY KAUP PHARMACY VIENNA PHARMACY CARE WHITE OAK PHARMACY RITZMAN PHARMACY GENOA-QOL HEALTHCARE SCHWIETERMAN PHARMACY ANTHONY'S FAMILY PHARMACY CHAMPION DISCOUNT PHARMACY FRANKLIN PHARMACY INC GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE SJHC AMBULATORY PHARMACY CLEVELAND CLINIC SO PTE HSP UNIVERSITY HSP HOME CARE SVCS FAYETTE PHARMACY

(330) 405-0501 (740) 922-5400 (330) 899-0406 (330) 899-8600 (419) 294-1916 (937) 653-3914 (937) 653-3914 (740) 892-2971 (216) 957-4750 (330) 936-9189 (937) 898-5803 (937) 898-3221 (937) 526-3337 (330) 856-3429 (740) 678-2384 (330) 335-2595 (513) 221-7000 (419) 738-5959 (330) 469-6421 (234) 806-3137 (330) 369-4567 (330) 306-9008 (330) 399-6451 (330) 980-7037 (330) 841-4559 (216) 491-7165 (216) 765-2785 (740) 335-9900

10735 RAVENNA RD STE J 240 E 3RD ST 4016 MASSILLON RD STE B 1790 GRAYBILL RD STE 150 136 N SANDUSKY AVE 823 SCIOTO ST 821 SCIOTO ST 244 N MAIN ST 9885 ROCKSIDE RD STE 157 1166 S SHANNON STREET 535 S DIXIE DR 330 E NATIONAL RD 42 W MAIN ST 347 YOUNGSTOWN KINGSVILLE RD S 8465 SR 339 120 HIGH ST 1501 MADISON RD 1302 DEFIANCE ST 8600 E MARKET ST STE 9 4299 MAHONING AVE NW 1732 YOUNGSTOWN RD SE 552 NORTH PARK AVENUE STE P 150 E MARKET ST STE 100 1977 NILES RD SE 667 EASTLAND AVE SE 4110 WARRENSVILLE CENTER RD 4510 RICHMOND RD 1122 COLUMBUS AVE

TWINSBURG UHRICHSVILLE UNIONTOWN UNIONTOWN UPPER SANDUSKY URBANA URBANA UTICA VALLEY VIEW VAN WERT VANDALIA VANDALIA VERSAILLES VIENNA VINCENT WADSWORTH WALNUT HILLS WAPAKONETA WARREN WARREN WARREN WARREN WARREN WARREN WARREN WARRENSVILLE HT WARRENSVILLE HT WASHINGTON COURT HOUSE

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

44087-3107 44683-1821 44685-7867 44685-7992 43351-1254 43078 43078-2223 43080-9501 44125 45891-2481 45377-2557 45377-2306 45380-1214 44473-9601 45784 44281-1855 45206-1706 45895-1081 44484-2375 44483-1928 44484-4254 44481 44481-1141 44484-5118 44484-4503 44122-7024 44128 43160-1653

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 494 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ADENA PIKE PHARMACY FRUTH PHARMACY FRUTH PHARMACY WELLNESS1 PHARMACY WELLNESS1 PHCY WEST CARROLLTON BIOMED SPECIALTY PHARMACY-CT COMPLETE PHARMACY SOLUTIONS GROUP HEALTH PHARMACY SIMPLICITYRX WEST CHESTER HOSP OP PHCY HAPPY DRUGGIST PHARMACY C & R PHARMACY OWL DRUGS GAHM'S PHARMACY II STAKERS DRUGS SOMC PHARMACY WEST UNION KLINGER PHARMACY DIAMOND PHARMACY SERVICES GENOA-QOL HEALTHCARE MOUNT CARMEL PHARMACY

Provider Name

(740) 947-6320 (740) 947-5018 (740) 384-2174 (937) 384-7777 (937) 384-7777 (513) 847-1260 (513) 644-1600 (513) 346-5065 (513) 878-1285 (513) 298-7790 (740) 720-0039 (937) 650-3333 (937) 698-3292 (740) 858-5000 (740) 858-2228 (937) 544-8989 (419) 924-2444 (724) 599-1524 (614) 948-6040 (614) 865-8140

100 DAWN LN 101 JAMES RD 120 W 2ND ST 2092 S ALEX RD 2092 S ALEX STE A 7731 COX LN 9874 WINDISCH RD 8040 PRINCETON GLENDALE RD 10160 INTERNATIONAL BLVD 7626 UNIVERSITY DR STE 100 487 W MAIN ST 204 N DETROIT STREET 1165 S MIAMI ST 1565 GALENA PIKE 2339 GALENA PIKE 90 CIC BLVD 102 W JACKSON 975 EASTWIND DR STE 115 700 BROOKSEDGE BLVD STE 100 500 S CLEVELAND AVE # 1L1003

WAVERLY WAVERLY WELLSTON WEST CARROLLTON WEST CARROLLTON WEST CHESTER WEST CHESTER WEST CHESTER WEST CHESTER WEST CHESTER WEST JEFFERSON WEST LIBERTY WEST MILTON WEST PORTSMOUTH WEST PORTSMOUTH WEST UNION WEST UNITY WESTERVILLE WESTERVILLE WESTERVILLE

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH

45690-9138 45690-1017 45692-1435 45449 45449-2491 45069-6549 45069-3806 45069 45246-4846 45069-2509 43162-1178 43357 45383-1218 45663-6059 45663-6211 45693 43570 43081-3344 43081-2820 43081-8971

TWC PHARMACY AND WELLNESS CTR LLC UPTOWN PHARMACY INC ACCUSCRIPTS PHARMACY HALLMARK PHARMACY SOMC PHARMACY WHEELERSBURG STULTZ PHCY OF WHEELERSBURG WILLIAMSBURG FITZGERALD PHCY

(614) 414-7885 (614) 882-2392 (440) 250-5400 (740) 574-0202 (740) 574-8933 (606) 473-7346 (513) 724-7081

273A W SCHROCK RD 23 N STATE ST 24340 SPERRY DR 2ND FLOOR 8036 OHIO RIVER RD 8770 OHIO RIVER RD 8991 OHIO RIVER RD 305 W MAIN ST

WESTERVILLE WESTERVILLE WESTLAKE WHEELERSBURG WHEELERSBURG WHEELERSBURG WILLIAMSBURG

OH OH OH OH OH OH OH

43081-2874 43081-2113 44145-1565 45694-1621 45694-1918 45694 45176-1309

CLEVELAND CLINIC WILLOUGHBY HILLS LAKE HEALTH PHARMACY WEST SIGNATURE HEALTH INC PHARMACY MARCS MARCS KRATZERS PHARMACY WEST END PHARMACY ZEIGLER PHARMACY WINDHAM PHARMACY INC DIAMOND PHARMACY RIESBECKS PHCY MEDICINE SHOPPE

(440) 516-8620 (440) 602-6701 (440) 954-3333 (440) 943-3670 (440) 944-2801 (937) 382-0081 (937) 382-6717 (937) 382-0921 (330) 326-3851 (740) 264-6500 (740) 264-4237

2550 SOM CENTER RD 36000 EUCLID AVE 38882 MENTOR AVE 28121 CHARDON 29700 LAKE SHORE BLVD 179 W LOCUST ST 1150 W LOCUST ST STE 100 159 W MAIN ST 9650 E CENTER ST 503 CADIZ RD 100 MAIN ST

WILLOUGHBY WILLOUGHBY WILLOUGHBY WILLOUGHBY HILLS WILLOWICK WILMINGTON WILMINGTON WILMINGTON WINDHAM WINTERSVILLE WINTERSVILLE

OH OH OH OH OH OH OH OH OH OH OH

44094-9655 44094-4625 44094 44092 44095-4609 45177-2180 45177-2063 45177-2238 44288-1050 43953-4126 43953-3734

VALUE LEADER PHCY, MEDICINE SHOPPE

(740) 314-5321

200 LURAY DR STE B

WINTERVILLE

OH

43953

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 495 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BELLWOOD DRUGS PILLS 'N' PACKAGES GENOA-QOL HEALTHCARE RITZMAN PHARMACY RITZMAN PHARMACY WOOSTER COMMUNITY PHARMACY LINWORTHS PHARMACY OREILLY FAMILY PHARMACY

Provider Name

(740) 472-1991 (419) 849-2781 (330) 439-4664 (330) 202-9081 (330) 345-6905 (330) 202-5570 (614) 392-0960 (614) 865-2577

135 S MAIN ST 100 E MAIN ST 2285 BENDEN DR 235 W LIBERTY ST 3540 BURBANK RD 1761 BEALL AVE 2245 W DUBLIN GRANVILLE RD 1020 HIGH ST

WOODSFIELD WOODVILLE WOOSTER WOOSTER WOOSTER WOOSTER WORTHINGTON WORTHINGTON

OH OH OH OH OH OH OH OH

43793-1093 43469-1209 44691-2568 44691-4831 44691-9007 44691-2342 43085-3350 43085-4014

IHS PHARMACY AND WELLNESS CENTER

(937) 374-0899

100 N DETROIT ST

XENIA

OH

45385-2912

SUPER TOWN DRUGS OF YELLOW SPRINGS CORNERSBURG PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE LINCOLN KNOLLS PHARMACY SEHC AMBULATORY PHARMACY ST ELIZABETH HC CLINIC PHARMACY THE HOMETOWN PHARMACY THE HOMETOWN PHARMACY THE MEDICINE SHOPPE MVHC PHARMACY NORTHSIDE MAYSVILLE PHARMACY NORTHSIDE PAVILION PHARMACY NORTHSIDE PHARMACY NORTHSIDE PHARMACY FOREST AVE SHRIVERS PHARMACY ADA APOTHECARY ADA DOLLAR SAVER PHARMACY BROWN'S PHARMACY AND GIFTS DICUS THRIF-T-WISE PHARMACY DOCTORS PARK PHARMACY

(937) 767-1070 (330) 792-7654 (330) 743-0922 (330) 531-6029 (330) 744-3337 (330) 480-3804 (330) 480-8610 (330) 793-4555 (330) 629-7345 (330) 792-6585 (740) 868-8171 (740) 453-3700 (740) 454-4044 (740) 453-0508 (740) 454-6970 (740) 452-7685 (580) 332-2000 (580) 436-0900 (580) 279-1416 (580) 332-8888 (580) 332-5720

263 XENIA AVE 3307 CANFIELD RD 611 BELMONT AVE 726 WICK AVE 819 MCCARTNEY RD PARK AVE LOBBY 1044 BELMONT AV 1044 BELMONT AVE 3623 S MERIDIAN RD 1135 W WESTERN RESERVE RD 4405 MAHONING AVE 716 ADAIR AVE 15 MAYSVILLE AVENUE 945 BETHESDA DR 2899 BELL ST 751 FOREST AVE STE 204 406 BRIGHTON BLVD 1201 ARLINGTON 1601 N BROADWAY AVE 1800 ARLINGTON ST 312 W 12TH ST 1414 ARLINGTON ST STE 2000

YELLOW SPRINGS YOUNGSTOWN YOUNGSTOWN YOUNGSTOWN YOUNGSTOWN YOUNGSTOWN YOUNGSTOWN YOUNGSTOWN YOUNGSTOWN YOUNGSTOWN ZANESVILLE ZANESVILLE ZANESVILLE ZANESVILLE ZANESVILLE ZANESVILLE ADA ADA ADA ADA ADA

OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OH OK OK OK OK OK

45387-1832 44511-2811 44502-1037 44505-2827 44505-5047 44506 44504-1006 44511-2622 44514-3543 44515-1602 43701-2836 43701-0000 43701-0801 43701-1720 43701-2875 43701-4706 74820 74820-1403 74820-2813 74820-6406 74820-2643

MCCORTNEY FAMILY PHCY & CMPDING CTR SOVEREIGN PCY SLTNS & FNE GFTS ALLEN COMMUNITY PHARMACY BROADWAY PHARMACY BUNKER HILL UNITED DRUG CLINIC PHARMACY REXCO DISCOUNT DRUG HOLDER DRUG CLINIC PHARMACY

(580) 332-3344 (580) 421-8775 (580) 857-2492 (580) 477-0800 (580) 482-7530 (580) 482-6464 (580) 477-0381 (580) 327-3332 (405) 247-3081

711 E 9TH ST 1007 NORTH COUNTRY CLUB 200 EAST LEXINGTON 601 E BROADWAY ST 1610 N MAIN ST 205 S PARK LN STE 110 2101 N MAIN ST 513 BARNES AVE 1104 E CENTRAL BLVD STE A

ADA ADA ALLEN ALTUS ALTUS ALTUS ALTUS ALVA ANADARKO

OK OK OK OK OK OK OK OK OK

74820-3807 74820 74825 73521-5512 73521-2145 73521-5733 73521-1605 73717-2229 73005-4406

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 496 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LOVELL'S PHARMACY ANTLERS PHARMACY PRUETT'S CUT RATE PHARMACY APACHE DRUG HENRY ROBERTS EXPRESS PHARMACY HOMELAND PHARMACY MERCY PHARMACY ARDMORE REED FAMILY PHARMACY STEELE DRUG CO T & M PHARMACY TIGERT PHARMACY LLC RITTERS EXPRESS PHARMACY RX SHOPPE BOULEVARD PHARMACY EXPRESS RX OF BARTLESVILLE H & G HOME MEDICAL HOMELAND PHARMACY JANE PHILLIPS MEDCARE AMB PHCY LIMESTONE PHARMACY MEDICAL PARK CTR PHARMACY INC PYRAMID PHARMACY COMMUNITY PHARMACY KATHY'S PHARMACY & GIFTS LLC DON COODY PHARMACY DONS PHARMACY HOMELAND PHARMACY WESTERN OAKS PHARMACY MEDICAP PHARMACY PILL BOX PHARMACY REASOR'S PHARMACY HUTTON PHARMACY BLANCHARD DRUG & GIFT RED CROSS DRUG BOISE CITY FAMILY PHARMACY KEMP DRUG SUPER H PHARMACY BROKEN ARROW FAMILY DRUG BROKEN ARROW FAMILY DRUG NORTH CAREFIRST PHARMACY GENOA-QOL HEALTHCARE NEW SPRING PHARMACY LLC REASORS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (405) 247-3348 (580) 298-3377 (580) 298-5064 (580) 588-3639 (580) 226-2684 (580) 223-0143 (580) 220-6250 (580) 223-7636 (580) 223-3000 (580) 223-0671 (580) 223-1331 (580) 889-3353 (580) 889-3331 (918) 336-2140 (918) 876-4204 (918) 333-4848 (918) 336-9411 (918) 331-1540 (918) 331-0000 (918) 331-2525 (918) 335-2020 (580) 625-3646 (918) 267-4890 (405) 789-8921 (405) 789-2453 (405) 789-2596 (405) 789-6881 (918) 364-7222 (918) 366-2000 (918) 970-4919 (580) 363-2137 (405) 485-2112 (405) 485-9311 (580) 544-3441 (918) 367-3391 (918) 367-3328 (918) 451-3784 (918) 251-3784 (918) 994-1400 (918) 940-6783 (918) 251-6655 (918) 251-1295

Provider Street 602 W CENTRAL BLVD 810 EAST MAIN ST 906 E MAIN ST 116 E EVANS 1306 12TH AVE NW 205 N COMMERCE ST 1011 14TH AVE NW 814 W BROADWAY ST 907 GRAND AVE 423 12TH AVE NW 35C TIFFANY PLZ 702 S MISSISSIPPI AVE 1002 W 13TH ST 1117 E FRANK PHILLIPS BLVD 143 SE WASHINGTON BLVD 112 NE WASHINGTON BLVD 811 SE FRANK PHILLIPS BLVD 3500 E FRANK PHILLIPS BLVD 3803 NOWATA RD 3400 E FRANK PHILLIPS BLVD 2501 SE WASHINGTON 212 E 8TH ST 8054 HIGHWAY 16 STE 100 7530 NW 23RD ST 6801 NW 39TH EXPY 7101 NW 23RD ST 2703 N ROCKWELL AVE 15024 S MEMORIAL DR STE F 12800 S MEMORIAL DR STE A 11116 S MEMORIAL DR 119-121 NORTH MAIN STREET 1203 N COUNCIL RD # 76 301 NE 10TH STREET 318 W MAIN 215 N MAIN ST 201 E 7TH AVE 3359 S ELM PL 1030 E LANSING ST 2530 N. ELM PL. 8937 S GARNETT RD STE P 511 S ASPEN AVE 1100 E KENOSHA ST

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Provider City ANADARKO ANTLERS ANTLERS APACHE ARDMORE ARDMORE ARDMORE ARDMORE ARDMORE ARDMORE ARDMORE ATOKA ATOKA BARTLESVILLE BARTLESVILLE BARTLESVILLE BARTLESVILLE BARTLESVILLE BARTLESVILLE BARTLESVILLE BARTLESVILLE BEAVER BEGGS BETHANY BETHANY BETHANY BETHANY BIXBY BIXBY BIXBY BLACKWELL BLANCHARD BLANCHARD BOISE CITY BRISTOW BRISTOW BROKEN ARROW BROKEN ARROW BROKEN ARROW BROKEN ARROW BROKEN ARROW BROKEN ARROW

State

ZIP code

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

73005-3228 74523 74523-2808 73006-9998 73401-1285 73401-3906 73401-1828 73401-4527 73401-4346 73401-5729 73401-2534 74525-3324 74525-3435 74003 74006-2334 74006-1634 74003-4025 74006 74006 74006-2495 74006 73932-0000 74421-3126 73008-4942 73008-2512 73008-5159 73008-5246 74008-3700 74008 74008-2038 74631 73010-8000 73010 73933-0000 74010-2407 74010-2503 74012-7924 74012-2073 74012 74012-6004 74012 74012-2067

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name REASOR'S PHARMACY E. D. ALLEN'S PHARMACY PRUETTS FOOD PHARMACY SHERILLS PHARMACY SIMPSON PHARMACY MEDIC PHARMACY AND GIFTS WESTERN DRUG #6 ONESOURCE #11102 ONESOURCE HEROD DRUG LIBERTY DRUG CATOOSA FAMILY PHARMACY REASORS PHARMACY HITE DRUG CHECOTAH PHARMACY NICHOLS DOLLAR SAVER CHELSEA FAMILY PHARMACY SMITH DRUG CHEYENNE PROFESSIONAL DRUG CHICKASHA CLINIC PHARMACY, LLC GRAND CARE PHARMACY LIBERTY DRUG INC MATT'S COUNTRY BOY PHARMACY CHOUTEAU FAMILY PHARMACY BENNETT'S ROUTE 66 PHARMACY CLAREMORE COMPOUNDING J & J PHARMACY & GIFTS REASOR'S PHARMACY CLAYTON PHARMACY PALACE DRUG STORE S & D DRUG COMPANY SALISBURY PHARMACY WESTERN DRUG NUMBER 4 PALACE DRUG STORE COLLINSVILLE FAMILY PHARMACY THOMPSON'S PHARMACY CLINIC PHARMACY EVETTS DRUG INC CITY DRUG OF COWETA COUNTRY MART PHARMACY DRUG WAREHOUSE EXPRESS RX OF COWETA

NR_0009_10823 10/2017

Provider Phone Number (918) 455-8102 (580) 584-5841 (580) 584-6085 (580) 584-2171 (580) 584-2850 (580) 735-2161 (580) 735-2277 (580) 279-6001 (580) 279-6001 (580) 886-3444 (580) 654-1111 (918) 543-8777 (918) 266-8113 (405) 258-1218 (918) 473-3838 (918) 473-2304 (918) 789-2241 (580) 596-2411 (580) 497-3325 (405) 224-4851 (405) 222-2273 (405) 224-1204 (405) 390-3205 (918) 476-6455 (918) 342-8050 (918) 283-3784 (918) 341-1184 (918) 341-4557 (918) 569-4884 (918) 358-2524 (580) 323-2020 (580) 323-1244 (580) 323-1136 (580) 927-2064 (918) 371-2547 (580) 439-8869 (580) 832-3714 (580) 832-3388 (918) 486-2193 (918) 279-6600 (918) 486-8800 (918) 887-1040

Provider Street 3701 S ELM PL 619 S PARK DR 201 S PARK DR 101 MAIN ST 813 W CHOCTAW ST 506 N HOY 105 S HOY 124 BUFFALO ST 213 E MAIN ST STE 100 107 W MAIN 15 WEST MAIN 1755 N HIGHWAY 66 STE E 2500 N HIGHWAY 66 913 MANVEL AVE 1003 W GENTRY AVE 207 N BROADWAY ST 600 WALNUT ST 121 S GRAND AVE 413 BROADWAY 2224 W IOWA AVE 2103 W IOWA AVE 315 W CHICKASHA AVE 14890 SE 29TH ST STE 108 214 N CHOUTEAU AVE 700 N LYNN RIGGS BLVD 1151 N LYNN RIGGS BLVD 977 W WILL ROGERS BLVD 1000 W WILL ROGERS BLVD 102 LAWSON BLVD 301 N BROADWAY ST 915 FRISCO AVE 815 FRISCO AVE 200 S 30TH ST 104 W OHIO AVE 1205 W MAIN ST 513 HILLERY RD STE B 1213 N.GLENN ENGLISH 100 E 1ST ST 114 N BROADWAY 13937 S STATE HIGHWAY 51 14003 S STATE HIGHWAY 51 12071 S STATE HIGHWAY 51

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Provider City BROKEN ARROW BROKEN BOW BROKEN BOW BROKEN BOW BROKEN BOW BUFFALO BUFFALO CADDO CALERA CANTON CARNEGIE CATOOSA CATOOSA CHANDLER CHECOTAH CHECOTAH CHELSEA CHEROKEE CHEYENNE CHICKASHA CHICKASHA CHICKASHA CHOCTAW CHOUTEAU CLAREMORE CLAREMORE CLAREMORE CLAREMORE CLAYTON CLEVELAND CLINTON CLINTON CLINTON COALGATE COLLINSVILLE COMANCHE CORDELL CORDELL COWETA COWETA COWETA COWETA

State

ZIP code

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

74011-1804 74728-5331 74728-4737 74728-3973 74728-4525 73834 73834 74729-2606 74730-2102 73724-0000 73015 74015-2409 74015-2864 74834-3851 74426-2046 74426-2431 74016 73728-2028 73628 73018 73018-2737 73018-2652 73020-3516 74337 74017 74017-3068 74017-5040 74017-5419 74536 74020-3421 73601-3324 73601-3322 73601-3657 74538-2827 74021-3114 73529-1200 73632 73632-4810 74429-2600 74429-7118 74429-7100 74429-7136

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name KOWETA INDIAN HEALTH FACILITY DON'S DRUG BAKER PHARMACY INC CUSHING FAMILY PHARMACY CITY DRUG OF DAVIS OKLA INC SOONER PHARMACY OF DAVIS INC LASSITER DRUG POPKESS PHARMACY MURPHY DRUG BAKER EXPRESS PHARMACY HOMELAND PHARMACY R&S DRUG R&S DRUG R&S DRUG STAR MEDICAL CENTER PHARMACY CHOCTAW NATION HLTH SYST DURANT CORNER DRUG DURANT MEDICAL PHARMACY MEDICAL CENTER PHARMACY NICHOLS DOLLAR SAVER THE MEDICINE STORE APS PHARMACY BARRETT DRUG CENTER CLINIC PHARMACY CREST PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY HOSPITAL DISCOUNT PHARMACY INTEGRIS PHARMACY 4187 LIFE PHARMACY MERCY PHARMACY I-35 METRO PHARMACY RALPH'S FAMILY PHARMACY SHERRYS DISCOUNT DRUG SPRING CREEK PHARMACY THRIFTY PHARMACY EDMOND TV DISCOUNT DRUGS CANADIAN VALLEY PHARMACY RUKES DISCOUNT PHARMACY ELGIN DISCOUNT PHARMACY INC GRANDVIEW PHARMACY HOMELAND PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (918) 279-3200 (405) 969-3518 (918) 225-2200 (918) 225-5200 (580) 369-2831 (580) 369-3776 (405) 677-0549 (918) 534-2262 (918) 352-9301 (580) 255-3784 (580) 255-0228 (580) 255-6292 (580) 255-9648 (580) 252-0140 (580) 255-7165 (580) 920-2100 (580) 924-4444 (580) 920-1400 (580) 924-7425 (580) 924-2903 (800) 370-3784 (405) 844-6955 (405) 341-1504 (405) 341-8490 (405) 330-1089 (405) 330-7202 (405) 844-4404 (405) 348-1677 (405) 657-3900 (405) 562-4242 (405) 757-3395 (405) 513-8210 (405) 285-2600 (405) 341-1683 (405) 285-9082 (405) 715-4405 (405) 348-0220 (405) 262-4154 (405) 262-5590 (580) 492-5007 (580) 225-5550 (580) 225-7961

Provider Street 31870 E STATE HIGHWAY 51 101 N GRAND ST 1022 E CHERRY ST 200 S HIGHLAND AVE 218 E MAIN ST 705 E MAIN ST 3252 SE 29TH ST 524 E DON TYLER AVE 145 E BROADWAY ST 1842 N HIGHWAY 81 1401 BEECH 821 W MAIN ST 821 W MAIN ST, #201 1507 N HIGHWAY 81 2120 W ELK AVE RM 10 1801 CHUKKA HINA 1005 W MAIN ST 1028 CRISWELL BLVD STE 102 1026 RADIO RD 1231 N WASHINGTON AVE 311 N WASHINGTON AVE 1701 RENAISSANCE BLVD STE 120 410 W EDMOND RD 120 N BRYANT AVE STE A2 2200 W 15TH ST 24 E 33RD ST 1151 N BRYANT AVE 104 S BRYANT AVE 4833 INTEGRIS PKWY 1260 W COVELL RD SUITE 124 2017 W I35 FRONTAGE RD STE 120 125 E 3RD ST STE E 1101 NW 178TH ST STE A 220 S LITTLER AVE 1218 E 9TH ST STE 1 230 S SANTA FE AVE 1701 E 2ND ST 2005 PARKVIEW DR STE 3 108 S ROCK ISLAND AVE 7523 US HIGHWAY 277 2406 BELL AVE 412 W 3RD ST

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Provider City COWETA CRESCENT CUSHING CUSHING DAVIS DAVIS DEL CITY DEWEY DRUMRIGHT DUNCAN DUNCAN DUNCAN DUNCAN DUNCAN DUNCAN DURANT DURANT DURANT DURANT DURANT DURANT EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EDMOND EL RENO EL RENO ELGIN ELK CITY ELK CITY

State

ZIP code

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

74429-7900 73028-9091 74023-4102 74023-4117 73030-1904 73030-1913 73115-1606 74029-2518 74030-3801 73533-1414 73533-0000 73533 73533 73533-1407 73533-1576 74701-2128 74701-5038 74701-2156 74701-2991 74701-2119 74701-3641 73013-3086 73003 73034-6300 73013 73013-4603 73034-3251 73034-6327 73034-8864 73003-3555 73013-8504 73034-3822 73012-4281 73034-3856 73034-5796 73003 73034-6387 73036-2145 73036-2733 73538-2161 73644-2262 73644-5202

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KEYES' COMPOUNDING PAUL JONES DRUG UNITED PHARMACY EVANS EXPRESS PHARMACY EVANS PHARMACY LLC FAMILY PHARMACY FAMILY PHARMACY FAMILY PHARMACY INTEGRIS PHARMACY 4173 RICKS PHARMACY SCHEFFE PRESCRIPTION SHOP SCHEFFE PRESCRIPTION SHOP WEST

Provider Name

(580) 225-5273 (580) 225-3263 (580) 225-1600 (580) 233-1202 (580) 234-4343 (580) 233-4244 (580) 237-3801 (580) 234-7700 (580) 213-3442 (580) 237-1535 (580) 233-2152 (580) 242-3784

2103 S MAIN ST STE K 105 N MAIN ST 2700 W 3RD ST 110 N OAKWOOD RD 1106 W WILLOW RD 915 E OWEN K GARRIOTT RD 221 S 30TH ST 2311 W WILLOW 600 S MONROE ST STE 1A 811 W RANDOLPH 127 E RANDOLPH 1925 W OWEN K GARRIOTT RD

ELK CITY ELK CITY ELK CITY ENID ENID ENID ENID ENID ENID ENID ENID ENID

OK OK OK OK OK OK OK OK OK OK OK OK

73644-9166 73644-4751 73644-4320 73703-4946 73703-2503 73701-6156 73701-6455 73703-2433 73701-7211 73701 73701-4103 73703-5528

EUFAULA INDIAN HEALTH CENTER PHCY EUFAULA PHARMACY LAKESIDE PHARMACY FAIRVIEW PHARMACY KIDD DRUG CO INC OLIVER'S EXPRESS PHARMACY HARPS PHARMACY SCOTTS VALU-MED PHARMACY FREDERICK PHARMACY INC CURTIN DRUG MEDICAP PHARMACY GORE GREEN COUNTRY DRUG INC FIKES PHARMACY GRANITE DRUG GROVE DRIVE-IN PHARMACY RX SHOPPE CORNWELL PHARMACY SPOONFUL PHARMACY TV DISCOUNT DBA MARKS DRUG CLINIC PHARMACY PARKVIEW PHARMACY UNITED DISCOUNT DRUG ALLCARE PHARMACY & GIFTS BESTYET HEALTHMART PHARMACY HARRAH PHARMACY CAL DRUG LLC BEAN PHARMACY GREEN'S PRESCRIPTION CENTER HERITAGE PHARMACY II

(918) 689-2547 (918) 689-7701 (918) 689-9940 (580) 227-2045 (580) 227-4529 (580) 227-4000 (918) 478-3784 (918) 478-3002 (580) 335-5501 (918) 528-6000 (918) 322-3667 (918) 489-5558 (580) 479-5696 (580) 535-2130 (918) 786-2268 (918) 786-1092 (405) 282-7800 (405) 282-0661 (405) 282-2700 (580) 338-3339 (580) 338-7565 (580) 338-8421 (405) 391-7433 (405) 454-6261 (405) 454-2476 (918) 297-7283 (580) 229-1141 (918) 653-4803 (405) 853-7200

800 W FORREST AVE 401 S MAIN ST 605 N MAIN ST 210 E STATE RD 104 N MAIN ST 820 E STATE RD 1010 E POPLAR ST 1201 S LEE ST 1600 N MAIN ST 13101 S ELWOOD AVE STE B 262 E 141ST ST 305 N MAIN 101 E 2ND ST 316 MAIN ST 1027 S MAIN ST 901 S MAIN ST 102 WEST NOBLE 105 E INDUSTRIAL STE B 112 W OKLAHOMA AVE 1210 N LELIA ST 115 MEDICAL DR 1902 N ACADEMY 20916 SE 29TH ST 19671 NE 23RD ST 2060 N CHURCH AVE 401 HIGHWAY 270 11103 HIGHWAY 76 115 E AVENUE C 529 N MAIN

EUFAULA EUFAULA EUFAULA FAIRVIEW FAIRVIEW FAIRVIEW FORT GIBSON FORT GIBSON FREDERICK GLENPOOL GLENPOOL GORE GRANDFIELD GRANITE GROVE GROVE GUTHRIE GUTHRIE GUTHRIE GUYMON GUYMON GUYMON HARRAH HARRAH HARRAH HARTSHORNE HEALDTON HEAVENER HENNESSEY

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

74432-3249 74432-3251 74432-1634 73737-1326 73737-1621 73737-2601 74434-8289 74434-8757 73542-1419 74033-2302 74033-3583 74435-0000 73546-9799 73547-0158 74344-2865 74344-2845 73044 73044-3132 73044-3130 73942-3647 73942-3606 73942 73045-6439 73045-9305 73045-0247 74547-2831 73438 74937-2603 73742-1033

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 500 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name LAPORTE PHARMACY HENRYETTA DRUG HOMELAND PHARMACY HINTON PHARMACY GRINNELL PRESCRIPTION SHOP NICHOLS DOLLAR SAVER CLINIC PHARMACY HOMINY DRUG AND GIFT, LLC CITY DRUG HUGO EXPRESS PHARMACY HUGO FAMILY PHARMACY NEOHEALTH HULBERT PHARMACY DEER CREEK FREDS PHARMACY PALACE DRUG INOLA DRUG SAM HIDER HEALTH CTR PHCY V & V DRUG REASOR'S PHARMACY JONES DRUG STORE KANSAS PHARMACY DENNIS EXPRESS PHARMACY HERITAGE PHARMACY MEDIC PHARMACY AND GIFTS KINGSTON PHARMACY CENTRAL OK FAMILY MED CTR MEDIC DRUG AND GIFTS ANDERSON PHARMACY AND ACCENTS EASTSIDE PHARMACY GREAT PLAINS PHARMACY KEN'S RX DISCOUNT PHARMACY LAWTON HERITAGE PHARMACY SHERIDAN EXPRESS PHARMACY WEST END DRUG LEEDEY DRUG WILLIAMS PHARMACY TABORS DRUG STORE BLACK DRUG INC CORNER DRUG PHARMACY PLUS INC BRATTON DRUG PUCKETT DISCOUNT DRUG

NR_0009_10823 10/2017

Provider Phone Number (405) 853-2557 (918) 652-3361 (918) 652-2553 (405) 542-6222 (580) 726-2206 (405) 379-3381 (580) 688-2247 (918) 885-2715 (580) 326-3301 (580) 326-1600 (580) 326-8337 (918) 772-2727 (405) 663-4111 (580) 208-2400 (580) 286-2190 (918) 543-8777 (918) 253-1780 (918) 253-4519 (918) 299-2684 (405) 399-2277 (918) 543-8777 (405) 375-5400 (405) 375-6300 (405) 375-3202 (580) 564-2337 (580) 925-8911 (580) 921-3373 (580) 595-9500 (580) 355-6400 (580) 585-5401 (580) 353-4113 (580) 354-9860 (580) 248-0300 (580) 536-1133 (580) 488-3393 (405) 527-5682 (405) 756-4511 (918) 479-5223 (580) 795-3376 (580) 795-7322 (580) 782-2195 (580) 782-2131

Provider Street 103 S MAIN 623 W MAIN ST 310 W TRUDGEON ST 401 N BROADWAY 304 S BROADWAY AVE 203 E HIGHWAY ST 509 E CHESTNUT ST 104 W MAIN ST 116 E DUKE ST 1200 E JACKSON ST 420 E JACKSON ST 131 E MAIN ST 510 N ARAPAHO AVE STE 102 1106 SE WASHINGTON ST 1200 LINCOLN RD 19 W COMMERCIAL 859 E MELTON DR 453 S MAIN 446 S ELM ST 101 W MAIN ST 1119 E TULSA AVE 1308 S MAIN ST 1309 S MAIN ST 119 W ADMIRE AVE 7 N MAIN ST 527 W 3RD ST 102 W JANE JAYROE 5366 NW CACHE RD STE 1 3612 SE LEE BLVD 3201 W GORE BLVD 802 W GORE BLVD 12 NW SHERIDAN 205 SW SHERIDAN RD 7210 NW CACHE RD 421 SOUTH MAIN 700 E BROADWAY 225 S MAIN ST 412 E MAIN ST 100 E MAIN ST 211 S 1ST ST 109 S OKLAHOMA 101 N LOUIS TITTLE AVE

Page 501 of 679

Provider City HENNESSEY HENRYETTA HENRYETTA HINTON HOBART HOLDENVILLE HOLLIS HOMINY HUGO HUGO HUGO HULBERT HYDRO IDABEL IDABEL INOLA JAY JAY JENKS JONES KANSAS KINGFISHER KINGFISHER KINGFISHER KINGSTON KONAWA LAVERNE LAWTON LAWTON LAWTON LAWTON LAWTON LAWTON LAWTON LEEDEY LEXINGTON LINDSAY LOCUST GROVE MADILL MADILL MANGUM MANGUM

State

ZIP code

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

73742-0216 74437-4245 74437-4026 73047 73651-1846 74848-4011 73550-2031 74035-1032 74743-4033 74743-4230 74743-4021 74441-8901 73048-8702 74745 74745-7358 74036-0000 74346-2704 74346-3834 74037-3704 73049-7586 74347 73750-4408 73750-4402 73750-2609 73439 74849-1415 73848-0000 73505-3353 73501-8451 73505-6378 73501-3719 73505 73505-1518 73505-2712 73654 73051-9067 73052-5633 74352-5117 73446-2239 73446-3401 73554-4219 73554-4420

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

UNITED PHARMACY OF MANGUM CENTER PHARMACY MARIETTA PHARMACY MARLOW MEDICINE NEWBERRY EXPRESS PHARMACY JACK'S RX COUNTRY MART PHARMACY THE MEDICINE SHOPPE WOODS PHARMACY MCLOUD CLINIC PHARMACY HUGHES PHARMACY EXPRESS RX OF MIAMI OSBORN DRUGS MARKS PRESCRIPTION SHOP VALU-MED PHARMACY WILSON PHARMACY LEONS MEDICAL CLINIC PHARMACY MOORE RX WESTERN DRUG THE APOTHECARY JERRYS PHARMACY BROADWAY CORNER DRUG MULDROW PHARMACY ECONOMY DISCOUNT PHARMACY ECONOMY PHARMACY

Provider Name

(580) 782-5400 (918) 865-2164 (580) 276-5555 (580) 658-6060 (580) 658-5428 (405) 867-4427 (918) 423-2980 (918) 426-5223 (918) 423-4333 (405) 964-3956 (580) 395-3116 (918) 542-4795 (918) 542-4444 (405) 737-3451 (405) 741-1200 (405) 737-3464 (405) 794-3565 (405) 735-5101 (580) 994-5988 (918) 827-6301 (580) 347-2519 (918) 427-1985 (918) 427-3243 (918) 682-7765 (918) 682-2418

1000 N LOUIS TITTLE AVE 124 COONROD AVE 300 S HWY 77 129 N BROADWAY ST 801 S BROADWAY ST 500 WILLIAMS ST 601 E WYANDOTTE AVE 622 E WYANDOTTE AVE 7 E CHICKASAW AVE 704 S 8TH STREET STE B 107 E CHEROKEE STREET 1910 N MAIN ST 11 W CENTRAL AVE 7201 E RENO AVE 1212A S DOUGLAS BLVD 911 S AIR DEPOT BLVD 322 N SERVICE RD 2018 S I-35 SERVICE RD 417 SW 7TH STE 2 1419 COMMERCIAL AVE 221 MAIN ST 101 E SHAWNTEL SMITH BLVD 710 E SHAWNTEL SMITH BLVD 3414 W OKMULGEE 412 N YORK

MANGUM MANNFORD MARIETTA MARLOW MARLOW MAYSVILLE MCALESTER MCALESTER MCALESTER MCLOUD MEDFORD MIAMI MIAMI MIDWEST CITY MIDWEST CITY MIDWEST CITY MOORE MOORE MOORELAND MOUNDS MOUNTAIN VIEW MULDROW MULDROW MUSKOGEE MUSKOGEE

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

73554-2210 74044 73448-2206 73055-2433 73055-3433 73057 74501-5425 74501-5426 74501-5328 74851 73759 74354-2132 74354-6815 73110-4446 73130-5213 73110-4836 73160-4945 73129 73852 74047 73062-0000 74948-4415 74948-4830 74401-5071 74403-3960

ERNIES PHARMACY AND WELLNESS CTR IN GADDY'S DISCOUNT DRUG THREE RIVERS HLTH CTR PHCY MUSTANG DRUG KANZA PHARMACY NEWKIRK PHARMACY NOBLE PHARMACY

(918) 683-0611 (918) 682-5584 (918) 781-6575 (405) 256-0555 (580) 362-2449 (580) 362-2556 (405) 872-5335

410 S 32ND ST 1126 W BROADWAY ST 1001 S 41ST ST E 103 E STATE HIGHWAY 152 3151 E RIVER RD 716 S HIGHWAY 77 SUITE A 125 S MAIN

MUSKOGEE MUSKOGEE MUSKOGEE MUSTANG NEWKIRK NEWKIRK NOBLE

OK OK OK OK OK OK OK

74401-5007 74401-6246 74403-6253 73064-4406 74647-5525 74647 73068-9573

ABSENTEE SHAWNEE TRIBAL CLINIC PHCY CENTRAL PHARMACY CREST PHARMACY DAVE'S HEALTHMART PHARMACY INC. DOCTORS PARK PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY

(405) 292-9530 (405) 321-2838 (405) 330-1089 (405) 360-8882 (405) 364-5020 (405) 364-3900 (405) 360-9701 (405) 447-0041

15951 LITTLE AXE DRIVE 222 ALAMEDA ST 2550 MOUNT WILLIAMS DR. 329 N PORTER AVE 500 E ROBINSON ST SUITE 200 1724 W LINDSEY ST 2600 W ROBINSON ST 1251 ALAMEDA ST

NORMAN NORMAN NORMAN NORMAN NORMAN NORMAN NORMAN NORMAN

OK OK OK OK OK OK OK OK

73026 73069-6001 73069-9300 73071-5838 73071-6648 73069-4306 73069-6359 73071-3006

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 502 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PHYSICIANS & SURGEONS PHARMACY SOONER DISCOUNT PHARMACY SOVEREIGN PHARMACY SOLUTIONS THUNDER DISCOUNT DRUG CITY DRUG INC REIDS PHARMACY COOWEESCOOWEE HLTH CLINIC PHCY KRITTENBRINK PHARMACY LUCKIE DRUG

Provider Name

(405) 364-5222 (405) 329-6001 (405) 322-6868 (405) 212-3177 (918) 273-3825 (918) 273-0433 (918) 535-6061 (405) 263-4433 (580) 822-3789

900 N PORTER AVE STE 101 1811 W LINDSEY ST 2080 W STATE HWY 9 2296 W MAIN ST 128 E CHEROKEE AVE 206 S ASH ST 395200 WEST 2900 ROAD 315 W KANSAS AVE 116 N MAIN ST

NORMAN NORMAN NORMAN NORMAN NOWATA NOWATA OCHELATA OKARCHE OKEENE

OK OK OK OK OK OK OK OK OK

73071-6426 73069-4101 73072-9795 73069-6462 74048-2702 74048-4627 74051 73762-0405 73763-9401

OKEMAH COMMUNITY CLINI PHARMACY OKEMAH PHARMACY SOONER DRUG 23RD STREET PHARMACY

(918) 623-1424 (918) 623-2510 (918) 623-1771 (405) 602-6442

309 N 14TH ST 106 S WOODY GUTHRIE ST 324 W BROADWAY ST 2316 NW 23RD ST

OKEMAH OKEMAH OKEMAH OKLAHOMA CITY

OK OK OK OK

74859-2028 74859-4047 74859-2608 73107-2406

AFFORDABLE PHCY HEALTH FOOD STORE ASBURY PHARMACY ASPCARES BEACHLERS PHARMACY BOB'S PHARMACY BUY FOR LESS PHARMACY BUY FOR LESS PHARMACY CHRIS' EXPRESS DRUG COMFORT CARE PHARMACY CREATIVE CARE PHARMACY CREST RX DRUG CREST RX LLC EXCHANGE PHARMACY FAMILY HEALTH CENTER PHARMACY FAMILY MEDICINE PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY HOMELAND PHARMACY INTEGRIS PHARMACY INTEGRIS PHARMACY 4176 INTEGRIS PHARMACY 4177 INTEGRIS PHARMACY 4188 INTEGRIS PHARMACY 4190 JIM'S COMMUNITY PHARMACY

(405) 636-4091 (405) 843-6691 (405) 607-3995 (405) 262-3212 (405) 631-8174 (405) 946-6386 (405) 737-8100 (405) 735-3950 (405) 619-3736 (405) 562-1800 (405) 737-5681 (405) 378-7171 (405) 235-4242 (405) 692-3370 (405) 271-2333 (405) 524-7741 (405) 672-2180 (405) 682-6191 (405) 751-7119 (405) 720-9303 (405) 691-3604 (405) 945-4403 (405) 945-4403 (405) 231-0400 (405) 773-2300 (405) 945-4403 (405) 605-0346

2636 SW 28TH ST 3401 N MAY 3405 NW EXPRESSWAY 390 NE 36 ST 210 SW 89TH ST STE F 3501 NW EXPRESSWAY ST 10011 SE 15TH ST 851 SW 119TH ST 3252 SE 29TH ST 14101 N. EASTERN AVE. SUITE A 249 N DOUGLAS BLVD # 73140 10601 S MAY AVE 2300 EXCHANGE AVE 10021 S WESTERN AVE 900 NE 10TH ST # 1101 1108 NW 18TH ST 4129 SE 29TH ST 4301 S MAY AVE 9225 N MAY AVE 7001 NW 122ND ST 10700 S PENNSYLVANIA AVE 4221 S WESTERN AVE STE 1020 3300 NW EXPRSWY STE 1D1191 4401 S WESTERN AVE STE 1F181 5915 W MEMORIAL RD STE 110 3433 NW 56TH ST STE 140B 908 STRAKA TER

OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

73108 73112 73112 73105 73139-8514 73112-4469 73130-5625 73170-6005 73115-1606 73013 73130-3309 73170 73108-2436 73139-2927 73104-5420 73106-6002 73115-2643 73119-3275 73120-4453 73142-3924 73170-4206 73109-3448 73112 73109 73142-2015 73112-4430 73139-2534

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 503 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JIM'S TOWER PHARMACY MCBRIDE ORTHOPEDIC HOSP PHCY MEDIC PHARMACY- HEFNER POINTE MERCY PHARMACY MERCY SPECIALTY PHARMACY OK CITY NICHOLS HILLS DRUG NORTHCARE PHARMACY OKEY PHARMACY, LLC

Provider Name

(405) 631-9625 (405) 486-2184 (405) 755-3921 (405) 752-3590 (405) 486-8727 (405) 843-9501 (405) 858-1780 (405) 604-9085

1044 SW 44TH ST STE 103 9600 BROADWAY EXT 11101 HEFNER POINTE DR STE 101 4200 W MEMORIAL RD STE 106 4401 MCAULEY BLVD STE 1700 7538 BERKLEY AVENUE 2617 GENERAL PERSHING BLVD 1515 N CLASSEN BLVD STE 101

OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY

OK OK OK OK OK OK OK OK

73109-3609 73114-7408 73120-5054 73120-8305 73120 73116 73107 73106-6611

OMNICARE CLINICAL INTERVENTION CTR OPTION CARE OPTIONONE OU CHILDREN'S PHARMACY OU PHARMACISTS CARE CENTER PPM PHARMACY PREFERRED RX PHARMACY PRIME RX PHARMACY LLC RELIABLE DISCOUNT PHARMACY REMEDI SENIORCARE OF OKLAHOMA R-X PRESCRIPTION SHOP SPECIALTY PHARMACY ST ANTHONY PHARMACY EAST ST. ANTHONY MIDTOWN PHARMACY STEPHENSON SPECIALTY PHARMACY THRIFTY PHARMACY UNITED DISCOUNT PHARMACY VARIETY CARE PHARMACY VARIETY CARE PHARMACY WESTMINSTER FAMILY DRUG WHEELER & STUCKEY RX PHARMACY WINDSOR PARK PHCY OF OK M & D STAR DRUG COMPANY OKMULGEE DISCOUNT PHARMACY OKMULGEE INDIAN HEALTH CENTER TRUMMELS DRUG STORE MEDICAP PHARMACY OWASSO DRUG REASORS PHARMACY REASOR'S PHARMACY HOMELAND PHARMACY LEGACY DRUG REAVIS DRUG

(800) 940-9963 (405) 789-1600 (405) 548-4848 (405) 271-2156 (405) 271-6446 (405) 604-6861 (405) 609-1911 (405) 632-0519 (405) 681-6631 (877) 927-8713 (405) 634-1415 (405) 749-0600 (405) 772-4034 (405) 815-5655 (405) 271-2604 (405) 751-2852 (405) 947-6828 (405) 605-0316 (405) 629-5281 (405) 769-8585 (405) 232-0241 (405) 702-4747 (918) 756-1322 (918) 756-1223 (918) 756-0206 (918) 443-2414 (918) 274-1737 (918) 272-2881 (918) 371-6455 (918) 272-3030 (405) 238-7505 (405) 238-3305 (405) 238-7391

4149 HIGHLINE BLVD STE 300 235 N MACARTHUR BLVD STE 1000 14000 N PORTLAND AVE STE 205 1200 N PHILLIPS AVE STE 2100 825 NE 10 NUMBER 2200 3300 NW 56TH ST STE 101 1111 N LEE AVE STE 105 1024 SW 44TH ST STE 700 5900 S PENNSYLVANIA AVE 4243 WILL ROGERS PKWY 6517 S WESTERN AVE 9402 N MAY AVE STE D 3400 S DOUGLAS BLVD STE 101 608 NW 9TH STE 3200 800 NE 10TH ST STE 3029 10904 N MAY AVE STE L 5420 N PORTLAND 5320 N PORTLAND AVE 1025 STRAKA TERRACE 10911 NE 23RD ST 1211 N SHARTEL AVE 2506 N MERIDIAN AVE 108 S MORTON AVE 1160 S BELMONT AVE 1313 E 20TH ST 459 S ELM ST 130 S MAIN ST 12802 E 86TH ST N 11550 N 135TH E AVE 11815 E 86TH ST N 505 S CHICKASAW ST 111 W GRANT 110 BURR AVE STE A

OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKLAHOMA CITY OKMULGEE OKMULGEE OKMULGEE OOLOGAH OWASSO OWASSO OWASSO OWASSO PAULS VALLEY PAULS VALLEY PAULS VALLEY

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

73108-2097 73127-6628 73134-4004 73104-4600 73104-5417 73112-4530 73103-2620 73109-3618 73119-7029 73108-2039 73139-1705 73120-2701 73150-1001 73102-1006 73104-5418 73120-6203 73112-2072 73112-2098 73139-2544 73141-6029 73103-2400 73107-1035 74447-5022 74447-6308 74447-6303 74053-3017 74055-3108 74055-2552 74055 74055-2536 73075-4601 73075-3257 73075-3848

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 504 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WAHZHAZHI HEALTH CENTER WEIGANTS PHARMACY PAWNEE HILLCREST PHARMACY PERKINS DRUG PERKINS FAMILY CLINIC FOSTER CORNER DRUG PERRY PHARMACY PIEDMONT PHARMACY AND GIFTS THE PHARMACY OF POCOLA FAMILY DISCOUNT PHARMACY O'CONNOR PHARMACY PYRAMID PHARMACY #68 TONI'S WESTSIDE REXALL DRUG BENZER PHARMACY D & D PHARMACY HOMETOWN DRUG COMPANY PRICE CUTTER PHARMACY BEACHLERS PHARMACY PRAGUE PHARMACY BEGGS PHARMACY ELLIOTT PLAZA PHARMACY THE CROSS PHARMACY TURNER DRUG UNITED DISCOUNT DRUG OF PURCEL MOORE DRUG JOHNNY'S HOMETOWN PHARMACY ROLAND PHARMACY RYAN DRUG STORE AMO SALINA HEALTH CENTER CLIF'S PHARMACY REDBIRD SMITH HEALTH CENTER SALLISAW PHARMACY REASOR'S PHARMACY SPOON DRUG SPOON DRUG INC TRIBEX LTC, LLC MED-WORLD PHARMACY PILL BOX PHARMACY REASOR'S PHARMACY SAPULPA DRIVE-IN PHARMACY SAPULPA INDIAN HEALTH CENTER CITY PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (918) 287-9373 (918) 287-1317 (918) 762-3666 (405) 547-2414 (405) 547-2473 (580) 336-2136 (580) 336-4474 (405) 373-3090 (918) 436-2900 (580) 762-6335 (580) 765-3055 (580) 762-7444 (580) 765-4456 (918) 647-2113 (918) 647-3137 (918) 647-2349 (918) 647-9531 (405) 567-4000 (405) 567-4322 (918) 825-3059 (918) 825-2225 (918) 824-1300 (405) 527-2107 (405) 527-5900 (580) 662-2366 (918) 427-0400 (918) 427-3219 (580) 757-2230 (918) 453-5603 (918) 776-0100 (918) 453-5603 (918) 775-4451 (918) 246-7202 (918) 245-7373 (918) 245-9693 (855) 444-5387 (918) 227-2010 (918) 512-6635 (918) 224-3600 (918) 224-6558 (918) 224-9310 (580) 928-3323

Provider Street 715 GRANDVIEW 714 KIHEKAH AVE 539 6TH ST 246 S MAIN ST 509 E HIGHWAY 33 328 N 6TH ST 800 FIR ST 97 GOODER SIMPSON BLVD 102 E FOLSOM BLVD 310 FAIRVIEW AVE 2701 N 14TH ST 2005 N 14TH ST STE 110 301 W GRAND AVE 219 DEWEY AVE 1940 N BROADWAY ST 307 N BROADWAY 2219 N BROADWAY ST 1000 W MAIN ST # NBU3301 1020 W MAIN 200 S ADAIR ST 510 S ELLIOTT ST 1101 NE 1ST ST 1300 N GREEN AVE 1602 N GREEN AVE 101 W MAIN 303 E RAY FINE BLVD 100 E RAY FINE BLVD 520 WASHINGTON 900 N OWEN WALTERS BLVD 505 E REDWOOD AVE 301 S J T STITES ST 1212A E CHEROKEE AVE 3825 S HIGHWAY 97 3801 S STATE HWY 97 540 PLAZA CT 207 W. 1ST ST. 14 S MISSION ST 1329 S MAIN ST UNIT C 132 W TAFT ST 1029 E CLEVELAND AVE 1125 E CLEVELAND AVE 414 E WASHINGTON AVE

Page 505 of 679

Provider City PAWHUSKA PAWHUSKA PAWNEE PERKINS PERKINS PERRY PERRY PIEDMONT POCOLA PONCA CITY PONCA CITY PONCA CITY PONCA CITY POTEAU POTEAU POTEAU POTEAU PRAGUE PRAGUE PRYOR PRYOR PRYOR PURCELL PURCELL RINGLING ROLAND ROLAND RYAN SALINA SALLISAW SALLISAW SALLISAW SAND SPRINGS SAND SPRINGS SAND SPRINGS SAND SPRINGS SAPULPA SAPULPA SAPULPA SAPULPA SAPULPA SAYRE

State

ZIP code

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

74056 74056-3206 74058-2542 74059-4371 74059-4129 73077-6607 73077-4239 73078-9215 74902-3150 74601 74601-1738 74601-1919 74601-5118 74953-4203 74953-2638 74953-3355 74953-2007 74864-4501 74864-0843 74361-5202 74361-6411 74361-4209 73080 73080-1626 73456-0000 74954 74954-5198 73565-9998 74365-5003 74955-3020 74955-9302 74955-5232 74063-3832 74063 74063-7915 74063 74066-4634 74066 74066-5433 74066-4516 74066-4641 73662-1354

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CLINIC PHARMACY SAYRE PROFESSIONAL PHARMACY BIVENS DRUG INC WESTERN DRUG HOMELAND PHARMACY SEMINOLE DRUG INC MEDIC DRUG AND GIFTS ERIC'S PHARMACY HARRISON DISCOUNT PHARMACY RICHARDS DRUG THE CLINIC PHARMACY THE MEDICINE SHOPPE KENDALL HEALTHMART SULLINS DRUGS HEADS PHARMACY HOOVER DRUG ALAN'S PHARMACY CENTRAL DRUG CHARLIES DISCOUNT DRUG,INC PYRAMID PHARMACY RAZOOK'S DRUG TIGER DRUG STILWELL PHARMACY WILMA P MANKILLER HEALTH CENTER BAYLESS DRUG COMPANY STROUD DRUG HOBBS PHARMACY LARRY'S PHARMACY SOONER PHARMACY OF OK LLC CHEROKEE HILLS PHARMACY REASORS PHARMACY TAHLEQUAH DRUG COMPANY LLC TAHLEQUAH MEDICAL CENTER PHCY W W HASTINGS HOSPITAL RX CHEROKEE NATION LAWSON PHARMACY RALPHS PHARMACY

Provider Name

(580) 928-3058 (580) 928-3633 (580) 922-4812 (580) 922-4403 (405) 382-1467 (405) 382-5420 (580) 938-2854 (405) 275-9640 (405) 273-9906 (405) 273-7810 (405) 273-9417 (405) 273-7360 (918) 396-2411 (918) 962-2131 (918) 967-8877 (918) 967-8321 (405) 372-3331 (405) 372-6120 (405) 624-3535 (405) 743-1080 (405) 377-4445 (405) 372-7900 (918) 696-2500 (918) 696-8800 (580) 759-3233 (918) 968-2323 (580) 622-3131 (580) 622-3131 (580) 622-2208 (918) 456-2531 (918) 456-6103 (918) 431-0555 (918) 456-0694 (918) 458-3100 (918) 772-4754 (918) 567-3111 (405) 598-3729

1601 WATTS ST 1505 WATTS ST 217 NORTH MAIN 908 NW HIGHWAY 270 STE A 1701 N MILT PHILLIPS AVE 1717 N MILT PHILLIPS AVE 522 S MAIN ST 3700 N KICKAPOO AVE STE 140 1442 N HARRISON AVE 324 E MAIN ST 3210 JD KETHLEY RD 1006 N HARRISON AVE 222 E ROGERS BLVD 213 W BROADWAY 501 NW H ST 1505 E MAIN ST 1721 W 6TH AVE 722 S MAIN ST 723 S WALNUT ST 421 N MAIN 1518 W 9TH AVE 825 S WALNUT ST 202 S 2ND ST RR 6 BOX 840 120 W MAIN 406 W MAIN ST 420 W BROADWAY AVE 1012 W 2ND ST 815 W BROADWAY AVE 1607 S MUSKOGEE AVE STE D 2001 S MUSKOGEE AVE 2028 MAHANEY AVE 1500 E DOWNING ST STE 106 100 S BLISS AVE 100 S BLISS AVE 301 2ND ST 211 N BROADWAY ST

SAYRE SAYRE SEILING SEILING SEMINOLE SEMINOLE SHATTUCK SHAWNEE SHAWNEE SHAWNEE SHAWNEE SHAWNEE SKIATOOK SPIRO STIGLER STIGLER STILLWATER STILLWATER STILLWATER STILLWATER STILLWATER STILLWATER STILWELL STILWELL STRATFORD STROUD SULPHUR SULPHUR SULPHUR TAHLEQUAH TAHLEQUAH TAHLEQUAH TAHLEQUAH TAHLEQUAH TAHLEQUAN TALIHINA TECUMSEH

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

73662-1314 73662-1312 73663 73663 74868-2333 74868-2333 73858-9604 74804-0007 74801-5208 74801-7012 74804 74801-6419 74070-1250 74959-2419 74462-1627 74462-2913 74074-4200 74074-4668 74074-4224 74075 74074-5468 74074-4226 74960-3806 74960-8703 74872 74079-3614 73086-4622 73086-4814 73086-4611 74464-5440 74464-5454 74464-5783 74464-3354 74464-2512 74464 74571-0000 74873-3227

TECUMSEH MEDICAL CLINIC PHARMACY THACKERVILLE PHARMACY

(405) 598-6597 (580) 276-5161

418 E WALNUT ST STE 100 11530 RIDGE RD STE 1

TECUMSEH THACKERVILLE

OK OK

74873-2201 73459-9623

UPTOWN GROCERY COMPANY PHARMACY

(405) 286-9932

9515 N MAY AVE

THE VILLAGE

OK

73120-2709

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 506 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THOMAS DRUG COMPANY FHCSO-PHARMACY GENE LAFITTE PHARMACY SOONER PHARMACY OF TISHOMINGO ACT PHARMACY LLC APOTHEKE RX BETHEL PHARMACY BOOMER SOLUTIONS OF TULSA CAREFIRST PHARMACY CENTRAL RX PHARMACY CF SOLUTIONS INC

Provider Name

(580) 661-3545 (580) 371-0203 (580) 371-2355 (580) 371-9509 (918) 493-1800 (918) 728-6420 (918) 505-9650 (866) 237-8217 (918) 940-6767 (918) 494-9291 (918) 610-0772

145 W BROADWAY AVE 610 E 24TH ST 140 E MAIN ST 101 S BYRD 7010 S YALE AVE STE 215 2516 E 15TH ST 205 E PINE ST # 7 5415 S 125TH EAST AVE STE 2016214 S SHERIDAN RD 6585 S YALE AVE STE 200 7471 E 46TH PL

THOMAS TISHOMINGO TISHOMINGO TISHOMINGO TULSA TULSA TULSA TULSA TULSA TULSA TULSA

OK OK OK OK OK OK OK OK OK OK OK

73669-8266 73460 73460-2838 73460 74136-5743 74104-4621 74106-4859 74146-6232 74133-4055 74136-8315 74145-6305

COMMUNITY HEALTH CONNECTION PHCY COUCH PHARMACY DRUG WAREHOUSE DRUG WAREHOUSE DRUG WAREHOUSE DRUG WAREHOUSE ECONOMY PHARMACY EXPRESS ECONOMY PHARMACY ST. FRANCIS FREELAND BROWN FREELAND BROWN PHARMACY GETMAN-APOTHECARY SHOPPE HARVARD FAMILY PHYSICIANS PHCY INSYNC RX MAY'S DRUG STORE OLYMPIA PHARMACY OMNI PHARMACY ONE STOP RX, LLC OU CLINIC PHARMACY PHARMACY & NUTRITION SHOPPE

(918) 710-4400 (918) 835-9577 (918) 833-5180 (918) 384-0260 (918) 492-3650 (918) 627-6464 (918) 615-3388 (918) 491-1004 (918) 986-8644 (918) 743-4491 (918) 742-1111 (918) 728-7654 (918) 582-7500 (918) 437-9677 (918) 513-3234 (918) 994-5555 (918) 528-3700 (918) 619-4990 (918) 286-5370

2321 E. 3RD ST 444 S SHERIDAN RD 6336 E 4TH PL 3063 S SHERIDAN RD 6505 E 71ST ST 5046 S SHERIDAN RD 10120 E 91ST SOUTH 6585 S YALE AVE STE 102 4227 SOUTHWEST BLVD 4112 S PEORIA AVE 1725 E 19TH ST STE 101-103 7912 E 31ST CT STE 130 1515 E 71ST ST STE 100 1150 S GARNETT RD 6802 S OLYMPIA AVE STE 125 8066 S MEMORIAL DR 10106 S SHERIDAN RD 4444 E 41ST ST 10109 E 79TH ST

TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

74104 74112-1734 74112-1727 74129-1017 74133-2755 74145-5714 74133-5830 74136 74107-6522 74105-4579 74104-5426 74145-1346 74136 74128-1822 74132-1830 74133-3644 74133 74135-2527 74133-4564

PLANNED PARENTHOOD PHARMACY INC PREFERRED PHARMACY PROFESSIONAL PHARMACY QUALITY CARE PHARMACY REASORS PHARMACY REASORS PHARMACY REASORS PHARMACY REASOR'S PHARMACY REASOR'S PHARMACY REASOR'S PHARMACY

(918) 858-4658 (918) 252-2000 (918) 748-7699 (918) 749-4200 (918) 747-6756 (918) 293-2256 (918) 481-0000 (918) 743-5782 (918) 748-8350 (918) 270-7060

1007 S PEORIA AVE 12331 E 60TH ST 1919 S WHEELING AVE STE 106 3414 S YALE AVE STE F 3915 S PEORIA 1885 S YALE AVE 7114 S SHERIDAN RD 3328 E 51ST ST 2429 E 15TH ST S 4909 E 41ST ST

TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA TULSA

OK OK OK OK OK OK OK OK OK OK

74120-4495 74146-6904 74104-5637 74135-8020 74105-3130 74112-6223 74133-2748 74135 74104-4618 74135-6057

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 507 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

REASOR'S PHARMACY RX CONCEPTS LLC SAINT FRANCIS ONCOLOGY PHARMACY

Provider Name

(918) 610-3245 (918) 392-3366 (918) 556-7125

11005 E 41ST ST 7302 S YALE AVE STE 101 11212 E 48TH ST

TULSA TULSA TULSA

OK OK OK

74146-2714 74136-7027 74146-5806

SAINT FRANCIS WARREN CL TOWER PHCY T ROY BARNES DRUGRY T ROY BARNES DRUGS THE APOTHECARY SHOPPE TULSA CANCER INSTITUTE PHCY WESTVIEW PHARMACY CEDAR SPRINGS PHARMACY PRUETTS FOOD PHARMACY VIAN PHARMACY WESTERN DRUG & IV LANGLEY DRUG OSBORN DRUGS REASOR'S PHARMACY V & V DRUG INC OWL DRUG ROGERS DRUG COMPANY COTTON COUNTY DRUG BUY FOR LESS PHARMACY CITY PHARMACY SWANNS PHARMACY ECK DRUG & GIFT INC EAGLE PHARMACY HEALTH EXPRESS PHARMACY MORE THAN MEDICINE WELEETKA DRUG WELLSTON CLINIC PHARMACY WESTVILLE PRESCRIPTION CENTER E CENTRAL OK FAM HEALTH CTR PHCY WETUMKA INDIAN HEALTH CENTER NORMAN DRUG ROBERTS DRUG STORE MAIN STREET DRUG ROY'S DISCOUNT PHARMACY MICKS FAMILY PHARMACY INC RANDY'S PHARMACY UNITED PHARMACY WESTERN DRUG BEARSKIN HEALTH CLINIC PHCY

(918) 488-6660 (918) 743-6623 (918) 622-3213 (918) 665-2003 (918) 505-3202 (918) 425-1385 (405) 381-4425 (580) 584-6085 (918) 773-8111 (580) 995-3500 (918) 782-3271 (918) 256-6459 (918) 782-9619 (918) 256-2541 (918) 485-2722 (918) 485-2317 (580) 875-6161 (405) 495-8283 (580) 623-4545 (580) 623-4626 (580) 228-2383 (580) 772-3300 (580) 774-1200 (580) 772-2781 (405) 786-2247 (405) 356-4199 (918) 723-5466 (405) 452-5400 (405) 452-1313 (405) 257-5461 (405) 257-3388 (918) 465-9300 (918) 465-0111 (580) 254-3504 (580) 256-6600 (580) 254-3411 (580) 256-5586 (918) 678-2282

6600 S YALE SUITE 110 3404 S YALE AVE 9757 E 31ST ST 6136 E 51ST ST 12697 E 51ST STREET SOUTH 3606 N CINCINNATI AVE 5310 E HIGHWAY 37 53 W WILSON ST 10 THORNTON ST 202 E BROADWAY 1631 N 3RD ST 207 W ILLINOIS AVE 1624 N 3RD ST 201 N SCRAPER ST 115 S MAIN ST 326 E CHEROKEE ST 619 E MISSOURI ST 3701 N MACARTHUR BLVD 101 N CLARENCE NASH BLVD 407 W MAIN ST 101 S MAIN ST 3741 LEGACY 1001 N WASHINGTON ST 101 W MAIN ST 309 W 9TH STREET 309 E 2ND ST 301 S WILLIAMS 109 S MAIN ST 325 S WASHITA ST 109 N WEWOKA AVE 309 S WEWOKA AVE 225 W MAIN ST 621 HIGHWAY 2 N 2116 OKLAHOMA AVE 1310 MAIN ST 2821 8TH ST 1003 17TH ST 1 TURTLE DR

TULSA TULSA TULSA TULSA TULSA TULSA TUTTLE VALLIANT VIAN VICI VINITA VINITA VINITA VINITA WAGONER WAGONER WALTERS WARR ACRES WATONGA WATONGA WAURIKA WEATHERFORD WEATHERFORD WEATHERFORD WELEETKA WELLSTON WESTVILLE WETUMKA WETUMKA WEWOKA WEWOKA WILBURTON WILBURTON WOODWARD WOODWARD WOODWARD WOODWARD WYANDOTTE

OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK OK

74136 74135-8016 74146-1222 74135-7704 74146 74106-1536 73089-8578 74764-9018 74962-0000 73859 74301-6694 74301-3129 74301-6695 74301-3209 74467-5220 74467-4706 73572-1605 73122-2003 73772-4250 73772-4233 73573-3053 73096-9746 73096-3256 73096-4939 74880-0727 74881-9496 74965 74883-4015 74883-5522 74884-2219 74884-2641 74578-4045 74578-3620 73801-4258 73801-3002 73801-6721 73801-3009 74370-2114

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 508 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CRESCENT DRUG DAVID'S PHARMACY YALE DRUG CONRAD-MARR DRUG HOMELAND PHARMACY INTEGRIS PHARMACY MILLER DRUG UNITED PHARMACY WEST POINTE PHARMACY BI-MART PHARMACY ELM STREET PHARMACY GEARY STREET CLINIC PHARMACY MEDICAP PHARMACY ASHLAND DRUG BI-MART PHARMACY COLUMBIA MEMORIAL HOSP OP PHCY PARAMOUNT DRUG BI-MART PHARMACY SAV-ON PHARMACY BANDON COMMUNITY PHARMACY BANKS PHARMACY BEAVERTON PHARMACY BI-MART PHARMACY BI-MART PHARMACY PHARMACA INTEGRATIVE PHARMACY BI-MART PHARMACY CASCADE CUSTOM PHARMACY OPTION CARE AT LEGACY HEALTH SAV-ON PHARMACY ST CHARLES COMMUNITY PHARMACY WESTSIDE PHARMACY GOOD SHEPHERD BOARDMAN PHCY BI-MART PHARMACY BROWNSVILLE PHARMACY DAVES PRESCRIPTION SHOP PARSONS CANBY PHARMACY INC GORDONS PHARMACY CAVES PHARMACY

Provider Name

(405) 665-4115 (405) 665-4225 (918) 387-4183 (405) 354-2582 (405) 354-7449 (405) 717-5330 (405) 373-1717 (405) 354-5233 (405) 256-6653 (541) 926-4491 (541) 812-5070 (541) 812-5544 (541) 924-9598 (541) 482-3366 (541) 482-8191 (503) 338-4559 (503) 325-4541 (541) 523-0607 (541) 523-2850 (541) 347-2724 (503) 324-5780 (503) 644-2101 (503) 626-4710 (503) 649-6562 (503) 596-3552 (541) 389-5610 (541) 389-3671 (541) 385-3254 (541) 382-1444 (541) 706-7731 (541) 323-3777 (541) 667-3647 (541) 813-1913 (541) 466-5112 (503) 266-2081 (503) 266-2233 (541) 839-4452 (541) 592-4560

116 S DEAN A MCGEE AVE 1300 E KERR BLVD 121 N MAIN ST 2600 N MUSTANG RD 2400 S CORNWELL DR 1205 HEALTH CTR PKWY STE 115 11101 SURREY HILLS BLVD 901 S CORNWELL DR 520 S MUSTANG RD 2272 SANTIAM HWY SE 1010 7TH AVE SW 1700 GEARY ST SE 1333 CLAY ST SE 275 E MAIN ST 2280 ASHLAND ST 2120 EXCHANGE ST STE 101 1319 COMMERCIAL ST 700 CAMPBELL ST 1120 CAMPBELL ST 1010 1ST ST SE 662 S MAIN ST 12250 SW CANYON RD 4750 SW WESTERN AVE 5975 SW 185TH AVE 240 NW LOST SPRINGS TER STE 36 351 NE 2ND ST 19550 SW AMBER MEADOW DR #170 2275 NE DOCTORS DR STE 10 61155 S HIGHWAY 97 2500 NE NEFF RD 359 SW CENTURY DR 220 S. MAIN 248 WHARF ST 411 N MAIN ST 911 SW 4TH AVE 294 NW 2ND AVE 314 S MAIN ST 143 REDWOOD HWY

WYNNEWOOD WYNNEWOOD YALE YUKON YUKON YUKON YUKON YUKON YUKON ALBANY ALBANY ALBANY ALBANY ASHLAND ASHLAND ASTORIA ASTORIA BAKER CITY BAKER CITY BANDON BANKS BEAVERTON BEAVERTON BEAVERTON BEAVERTON BEND BEND BEND BEND BEND BEND BOARDMAN BROOKINGS BROWNSVILLE CANBY CANBY CANYONVILLE CAVE JUNCTION

OK OK OK OK OK OK OK OK OK OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR

73098-7822 73098-1005 74085-2507 73099-1801 73099-5804 73099-6396 73099 73099-4552 73099-6737 97322-5205 97321-1922 97322-6842 97322-6868 97520-1832 97520-1406 97103-3366 97103-3915 97814-2212 97814-2220 97411 97106-9042 97005-2116 97005-3431 97078-4553 97229-6402 97701-5175 97702-3527 97701-6324 97702-2523 97701-6015 97702-1054 97818 97415-9653 97327-2147 97013-3832 97013-3624 97417-0000 97523-9336

SISKIYOU COMMUNITY HEALTH CENTER ALBERTSON'S PHARMACY BI-MART PHARMACY

(541) 592-2010 (541) 665-3766 (503) 558-8606

25647 REDWOOD HWY 1360 PLAZA BLVD 20000 SE HIGHWAY 212

CAVE JUNCTION CENTRAL POINT CLACKAMAS

OR OR OR

97523-9332 97502-2670 97015

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 509 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HI SCHOOL PHARMACY BI-MART PHARMACY BI-MART PHARMACY BI-MART PHARMACY CORVALLIS CLINIC PHARMACY RICES PHARMACY SAMARITAN PHARMACY SERVICES BI-MART PHARMACY BI-MART PHARMACY DALLAS PILL BOX OLIVE BRANCH PHARMACY HI SCHOOL PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY BI-MART PHARMACY BI-MART PHARMACY BI-MART PHARMACY BROADWAY APOTHECARY HIRONS DRUG HIRONS DRUG RIVER ROAD HEALTHMART PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SYNERGY RX UNIVERSITY OF OREGON BI-MART PHARMACY FLORENCE PHARMACY BI-MART PHARMACY CORNER DRUG & GIFTS GOLD HILL PHARMACY ASANTE THREE RIVERS PHARMACY BI-MART PHARMACY GRANTS PASS PHARMACY INC SAV-ON PHARMACY TRINITY VALLEY PHARMACY LLC BI-MART PHARMACY GENOA-QOL HEALTHCARE HARRISBURG PHARMACY BI-MART PHARMACY GOOD SHEPHERD CLINIC PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (503) 728-2102 (541) 269-9890 (541) 752-2468 (541) 758-3392 (541) 754-1284 (541) 752-7779 (541) 768-5225 (541) 942-9107 (541) 895-9810 (503) 623-2400 (541) 426-7455 (503) 630-3266 (541) 342-7893 (541) 688-6569 (541) 689-3965 (541) 687-7613 (541) 463-9559 (541) 342-5581 (541) 687-7620 (541) 684-9352 (541) 342-4995 (541) 344-5268 (541) 636-3522 (541) 485-9269 (541) 687-4241 (541) 342-4928 (541) 346-4454 (541) 997-3099 (541) 902-9966 (503) 357-2034 (541) 247-4544 (541) 855-1544 (541) 472-7420 (541) 479-8337 (541) 476-4262 (541) 471-7085 (541) 474-9475 (503) 661-3356 (503) 465-5849 (541) 995-9711 (541) 567-6850 (541) 667-3652

Provider Street 401 E COLUMBIA RIVER HWY 550 S 4TH ST 2045 NW 9TH ST 1555 SW 53RD ST 3680 NW SAMARITAN DR 910 NW KINGS BLVD 3521 NW SAMARITAN DR STE 102 100 GATEWAY BLVD 150 MELTON RD 625 SE MILLER AVE 306 W NORTH ST 207 S BROADWAY ST 311 COBURG RD 4740 ROYAL AVE 55 DIVISION AVE 2510 WILLAKENZIE RD 4780 ROYAL AVE 1680 W 18TH AVE 2030 RIVER RD 1515 OAK ST 185 E 18TH AVE 1950 FRANKLIN BLVD 884 RIVER RD 1675 W 18TH AVE 3075 HILYARD STREET 55 COBURG RD 1590 E 13TH AVE 4310 HIGHWAY 101 2935 HIGHWAY 101 3225 PACIFIC AVE 29670 ELLENSBURG AVE 808 2ND AVE 500 SW RAMSEY AVE 230 REDWOOD HWY 414 SW 6TH ST 1690 ALLEN CREEK ROAD 2001 NE FOOTHILL BLVD STE F3 2800 NE HOGAN DR 400 NE 7TH ST 230 N 3RD ST STE 106 200 S 1ST ST UNIT 1 600 NW 11TH ST STE E04

Page 510 of 679

Provider City CLATSKANIE COOS BAY CORVALLIS CORVALLIS CORVALLIS CORVALLIS CORVALLIS COTTAGE GROVE CRESWELL DALLAS ENTERPRISE ESTACADA EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE EUGENE FLORENCE FLORENCE FOREST GROVE GOLD BEACH GOLD HILL GRANTS PASS GRANTS PASS GRANTS PASS GRANTS PASS GRANTS PASS GRESHAM GRESHAM HARRISBURG HERMISTON HERMISTON

State

ZIP code

OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR

97016-2165 97420-1506 97330-1460 97333-2630 97330-3737 97330-2505 97330 97424-1741 97426-9453 97338-2634 97828-1041 97023 97401-6109 97402-1755 97404-5428 97401-4805 97402-1755 97402-3815 97404-2504 97401-4008 97401-4107 97403-2068 97404-3233 97402-3814 97405-3719 97401-2433 97403-1232 97439-8832 97439 97116-1912 97444-9721 97525-5502 97527-5554 97527-5404 97526-2810 97527-5559 97526-3947 97030-3100 97030-5604 97446-9679 97838-2386 97838-8602

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HERMISTON DRUG ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY HILLSBORO UNITED DRUGS PROVIDENCE TANASBOURNE PHCY THE MEDICINE SHOPPE ZOOMCARE PHARMACY HI SCHOOL PHARMACY LENS DRUG BI-MART PHARMACY BI-MART PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY SKY LAKES OUTPATIENT PHARMACY BI-MART PHARMACY RED CROSS DRUG STORE BI-MART PHARMACY DRUG MART PHARMACY SAV-ON PHARMACY HOWARD'S DRUGS BI-MART PHARMACY LEBANON PILL BOX

Provider Name

(541) 567-3072 (503) 591-0997 (503) 681-8640 (503) 640-3777 (503) 648-1811 (503) 216-9020 (503) 640-4433 (503) 941-3807 (503) 838-2195 (541) 575-0629 (541) 998-6498 (503) 371-6717 (541) 882-8863 (541) 882-7714 (541) 274-3499 (541) 963-9515 (541) 963-5741 (541) 536-5052 (541) 536-1111 (503) 635-0914 (541) 947-2141 (541) 258-8045 (541) 259-1225

114 E MAIN ST 7500 W BASELINE 888 NE 25TH AVE 2075 SE TUALATIN VALLEY HWY 243 E MAIN ST 18610 NW CORNELL RD STE 102 333 SE 7TH AVE STE 1500 19075 NW TANASBOURNE DR # 210 1357 MONMOUTH ST 120 E MAIN ST 110 E 6TH AVE 3862 RIVER RD N 5500 S 6TH ST 1920 WASHBURN WAY 2865 DAGGETT AVE 2510 ADAMS AVE 1123 ADAMS AVE 51670 S HUNTINGTON RD 51600 HUNTINGTON RD STE A 16199 BOONES FERRY RD 101 N F ST 2680 S SANTIAM HWY 185 S MAIN ST

HERMISTON HILLSBORO HILLSBORO HILLSBORO HILLSBORO HILLSBORO HILLSBORO HILLSBORO INDEPENDENCE JOHN DAY JUNCTION CITY KEIZER KLAMATH FALLS KLAMATH FALLS KLAMATH FALLS LA GRANDE LA GRANDE LA PINE LA PINE LAKE OSWEGO LAKEVIEW LEBANON LEBANON

OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR

97838-1838 97123 97124-5975 97123-5058 97123-4020 97124-9206 97123-4171 97124-5860 97351-1126 97845-1211 97448-1807 97303-4866 97603-5104 97603-4502 97601 97850-3467 97850-2692 97739-9626 97739-9626 97035-4201 97630-1529 97355-3054 97355-4223

SAMARITAN LEBANON COMM PHARMACY BI-MART PHARMACY

(541) 451-7119 (541) 994-6284

35 MULLINS DR STE 1 1030 SE OAR AVE

LEBANON LINCOLN CITY

OR OR

97355 97367

SAMARITAN NORTH LINCOLN HOSP PHCY BI-MART PHARMACY HOMETOWN DRUGS BI-MART PHARMACY MAC PRESCRIPTION SHOP MAC PRESCRIPTION SHOP AT PMC ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY BI-MART PHARMACY BLACK OAK PHARMACY LONE PINE DRUG PHARMBLUE OREGON LLC ROGUE COMMUNITY HEALTH PHCY ROGUE VALLEY RX

(541) 996-7378 (541) 475-1601 (541) 475-2142 (503) 472-8423 (503) 472-2146 (503) 472-2148 (541) 858-5078 (541) 770-7110 (541) 779-8016 (541) 772-3461 (541) 773-5356 (541) 776-0606 (541) 200-7135 (541) 842-7747 (541) 789-5850

3043 NE 28TH ST 1575 SW HIGHWAY 97 65 NE OAK ST STE 100 1635 S BAKER 225 NE 3RD ST 2435 NE CUMULUS AVE STE C 113 N ROSS LN 910 N PHOENIX RD 2687 W MAIN ST 990 BIDDLE RD 2924 SISKIYOU BLVD STE 102 3528 LONE PINE RD # 2 140 S HOLLY ST SUITE 1131 11 MYRTLE ST 2900 E BARNETT RD STE 1

LINCOLN CITY MADRAS MADRAS MCMINNVILLE MCMINNVILLE MCMINNVILLE MEDFORD MEDFORD MEDFORD MEDFORD MEDFORD MEDFORD MEDFORD MEDFORD MEDFORD

OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR

97367-4518 97741-9267 97741-1814 97128-6646 97128-4818 97128-8862 97501-2266 97504-9392 97501-2127 97504-6118 97504-8194 97504-5637 97501-3113 97504 97504-8309

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 511 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROUGE MANOR VALLEY PHARMACY WEST MAIN PHARMACY GENEVA WOODS PHARMACY BI-MART PHARMACY CUTTERS HI SCHOOL PHARMACY BI-MART PHARMACY MOUNT ANGEL DRUG SEMPERTS DRUG STORE BI-MART PHARMACY CENTER PHARMACY BI-MART PHARMACY WATERFALL COMMUNITY PHARMACY MALHEUR DRUG POSTAL PHARMACY BI-MART PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE BI-MART PHARMACY PHILOMATH FAMILY PHARMACY @PHARMACY.COM ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY

Provider Name

(541) 857-7777 (541) 772-2330 (503) 657-9422 (503) 829-4555 (503) 829-9111 (503) 838-1176 (503) 845-6133 (541) 572-5010 (503) 538-0691 (503) 538-0147 (541) 756-7561 (541) 756-6232 (541) 372-2222 (541) 782-2617 (541) 889-2188 (503) 657-3191 (503) 657-3187 (503) 557-3051 (971) 204-8424 (541) 276-7909 (541) 929-2880 (503) 384-2475 (503) 284-7268 (503) 246-2842 (503) 667-9878

1200 MIRA MAR AVE 2355 WEST MAIN ST 16246 SE MCLOUGHLIN BLVD 514 W MAIN ST 103 ROBBINS ST 444 PACIFIC AVE S 105 N MAIN ST 735 SPRUCE ST 2900 HAWORTH AVE 502 VILLA RD 2131 NEWMARK ST 1890 WAITE ST 424 MAIN ST 47809 HIGHWAY 58 2283 SW 4TH AVE 19007 BEAVERCREEK RD 1813 MOLALLA AVE 998 LIBRARY CT RM 4 1425 BEAVERCREEK RD STE B 901 SW EMIGRANT AVE 1640 MAIN ST 7901 SE POWELL BLVD STE J 5850 NE PRESCOTT ST 5415 SW BEAVERTON HILLSDALE HW 451 NE 181ST AVE

MEDFORD MEDFORD MILWAUKIE MOLALLA MOLALLA MONMOUTH MOUNT ANGEL MYRTLE POINT NEWBERG NEWBERG NORTH BEND NORTH BEND NYSSA OAKRIDGE ONTARIO OREGON CITY OREGON CITY OREGON CITY OREGON CITY PENDLETON PHILOMATH PORTLAND PORTLAND PORTLAND PORTLAND

OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR

97504-8546 97501-2192 97267-4657 97038-9260 97038-0449 97361-1543 97362-9631 97458-1154 97132-2000 97132-1860 97459-1219 97459-1229 97913-3897 97463-9572 97914-1849 97045-9537 97045-4064 97045-4041 97045-4076 97801-1948 97370-9237 97206-2314 97218-2232 97221-1918 97230-6660

APOTHECARY AT GOOD SAMARITAN HOSP. BI-MART PHARMACY BI-MART PHARMACY BI-MART PHARMACY BROOKLYN PHARMACY INC CENTRAL DRUGS COLUMBIA PHARMACY EMANUEL PHARMACY FAIRLEYS PHARMACY INC GATEWAY MEDICAL PHARMACY HILLSDALE PHARMACY MEDICAL OFFICE BUILDING PHCY OHSU RICHMOND CLINIC PHARMACY OPTION CARE AT LEGACY HEALTH PAULSENS PHARMACY PHARMACA INTEGRATIVE PHARMACY

(503) 413-8122 (503) 771-1881 (503) 257-3138 (503) 667-5377 (503) 234-8348 (503) 226-2222 (503) 777-7055 (503) 413-4225 (503) 284-1159 (503) 254-7383 (503) 244-7582 (503) 216-2630 (503) 418-3250 (866) 347-8660 (503) 287-1163 (503) 226-6213

1040 NW 22ND AVE 4315 SE WOODSTOCK BLVD 12321 NE HALSEY ST 17108 SE POWELL BLVD 3131 SE MILWAUKIE AVE 538 SW 4TH AVE 8122 SE TIBBETTS STREET 501 N GRAHAM ST 7206 NE SANDY BLVD 1125 NE 99TH AVE 6256 SW CAPITOL HWY 9155 SW BARNES RD 3930 SE DIVISION ST 16195 SW 72ND AVE 4246 NE SANDY BLVD 13 NW 23RD PL

PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND

OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR

97210-3057 97206-6269 97230-1926 97236-1753 97202-2427 97204-2102 97206 97227-1654 97213-5741 97220-9428 97239-2674 97225-6625 97202-1643 97224-7766 97213-1432 97210-3534

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 512 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PORTLAND PROFESSIONAL PHARMACY PRESTIGE PROFESSIONAL PHARMACY PROVIDENCE PLAZA PHARMACY QFC PHARMACY QFC PHARMACY STROHECKERS PHARMACY BI-MART PHARMACY CLINIC PHARMACY BI-MART PHARMACY CENTRAL OREGON PHCY & COMPD COMMUNITY PHARMACY REDMOND LOWER UMPQUA HOSPITAL PHARMACY REEDSPORT PHARMACY ROGUE RIVER PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY HARVARD AVENUE DRUGS HOMETOWN DRUGS OF ROSEBURG BI-MART PHARMACY CALHOUN COMPOUNDING PHARMACY GENOA-QOL HEALTHCARE OAK TREE PHARMACY PHYSICIANS BUILDING PHARMACY QUISENBERRY PHARMACY SALEM HOSP OUTPATIENT RETAIL PHCY BI-MART PHARMACY BI-MART PHARMACY HI SCHOOL PHARMACY PROVIDENCE SEASIDE PHCY SHADY COVE PHARMACY SHERIDAN PHARMACY SILVERTON HI SCHOOL PHCY SILVERTON PILL BOX BI-MART PHARMACY SISTERS DRUG AND GIFT ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY BI-MART PHARMACY OREGON UROLOGY INSTITUTE PEACEHEALTH EMPLOYEE BENF PHCY BI-MART PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (503) 477-6256 (503) 542-0734 (503) 215-6296 (503) 239-7710 (503) 203-5951 (503) 222-4822 (541) 447-0395 (541) 447-4111 (541) 923-7223 (541) 548-1066 (541) 516-3807 (541) 271-6370 (541) 271-3631 (541) 582-0559 (541) 957-9236 (541) 672-5730 (541) 672-1961 (541) 229-1112 (503) 588-8173 (877) 814-2968 (503) 364-3047 (503) 585-2877 (503) 362-4874 (503) 364-3336 (503) 561-6730 (503) 783-1023 (503) 543-1078 (503) 543-7887 (503) 717-7380 (541) 878-3151 (503) 843-2422 (503) 873-8391 (503) 873-6321 (541) 719-2003 (541) 549-6221 (541) 746-9424 (541) 741-1525 (541) 687-7633 (541) 687-7643 (541) 334-3350 (541) 222-5800 (503) 769-6736

Provider Street 11717 NE GLISAN ST 11723 NE GLISAN ST 5050 NE HOYT ST STE 142 5544 E BURNSIDE ST 7525 SW BARNES RD 1286 SE HOLGATE BLVD STE C-1 2091 NE 3RD ST 198 NE COMBS FLAT RD 1727 SW ODEM MEDO RD 655 NW GREENWOOD AVE.,SUITE #1 1253 N CANAL BLVD 600 RANCH RD 1409 HWY 101 506 E MAIN ST 3013 NW STEWART PKWY 1381 NW GARDEN VALLEY BLVD 1175 W HARVARD AVE 1813 W HARVARD AVE STE 210 2155 LANCASTER DR NE 990 COMMERCIAL ST SE 3180 CENTER ST NE STE 3360 2940 COMMERCIAL ST SE 1234 COMMERICAL ST SE 150 LIBERTY ST SE 890 OAK ST SE 36859 HIGHWAY 26 51536 SE 2ND ST 33454 SW CHINOOK PLZ 725 S WAHANNA RD 21195 HIGHWAY 62 103 E MAIN ST 406 MCCLAINE ST 302 N 1ST ST 445 W HIGHWAY 20 211 E CASCADE 2000 MARCOLA RD 5755 MAIN ST 1521 MOHAWK BLVD 5744 MAIN ST 2400 HARTMAN LANE 3333 RIVERBEND DR 1701 SHAFF RD

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Provider City PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PORTLAND PRINEVILLE PRINEVILLE REDMOND REDMOND REDMOND REEDSPORT REEDSPORT ROGUE RIVER ROSEBURG ROSEBURG ROSEBURG ROSEBURG SALEM SALEM SALEM SALEM SALEM SALEM SALEM SANDY SCAPPOOSE SCAPPOOSE SEASIDE SHADY COVE SHERIDAN SILVERTON SILVERTON SISTERS SISTERS SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD STAYTON

State

ZIP code

OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR

97220-2141 97220-2141 97213-2956 97215-1259 97225-6203 97202 97754-8130 97754 97756-9573 97756 97756 97467-1720 97467 97537-9615 97471 97471 97471-2834 97471-2709 97305-1228 97302-4110 97301-4532 97302-4552 97302 97301-3506 97301-3905 97055-7213 97056-4551 97056-3731 97138-7735 97539-9715 97378-1828 97381-1921 97381-1606 97759-2621 97759 97477-2562 97478-5426 97477-3355 97478-6964 97477 97477-8800 97383-1091

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name STAYTON PHARMACY LLC SUBLIMITY PHARMACY SERVICES INC SUNRIVER PHARMACY BI-MART PHARMACY SUTHERLIN DRUG BI-MART PHARMACY ECONOMY DRUGS MEDICAP PHARMACY BI-MART PHARMACY BI-MART PHARMACY MCCANN'S PHARMACY PHARMACA INTEGRATIVE PHCY INC SAV-ON PHARMACY TILLAMOOK PHARMACY MIKES PHARMACY ALBERTSON'S PHARMACY MERIDIAN PARK MED CTR COMM PHC TUALATIN PHARMACY CARLSONS UMATILLA UNTDDRUG UNION DRUG COMPANY MALHEUR DRUG BI-MART PHARMACY HI-SCHOOL PHARMACY #1188 WALDPORT PHARMACY HI SCHOOL PHARMACY RINEHART PHARMACY LLC CASCADE PHARMACY ROGUE COMM HEALTH WHITE CT BI-MART PHARMACY VALLEY DRUGS BI-MART PHARMACY ABINGTON PHARMACY ALLIANCE PHARMACY GIANT PHARMACY ROYER PHARMACY ALBION PHARMACY A & G PHARMACY SERVICE INC HOFFMAN'S DRUG STORE INC THE MEDICINE SHOPPE ALLENTOWN PHARMACY INC EXPRESS CARE PHARMACY G&K PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (503) 769-2616 (503) 769-4344 (541) 647-2377 (541) 459-0626 (541) 459-2712 (541) 818-0651 (541) 367-6777 (541) 535-5843 (541) 298-2055 (503) 624-0713 (503) 639-7377 (503) 603-9434 (503) 590-0411 (503) 842-4181 (541) 336-2261 (503) 667-9003 (503) 692-7470 (503) 218-1200 (541) 922-3281 (541) 562-5441 (541) 473-3333 (541) 935-0903 (541) 935-2201 (541) 563-4848 (503) 656-0306 (503) 368-7455 (541) 826-4414 (541) 842-7747 (541) 679-4801 (541) 236-7060 (503) 981-2106 (215) 884-2767 (215) 481-4318 (215) 881-9508 (717) 859-4911 (814) 756-3429 (724) 375-1230 (724) 375-4111 (724) 375-5561 (610) 351-1900 (610) 351-2273 (610) 351-2666

Provider Street 102 MARTIN DR STE A 102 MARTIN DR STE B 56890 VENTURE LN 833 E CENTRAL AVE 113 E CENTRAL AVE 1980 MAIN ST 621 MAIN ST STE A 205 N PACIFIC HWY 3300 W 6TH ST 13500 SW PACIFIC HWY STE 70 15685 SW 116TH AVE 12180 SW SCHOLLS FERRY RD 14300 SW BARROWS RD 915 MAIN AVE 722 W HIGHWAY 20 25691 SE STARK ST 19300 SW 65TH AVE 19297 SW MARTINAZZI 821 6TH ST 105 N MAIN 198 A ST E 25126 JEANS RD 25013 HWY 126 180 NW HIGHWAY 101 5639 HOOD ST 278 ROWE ST STE 222 7591 CRATER LAKE HWY STE A 8385 DIVISION RD 391 NW DOUGLAS BLVD 157 NW DOUGLAS BLVD 1600 MOUNT HOOD AVE 1460 OLD YORK RD 1245 HIGHLAND AVE 2350 SUSQUEHANNA RD 113 S 7TH ST 9 E STATE ST 2665 BRODHEAD RD STE B 536 FRANKLIN AVE 2665 BRODHEAD RD 416 W TILGHMAN ST 1727 W LIBERTY ST UNIT 2 4680 BROADWAY

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Provider City STAYTON STAYTON SUNRIVER SUTHERLIN SUTHERLIN SWEET HOME SWEET HOME TALENT THE DALLES TIGARD TIGARD TIGARD TIGARD TILLAMOOK TOLEDO TROUTDALE TUALATIN TUALATIN UMATILLA UNION VALE VENETA VENETA WALDPORT WEST LINN WHEELER WHITE CITY WHITE CITY WINSTON WINSTON WOODBURN ABINGTON ABINGTON ABINGTON AKRON ALBION ALIQUIPPA ALIQUIPPA ALIQUIPPA ALLENTOWN ALLENTOWN ALLENTOWN

State

ZIP code

OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR PA PA PA PA PA PA PA PA PA PA PA

97383-1296 97383-1296 97707-2100 97479-9607 97479-9556 97386-1711 97386-3339 97540-9637 97058-4144 97223-4803 97224-2651 97223-3334 97223-2063 97141-3815 97391-1128 97060-3305 97062 97062 97882-9513 97883-9286 97918-1345 97487-9644 97487 97394 97068-3235 97147 97503-1663 97503 97496-8567 97496-9670 97071-9071 19001-2617 19001-3714 19001-4211 17501-1332 16401-1110 15001-2723 15001-3728 15001-2723 18102-2426 18104 18104

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GIANT PHARMACY GIANT PHARMACY

Provider Name

(610) 351-2091 (610) 791-9588

CEDAR CREST AND TILGHMAN 3015 W EMAUS AVE

ALLENTOWN ALLENTOWN

PA PA

18104 18103-7107

HEALTH SPECTRUM PHARMACY SERVICES HEALTH SPECTRUM PHARMACY SVCS HEALTH SPECTRUM PHCY SERVICES HEALTH SPECTRUM PHCY SRVCS HOMESTAR PHARMACY AND MED EQUIPMENT MEDICAP PHARMACY NEW LIBERTY PHARMACY S H PHARMACY SOUTH MOUNTAIN PHARMACY VALLEY DISCOUNT PHARMACY INC WALTERS PHARMACY WEIS PHARMACY WEIS PHARMACY WEST END PHARMACY WEST END SERVICES ALTOONA PHARMACY BROAD AVENUE PHARMACY DICKS PHARMACY INC MARTINS PHARMACY MARTINS PHARMACY MARTINS PHARMACY THE MEDICINE SHOPPE THOMPSON LTC PHARMACY THOMPSON PHARMACY THOMPSON PHARMACY-INTOWN UNIVERSITY ORTHOPEDIC CENTER LTD WEIS PHARMACY WEIS PHARMACY AMBER PHARMACY NATIONAL WELLNESS SUPPLY WYBLE'S PHARMACY, INC. FAMILY PHARMACY OF ARCHBALD J.B.MERRICK APOTHECARY INC. BRACEY PHARMACY ASTON PHARMACY HOME HEALTH CTR GIANT PHARMACY LLEWELLYN'S INC ACME/SAV-ON PHARMACY

(610) 969-2780 (610) 969-2780 (610) 402-1968 (610) 402-8444

1637 W CHEW STREET 1637 W CHEW ST 1247 S CEDAR CREST BLVD 1202 S CEDAR CREST BLVD

ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN

PA PA PA PA

18102-3648 18102-3648 18103-6298 18103-6202

(610) 419-7652 (610) 336-9033 (610) 437-8800 (610) 776-4999 (610) 791-3917 (484) 202-7777 (610) 435-4706 (610) 821-4560 (610) 395-0527 (610) 433-1826 (610) 437-8850 (814) 283-0602 (814) 943-1310 (814) 944-6425 (814) 940-2554 (814) 949-3735 (814) 944-9998 (814) 944-2095 (814) 944-5837 (814) 944-6139 (814) 944-5033 (814) 949-4050 (814) 941-5442 (814) 949-6414 (267) 419-8506 (724) 266-4400 (724) 478-4051 (570) 876-3312 (610) 642-8900 (570) 875-1300 (610) 494-1445 (610) 497-5890 (570) 457-2341 (610) 268-8578

1736 W HAMILTON ST GRN FL E TW 5924 TILGHMAN ST STE A 1606 W ALLEN ST 451 W CHEW ST 2441 W EMMAUS AVE 324 N 7TH ST 401 N 17TH ST STE 102 365 S CEDAR CREST BLVD 1500 N CEDAR CREST BLVD 133 S 17TH ST 6620 GRANT WAY STE B 620 HOWARD AVE BLDG G STE 403 2329 BROAD AVE 1903 4TH ST 200 E CHESTNUT AVE 1000 LOGAN BLVD STE 108 2032 E PLEASANT VALLEY BLVD 2411 8TH AVE 600 E CHESTNUT AVE 600 E CHESTNUT AVE 1118 12TH ST 1505 NINTH AVE 100 PARK HILLS PLZ 601 PLEASANT VALLEY BLVD 323 NORRISTOWN RD STE 100 643 MERCHANT ST 200 N WARREN AVE 4 KELLY ST STE 1 31 CRICKET AVE 626 CENTER ST 10 SCHEIVERT AVE 3400 CONCORD RD 703 MAIN ST 851 GAP NEWPORT PIKE

ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALLENTOWN ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA ALTOONA AMBLER AMBRIDGE APOLLO ARCHBALD ARDMORE ASHLAND ASTON ASTON AVOCA AVONDALE

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

18104-5656 18104-9171 18102-2012 18102-3472 18103-7234 18102-3212 18104-5049 18103-3600 18104-2357 18104-6776 18106-9316 16601-4804 16601-1937 16601-4222 16601-5204 16602-4028 16602-7515 16602-2105 16601-5216 16601-5216 16601-3412 16602 16602-2841 16602-4803 19002-2757 15003 15613-1339 18403-1627 19003-2230 17921-1332 19014-2762 19014-1933 18641-1622 19311-9513

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 515 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MEDARBOR PHARMACY SAV-ON PHARMACY GIANT PHARMACY BATH DRUG SOUTHMOORE PHARMACY LLC BEAVER HEALTH MART PHARMACY BEAVER FALLS HEALTH MART PHCY MEDICINE STOP FISHERS PHARMACY ICKES DRUG STORE HOMETOWN PHARMACY ROSTRAVER DRUG STORE PARRISH APOTHECARY SHOP PLUMBS DRUG STORE WEIS PHARMACY CARESITE PHARMACY BELMONT PHARMACY BENSALEM PHARMACY GIANT PHARMACY GRAND PLAZA PHARMACY HULMEVILLE RD PHARMACY INC KNIGHTS ROAD PHARMACY LLC NESHAMINY PHARMACY PARKWOOD STREET ROAD PHARMACY RICCIO FAMILY PHARMACY SAV-ON PHARMACY TYAN PHARMACY & MEDICAL SUPPLY BENTLEYVILLE MEDICINE SHOPPE BERLIN PHARMACY CARE FIRST PHARMACY SERVICES GIANT PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY HUP VALLEY FORGE PHARMACY SPARTAN PHARMACY FAMILY PRESCRIPTION CENTER GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY HEALTH SPECTRUM PHCY SERVICES HOMESTAR PHARMACY OPTION CARE

NR_0009_10823 10/2017

Provider Phone Number (610) 660-8100 (610) 667-7051 (570) 421-2896 (610) 837-9992 (484) 287-6337 (724) 774-0919 (724) 384-0766 (724) 843-2338 (814) 623-5512 (814) 623-5615 (724) 379-6000 (724) 929-5533 (814) 355-2914 (814) 355-3225 (814) 355-2429 (717) 935-2341 (215) 645-1527 (215) 244-4244 (215) 604-1390 (215) 447-8277 (267) 332-2948 (215) 638-1256 (215) 757-4557 (215) 639-1950 (215) 639-6680 (215) 741-9772 (215) 639-9400 (724) 239-3600 (814) 267-4013 (570) 802-0160 (570) 802-0599 (570) 759-1239 (570) 759-0896 (610) 576-7545 (412) 831-1333 (610) 866-0709 (610) 866-3393 (610) 691-2845 (610) 882-1593 (484) 884-7004 (484) 526-7500 (610) 867-7774

Provider Street 150 MONUMENT RD STE 601D 121 E CITY LINE AVE 3560 ROUTE 611 STE 105 310 S WALNUT ST 2453 PLAZA CT STE A 601 3RD ST 1314 7TH AVE 1529 7TH AVE 654 E PITT ST 122 S JULIANA ST 4627 STATE ROUTE 51 N STE 602 520 CIRCLE DR 114 N ALLEGHENY ST 105 N ALLEGHENY ST 170 BUCKAROO LANE 4752 SR 655 STE A 3571 HULMEVILLE ROAD 2112 STREET RD 2721 STREET RD 965 BRISTOL PIKE 3554 HULMEVILLE RD STE 108 2788 KNIGHTS RD 5417 NESHAMINY BLVD 3532 STREET RD 2217 BRISTOL PIKE STE 2 2301 BRISTOL PIKE 2803 BRISTOL PIKE 808 MAIN ST 413 BROADWAY ST 1015 N VINE ST 50 BRIAR CREEK PLZ 145 E 9TH ST 1205 CHESTNUT ST 1001 CHESTERBROOK BLVD 3400 S PARK RD 439 WYANDOTTE ST 2918 EASTON AVE 2174 W UNION BLVD 3926 NAZARETH PIKE 2545 SCHOENERSVILLE RD 801 OSTRUM ST STE 101A 3895 ADLER PL BLDG A

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Provider City BALA CYNWYD BALA CYNWYD BARTONSVILLE BATH BATH BEAVER BEAVER FALLS BEAVER FALLS BEDFORD BEDFORD BELLE VERNON BELLE VERNON BELLEFONTE BELLEFONTE BELLEFONTE BELLEVILLE BENSALEM BENSALEM BENSALEM BENSALEM BENSALEM BENSALEM BENSALEM BENSALEM BENSALEM BENSALEM BENSALEM BENTLEYVILLE BERLIN BERWICK BERWICK BERWICK BERWICK BERWYN BETHEL PARK BETHLEHEM BETHLEHEM BETHLEHEM BETHLEHEM BETHLEHEM BETHLEHEM BETHLEHEM

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19004 19004 18321-9452 18014-1025 18014-8762 15009-2115 15010-4217 15010-4121 15522 15522-1301 15012-4032 15012-9680 16823-1627 16823 16823 17004 19020 19020 19020-2810 19020-8142 19020-4366 19020-3570 19020-1782 19020-1506 19020-5720 19020-5731 19020 15314-1214 15530-1001 18603-2025 18603-4100 18603-3132 18603-2234 19312 15102 18015-1529 18017-4206 18018-2011 18020-1116 18017-7300 18015-1000 18017-9092

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STEFKO PHARMACY VITA MEDICAL ASSOCIATES PC WEIS PHARMACY YOUNGS PHARMACY ADAMS CUMBERLAND PHARMACY BIRDSBORO PHARMACY BLAIRSVILLE PHARMACY BLANDON PHARMACY GIANT PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY BLOSS PHARMACY INC GIANT PHARMACY BOOTHWYN APOTHECARY BOSWELL PRESCRIPTION CENTER THE MEDICINE SHOPPE OTT & MCHENRY PHARMACY THE PHARMACY AT UNION SQUARE SPARTAN PHARMACY BRIDGEPORT FAMILY PHARMACY RX PARTNERS LTC BROCKWAY DRUG CO. INC. KINSLEYS SHOPRITE PHARMACY MR Z'S PHARMACY BURMANS APOTHECARY

Provider Name

(610) 419-4198 (610) 866-0113 (610) 954-8323 (610) 866-4552 (717) 677-8144 (610) 582-4005 (724) 459-7400 (610) 944-8899 (570) 389-9909 (570) 784-9582 (570) 387-6264 (570) 638-2820 (610) 239-7810 (610) 485-1130 (814) 629-6624 (610) 369-3888 (814) 362-3827 (814) 362-6200 (412) 440-5888 (484) 370-2673 (412) 257-1263 (814) 268-3305 (570) 992-2670 (570) 992-5114 (610) 876-6068

1816 STEFKO BLVD STE A 800 OSTRUM ST STE 300 5580 CRAWFORD DR 3708 FREEMANSBURG AVE 3463 BIGLERVILLE RD 330 W MAIN ST 135 E MARKET ST STE 100 104 ANNA AVE 1000 SCOTT TOWN PLZ 1000 SOUTH MARKET ST 725 COLUMBIA BLVD 2 RIVERSIDE PLAZA 1760 DEKALB PIKE 2341 CHICHESTER AVE 210 OHIO ST 2 E PHILADELPHIA AVE 102 MAIN ST 36 DAVIS ST 3520 CLAIRTON BLVD 54 W 4TH ST STE 38 500 OLD POND RD STE 406 1365 MAIN ST 107 KINSLEY DR RT 209 & E WEIR LAKE ROAD 3413 EDGMONT AVE STE B

BETHLEHEM BETHLEHEM BETHLEHEM BETHLEHEM BIGLERVILLE BIRDSBORO BLAIRSVILLE BLANDON BLOOMSBURG BLOOMSBURG BLOOMSBURG BLOSSBURG BLUE BELL BOOTHWYN BOSWELL BOYERTOWN BRADFORD BRADFORD BRENTWOOD BRIDGEPORT BRIDGEVILLE BROCKWAY BRODHEADSVILLE BRODHEADSVILLE BROOKHAVEN

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

18017-6235 18015-1010 18017-8797 18020-6512 17307 19508-1900 15717 19510 17815-2322 17815-2600 17815-2323 16912 19422-3352 19061 15531-1245 19512-1125 16701-2023 16701-2016 15227-2720 19405-1009 15017-1272 15824-1635 18322-7790 18322 19015-2803

BURMANS COMMUNITY PHARMACY INC GIANT PHARMACY MEANS LAUF SUPER DRUG THE MEDICINE SHOPPE GIANT PHARMACY MELS MARPLE PHARMACY MEDICINE SHOPPE PARVIN'S PHARMACY FAMCARE PHARMACY GIANT PHARMACY WEIS PHARMACY BHS RETAIL PHARMACY GENOA-QOL HEALTHCARE INSTITUTE HILL PHARMACY INC THE MEDICINE SHOPPE REDSTONE PHARMACY

(610) 872-5418 (610) 876-6406 (814) 849-7504 (814) 849-5217 (610) 355-9244 (610) 356-6491 (724) 785-7095 (610) 525-6664 (724) 947-7000 (717) 242-3141 (717) 248-1525 (724) 284-6363 (724) 602-0532 (724) 285-3693 (724) 282-8446 (724) 938-2395

3400 EDGMONT AVE 4930 EDGEMONT AVE 155 MAIN ST 240 W MAIN ST 2910 SPRINGFIELD RD 2530 W CHESTER PIKE 25 MARKET ST 30 N BRYN MAWR AVE 1429 BURGETTSTOWN PLZ 325 W FREEDOM AVE STE 150 224 N LOGAN BLVD ONE HOSPITAL WAY 1610 N MAIN STREET EXT STE 104 937 E JEFFERSON ST 125 PILLOW ST 322 3RD ST

BROOKHAVEN BROOKHAVEN BROOKVILLE BROOKVILLE BROOMALL BROOMALL BROWNSVILLE BRYN MAWR BURGETTSTOWN BURNHAM BURNHAM BUTLER BUTLER BUTLER BUTLER CALIFORNIA

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19015-2804 19015 15825-1234 15825-2528 19008-1224 19008-2429 15417-1764 19010-3304 15021-1187 17009-1846 17009-1850 16001 16001-1513 16001-2002 16001-5619 15419-1134

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 517 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CAMBRIDGE SPRINGS PHARMACY ANDREWS AND PATEL ASSOC CUMBERLAND APOTHECARY GIANT PHARMACY

Provider Name

(814) 398-4600 (717) 761-8740 (717) 761-4200 (717) 724-1170

227 S MAIN ST 3912 TRINDLE RD 3300 MARKET ST 3301 TRINDLE RD

CAMBRIDGE SPRINGS CAMP HILL CAMP HILL CAMP HILL

PA PA PA PA

16403-1139 17011-4246 17011-4423 17011-4413

HEMATOLOGY & ONCOLOGY CONSULTANTS WEIS PHARMACY MEDICINE SHOPPE PRESCRIPTION CENTER PLUS SOLLON PHARMACY BROWNS PHARMACY INC GIANT PHARMACY GIANT PHARMACY QUALITY CARE PHARMACY SMARTMED PRESCRIPTION CENTER WEIS PHARMACY GABLER'S DRUG THE MEDICINE MINE ACORX THE MEDICINE SHOPPE SHARBAUGH'S DRUGSTORE INC HARTZELLS PHARMACY INC PENN LAUREL PHARMACY THOMPSON PHARMACY GIANT PHARMACY ALERT PHARMACY SERVICES INC CHAMBERS' APOTHECARY GIANT PHARMACY GIANT PHARMACY KEYSTONE PHARMACY NORLAND AVE PHARMACY PARK AVE PHARMACY WEIS PHARMACY RXBOX PHARMACY AVENUE PHARMACY GOOD HEALTH PHARMACY CHICORA DRUG QUALITY PHARMACY THE MEDICINE SHOPPE CLARION PHARMACY HEALTH COMPLEX PHARMACY THE MEDICINE SHOPPE

(717) 975-8900 (717) 737-9230 (724) 745-6480 (724) 941-2522 (724) 745-6700 (570) 673-4372 (717) 249-8836 (717) 258-1280 (717) 249-5691 (717) 243-9100 (717) 245-2541 (724) 966-2018 (724) 966-5237 (412) 857-2916 (412) 279-3361 (814) 344-9950 (610) 264-5471 (814) 754-5717 (814) 364-1608 (215) 716-7014 (717) 496-9409 (717) 263-0747 (717) 261-1556 (717) 267-3304 (717) 709-7977 (717) 217-6790 (717) 264-7312 (717) 261-2574 (267) 579-2692 (484) 816-0344 (610) 497-1015 (724) 445-2210 (724) 445-3027 (412) 233-3303 (814) 226-4015 (814) 226-7970 (814) 226-9310

101 ERFORD RD STE 101 1195 LOWTHER RD 1 N CENTRAL AVE 4080 WASHINGTON RD STE 106 368 EUCLID AVE 121 SULLIVAN ST 255 S SPRING GARDEN ST 950 WALNUT BOTTOM RD 1 SPRINT DR 233 E HIGH ST 351 E HIGH ST 106 MARKET STREET 555 ROUTE 88 520 E MAIN ST 132 E MAIN ST 2073 PLANK RD 300 AMERICAN ST 112 SUNSHINE AVE 2827 EARLYSTOWN RD 4275 COUNTY LINE RD 2075 SCOTLAND AVE 278 LINCOLN WAY EAST 993 WAYNE AVE 925 NORLAND AVE 830 5TH AVE STE 101 12 ST PAUL DR STE 105 220 PARK AVE 1056 WAYNE AVE 225 OLD SOLDIERS RD 1111 AVENUE OF THE STATES 2224 W 9TH ST 100 W SLIPPERY ROCK ST 164 MEDICAL CENTER RD STE E 645 MILLER AVE 30 PINNACLE DR 24 DOCTORS LN STE 100 100 LIBERTY ST

CAMP HILL CAMP HILL CANONSBURG CANONSBURG CANONSBURG CANTON CARLISLE CARLISLE CARLISLE CARLISLE CARLISLE CARMICHAELS CARMICHAELS CARNEGIE CARNEGIE CARROLLTOWN CATASAUQUA CENTRAL CITY CENTRE HALL CHALFONT CHAMBERSBURG CHAMBERSBURG CHAMBERSBURG CHAMBERSBURG CHAMBERSBURG CHAMBERSBURG CHAMBERSBURG CHAMBERSBURG CHELTENHAM CHESTER CHESTER CHICORA CHICORA CLAIRTON CLARION CLARION CLARION

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17011-1802 17011-7531 15317-1301 15317-2561 15317-1739 17724-1733 17013-2565 17015-7636 17015-7696 17013-2521 17013-2523 15320-0000 15320-1173 15106-2051 15106 15722-6411 18032-1800 15926-1129 16828 18914-2212 17201-1451 17201-2234 17201-3895 17201-4204 17201-4219 17201-4230 17201-1230 17201-2924 19012-2130 19013-5946 19013 16025-3212 16025-2612 15025 16214-3876 16214-8514 16214-1808

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 518 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CLARK SUMMIT STATE HOSP PHCY THE MEDICINE SHOPPE WEIS PHARMACY DICKS PHARMACY CURTIS PHARMACY CLEARFIELD PHARMACY ENDLESS MOUNTAINS PHARMACY GIANT PHARMACY WESTBROOK PARK PHARMACY LEYO'S PHARMACY

Provider Name

(570) 319-3520 (570) 586-1961 (570) 587-2460 (814) 239-5136 (724) 663-7707 (814) 765-7841 (570) 222-7500 (610) 623-5343 (610) 626-2949 (814) 672-5387

1451 HILLSIDE DR 100 E GROVE ST 1020 NORTHERN BLVD 13181 DUNNINGS HWY 305 MAIN ST 307 E MARKET ST 1866 STATE ROUTE 106 SUITE 11 39 N OAK AVE 244 W BALTIMORE AVE 1564 MAIN ST

CLARKS SUMMIT CLARKS SUMMIT CLARKS SUMMIT CLAYSBURG CLAYSVILLE CLEARFIELD CLIFFORD CLIFTON HEIGHTS CLIFTON HEIGHTS COALPORT

PA PA PA PA PA PA PA PA PA PA

18411-9504 18411-1750 18411-2220 16625-7925 15323 16830-2432 18413 19018-1425 19018-2101 16627-0000

COCHRANTON COMMUNITY PHARMACY LIFE TREE PHARMACY HINKLES PHARMACY THE MEDICINE SHOPPE YOUGH VALLEY PHARMACY HUNTER PHARMACY MARTINS PHARMACY MEDMART PHARMACY NICKMAN'S DRUG PECHIN PHARMACY GIANT PHARMACY WEIS PHARMACY CONYNGHAM PHARMACY GIANT PHARMACY GIANT PHARMACY LIFE TREE PHARMACY PORTERS PRESCRIPTION PHARMACY BUCHANAN BROTHERS PHARMACY BILLS SHOPRITE PHCY OF DALEVILLE PHARMSCRIPT OF PA LLC MAINLINE PHARMACY MAT'S PHARMACY WHITE OAKS PHARMACY CITY DRUGS OF CURWENSVILLE CARESITE PHARMACY FINOS PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY WELLSPAN PHARMACY DALTON PHARMACY DANVILLE PHARMACY

(814) 724-3107 (610) 489-6640 (717) 684-2551 (717) 684-5808 (814) 395-5300 (724) 626-1091 (724) 626-7690 (724) 628-7500 (724) 628-8125 (724) 626-9600 (610) 825-3784 (610) 276-1010 (570) 788-1344 (610) 282-5880 (610) 262-6314 (412) 269-8605 (412) 264-2230 (814) 274-8660 (570) 842-7848 (908) 389-1818 (814) 886-5667 (215) 785-3537 (267) 812-5075 (814) 236-1820 (570) 255-1167 (570) 675-1141 (570) 674-5577 (570) 674-1120 (717) 851-1351 (570) 563-1151 (570) 284-4669

180 N FRANKLIN ST 5 BLUE HERON DR 261 LOCUST ST 960 LANCASTER AVE 511 WILLIAMS ST STE 2 802 VANDERBILT RD 800 VANDERBILT RD 2618 MEMORIAL BLVD STE A 107 MEMORIAL BLVD 309 LAUREL DR 10 E RIDGE PIKE 200 W RIDGE PIKE 303 MAIN STREET 216 E FAIRMOUNT ST # RT309 202 CHESTNUT ST 1996 EWINGS MILL RD 935 BEAVER GRADE RD 101 N MAIN ST 921 DRINKER TPKE STE 24 200 W KENSINGER DR STE 600 1207 2ND ST 701 BRISTOL PIKE 800 STATE RD 360 THOMPSON ST 114 LT MICHAEL CLEARY DRIVE 3 MAIN ST 26 DALLAS VILLAGE SHOPPING CTR 2525 MEMORIAL HWY 755 S PLEASANT AVE 102 W MAIN ST 229 MILL ST

COCHRANTON COLLEGEVILLE COLUMBIA COLUMBIA CONFLUENCE CONNELLSVILLE CONNELLSVILLE CONNELLSVILLE CONNELLSVILLE CONNELLSVILLE CONSHOHOCKEN CONSHOHOCKEN CONYNGHAM COOPERSBURG COPLAY CORAOPOLIS CORAOPOLIS COUDERSPORT COVINGTON TOWNSHIP CRANBERRY TOWNSHIP CRESSON CROYDON CROYDON CURWENSVILLE DALLAS DALLAS DALLAS DALLAS DALLASTOWN DALTON DANVILLE

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

16314-9706 19426 17512-1110 17512-1857 15424-1048 15425 15425-6241 15425-1419 15425-2653 15425-3872 19428-2117 19428-3702 18219-0000 18036-1634 18037-1252 15108 15108-2747 16915-1621 18444-7948 16066 16630-1147 19021-5412 19021-6117 16833-1131 18612 18612-1603 18612-1231 18612-9254 17313-9252 18414-9522 17821-1964

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 519 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DANVILLE STATE HOSPITAL GIANT PHARMACY WEIS PHARMACY MERCY PHARMACY DAUPHIN PROFESSIONAL PHARMACY TOWNSHIP PHARMACY SALEM CRSSRDS APOTHECARY ANDERSON PHARMACY ANDERSONS PHARMACY GIANT PHARMACY GOOD HEALTH PHARMACY INC DONEGAL PHARMACY HAYDEN'S PHARMACY DONORA UNION PHARMACY GIANT PHARMACY WEIS PHARMACY DOWNINGTOWN PHARMACY HOPEWELL ROAD PHARMACY THE MEDICINE SHOPPE HARRIS PHARMACY SAV-ON PHARMACY WEIS PHARMACY

Provider Name

(570) 271-4535 (570) 271-2509 (570) 271-0624 (610) 237-7330 (717) 474-8343 (814) 479-2588 (724) 468-5565 (717) 484-2649 (717) 336-4889 (717) 638-1234 (570) 828-7494 (724) 593-2502 (724) 593-4400 (724) 379-5630 (717) 292-3043 (717) 764-3382 (484) 593-4321 (610) 269-0002 (610) 269-7368 (215) 345-4800 (215) 340-1983 (215) 622-2035

200 STATE HOSPITAL DR 328 CHURCH ST 600 CONTINENTAL BLVD 1503 LANSDOWNE AVE STE 1000 722 ALLEGHENY ST STE 1 118 N MAIN ST 195 SHEFFIELD DR STE B 2590 N READING RD 334 MAIN ST 830 N US ROUTE 15 1592 ROUTE 739 STE 2 181 MAIN ST 3846 STATE ROUTE 31 642 MCKEAN AVE 2130 PALOMINO RD 2850 CARLISLE RD 116 WALLACE AVE 1199 HORSESHOE PIKE 1169 HORSESHOE PIKE 511 EAST ST 480 N MAIN ST 73 OLD DUBLIN PIKE

DANVILLE DANVILLE DANVILLE DARBY DAUPHIN DAVIDSVILLE DELMONT DENVER DENVER DILLSBURG DINGMANS FERRY DONEGAL DONEGAL DONORA DOVER DOVER DOWNINGTOWN DOWNINGTOWN DOWNINGTOWN DOYLESTOWN DOYLESTOWN DOYLESTOWN

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17821-9103 17821-1982 17821-1022 19023-1330 17018 15928 15626-1744 17517-9153 17517-1448 17019-1617 18328-3477 15628-4020 15628-4033 15033-1003 17315-3669 17315-4602 19335-2641 19335 19335-1367 18901-3845 18901-3404 18901-2491

CONSULTANTS IN MDCL ONC & HEMA PC CORUS PHARMACY SHADELAND PHARMACY VALLEY PHARMACY DUBOIS DRUG AND WELLNESS#1 MARTINS PHARMACY ONCOLOGY HEMATOLOGY ASSOC PENN HIGHLANDS COMMUNITY PHACY SHANKELS PHARMACY THE MEDICINE SHOPPE DUNCANSVILLE PHARMACY MARTINS PHARMACY DEPIETRO'S PHARMACY MEDICAP PHARMACY PRICE CHOPPER PHARMACY FAMILY PRESCRIPTION COUNTER WEIS PHARMACY CHOICE APOTHECARY EAST BERLIN PHARMACY

(610) 622-3818 (484) 452-8082 (610) 622-1630 (570) 788-4000 (814) 371-5827 (814) 371-7226 (814) 375-3800 (814) 375-6165 (814) 371-9320 (814) 371-0800 (814) 695-8065 (814) 695-4609 (570) 209-7440 (570) 342-8427 (570) 346-4593 (570) 457-6789 (570) 451-6390 (717) 259-6440 (717) 259-0421

2100 KEYSTONE AVE STE 502 1246 TOWNSHIP LINE RD 403 SHADELAND AVE 8 RITTENHOUSE PL 700 S BRADY ST 22 HOOVER AVE STE 130 100 HOSPITAL AVE 621 S MAIN ST 241 W LONG AVE 30 W PARK AVE 1328 3RD AVE 221 GLIMCHER DR 617 3RD ST 702 N BLAKELY ST STE G UNIT 9 1228 ONEILL HWY 335 MAIN ST 70 PHOENIX ST 105 4TH ST 335 W KING ST

DREXEL HILL DREXEL HILL DREXEL HILL DRUMS DU BOIS DU BOIS DU BOIS DU BOIS DU BOIS DU BOIS DUNCANSVILLE DUNCANSVILLE DUNMORE DUNMORE DUNMORE DURYEA DURYEA EAST BERLIN EAST BERLIN

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19026 19026 19026 18222 15801-1266 15801-2428 15801-1440 15801-1413 15801-2105 15801-2432 16635-1247 16635-9415 18512-2849 18512-1963 18512-1708 18642-1026 18642-1216 17316-9638 17316-9730

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 520 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WEIS PHARMACY BRACKENS PHARMACY WEIS PHARMACY BELL APOTHECARY CROSSROAD DISPENSARY EASTON SPECIALTY PHARMACY INC EASTON'S NEIGHBORX PHARMACY GIANT PHARMACY GIANT PHARMACY ST. LUKE'S HOMESTAR PHARMACY WEIS PHARMACY WEIS PHARMACY WELCOME PHARMACY MAINLINE PHARMACY EDDYSTONE COMMUNITY PHARMACY FORLENZA'S PHARMACY PRESCRIPTION CENTER PLUS BUCHANAN BROTHERS PHARMACY DARRENKAMPS ELIZABETHTOWN PHCY GIANT PHARMACY SLOAN'S E-TOWN PHARMACY SLOANS NORLANCO PHARMACY WEIS PHARMACY WELLNESS FIRST PHARMACY WELLNESS FIRST PHARMACY YORKTOWN PHARMACY BUCHANAN BROTHERS PHARMACY DOUG'S FAMILY PHARMACY BURCH DRUG STORE LINMAS DRUGS WEIS PHARMACY

Provider Name

(717) 259-6598 (724) 526-3110 (570) 424-8065 (610) 258-2311 (610) 330-2630 (484) 600-6666 (610) 829-1515 (610) 559-1209 (484) 546-0216 (484) 503-7500 (610) 252-6756 (610) 923-7932 (610) 438-9333 (814) 472-9390 (484) 480-3341 (570) 288-6626 (724) 222-2512 (814) 225-4723 (717) 367-2212 (717) 367-2613 (717) 367-6367 (717) 653-6888 (717) 361-8699 (215) 277-7132 (215) 277-7132 (267) 282-0070 (814) 258-7332 (610) 286-0496 (570) 672-2711 (724) 867-2400 (610) 967-2900

30 PRIMROSE LANE 7 WATER ST 695 N COURTLAND ST 2045 FAIRVIEW AVE 3465 NAZARETH RD STE 102 2024 LEHIGH ST 1800 SULLIVAN TRL SUITE 305 301 TOWN CENTER BLVD 801 S 25TH ST 1700 ST LUKES BLVD 3825 SULLIVAN TRAIL 3011 WILLIAM PENN HWY 1607 NORTHAMPTON ST 3720 NEW GERMANY RD 1207B CHESTER PIKE 531 MAIN ST 1045 ROUTE 519 170 MAIN ST 191 RIDGEVIEW RD S 1278 S MARKET ST 2389 S MARKET ST 428 CLOVERLEAF RD 1629 S MARKET ST 411 TOWNSHIP LINE ROAD 411 TOWNSHIP LINE RD 8110 OLD YORK RD STE B 206 W MAIN ST 101 DARBY SQ 120 W VALLEY AVE 603 MAIN ST 1220 CHESTNUT ST

EAST BERLIN EAST BRADY EAST STROUDSBURG EASTON EASTON EASTON EASTON EASTON EASTON EASTON EASTON EASTON EASTON EBENSBURG EDDYSTONE EDWARDSVILLE EIGHTY FOUR ELDRED ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELIZABETHTOWN ELKINS PARK ELKINS PARK ELKINS PARK ELKLAND ELVERSON ELYSBURG EMLENTON EMMAUS

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17316 16028-0000 18301-1313 18042-3915 18045 18042-3817 18040 18040-8367 18045-5376 18045-5670 18040 18045-5258 18042 15931-1862 19022 18704-2500 15330-2813 16731-0000 17022-9502 17022-2843 17022-9793 17022-9320 17022-2852 19027 19027-2202 19027-1430 16920-1108 19520-9303 17824-9703 16373 18049-1907

CAMERON COUNTY HEALTH CARE CENTER GIANT PHARMACY WEIS PHARMACY EPHRATA COM HOSP N ANNEX PHCY GIANT PHARMACY ROYER PHARMACY ROYER PHARMACY INC WEIS PHARMACY WELLSPAN PHARMACY BAYSIDE PHCY & PHCY SUP

(855) 355-3402 (717) 909-6950 (717) 732-4106 (717) 721-3493 (717) 733-6335 (717) 733-1215 (717) 733-6541 (717) 733-4052 (717) 721-5784 (814) 877-6785

90 EAST 2ND STREET 4510 MARKETPLACE WAY 4525 VALLEY ROAD 460 N READING RD 850 E MAIN ST 1021 SHARP AVE 2 E MAIN ST 331 N READING RD 183 N READING RD STE 9 300 STATE ST STE 102

EMPORIUM ENOLA ENOLA EPHRATA EPHRATA EPHRATA EPHRATA EPHRATA EPHRATA ERIE

PA PA PA PA PA PA PA PA PA PA

15834 17025 17025-1421 17522-9606 17522-2562 17522-1135 17522-2701 17522-1652 17522-1647 16507-1428

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 521 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BURHENN'S PHARMACY COLONIAL FAMILY PHARMACY COMMUNITY HEALTH NET PHARMACY FRONTIER PHARMACY INC GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE LECOM SR LIVING CENTER PHARMACY MEDICAP PHARMACY PHARMACY INNOVATIONS PHARMSV A PATIENT ASSOCIATE PHCY QUALITY PHARMACY YOUR HOMETOWN PHARMACY EVERETT PHARMACY LOWERS PHARMACY INC EXTON PHARMACY AT MARCHWOOD GIANT PHARMACY TOWN CENTER PHARMACY FAIRCHANCE PHARMACY VALENTINE PHARMACY WELLSPAN PHARMACY FAIRFIELD GIANT PHARMACY OXFORD VALLEY PHARMACY RELIANT CARE SOLUTIONS VIP PHARMACY HEALTH CENTER PHARMACY VALLEY PHARMACY, INC. ALLTOWN PHARMACY NEW CARE CHESTNUT RIDGE PHARMACY GIANT PHARMACY WEIS PHARMACY DELMAR PHARMACY PHARMACY SOLUTIONS RX KLINGENSMITH'S DRUG STORES RED CROSS PHARMACY CARE PARTNERS MEDICAL ASTORINO FAMILY PHARMACY LLC CALLAGHANS PHARMACY INC THE MEDICINE SHOPPE REDNER'S PHARMACY GALETON DRUG LONGENECKER PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (814) 824-8224 (814) 835-0000 (814) 464-9520 (814) 452-2347 (814) 651-9098 (814) 636-6036 (814) 868-3869 (814) 456-4108 (814) 838-2102 (814) 452-5600 (814) 864-0653 (814) 898-2085 (814) 652-5532 (814) 652-5633 (610) 363-9444 (610) 594-0851 (610) 458-3767 (724) 564-7817 (724) 564-1700 (717) 642-8812 (215) 949-8955 (215) 269-7900 (215) 547-1700 (215) 486-7300 (724) 329-4620 (724) 981-4553 (215) 354-9440 (215) 357-7737 (814) 839-9950 (215) 948-8016 (610) 530-3117 (484) 494-8899 (484) 494-5406 (724) 763-1201 (570) 785-5400 (844) 257-1371 (814) 432-9400 (814) 432-4125 (814) 437-9115 (717) 865-6566 (814) 435-6588 (717) 442-9523

Provider Street 861 E 38TH ST 3822 COLONIAL AVE 1202 STATE ST 1216 W 6TH ST 1330 W 26TH ST 1350 W 26TH ST STE 100 5535 PEACH ST 1896 E LAKE RD 3330 W 26TH ST STE 31 232 W 25TH ST 712 W 38TH ST 3106 BUFFALO RD 108 E MAIN ST 33 E MAIN ST 1 MARCHWOOD RD 141 E SWEDESFORD RD 606 WHARTON BLVD 90 W CHURCH ST 92 N MORGANTOWN ST 4910 FAIRFIELD RD # B 471 S OXFORD VALLEY RD 403 S OXFORD VALLEY RD 403 S OXFORD VALLEY RD STE 2 516 S OXFORD VALLEY RD 4164 NATIONAL PIKE 827 SHARON NEW CASTLE RD 1137 BUSTLETON PIKE 711 BUSTLETON PIKE 2262 QUAKER VALLEY ROAD 1874 BETHLEHEM PIKE 7801 GLENLIVET WEST DRIVE 1934 DELMAR DR 1932 DELMAR DR 313 FORD ST 420 MAIN ST 5055 SWAMP RD STE 202 1015 BUFFALO ST 1262 LIBERTY ST 102 E ATLANTIC AVE 2977 STATE ROUTE 22 20 WEST ST 5277 LINCOLN HWY

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Provider City ERIE ERIE ERIE ERIE ERIE ERIE ERIE ERIE ERIE ERIE ERIE ERIE EVERETT EVERETT EXTON EXTON EXTON FAIRCHANCE FAIRCHANCE FAIRFIELD FAIRLESS HILLS FAIRLESS HILLS FAIRLESS HILLS FAIRLESS HILLS FARMINGTON FARRELL FEASTERVILLE TREVOSE FEASTERVILLE TREVOSE FISHERTOWN FLOURTOWN FOGELSVILLE FOLCROFT FOLCROFT FORD CITY FOREST CITY FOUNTAINVILLE FRANKLIN FRANKLIN FRANKLIN FREDERICKSBURG GALETON GAP

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

16504-1768 16506-3826 16501-1914 16507-1022 16508-1402 16508-1402 16509 16511-1072 16506-2471 16544-0002 16508-2627 16510-1772 15537-1258 15537-1257 19341-1840 19341 19341-1184 15436-1136 15436-1038 17320-9201 19030-4202 19030-4202 19030-4202 19030 15437-1344 16121-2413 19053-7609 19053-6055 15539-0000 19031-1504 18051 19032-1401 19032-1401 16226-1268 18421-1420 18923-9655 16323-1207 16323-1322 16323-2364 17026-9304 16922-1136 17527-9427

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WEIS PHARMACY ELWYN SPECIALTY CARE GIANT PHARMACY LASLOWS PHARMACY WELLSPAN PHARMACY GIANT PHARMACY GIRARD PHARMACY GLADWYNE PHARMACY NEIGHBORCARE MARIS GROVE SAV-ON PHARMACY ADAMS DISCOUNT PHARMACY WESLEY APOTHECARY CARLS DRUG STORE INC HAYDEN'S PHARMACY PRECISION CARE PHARMACY THE HOMETOWN PHARMACY THE HOMETOWN PHARMACY

Provider Name

(717) 442-9448 (610) 545-6040 (717) 337-0585 (717) 337-0881 (717) 359-0048 (610) 473-3204 (814) 774-3070 (610) 649-1100 (610) 387-4540 (610) 361-9523 (215) 572-1118 (215) 887-4577 (717) 597-2426 (724) 836-2400 (724) 834-5113 (724) 853-3254 (724) 853-3254

5360 LINCOLN HWY 3070 MCCANN FARM DR STE 101 44 NATURAL SPRINGS RD 6 SPRINGS AVE 40 V TWIN DR 173 HOLLY ROAD 83 MAIN ST W 352 RIGHTERS MILL RD 100 MARIS GROVE WY 101 BYERS DR 241 N KESWICK AVE 108 S EASTON RD # 110 145 N ANTRIM WAY 500 PELLIS RD 434 E PITTSBURGH ST STE 17 730 EAST PITTSBURGH STREET 730 E. PITTSBURGH ST

GAP GARNET VALLEY GETTYSBURG GETTYSBURG GETTYSBURG GILBERTSVILLE GIRARD GLADWYNE GLEN MILLS GLEN MILLS GLENSIDE GLENSIDE GREENCASTLE GREENSBURG GREENSBURG GREENSBURG GREENSBURG

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17527-9451 19060-2131 17325-7502 17325-1724 17325 19525 16417-1611 19035-1543 19342 19342-3319 19038-4803 19038-4001 17225-1403 15601-4506 15601 15601 15601

WESTMORELAND HOSP OUTPATIENT PHCY CARE FILL PHARMACY THE MEDICINE SHOPPE RX XPRESS HEALTH MART PHARMACY THE HOMETOWN PHARMACY REDDON DRUG INC ADAMS & BRIGHT DRUGS, LLC. WEIS PHARMACY WEIS PHARMACY GIANT PHARMACY GIANT PHARMACY HANOVER APOTHECARY LASLOWS PHARMACY WEIS PHARMACY WEIS PHARMACY GERRITYS PHARMACY HANOVER NOCKLEY FAMILY PHARMACY LANDIS PHARMACY VERNFIELD RANN PHARMACY HOMETOWN PHARMACY ANDREWS AND PATEL ASSOC GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY

(724) 832-4255 (724) 373-8533 (724) 588-3875 (724) 458-8420 (724) 458-1900 (570) 879-2125 (610) 562-2738 (610) 562-3795 (570) 689-5231 (717) 633-7292 (717) 632-4887 (717) 630-8835 (717) 637-4003 (717) 637-0607 (717) 632-7781 (570) 812-0016 (570) 208-5500 (215) 723-1045 (215) 256-4146 (724) 452-5334 (717) 526-1030 (717) 909-0703 (717) 545-2986 (717) 920-1323

532 W PITTSBURGH ST 43 WILLIAMSON RD STE 1 419 S MAIN ST 111 MILL ST 49 PINE GROVE PLAZA 25059 STATE ROUTE 11 306 STATE ST 552 STATE ST 793 STATE ROUTE 590 801 BALTIMORE ST 455 EISENHOWER DR 310 STOCK ST STE 1 800 CARLISLE ST 1424 BALTIMORE ST 860 CARLISLE ST 2280 SANS SOUCI PKWY 1198 S MAIN ST 2700 SHELLY RD 377 MAIN ST 3 NORTHGATE PLZ 4518 UNION DEPOSIT RD STE 201 136 KLINE VLG 2300 LINGLESTOWN RD 4211 UNION DEPOSIT RD

GREENSBURG GREENVILLE GREENVILLE GROVE CITY GROVE CITY HALLSTEAD HAMBURG HAMBURG HAMLIN HANOVER HANOVER HANOVER HANOVER HANOVER HANOVER HANOVER TOWNSHIP HANOVER TOWNSHIP HARLEYSVILLE HARLEYSVILLE HARMONY HARRISBURG HARRISBURG HARRISBURG HARRISBURG

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

15601-2239 16125 16125-1774 16127-1514 16127-4447 18822-8831 19526-1802 19526-1227 18427 17331-4100 17331-5214 17331-2276 17331-1703 17331 17331-1703 18706-5049 18706-4030 19438-1281 19438-2309 16037-9257 17111-2921 17104-1581 17110-9534 17111-2802

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 523 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GIANT PHARMACY HARRISBURG PHARMACY MEDICINE SHOPPE PHARMACY PINNACLE HEALTH CONNECTIONS RX SEE-RIGHT PHARMACY, INC. UPTOWN DISCOUNT DRUGS WEIS PHARMACY WEIS PHARMACY WEIS PHARMACY BUSHY RUN PHARMACY FOWLER'S PHARMACY COUNTY LINE PHARMACY PHARMACY OF HATBORO PHILADELPHIA PROF COMPOUNDING GIANT PHARMACY 700 PHARMACY GIANT PHARMACY HEALTH PLUS PHARMACY KATZ PHARMACY BRUNDAGE'S LAKE REGION PHARMACY LORDS VALLEY VILLAGE PHCY INC GIANT PHARMACY HAZLE DRUGS INC HEIGHTS-TERRACE PHARMACY JOHNSONS PHARMACY OF HAZLETON WEIS PHARMACY YOCUMS PHARMACY REDNER'S PHARMACY GIANT PHARMACY YEAGER'S PHARMACY THE MEDICINE SHOPPE DAL-HERN PHARMACY GIANT PHARMACY HERSHEY PHARMACY MILTON S HERSHEY MED CTR O/P PHCY

Provider Name

(717) 545-9313 (717) 232-0400 (717) 236-7588 (717) 782-3200 (717) 236-9094 (717) 236-9999 (717) 558-9407 (717) 540-3906 (717) 540-6011 (724) 744-3300 (814) 247-9959 (215) 443-7700 (215) 443-9999 (215) 672-8552 (215) 412-9264 (215) 525-1100 (610) 449-1414 (610) 853-2393 (610) 446-4040 (570) 390-7655 (570) 775-9555 (570) 459-5759 (570) 454-2476 (570) 454-8748 (570) 455-5884 (570) 455-6670 (570) 454-1135 (570) 682-3855 (610) 838-3007 (610) 838-0411 (724) 983-8451 (570) 758-2042 (717) 312-0729 (717) 534-1300 (717) 531-8094

5074 JONESTOWN RD 2645 N 3RD ST STE 180 110 S 17TH ST 111 S FRONT ST STE 1 2647 N 6TH ST 2336 N 3RD ST 3885 UNION DEPOSIT RD 5125 JONESTOWN RD STE 371 4300 LINGLESTOWN RD 2106 ROUTE 130 317 BEAVER STREET 25 S YORK RD 420 S YORK RD STE D 23 S YORK RD FRNT 1540 COWPATH RD STE 110 700 E TOWNSHIPLINE RD 116 W TOWNSHIP LINE RD 805 W CHESTER PIKE 2 E EAGLE RD 2489 ROUTE 6 658 RT 739 STE 5 70 S LOCUST ST 1 E BROAD ST 475 S POPLAR ST 901 W 15TH ST 100 WEIS LANE 1749 E BROAD ST 22 FOREST DR 1880 LEITHSVILLE RD 654 MAIN ST 1899 E STATE ST 4372 STATE ROUTE 147 1250 COCOA AVE 731 CHERRY DR 500 UNIVERSITY DR # 1200

HARRISBURG HARRISBURG HARRISBURG HARRISBURG HARRISBURG HARRISBURG HARRISBURG HARRISBURG HARRISBURG HARRISON CITY HASTINGS HATBORO HATBORO HATBORO HATFIELD HAVERTOWN HAVERTOWN HAVERTOWN HAVERTOWN HAWLEY HAWLEY HAZLETON HAZLETON HAZLETON HAZLETON HAZLETON HAZLETON HEGINS HELLERTOWN HELLERTOWN HERMITAGE HERNDON HERSHEY HERSHEY HERSHEY

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17112-4905 17110-2001 17104 17101-2010 17110-2641 17110 17109-5920 17112-2983 17112-9532 15636-1516 16646-6200 19040-3231 19040 19040-3231 19440-3184 19083-5733 19083-5235 19083 19083-1424 18428-6078 18428-6086 18201-6100 18201-6520 18201-7732 18201-2783 18202 18201-5650 17938-9018 18055-2505 18055-1726 16148-1866 17830 17033-1714 17033-2006 17033-2360

PENN STATE MILTON S HERSHEY MED CTR WHITMAN PHARMACY VILLAGE SHIRES PHARMACY THOMPSON PHARMACY HERITAGE THERAPEUTICS, LLC THE MEDICINE CENTER LLC

(717) 531-1372 (215) 794-8850 (215) 860-8000 (814) 693-0270 (855) 343-2136 (610) 461-4123

500 UNIVERSITY DR 4950 YORK RD 1464 BUCK RD 510 BLAIR ST 2173 MACDADE BLVD UNIT C & D 2209 MACDADE BLVD

HERSHEY HOLICONG HOLLAND HOLLIDAYSBURG HOLMES HOLMES

PA PA PA PA PA PA

17033-2360 18928-5038 18966-2626 16648-1808 19043 19043-1222

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name YANKEETOWN APOTHECARY STEPHENS PHARMACY WAYNE HEALTH PHARMACY & MED EQ WEIS PHARMACY BRANDYWINE PHARMACY HONEYBROOK PHARMACY NICKMAN'S DRUG ERIC'S RX SHOPPE LLC KABA FUSION INC. PMC PHARMACY WOODWARD PHARMACY GIANT PHARMACY RHOADS PHARMACY WEIS PHARMACY GIANT PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY GIANT PHARMACY WEIS PHARMACY POTOMAC VALLEY PHARMACY INC CAMILLA HALL PHARMACY DIAMOND DRUGS DIAMOND DRUGS EAGLESCRIPTS APOTHECARY GATTI PHARMACY GENOA-QOL HEALTHCARE MARTINS PHARMACY RX PRO PENNSYLVANIA JAMESTOWN PHARMACY GIANT PHARMACY RANIER'S PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE BAEDERWOOD PHARMACY WEIS PHARMACY FAMILY PHARMACY OF JESSUP INC MAUCH CHUNK PHARMACY EAST HILLS FAMILY PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE JOHNSTOWN PHARMACY MARTELLA'S PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (724) 471-7471 (570) 253-7700 (570) 253-8162 (570) 253-1620 (610) 273-3900 (610) 273-7300 (724) 437-2353 (215) 646-4800 (877) 629-4844 (215) 922-2502 (814) 378-7648 (717) 256-0054 (717) 566-2525 (717) 533-2963 (814) 643-1021 (814) 641-7442 (814) 643-1291 (215) 379-3257 (215) 355-2730 (814) 842-3201 (484) 321-5656 (724) 463-3440 (724) 465-4200 (724) 349-9170 (724) 349-4200 (724) 349-7060 (724) 465-5943 (724) 463-9300 (724) 932-5355 (215) 488-2030 (724) 527-7788 (724) 523-3550 (610) 539-7282 (215) 887-7877 (570) 398-7757 (570) 383-7311 (570) 325-5020 (814) 266-9602 (814) 792-3855 (814) 266-1699 (814) 535-3203 (814) 535-1833

Provider Street 60 YANKEETOWN AVE 1101 MAIN ST 601 PARK ST 1199 TEXAS PALMYRA HWY STE N 2503 CONESTOGA AVE 35 VILLAGE SQ 1238 NATIONAL PIKE 810 WELSH RD 223 WITMER ROAD 1250 EASTON RD STE 201N 565 SPRING ST 277 HERSHEY RD 17 W MAIN ST 1130 MAE ST 7673 LAKE RAYSTOWN SHOPPING CT 730 WASHINGTON ST 611 15TH ST # 619 737 HUNTINGDON PIKE 2100 COUNTY LINE RD 138 WASHINGTON ST 1145 KING ROAD 841 HOSPITAL RD STE 1100 670 PHILADELPHIA ST 401 N 4TH ST 1024 PHILADELPHIA ST 793 OLD ROUTE 119 HWY N 1570 OAKLAND AVE 280 INDIAN SPRINGS RD, STE 125 121 LIBERTY ST 2395 YORK RD 1107 LOWRY AVE 501 HARRISON AVE 2113 W MAIN ST 1585 THE FAIRWAY 1440 ALLEGHENY ST 140 CONSTITUTION AVE 1204 NORTH ST 1111 SCALP AVE 119 WALNUT ST STE 500 214 COLLEGE PARK PLZ # 214B 339 WALNUT ST STE 100 1079 FRANKLIN ST

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Provider City HOMER CITY HONESDALE HONESDALE HONESDALE HONEY BROOK HONEY BROOK HOPWOOD HORSHAM HORSHAM HORSHAM HOUTZDALE HUMMELSTOWN HUMMELSTOWN HUMMELSTOWN HUNTINGDON HUNTINGDON HUNTINGDON HUNTINGDON VALLEY HUNTINGDON VALLEY HYNDMAN IMMACULATA INDIANA INDIANA INDIANA INDIANA INDIANA INDIANA INDIANA JAMESTOWN JAMISON JEANNETTE JEANNETTE JEFFERSONVILLE JENKINTOWN JERSEY SHORE JESSUP JIM THORPE JOHNSTOWN JOHNSTOWN JOHNSTOWN JOHNSTOWN JOHNSTOWN

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

15748-1011 18431-1907 18431-1445 18431 19344-1053 19344-8646 15445 19044 19044 19044-1416 16651-1756 17036-9246 17036-1516 17036-9185 16652-8403 16652-1724 16652-2335 19006-8362 19006-1740 15545-7118 19345 15701-3660 15701-3930 15701-2026 15701-1676 15701-1372 15701-2429 15701 16134-9117 18929-1071 15644-3030 15644-1916 19403-3005 19046-1424 17740-1116 18434-1224 18229-1726 15904-3036 15901-1625 15904-2833 15901-1731 15905-4303

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MARTELLA'S PHARMACY ONCOLOGY PHARMACY VINCO PHARMACY SOLUTIONS, LLC. WESTMONT DRUG STORE QUALITY PHARMACY SMP RX AND HOME MEDICAL KANE BOOTHWYN PHARMACY GIANT PHARMACY ACADEMIC UROLOGY OF PA, LLC COMMUNITY SURGICAL INFUSION GIANT PHARMACY MAIN LINE SPINE PHARMACY PROMPTCARE HOME INFUSION LENOX PHARMACY COOK'S PHARMACY OF KINGSTON PIERCE DRUGS HILAND PHARMACY KLINGENSMITH'S DRUG STORES KLINGENSMITH'S DRUG STORES PCA MISSION PHARMACY TOMS RIVERSIDE PHARMACY WEIS PHARMACY CONTRACT PHARMACY SERVICES WHITEMARSH PHARMACY GANSE APOTHECARY GANSE APOTHECARY LTC GENOA-QOL HEALTHCARE GIANT PHARMACY GIANT PHARMACY HEALTH DEPOT PHARMACY LANCASTER CANCER CENTER LTD

Provider Name

(814) 322-1011 (814) 534-3399 (814) 322-4521 (814) 255-4101 (814) 837-4931 (814) 837-8500 (800) 476-7496 (610) 444-8165 (610) 382-5900 (877) 349-2990 (610) 290-1031 (610) 717-5588 (866) 776-6782 (570) 222-5005 (570) 288-3633 (570) 288-4519 (724) 543-2504 (724) 543-3400 (724) 548-5500 (724) 545-1600 (814) 797-2828 (610) 683-5827 (215) 402-8767 (610) 828-5222 (717) 394-5671 (717) 984-2204 (717) 723-9910 (717) 290-7201 (717) 291-9126 (717) 509-4844 (717) 291-1313

1940 WILLIAM PENN AVE STE 3 1020 FRANKLIN ST 2809 WILLIAM PENN AVE 1741 GOUCHER ST 525 N FRALEY ST 190 N FRALEY ST STE 2 221 GALE LN 350 SCARLET RD STE 220 211 S GULPH RD STE 200 625 CLARK AVE STE 16 310 S HENDERSON RD 700 S HENDERSON RD #308 741 THIRD AVE. SUITE B 5879 SR 92 STE 3 LENOX PLAZA 777 WYOMING AVE 435 PIERCE ST 231 BUTLER RD 200 MARKET ST 316 1ST AVE 201 N JEFFERSON ST STE 300 8868 RT 338 15260 KUTZTOWN RD STE 2 4000 FOX HOUND DRIVE 553 GERMANTOWN PIKE 355 W KING ST 7 N CHARLOTTE ST 790 NEW HOLLAND AVE STE 102 A 1605 LITITZ PIKE 1360 COLUMBIA AVE 1571 MANHEIM PIKE 1858 CHARTER LN STE 202

JOHNSTOWN JOHNSTOWN JOHNSTOWN JOHNSTOWN KANE KANE KENNETT SQUARE KENNETT SQUARE KING OF PRUSSIA KING OF PRUSSIA KING OF PRUSSIA KING OF PRUSSIA KING OF PRUSSIA KINGSLEY KINGSTON KINGSTON KITTANNING KITTANNING KITTANNING KITTANNING KNOX KUTZTOWN LAFAYETTE HILL LAFAYETTE HILL LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

15909-1609 15905-4109 15909-3629 15905-1205 16735-1162 16735-1165 19348-1735 19348-2271 19406-3101 19406-1438 19406-2408 19406 19406-1409 18826 18704-3863 18704-5503 16201-1958 16201-1525 16201-2264 16201-1387 16232-5556 19530-1342 19444-1014 19444 17603-3751 17603 17602-2137 17601-6507 17603-4700 17601 17601

LANCASTER HEMATOLOGY ONCOLOGY CARE REGIONAL PHARMACY ROYER PHARMACY SAVEMART PHARMACY SMITHGALL PHARMACY STAUFFERS OF KISSEL HILL PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY WEIS PHARMACY WEIS PHARMACY

(717) 735-3738 (717) 517-8109 (717) 299-4737 (717) 569-0825 (717) 397-6218 (717) 397-4710 (717) 208-3415 (717) 397-8161 (717) 285-7493 (717) 569-7518

233 COLLEGE AVE STE 303 250 COLLEGE AVE FIRST FLOOR 508 HERSHEY AVE 241 W. ROSEVILLE ROAD 536 W LEMON ST 301 ROHRERSTOWN RD 625 S DUKE ST 1700-A FRUITVILLE PIKE 1400 STONY BATTERY RD 1643 MANHEIM PIKE

LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER

PA PA PA PA PA PA PA PA PA PA

17603 17603-3363 17603-5702 17601 17603-3323 17603-2232 17602-4509 17601 17601-1280 17601-3027

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

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Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WEIS PHARMACY WEIS PHARMACY WILEYS PHARMACY WILLIAMS APOTHECARY WILLIAMS APOTHECARY WILLIAMS APOTHECARY WILLIAMS APOTHECARY INC GIANT PHARMACY LANGHORNE PHARMACY REGIONAL HEMATOLOGY ONCOLOGY ST. CLARE PHARMACY US 1 PHARMACY DETWEILER FAMILY MEDICINE KEYSTONE CARE PHARMACY LANSDALE RX PHARMACY RAMSRX PHARMACY SAV-ON PHARMACY WEIS PHARMACY GIANT PHARMACY PHILIP E PEPPER INC SUNNY PHARMACY PRECISION CARE PHARMACY THE MEDICINE SHOPPE DONOUGH PHARMACY LOEHLE PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY WEIS PHARMACY KLINGENSMITH'S DRUG STORES LEECHBURG HEALTHMART PHARMACY PROF CMPDNG PHMCTS OF WPA REDNER'S PHARMACY FIRST NATIONAL PHARMACY NICKMAN'S DRUG, INC. GIANT PHARMACY ROYER PHARMACY CHARLIES PHARMACY FAMILY 1 PHARMACY GIANT PHARMACY NU WAY PHARMACY PENNSBURY PHARMACY INC. WINDSOR PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (717) 394-9826 (717) 393-6074 (717) 898-8804 (717) 560-8822 (717) 393-9314 (717) 393-3814 (717) 464-4200 (215) 375-3015 (215) 752-1100 (215) 750-6119 (215) 710-7427 (215) 750-0111 (215) 369-1900 (215) 647-9308 (215) 855-7500 (267) 737-8484 (215) 361-7177 (215) 362-5336 (610) 623-8471 (610) 626-4941 (610) 259-0660 (724) 532-2120 (724) 539-4565 (717) 272-2261 (717) 272-6951 (717) 766-6191 (717) 273-8170 (717) 270-1919 (724) 845-7501 (724) 842-1771 (724) 845-7677 (610) 926-3129 (610) 377-0450 (724) 437-1179 (717) 656-8575 (717) 656-3784 (215) 269-7000 (215) 943-2221 (215) 946-2857 (215) 547-0250 (215) 547-2378 (215) 945-1125

Provider Street 1603 LINCOLN HWY E 1204 MILLERSVILLE PIKE 903 NISSLEY RD 3001 LITITZ PIKE 2001 HARRISBURG PIKE 201 E CHESTNUT ST 600 WILLOW VALLEY SQ 168 N FLOWERS MILL RD 172 N PINE ST 240 MIDDLETOWN BLVD STE 205 1203 LANGHORNE NEWTOWN RD 1254 E LINCOLN HWY 1970 N BROAD ST 203 NORTH BROAD STREET 1801 N BROAD ST STE 14 801 W MAIN ST 1150 W MAIN ST 1551 S VALLEY FORGE RD 300 E BALTIMORE AVE 195 E PLUMSTEAD AVE # 197 918 E BALTIMORE AVE 1906 DAILEY AVE 709 LIGONIER ST 545 CUMBERLAND ST 705 LEHMAN ST 1305 CUMBERLAND ST 800 S 12TH ST 1651 E CUMBERLAND ST 153 MARKET ST 165 MARKET ST 111 2ND ST STE 100 5471 POTTSVILLE PIKE 143 N 1ST ST 3 NICKMAN PLZ 10 NEWPORT RD 335 W MAIN ST 2235 VETERANS HWY 4005 VETERANS HWY 4001 NEW FALLS RD 1639 HAINES RD 8545 NEW FALLS RD 1508 HAINES RD

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Provider City LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANGHORNE LANGHORNE LANGHORNE LANGHORNE LANGHORNE LANSDALE LANSDALE LANSDALE LANSDALE LANSDALE LANSDALE LANSDOWNE LANSDOWNE LANSDOWNE LATROBE LATROBE LEBANON LEBANON LEBANON LEBANON LEBANON LEECHBURG LEECHBURG LEECHBURG LEESPORT LEHIGHTON LEMONT FURNACE LEOLA LEOLA LEVITTOWN LEVITTOWN LEVITTOWN LEVITTOWN LEVITTOWN LEVITTOWN

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17602-2609 17603-6656 17601-1472 17606 17601-2641 17602-2705 17602-4866 19047-1652 19047-2141 19047-1832 19047 19047 19446-1002 19446-2409 19446 19446 19446 19446-5461 19050-2504 19050-1243 19050 15650-3030 15650-1825 17042 17046-4747 17042-4529 17042-6903 17042-8324 15656-1334 15656-1334 15656 19533-8633 18235-1512 15456-9732 17540-1818 17540-2107 19056-3001 19056-3406 19056-3016 19055-1803 19054-1601 19055-1802

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

YORKE PHARMACY GIANT PHARMACY LEWISBURG PHARMACY WEIS PHARMACY CARESITE PHARMACY CARESITE PHARMACY-LTN LIGONIER PHARMACY INC LINESVILLE PHARMACY GIANT PHARMACY MCELROY PHARMACY WEIS PHARMACY WILLIAMS APOTHECARY WILLIAMS APOTHECARY INC KENNIES PHARMACY-LITTLESTOWN KELLER & MUNRO DRUG INC WEIS PHARMACY BURRELL PHARMACY WEST PERRY PHARMACY INC THE MEDICINE SHOPPE WEIS PHARMACY MORRIS DRUGS KOHLERMAN PHARMACY INC MANCHESTER PHCY AND MEDICAL SLOAN'S MANHEIM PHARMACY GIANT PHARMACY MARCUS HOOK PHARMACY MARIENVILLE PHARMACY NICKMAN'S DRUG PRICE CHOPPER PHARMACY MCLAUGHLINS DRUG STORE PAUL B MACDONALD'S PHARMACY MCDONALD PHARMACY THE MEDICINE SHOPPE CHOICE CRITICAL CARE PHCY CHOICE FAMILY PHARMACY STANDARD DRUG STORE CARESITE PHARMACY

Provider Name

(215) 945-5700 (570) 523-9469 (570) 768-4446 (570) 524-5757 (717) 242-7392 (717) 242-4264 (724) 238-6988 (814) 818-0010 (717) 625-0307 (717) 626-2222 (717) 626-8507 (717) 581-3950 (717) 626-4499 (717) 359-9899 (570) 748-5209 (570) 748-1790 (724) 334-1067 (717) 789-3093 (570) 283-1331 (484) 232-6863 (570) 773-3860 (610) 647-2266 (717) 978-5142 (717) 665-2223 (215) 643-2880 (610) 485-7750 (814) 226-5353 (724) 952-1040 (570) 491-5702 (717) 485-3724 (717) 485-3622 (724) 926-2117 (412) 331-7080 (717) 630-2773 (717) 630-2000 (570) 929-1130 (717) 463-3558

5524 NEW FALLS RD 224 HARDWOOD DR 50 N 2ND ST 6901 WESTBRANCH HWY 300 HIGHLAND AVE 21 GEISINGER LN 113 S FAIRFIELD ST 226 W ERIE ST 1008 LITITZ PIKE 100 E MAIN ST 740 S BROAD ST 1001 E OREGON RD 6 W NEWPORT RD 520 W KING ST 127 E CHURCH ST 313-337 W BALD EAGLE ST 2889 LEECHBURG RD 1102 MONTOUR RD 101 MAIN ST 3369 ROUTE 100 15 E CENTRE ST 101 W KING ST 4310 N GEORGE ST EXT 73 S MAIN ST 1925 NORRISTOWN RD 46 E 10TH ST 120 CHERRY ST 1878 MCCLELLANDTOWN ROAD 1025 PENNSYLVANIA AVE 182 BUCHANAN TRL STE 150 105 S 3RD ST 303 W BARR ST 1770 PINE HOLLOW RD 10 S 6TH ST 8 S 6TH ST 322 S HANCOCK ST 30968 RT 35 N

LEVITTOWN LEWISBURG LEWISBURG LEWISBURG LEWISTOWN LEWISTOWN LIGONIER LINESVILLE LITITZ LITITZ LITITZ LITITZ LITITZ LITTLESTOWN LOCK HAVEN LOCK HAVEN LOWER BURRELL LOYSVILLE LUZERNE MACUNGIE MAHANOY CITY MALVERN MANCHESTER MANHEIM MAPLE GLEN MARCUS HOOK MARIENVILLE MASONTOWN MATAMORAS MC CONNELLSBURG MC CONNELLSBURG MC DONALD MC KEES ROCKS MC SHERRYSTOWN MC SHERRYSTOWN MCADOO MCALISTERVILLE

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19056-3102 17837 17837-1567 17837-6353 17044 17044-3400 15658-1163 16424 17543-9328 17543-2010 17543-2806 17543-9205 17543-7774 17340-1414 17745-2007 17745 15068-2542 17047-9200 18709-1209 18062-9613 17948-2702 19355-2411 17345 17545-1645 19002 19061-4515 16239-4604 15461 18336-1713 17233 17233-1419 15057-1423 15136-1588 17344-1800 17344-1800 18237-1608 17049

PRIMARY CARE PHARMACY SERVICES INC AYRES DRUG STORE GENOA-QOL HEALTHCARE MCKEESPORT PRESCRIPTION CENTER

(412) 771-2149 (412) 672-3000 (412) 664-6590 (412) 673-7147

27 HECKEL RD STE 110 3000 WALNUT ST 331 SHAW AVE 2301 VERSAILLES AVE

MCKEES ROCKS MCKEESPORT MCKEESPORT MCKEESPORT

PA PA PA PA

15136-1616 15132-7158 15132-2918 15132-2036

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 528 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JACK'S PHARMACY MILL RUN COMMUNITY PHARMACY NORTHWEST COMMUNITY PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE ALERT PHARMACY SERVICES INC GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GOOD DAY PHARMACY SAMS CLUB PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE WEIS PHARMACY WEIS PHARMACY ELWYN PHARMACY ELWYN RX AT FAIR ACRES MURRAY OVERHILL PHARMACY HAEUN PHARMACY MEDICINE SHOPPE PHARMACY MERCER PHARMACY BABIS PHARMACY DAKES DRUG STORE F B THOMAS DRUG STORE INC GIANT PHARMACY

Provider Name

(814) 336-1113 (814) 337-6600 (814) 724-3107 (814) 337-8880 (814) 333-1121 (717) 796-3611 (717) 591-9565 (717) 796-0444 (717) 591-0993 (717) 728-4200 (717) 516-3772 (717) 697-0551 (717) 516-3103 (717) 697-8101 (717) 796-1692 (610) 566-2226 (610) 891-5783 (610) 566-2345 (215) 635-6532 (724) 662-2240 (724) 662-1414 (610) 664-4815 (610) 667-1316 (814) 634-8614 (717) 944-0882

285 CHESTNUT ST 404 NORTH ST 740 N. MAIN ST EXT. SUITE A 629 STATE ST 16332 CONNEAUT LAKE RD 940 OAK OVAL 5301 SIMPSON FERRY RD STE 101 6560 CARLISLE PIKE STE 100 255 CUMBERLAND PKWY 2025 TECHNOLOGY PKWY STE G04 6520 CARLISLE PIKE STE 250 33 E SIMPSON ST 5225 WILSON LN 5140 SIMPSON FERRY RD 2150 BUMBLE BEE HOLLOW RD 194 S NEW MIDDLETOWN RD # 196 340 N MIDDLETOWN RD 32 W STATE ST 7320 OLD YORK RD STE 210-211 315 S ERIE ST 737 GREENVILLE RD 338 MONTGOMERY AVE 201 CITY AVE 327 MAIN ST 450 E MAIN ST

MEADVILLE MEADVILLE MEADVILLE MEADVILLE MEADVILLE MECHANICSBURG MECHANICSBURG MECHANICSBURG MECHANICSBURG MECHANICSBURG MECHANICSBURG MECHANICSBURG MECHANICSBURG MECHANICSBURG MECHANICSBURG MEDIA MEDIA MEDIA MELROSE PARK MERCER MERCER MERION STATION MERION STATION MEYERSDALE MIDDLETOWN

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

16335-3266 16335-2562 16335 16335-2262 16335-3843 17055-8410 17050-3544 17050-8252 17055-5677 17050-9400 17050-5251 17055-3816 17055-6663 17050-3627 17055-5563 19063-5202 19063 19063-3319 19027-3007 16137-1503 16137-5023 19066-1202 19066-1803 15552-1035 17057-2740

MIDDLETOWN PHARMACY & GIFT SHOP WEIS PHARMACY BEWARD PHARMACY CARESITE PHARMACY MCLAUGHLIN PHARMACY INC WEIS PHARMACY

(717) 944-1640 (570) 966-6505 (717) 436-6844 (717) 436-8278 (717) 436-8020 (717) 436-9149

436 E MAIN ST 65 MEADOW GREEN DRIVE 24082 ROUTE 35 N 2813 INDUSTRIAL PARK RD STE 1 122 CARRIAGE LN 4521 WILLIAM PENN HWY

MIDDLETOWN MIFFLINBURG MIFFLINTOWN MIFFLINTOWN MIFFLINTOWN MIFFLINTOWN

PA PA PA PA PA PA

17057-2725 17844 17059-7926 17059 17059-9048 17059-9547

ALITONS PHCY HOME HEALTH CARE CNTR THE MEDICINE SHOPPE MILL HALL PHARMACY INC SCOT'S LO-COST PHARMACY MILLERSBURG PHARMACY WEIS PHARMACY WILEY'S PHARMACY OF MILLERSVILLE MEDICAP PHARMACY CUSTOM CARE PHARMACY

(845) 856-8314 (570) 296-5138 (570) 726-3213 (570) 748-1130 (717) 692-2161 (717) 692-3656 (717) 871-1100 (412) 821-1524 (570) 246-5700

111 ROUTE 6 # 113 105 WHEATFIELD DRIVE 260 MAIN ST 6 MILLBROOK PLZ 242 MARKET ST 1571 STATE ROUTE 209 507 LEAMAN AVE 225 GRANT AVE 57 S FRONT ST

MILFORD MILFORD MILL HALL MILL HALL MILLERSBURG MILLERSBURG MILLERSVILLE MILLVALE MILTON

PA PA PA PA PA PA PA PA PA

18337-1240 18337 17751-1707 17751-1911 17061-1334 17061-8266 17551-1109 15209-2609 17847-1110

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 529 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WEIS PHARMACY PRECISION CARE PHARMACY EXPRESS MED PHARMACEUTICALS INC THE HOMETOWN PHARMACY DIERKEN'S PHARMACY SPAN AND TAYLOR DRUG COMPANY FORBES HOSPITAL OPTION CARE PRIMARY CARE PHARMACY SERVICES SCOT'S LO-COST PHARMACY MONTROSE MEDICAL ARTS PHARMACY PRICE CHOPPER PHARMACY AMERICAN INFUSION SERVICES INC BIG OAK PHARMACY BURNS PHARMACY MAKEFIELD TOWN PHARMACY ADVANCED RX PHARMACY RIOS PHARMACY FAMILY PHARMACY OF MOSCOW, INC BELSKI COMMUNITY PHARMACY ALERT PHARMACY SERVICES HOLLY PHARMACY INC DARRENKAMPS PHARMACY SLOAN'S PHARMACY, INC. WEIS PHARMACY MOUNT MORRIS PHARMACY DIAMOND PHARMACY HAYDEN'S PHARMACY NORVELT PHARMACY SHADE MOUNTAIN PHARMACY BILLS SHOPRITE PHCY OF MT POCONO CARESITE PHARMACY-MP WEIS PHARMACY APPLEBY'S DRUG STORE CRESTWOOD PHARMACY TRIANGLE PHARMACY WEIS PHARMACY SLOANS MOUNTVILLE PHARMACY TOWNVILLE PHARMACY WEIS PHARMACY SHERMANS PHARMACY THE MEDICINE SHOPPE

NR_0009_10823 10/2017

Provider Phone Number (570) 742-8253 (610) 743-3132 (724) 775-8688 (724) 774-2990 (330) 318-3926 (724) 258-4545 (412) 858-2393 (412) 373-2784 (412) 380-5230 (570) 368-5599 (570) 278-2951 (570) 278-8790 (570) 343-7883 (267) 797-5030 (215) 295-5585 (215) 295-5300 (484) 474-1050 (610) 543-1858 (570) 843-6369 (570) 339-1460 (717) 486-8606 (717) 486-5321 (717) 653-6333 (717) 653-4001 (717) 653-5298 (724) 324-5555 (724) 547-6700 (724) 547-3400 (724) 423-4100 (570) 539-2050 (570) 839-5340 (570) 895-5055 (570) 839-6240 (814) 542-4412 (570) 474-5859 (570) 474-6520 (570) 474-9203 (717) 285-7443 (570) 546-8272 (570) 546-7228 (412) 461-1214 (412) 461-9800

Provider Street 553 MAHONING ST # 555 360 E WYOMISSING AVE STE H 3950 BRODHEAD RD STE 330 3589 BRODHEAD RD 100 E MAIN ST 175 W MAIN ST 2570 HAYMAKER RD 540 SECO RD 2550 MOSSIDE BLVD STE 210 801 N LOYALSOCK AVE 363 MAPLE ST 16750 STATE ROUTE 706 STE 5 4113 BIRNEY AVE 364 W TRENTON AVE STE C 82 N PENNSYLVANIA AVE 99 MAKEFIELD RD 407 BALTIMORE PIKE STE B 35 S MORTON AVE 330 N MAIN ST STE 202 49 S OAK ST 219 N BALTIMORE AVE 31 N BALTIMORE AVE 945 E MAIN ST 61 E MAIN ST 441 W MAIN ST 120 LOCUST AVE EXT STE 2 445 W MAIN ST 535 W MAIN ST 2310 MOUNT PLEASANT RD 9627 ROUTE 35 # 20 89 STATE ROUTE 940 126 MARKET WAY 3236 ROUTE 940 133 E SHIRLEY ST 10 S MOUNTAIN BLVD 89 S MAIN ST 237 S MOUNTAIN BLVD 2 COLLEGE AVE 2195 RT 442 HWY 1272 E PENN ST 3417 MAIN ST 2279 MAIN ST

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Provider City MILTON MOHNTON MONACA MONACA MONONGAHELA MONONGAHELA MONROEVILLE MONROEVILLE MONROEVILLE MONTOURSVILLE MONTROSE MONTROSE MOOSIC MORRISVILLE MORRISVILLE MORRISVILLE MORTON MORTON MOSCOW MOUNT CARMEL MOUNT HOLLY SPRINGS MOUNT HOLLY SPRINGS MOUNT JOY MOUNT JOY MOUNT JOY MOUNT MORRIS MOUNT PLEASANT MOUNT PLEASANT MOUNT PLEASANT MOUNT PLEASANT MILLS MOUNT POCONO MOUNT POCONO MOUNT POCONO MOUNT UNION MOUNTAIN TOP MOUNTAIN TOP MOUNTAIN TOP MOUNTVILLE MUNCY MUNCY MUNHALL MUNHALL

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17847-2213 19540 15061-3030 15061-3138 15063-2308 15063-2305 15146-3513 15146-1460 15146-3531 17754-1023 18801-1268 18801-6400 18507-1330 19067-2004 19067-1110 19067 19070-1042 19070-1734 18444-9003 17851-2164 17065-1204 17065-1302 17552-9347 17552-1424 17552-1228 15349-1355 15666-1533 15666-1833 15666-2491 17853-8409 18344-1426 18344 18344-1170 17066-1625 18707 18707-1920 18707-1911 17554-1546 17756 17756-8275 15120-3258 15120-2652

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FERRI PHARMACY MIKES PHCY MED SHOPPE TRUE CARE PHARMACY INC THE MEDICINE SHOPPE WEIS PHARMACY MAINLINE PHARMACY

Provider Name

(724) 327-6611 (717) 866-7547 (717) 866-4800 (570) 735-2300 (570) 735-3979 (814) 419-6717

3907 OLD WILLIAM PENN HWY 211 W WASHINGTON AVE 9 W MAIN AVE 69 N MARKET ST 1 WEIS PLZ 1049 SHOEMAKER ST

MURRYSVILLE MYERSTOWN MYERSTOWN NANTICOKE NANTICOKE NANTY GLO

PA PA PA PA PA PA

15668-1833 17067-1036 17067-1122 18634 18634-1618 15943-1248

HEIGHTS PRESCRIPTION PHARMACY INC THE MEDICINE SHOPPE GIANT PHARMACY KEYSTONE PHARMACY KLINGENSMITH DRUG STORE BLOOMFIELD PHARMACY INC BRIGHTON PHARMACY HOMETOWN APOTHECARY DRUGS INC HYDE DRUG LOMBARDOS APOTHECARY NEW CASTLE PHARMACY THE HOMETOWN PHARMACY THE HOMETOWN PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE VILLAGE PHARMACY GIANT PHARMACY THE MEDICINE SHOPPE NORTHERN BEDFORD PHARMACY STAUFFERS DRUG STORE YODER'S PHARMACY GIANT PHARMACY TOWN & COUNTRY PHARMACY WHYSONGS PHARMACY NEW STANTON PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY BIG SPRING PHARMACY INC ACCUSERV PHARMACY EAGLEVILLE HOSPITAL PHARMACY GIANT PHARMACY GIANT PHARMACY LA CON'S PHARMACY INC MYERS DRUG STORE NORRISTOWN STATE HOSPITAL

(724) 226-2600 (724) 224-7111 (610) 759-8368 (724) 668-2284 (814) 275-3424 (717) 582-2313 (724) 847-7979 (724) 891-7383 (724) 652-1451 (724) 654-8100 (724) 656-5000 (724) 658-9670 (724) 658-8661 (724) 652-8132 (724) 652-3366 (724) 667-7124 (717) 909-4320 (717) 774-6262 (814) 766-0124 (717) 355-9300 (717) 354-4999 (215) 862-9065 (724) 335-2330 (814) 839-9997 (724) 925-9810 (717) 567-6367 (717) 567-6047 (717) 776-0288 (724) 978-0110 (610) 635-7426 (610) 631-8134 (610) 728-5600 (610) 279-0140 (610) 272-0637 (610) 313-5867

1633 UNION AVE 2606 FREEPORT RD 859 NAZARETH PIKE 8279 STATE ROUTE 22 STE 10 332 BROAD ST 1 W MAIN ST 525 5TH AVE 807 3RD AVE 112 N LIBERTY ST 1230 S MILL ST 1112 S MILL ST 2016 W STATE ST 20 E LAWRENCE ST 18 N MILL ST 1707 WILMINGTON RD 1624 E POLAND RD 130 OLD YORK RD 701 BRIDGE ST 3499 BRUMBAUGH RD 149 E MAIN ST 14 S TOWER RD 6542 LOGAN SQ 2209 FREEPORT RD 4186 CORTLAND DR 144 POST AVE 48 RED HILL CT 316 WALNUT ST 91 S HIGH ST 8731 ROUTE 30 100 EAGLEVILLE RD 2670 EGYPT RD 10000 SHANNONDELL DR 1336 POWELL ST 328 DEKALB ST 1001 STERIGERE ST

NATRONA HEIGHTS NATRONA HEIGHTS NAZARETH NEW ALEXANDRIA NEW BETHLEHEM NEW BLOOMFIELD NEW BRIGHTON NEW BRIGHTON NEW CASTLE NEW CASTLE NEW CASTLE NEW CASTLE NEW CASTLE NEW CASTLE NEW CASTLE NEW CASTLE NEW CUMBERLAND NEW CUMBERLAND NEW ENTERPRISE NEW HOLLAND NEW HOLLAND NEW HOPE NEW KENSINGTON NEW PARIS NEW STANTON NEWPORT NEWPORT NEWVILLE NO HUNTINGDON NORRISTOWN NORRISTOWN NORRISTOWN NORRISTOWN NORRISTOWN NORRISTOWN

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

15065-2103 15065-2513 18064-9005 15670-3155 16242-1004 17068-0000 15066-1737 15066-1914 16102-1830 16101-4812 16101-4629 16101-1240 16101-3826 16101-3610 16105-2061 16102-2838 17070-2443 17070-1624 16664-8820 17557-1227 17557-1517 18938-1084 15068-4848 15554-7706 15672-0000 17074-8706 17074-1524 17241-1405 15642-3241 19403-1829 19403-2302 19403-5615 19401-3324 19401-4906 19401-5300

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 531 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PHARMACY OF NORRISTOWN WEIS PHARMACY SHOP N SAVE RX EVERGREEN PHARMACY GIANT PHARMACY NORTH WALES FAMILY PHARMACY WARREN STATE HOSPITAL PHARMACY NEWHARD PHARMACY NEWHARD PHARMACY LTC WATTERS BROS DRUG STORE NORRY PHARMACY KLINGENSMITH'S DRUG STORES MEDICINE SHOPPE PHARMACY OLD FORGE PHARMACY WEIS PHARMACY FAMILY PHARMACY OF OLYPHANT GIANT PHARMACY MEDICAP PHARMACY ORBY PHARMACY CARESITE PHARMACY - ORW THOMAS DRUG STORE SHIPMANS PHARMACY PALMYRA PHARMACY & GIFT REDNERS PHARMACY WEIS PHARMACY KING OF PRUSSIA PHARMACY PAOLI APOTHECARY PAOLI CENTER PHARMACY INC PATTON PHARMACY BIANCARELLI'S PHARMACY, LLC WEIS PHARMACY THE MEDICINE SHOPPE PENNDEL DRUGS PROFESSIONAL PHCY OF PENNSBURG GIANT PHARMACY PERRY DRUG STORE LLC PETROLIA PHARMACY 11TH & WALNUT PHARMACY 18TH STREET APOTHECARY 26TH & LEHIGH PHARMACY 52ND STREET PHARMACY 65TH AND WOODLAND PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (484) 231-1014 (610) 278-0256 (724) 864-2400 (215) 393-0902 (215) 661-0547 (215) 699-6949 (814) 726-4531 (610) 262-6721 (610) 261-1777 (814) 948-6720 (570) 473-1126 (724) 783-7341 (412) 826-9500 (570) 457-3200 (610) 987-9877 (570) 487-4447 (570) 307-1322 (570) 383-6700 (814) 447-3934 (570) 968-1320 (570) 366-0381 (610) 826-5555 (717) 838-1300 (717) 473-4054 (717) 838-3670 (610) 578-0411 (610) 251-2295 (610) 644-3880 (814) 674-3693 (570) 382-8570 (610) 863-3314 (412) 798-9800 (215) 970-5676 (215) 679-9700 (215) 257-8200 (724) 736-4422 (724) 756-4050 (215) 238-0002 (215) 564-0900 (267) 687-2702 (267) 713-7066 (215) 727-9501

Provider Street 420 W MARSHALL ST 25 W GERMANTOWN PIKE 12120 STATE ROUTE 30 1222 WELSH RD STE C-1 1201 KNAPP RD 107 S MAIN ST 33 MAIN DR 1001 MAIN ST 1001A MAIN STREET 4105 CRAWFORD AVE 125 DUKE ST 4075 THIRD ST 215 ALLEGHENY AVE # 1 821 S MAIN ST STE 1 61 KINGS PLZ 110 DELAWARE AVE 1550 MAIN ST 514 BURKE BYP 626 WATER ST 300 HOLLYWOOD BLVD 101 W MARKET ST 326 DELAWARE AVE 22 E MAIN ST 110 NORTHSIDE COMMONS 901 E MAIN ST STE 25 23 INDUSTRIAL BLVD 255 W LANCASTER AVE STE 107 82 E LANCASTER AVE 503 RAILROAD AVE STE 2 1318 MAIN STREET 1309 BLUE VALLEY DRIVE 12238 FRANKSTOWN RD 19 BELLEVUE AVE 931 MAIN ST 1153 N 5TH ST 301 INDEPENDENCE STREET 296 CHURCH STREET 134 S 11TH ST 113 S 18TH ST 2602 W LEHIGH AVE 1226 N 52ND ST 6548 WOODLAND AVE

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Provider City NORRISTOWN NORRISTOWN NORTH HUNTINGDON NORTH WALES NORTH WALES NORTH WALES NORTH WARREN NORTHAMPTON NORTHAMPTON NORTHERN CAMBRIA NORTHUMBERLAND NU MINE OAKMONT OLD FORGE OLEY OLYPHANT OLYPHANT OLYPHANT ORBISONIA ORWIGSBURG ORWIGSBURG PALMERTON PALMYRA PALMYRA PALMYRA PAOLI PAOLI PAOLI PATTON PECKVILLE PEN ARGYL PENN HILLS PENNDEL PENNSBURG PERKASIE PERRYOPOLIS PETROLIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19401 19401-1513 15642 19454-2054 19454-1831 19454 16365 18067-1658 18067-0000 15714-1341 17857-1910 16244 15139-2058 18518 19547-8718 18447-1518 18447-1345 18447-1805 17243-9432 17961 17961-1807 18071-1814 17078-1710 17078-8663 17078-1923 19301 19301 19301-1485 16668-1300 18452 18072-1825 15235-3404 19047-4001 18073-1603 18944-1868 15473 16050 19107-4931 19103-5117 19132-3120 19131-4315 19142-2215

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

8TH ST PHARMACY LLC 9TH & GIRARD PHARMACY INC A & F PHARMACY A & W PHARMACY INC A PLUS PHARMACY ACADEMY PHARMACY ALEXA PHARMACY ALLEGHENY APOTHECARY ALLIANCE CANCER SPECIALISTS PC AMERICARE 1 PHARMACY ANGKOR PHARMACY APEX PHARMACY APOLLO PHARMACY ARCH PHARMACY ASPIRE RX LLC AV PHARMACY B & A PHARMACY B & Y PHARMACY BELL APOTHECARY INC BELL-EDGES PHARMACY BELLS MARKET PHARMACY BELLS PHARMACY BERTOLINOS PHARMACY INC BEST CARE PHARMACY BLUEGRASS PHARMACY BREWERYTOWN RX PHARMACY BRIDESBURG PHARMACY BRIGHT MEDICAL TECHNOLOGY INC BROAD & LEHIGH PHARMACY BROAD AND GRANGE PHARMACY BROAD STREET APOTHECARY BROOKS PHARMACY

Provider Name

(215) 592-8888 (215) 235-8800 (215) 425-5881 (215) 426-4100 (267) 731-6163 (215) 632-2121 (215) 437-7573 (215) 203-0194 (215) 612-4837 (215) 821-2720 (267) 928-2600 (215) 338-5100 (215) 426-5100 (215) 925-9666 (215) 883-0332 (215) 425-4346 (215) 309-5701 (215) 755-0816 (215) 387-9100 (215) 729-4139 (215) 342-1697 (215) 745-5700 (215) 389-5917 (267) 292-5011 (215) 676-7650 (267) 773-8349 (215) 744-2277 (215) 725-6337 (215) 228-9007 (215) 424-2611 (215) 551-9485 (215) 338-3262

819 S 8TH ST 901 W GIRARD AVE # 105 3200 FRANKFORD AVE 2623 E WESTMORELAND ST 13023 BUSTLETON AVE STE 1C 10101 ACADEMY RD STE 105 919 TYSON AVE 2244 E ALLEGHENY AVE 3998 RED LION RD STE 130 821 ADAMS AVE 2129-31 S. 7TH STREET 7200 FRANKFORD AVE 460 W LEHIGH AVE 933 ARCH ST 132 S 45TH ST 3237 KENSINGTON AVE 3138 N BROAD ST 1551 MCKEAN ST 4014 LANCASTER AVE 5401 CHESTER AVE 8330 BUSTLETON AVE 8508 BUSTLETON AVE 1500 S 12TH ST 257 N 52ND STREET 2417 WELSH RD UNIT 15 2621 W GIRARD AVE 2608 ORTHODOX ST 2020 NAPFLE ST # 2040 1300 W LEHIGH AVE, STE 102 5751 N BROAD ST 2426 S BROAD ST 6552 TORRESDALE AVE

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19147-2820 19123 19134-3217 19134-5228 19116 19114-1120 19111 19134-3831 19114-1443 19124-2477 19148 19135 19133 19107 19104-2951 19134-1934 19132 19145-3034 19104-1712 19143-4913 19152-1909 19152-1204 19147-6202 19139 19114-2209 19130 19137-1627 19152-3614 19132-2760 19141-2307 19145-4418 19135-2822

BUCKS PHILADELPHIA MED CARE GROUP BUENA SALUD PHARMACY CAMBRIA PHARMACIES INC CAMBRIA PHARMACIES INC CAMBRIA PHARMACIES INC CAMPUS PHARMACY CARE PLUS PHARMACY INC CARE TRUST PHARMACY CARIBBEAN PHARMACY

(215) 947-6238 (215) 426-5186 (215) 229-6454 (215) 225-2886 (215) 425-6869 (215) 921-5660 (215) 279-7295 (215) 426-0200 (215) 278-7711

10745 HALDEMAN AVE 3119 FRANKFORD AVE 2900 GERMANTOWN AVE 2860 N 5TH ST 3169 N 5TH ST 4027 MARKET ST 110 W SUSQUEHANNA AVE 2534 E ALLEGHENY AVE 3825 N 5TH ST

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA

19116 19134-3820 19133-1832 19133-2712 19133-2823 19104-3002 19122 19134 19140-3337

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 533 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CARING PHARMACY CASTOR PHCY & SURGICAL SUPPLIES CENTENNIAL PHARMACY BRIDESBURG CHELTEN DRUG CHEMISTRY RX CHESTNUT HILL PHARMACY CHRISTIAN STREET PHARMACY CIRCLE PHARMACY LLC CITIMED PHARMACY LLC CITYCARE PHARMACY COMMUNITY CARE RX CONTRACT PHARMACY SERVICES-PPH

Provider Name

(215) 739-9975 (267) 233-1758 (215) 535-4111 (215) 548-5221 (855) 790-0100 (215) 247-1221 (215) 545-3582 (215) 677-1111 (215) 224-7100 (215) 971-1288 (215) 722-2500 (215) 214-6608

2541 KENSINGTON AVE 6449 CASTOR AVE 2660 LEFEVRE ST 2137 E CHELTEN AVE 829 SPRUCE ST STE 100 8030 GERMANTOWN AVE 1947 CHRISTIAN ST 2853 HOLME AVE 7606 OGONTZ AVE 1549 W PASSYUNK AVE 7601 CASTOR AVE STE 201 6500 TABOR AVE

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA PA

19125-1337 19149 19137-2044 19138-2534 19107-5752 19118 19146-1834 19152-2118 19150-1817 19145 19152-4026 19111-5332

COORDINATED CARE NETWORK PHARMACY CROWN DRUGS CURE DISCOUNT PHARMACY DAVIS PHARMACY DELAIRE PHARMACY DELUXE PHARMACY DESTINY PHARMACY DIAMOND PHARMACY DISCOVER PHARMACY DOCTORS PHARMACY INC DREAM PHARMACY EAST LEHIGH HEALTH PHARMACY EDISON SQUARE PHARMACY EINSTEIN APOTHECARY EINSTEIN AT CENTER ONE PHCY ELLIS PRESCRIPTION PHARMACY EMACARE PHARMACY E-Z PHARMACY E-Z PHARMACY II FAIRMOUNT PHARMACY INC FAMILY FARMACIA FARMACIA FIRST CLASS PHARMACY FIRXST PHARMACY FISHTOWN PHARMACY FOUR STAR PHARMACY

(267) 928-4381 (215) 624-4224 (215) 223-5700 (215) 222-3349 (267) 343-8741 (215) 941-7689 (215) 796-9381 (215) 278-2284 (215) 332-1111 (215) 567-6870 (215) 904-5548 (215) 425-2299 (267) 687-2085 (215) 456-7880 (215) 827-1680 (215) 765-1903 (215) 745-0202 (215) 728-6300 (215) 722-5300 (215) 567-0364 (267) 457-3222 (215) 465-1318 (215) 331-3361 (215) 613-8065 (267) 687-7562 (215) 877-2400

340 N 12TH ST 6519 FRANKFORD AVE 2310 N BROAD ST SPC A 4523 BALTIMORE AVE 9456 STATE RD 8749 FRANKFORD AVE 6037 WOODLAND AVE 2118 W DIAMOND ST 6730 BUSTLETON AVE 17 S 20TH ST 9808 BUSTLETON AVE UNIT F 163 E LEHIGH AVE 701 W LEHIGH AVE 5501 OLD YORK RD 9880 BUSTLETON AVE STE 332 2441 BROWN ST 6433 RISING SUN AVE 1701 COTTMAN AVE 8275 BUSTLETON AVE 1900 GREEN ST 2916 N 5TH ST 1530 W MOYAMENSING AVE 7316 FRANKFORD AVE FL 1 12043 BUSTLETON AVE 1802 FRANKFORD AVE 6542 LEBANON AVE

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19107 19135-2538 19132-4503 19143-2145 19114-3079 19136-2126 19142-2417 19121-1410 19149-2301 19103-3528 19115-2190 19125-1011 19133-2233 19141-3018 19115-2185 19130-1931 19111-5228 19111-3802 19152-2425 19130-3207 19133-2801 19145-4927 19136-3827 19116-2107 19125 19151-3328

FOX CHASE CANCER CENTER PHARMACY FRANKFORD AVENUE PHARMACY

(215) 728-3178 (215) 904-8801

333 COTTMAN AVENUE 4531 FRANKFORD AVE

PHILADELPHIA PHILADELPHIA

PA PA

19111 19124-3638

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 534 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FRANKFORD HEALTH PHARMACY FRIENDLY PHARMACY FRIENDSHIP PHARMACY FRONT STREET PHARMACY FUTURE PHARMACY GENOA-QOL HEALTHCARE GERMANTOWN PHARMACY INC GETWELL PHARMACY GIANT PHARMACY GIRARD AVE PHARMACY GLENDALE PRESCRIPTION CENTER INC GOLDEN HEALTH PHARMACY GOLD'S PHARMACY GOOD PHARMACY GOODHEART PHARMACY INC GOODWILL COMMUNITY PHARMACY GPHA PHARMACY GRACE POINT PHARMACY GRANT FAMILY PHARMACY GREATER PHILADELPHIA PHARMACY HAHNEMANN APOTHECARY HAUSSEMANNS PHARMACY HAVERFORD PHARMACY HEALING PHARMACY HEALTH FIRST PHARMACY HENDRIX PHARMACY HKS PHARMACY HOLMESBURG PHARMACY HOPKINS PHARMACY HOSP OF THE UNIV OF PENNA PHCY HOSPITAL OF THE UNIVERSITY OF JANA PHARMACY JAY'S HUNTING PARK PHARMACY JEFFERSON APOTHECARY

Provider Name

(215) 533-9300 (215) 425-5230 (215) 624-0440 (215) 960-4444 (215) 671-0980 (215) 426-1007 (215) 844-1319 (215) 457-5555 (215) 464-8140 (215) 236-1210 (215) 722-6200 (267) 969-3111 (215) 879-4653 (215) 425-5800 (215) 724-3300 (267) 385-5554 (215) 729-3912 (215) 744-3800 (267) 686-3370 (215) 789-6931 (215) 762-8901 (215) 925-1008 (267) 787-5210 (267) 297-6482 (215) 769-4979 (215) 969-3900 (215) 634-2444 (215) 332-2400 (215) 483-0900 (215) 662-2920 (215) 662-6260 (215) 324-7040 (215) 226-0140 (215) 955-8845

4943 FRANKFORD AVE 2258 N FRONT ST 3300 COTTMAN AVE 4823 N FRONT ST 9831 BUSTLETON AVE STE 6 2600 N AMERICAN ST 5100 GERMANTOWN AVE 4511 N 5TH ST 2550 GRANT AVE 1348-50 W GIRARD AVE 7601 CASTOR AVE STE 100 5401 CEDAR AVE 7543 HAVERFORD AVE 851 E ALLEGHENY AVE 1337 S 49TH 5002 WAYNE AVE 5501 WOODLAND AVE STE 201 6035 CASTOR AVE 2453 GRANT AVENUE 1401 S 31ST ST 230 N BROAD ST # 544 536 W GIRARD AVE 5601 VINE ST 109 W CHELTEN AVE 2820 W GIRARD AVE 11685 BUSTLETON AVE 3357 N FRONT ST 8039 FRANKFORD AVE 7700 RIDGE AVE 3400 SPRUCE ST FL 1 3400 CIVIC CENTER BLVD # 101W 413 E WYOMING AVE 2001 W HUNTING PARK AVE 111 S 11TH ST SUITE 1850

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19124-2643 19133-3714 19149-1601 19120 19115-3200 19133-3413 19144-2327 19140-2309 19114-2225 19123-1015 19152-4028 19143 19151-2226 19134-2401 19143 19144-3642 19143-5607 19149-3207 19114 19146-3506 19102-1121 19123-1447 19139-1306 19144-3301 19130-1243 19116 19140-5807 19136 19128-3140 19104-4229 19104-5127 19120-4532 19140-2813 19107-5084

JEFFERSON PHARMACY WALNUT STREET JEFFERSON SPECIALTY PHARMACY

(215) 503-1135 (215) 955-5200

908 WALNUT ST 919 WALNUT ST, STE 501

PHILADELPHIA PHILADELPHIA

PA PA

19107-5564 19107

JFK MEDICAL CTR PHARMACY SOUTHWEST JJ PHARMACY JOMICI APOTHECARY JUST HERE II PHARMACY

(215) 386-4708 (215) 698-8080 (215) 735-6337 (215) 226-8530

3001 WALNUT ST FL 4 728 RED LION RD 273 S 15TH ST 2909 N 22ND ST

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA

19104-3414 19115-1307 19102-5060 19132-1505

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 535 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name JUST HERE PHARMACY KEWAN PHARMACY KING PHARMACY KREWSTOWN PHARMACY LA VIDA DISCOUNT PHARMACY LAN APOTHECARY LANCASTER PHARMACY LEHIGH PHARMACY LINSKY PHARMACY LIVE WELL PHCY @ RISING SUN LN PHARMACY MAYFAIR DRUG STORE MC KEAN STREET PHARMACY MD COMPANY PHARMACY MEDCARE PHARMACY MEDICAL TOWER PHARMACY MEDPHARMA METHODIST HOSPITAL APOTHECARY MORRISON PHARMACY MR PHARMACY MY PHARMACY NATIONAL DISCOUNT PHARMACY ND PHARMACY NEFF DRUGS LLC NEIGHBORHOOD PHARMACY NEXCARE PHARMACY NEXCARE PHARMACY II INC NICE PHARMACY NORTH PHILLY PHARMACY NORTHEAST DISCOUNT NOVA STAR PHARMACY OAK LANE PHARMACY OLD CITY PHARMACY OLDE PHILLY PHARMACY OLDE PHILLY PHARMACY OLDE PHILLY PHARMACY FISHTOWN OVERBROOK PLAZA PHARMACY OXFORD PHARMACY PACKER APOTHECARY PATIENT CARE PHARMACY PELHAM PHARMACY PENN MED UNIV CITY APOTH

NR_0009_10823 10/2017

Provider Phone Number (215) 228-3470 (215) 929-1361 (215) 226-2000 (215) 673-7373 (215) 427-1603 (215) 923-1469 (215) 921-8778 (215) 225-7522 (215) 389-4148 (215) 821-2883 (215) 473-0750 (215) 338-2626 (215) 334-4185 (215) 763-1875 (215) 844-4500 (215) 545-3525 (267) 262-5160 (215) 952-9385 (215) 482-2697 (215) 634-3939 (215) 222-1288 (215) 537-2701 (215) 324-8477 (215) 474-4550 (215) 307-3609 (215) 278-2797 (215) 454-6112 (215) 425-0100 (215) 763-7080 (215) 743-5191 (215) 739-3900 (215) 924-9929 (215) 625-6668 (215) 739-0548 (215) 468-2111 (267) 773-7825 (215) 921-3656 (215) 425-1422 (267) 909-9814 (215) 592-1668 (215) 848-0500 (215) 662-9494

Provider Street 3800 N. BROAD ST. UNIT #2 7157 OGONTZ AVE 2100 W CAMBRIA ST 9313 KREWSTOWN RD 3204 KENSINGTON AVE 907 S 11TH ST 4127 LANCASTER AVE 1006 W LEHIGH AVE 1701 S 2ND ST 5805 RISING SUN AVE 5929 LANSDOWNE AVE 7522 FRANKFORD AVE 2745 MCKEAN ST # MC 1641 N FRANKLIN ST 5325 OLD YORK RD LOWR LEVEL 255 S 17TH ST 1701 WELSH RD STE 5 2301 S BROAD ST 1ST FLOOR 6113 RIDGE AVE 2510 N FRONT ST 20-24 N 40TH ST 900 ORTHODOX STREET 5012 OLD YORK RD 25 S 60TH ST 5701 CHESTNUT ST 2941 N 5TH ST 3227 KENSINGTON AVE 110 E ALLEGHENY AVE 2127 N 6TH ST 4675 FRANKFORD AVENUE 301 E GIRARD AVE 6724 OLD YORK RD 210 MARKET ST 2923 E THOMPSON ST 2036 S 3RD ST # 38 1427 E SUSQUEHANNA AVE 5610 LANCASTER AVE 3254 N FRONT ST 1532 PACKER AVE 801-21 WASHINGTON AVE 6555 GREENE ST STE 3 3737 MARKET ST

Page 536 of 679

Provider City PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19140 19138 19132-2632 19115-3710 19134 19147-3701 19104-1726 19133-1640 19148-1993 19120-1125 19151-3932 19136-3533 19145-2513 19122-2903 19141-2900 19103 19115 19148-3542 19128-1604 19133-4004 19104-2610 19124-3128 19141-2707 19139-3003 19139-3235 19133 19134-1934 19134-2207 19122-1415 19124 19125-3918 19126 19106-2805 19134-4812 19148-2643 19125 19131-3425 19140-5806 19145-5407 19147-4716 19119-4040 19104

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PENN PRESBYTERIAN APOTHECARY PENN PRESBYTERIAN MED CTR PHCY PENNMARK PHARMACY PENNSPORT MALL PHARMACY

Provider Name

(215) 662-9496 (215) 662-9494 (215) 735-1200 (267) 639-4657

51 N 39TH ST 51 N 39TH ST 1735 SOUTH ST FL 1 237 MCCLELLAN ST

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA

19104-2640 19104-2640 19146-1528 19148

PENNSYLVANIA HOSP OUTPATIENT PHCY PHARMACY & NUTRITION SHOPPE PHARMACY OF AMERICA PHARMACY OF AMERICA II PHARMACY OF AMERICA III PHARMACY OF AMERICA IV PHARMACY OF AMERICA V PHARMACY OF AMERICA VI PHARMACY OF AMERICA VII PHILADELPHIA PHARMACY PHILADELPHIAN PHARMACY PICKWICK PHARMACY POINT BREEZE PHARMACY PORT RICHMOND PHARMACY PRIMARY CHOICE PHARMACY QRX PHARMACY QRX2 PHARMACY

(215) 829-5873 (215) 537-7626 (215) 289-9500 (215) 613-7900 (215) 279-7981 (215) 787-9999 (267) 237-1188 (215) 535-0555 (267) 900-5858 (215) 425-2800 (215) 232-0533 (215) 563-4860 (267) 886-9150 (215) 426-5099 (215) 437-9043 (215) 725-3784 (215) 331-2100

801 SPRUCE ST 1331 E WYOMING AVE 1500 E ERIE AVE 5872 OXFORD AVE 217 W LEHIGH AVE 1900 N 9TH ST 232 W GIRARD AVE 919 LEVICK ST 4654 N 5TH ST 101 E LEHIGH AVE 2401 PENNSYLVANIA AVE 1700 MARKET ST 1407-11 POINT BREEZE AVE #B 2512 E CLEARFIELD ST 5575 OLD YORK RD 7063 CASTOR AVE 7339 FRANKFORD AVE

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19107-5701 19124-3808 19124-5642 19149-3722 19133-3434 19122 19123 19111-5421 19140-1420 19125-1011 19130-3010 19103-3913 19146 19134 19141-3001 19149-1712 19136

QRX3 PHARMACY AND MEDICAL SUPPLY RAPOPORT PHARMACY RENA'S PHARMACY RESES PHARMACY INC RIDGE DISCOUNT PHARMACY RISING SUN PHARMACY RITECHOICE PHARMACY

(267) 606-6363 (215) 333-1566 (267) 457-4555 (215) 726-1224 (267) 519-3387 (215) 613-6272 (215) 727-7700

962 E TIOGA ST 6934 BUSTLETON AVE 2904 S 70TH ST UNIT 3 5739 CHESTER AVE 1406 RIDGE AVE STE A 500A DEVEREAUX AVE 6328 WOODLAND AVE

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA

19134-1307 19149-1805 19142-2565 19143-5530 19130 19111 19142-2322

RITECHOICE PHARMACY AT 11TH STREET RITECHOICE PHARMACY III ROBINSON PHARMACY RXD MEDICATION SERVICES SAFE DRUGS PHARMACY SANKOFA PHARMACY SAV MOR PHARMACY INC SAV-ON PHARMACY SEDGLEY PLAZA PHARMACY SHOP AND CARRY PHARMACY SIDNEY HILLMAN M/C PHARMACY

(215) 769-2155 (215) 500-2223 (215) 228-7177 (215) 927-6700 (267) 928-2350 (215) 268-3426 (215) 467-1220 (215) 676-6279 (215) 978-0104 (267) 297-5030 (215) 496-9595

850 N 11TH ST FL 1 2100 S. BROAD ST, FL 1 2848 W LEHIGH AVE 1335 W TABOR RD 501 WASHINGTON AVE 7223 RISING SUN AVE 2232 S 7TH ST 920 RED LION RD 2815 RIDGE AVE 1301 LINDLEY AVE 1740 SOUTH ST

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA

19123-1957 19145 19132-3130 19141-3038 19147 19111-3926 19148-3261 19115-1500 19121 19141 19146-1514

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 537 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SILVERMAN PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SOMERTON PHARMACY SOUTH PHILLY PHARMACY SUBURBAN PHARMACY SUN RAY DRUG SUNRAY DRUGS 56TH AND MRKT STS SUNRAY DRUGS BALTIMORE AVE SUNRAY DRUGS C STREET SUNRAY DRUGS CHESTNUT PLAZA SUNRAY DRUGS GERMANTOWN AVE

Provider Name

(215) 465-3081 (215) 324-5100 (215) 537-3000 (215) 969-9700 (267) 773-8007 (215) 673-0994 (215) 474-4615 (215) 474-1700 (215) 748-1000 (215) 423-8500 (215) 387-5000 (215) 223-2033

2501 S 7TH ST 133 W HUNTING PARK AVE STE 200 841 E HUNTING PARK AVE STE 130 10806 BUSTLETON AVE 2101 S 19TH ST 10875 BUSTLETON AVE 142 S 52ND ST 5537 MARKET ST 5006 BALTIMORE AVE 424 E ALLEGHENY AVE 4323 CHESTNUT ST 3635 GERMANTOWN AVE

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA PA

19148-4601 19140 19124-4800 19116-3302 19145-3709 19116-3301 19139-3409 19139-3209 19143-3302 19134-2327 19104-2912 19140-4255

SUNRAY DRUGS KENSINGTON & ALLEGHENY TACONY PHARMACY TANG PHARMACY II TANG PHARMACY III TANG PHARMACY INC TANG PHARMACY IV TANG PHARMACY V TEMPLE UNIV HOSP OUTPTNT PHCY THE APPLE PHARMACY THE MEDICINE SHOPPE THE NEW PHARMACY THIEN MY PHARMACY TRANS DRUG STORE TRANS DRUG STORE TRX PHARMACY TWIN DRUG U-HEALTH PHARMACY INC URBANCARE PHARMACY VALUE PHARMACY VERREE PHARMACY WASHINGTON AVE PHARMACY WASHINGTON SQUARE PHARMACY INC WELLAID INC. WELLCARE PHARMACY WELLCARE PHARMACY 2 WELLCARE PHARMACY 3 WELLNESS PHARMACY WEST GIRARD HEALTH PHARMACY WEST VILLAGE PHARMACY

(215) 425-7700 (267) 686-6256 (215) 224-3333 (215) 725-6555 (215) 224-1500 (215) 235-1400 (215) 548-1800 (215) 707-3181 (215) 427-6527 (215) 426-0250 (215) 883-0568 (267) 297-7791 (215) 747-4700 (215) 729-1703 (215) 288-8701 (215) 455-2411 (267) 758-2990 (267) 858-4662 (215) 941-6240 (215) 342-0100 (215) 755-5100 (215) 925-0300 (215) 472-5000 (267) 538-2685 (267) 686-8800 (215) 560-8161 (215) 800-1248 (215) 235-3245 (215) 879-2520

825 E ALLEGHENY AVE 7100 TORRESDALE AVE 5600 N 5TH ST 6801 RISING SUN AVE 5925 N 5TH ST 900 N BROAD ST 7452 OGONTZ AVE 3401 N BROAD ST ERIE AVE @ FRONT ST 3025-27 KENSINGTON AVE 4624 WOODLAND AVE 439 W CHEW AVE 5466 SPRUCE ST 6218 WOODLAND AVE 5520 WHITAKER AVE UNIT C 5304 N 5TH ST 2704 W ALLEGHENY AVE # 06 169 W LEHIGH AVE 2842 COTTMAN AVE 7960 VERREE RD 600 WASHINGTON AVE UNIT 18E 241 S 6TH ST 21 S COBBS CREEK PARKWAY 2220 COTTMAN AVE FL 1 1550 PRATT ST 3621 N BROAD ST 2337 RIDGE AVE 1207 N 5TH ST 3901 CONSHOHOCKEN AVE

PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19134 19135 19120-2306 19111-3901 19120-1823 19130-1604 19138-1324 19140-5103 19134 19134-2415 19143-3838 19120-2355 19139-4060 19142-2324 19124-1705 19120-3204 19132-1223 19133-3832 19149-1422 19111-2531 19147-4836 19106 19139 19149 19124-1923 19140 19121-3026 19122-4301 19131-5430

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 538 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WYNNEFIELD PHARMACY YORK ST. PHARMACY GRATTAN'S PHARMACY MOSHANNON VALLEY PHARMACY WEIS PHARMACY GATEWAY PHCY OF PHOENIXVLL INC GIANT PHARMACY PINE GROVE PHARMACY TRI-VALLEY PHARMACY PHILS PHARMACY ADZEMA PHARMACY AGH APOTHECARY AMSLER PHARMACY ASTI'S SOUTH HILLS PHARMACY AUREUS PHARMACY BILL'S HOMETOWN PHARMACY BLOOMFIELD DRUG STORE CARRICK PHARMACY DUQUESNE UNIVERSITY PHARMACY ELIZABETH PHARMACY GENOA-QOL HEALTHCARE GREENTREE SPECIALITY PHARMACY HIEBERS PHARMACY INC HOMETOWN PHARMACY HOMETOWN PHARMACY HOMETOWN PHARMACY LEBANON SHOPS PHARMACY LINCOLN PHARMACY LOST AND FOUND PHARMACY PANTHERX SPECIALTY PHARMACY SCHILLER'S PHARMACY SHOP N SAVE PHARMACY SOUTHWESTERN VETS CENTER PHCY SPARTAN PHARMACY THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE MEDICINE SHOPPE TOWNE DRUGS LLC VALEDA RX WALTMIRE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (267) 353-8159 (215) 427-1200 (814) 342-2020 (814) 342-3750 (814) 342-1752 (610) 933-2609 (610) 917-9310 (570) 345-4422 (570) 345-4966 (412) 372-2480 (412) 364-7000 (412) 359-8677 (412) 431-5766 (412) 561-2347 (412) 275-6775 (412) 793-6500 (412) 682-4909 (412) 206-0996 (412) 246-0963 (412) 421-0114 (412) 931-3131 (412) 458-4672 (412) 681-6400 (412) 921-7731 (412) 892-9512 (724) 387-2260 (412) 344-6700 (412) 821-2379 (412) 243-1369 (855) 726-8479 (412) 621-5900 (412) 561-2417 (412) 665-6842 (412) 884-4400 (412) 481-2400 (412) 442-1925 (412) 586-5410 (412) 561-3180 (412) 367-5778 (412) 782-2244 (855) 698-2533 (412) 323-1801

Provider Street 2230 BRYN MAWR AVE 2334 E YORK ST 230 N FRONT ST 1043 N FRONT ST 501 N CENTRE ST 165 NUTT RD 700 NUTT RD 10 E POTTSVILLE ST 101 S TULPEHOCKEN ST 426 BROADWAY STE 1 8105 PERRY HWY STE 2 320 E NORTH AVE STE 111 818 E WARRINGTON AVE 250 MOUNT LEBANON BLVD 300 MERCHANT LN 313 UNITY CENTER RD 4727 LIBERTY AVE 2717 BROWNSVILLE RD 1860 CENTER AVE 5041 2ND AVE 4900 PERRY HWY STE 1 STE 101 969 GREENTREE RD SUITE 107 3500 5TH AVE 2103 NOBLESTOWN RD 3125 BANKSVILLE RD 2362 GOLDEN MILE HWY 300 MOUNT LEBANON BLVD 232 NORTH AVE 11555 FRANKSTOWN RD 24 SUMMIT PARK DR STE 101 811 S AIKEN AVE 799 CASTLE SHANNON BLVD 7060 HIGHLAND DR 3526 BROWNSVILLE RD 20 BAILEY AVE 412 E COMMONS STE 110 5020 CENTRE AVE 524 BROOKLINE BLVD 725 W INGOMAR RD 227 COMMERCIAL AVE 250 MOUNT LEBANON BLVD STE 208 1435 SPRING GARDEN AVE

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Provider City PHILADELPHIA PHILADELPHIA PHILIPSBURG PHILIPSBURG PHILIPSBURG PHOENIXVILLE PHOENIXVILLE PINE GROVE PINE GROVE PITCAIRN PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH PITTSBURGH

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19131 19125-3029 16866-1606 16866-8258 16866-2146 19460-3905 19460-3344 17963-1100 17963-1011 15140-1447 15237-5203 15212-4756 15210-1560 15234-1252 15205 15239-1317 15224-2025 15227 15219-4369 15207-1679 15229-2236 15220-3328 15213-3337 15205-3937 15216-2720 15239-2710 15234-1512 15209-2502 15235-3172 15275-1110 15232-2209 15234-1601 15206-1259 15227-3116 15211-1728 15212-5310 15213-1808 15226-2002 15237-4969 15215-3024 15234-1248 15212

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WILSON'S PHARMACY YOUR HOMETOWN PHARMACY ALBERT'S PHARMACY, INC. FINO'S PHARMACY LLC TRINITY PHARMACY SERVICES ADVANCED PHARMACY SERVICES LLC ROANS PRESCRIPTION DRUG STORE ADVANCED RX GIANT PHARMACY OPTION CARE BLAKESLEE PHARMACY PORT ALLEGANY PHARMACY CARESITE PHARMACY-GW JAMES DRUG STORE - PORTAGE MAINLINE LTC PHARMACY MAINLINE PHARMACY GENOA-QOL HEALTHCARE GIANT PHARMACY POTTSTOWN DISCOUNT PHARMACY

Provider Name

(412) 621-6471 (412) 306-9950 (570) 299-5150 (570) 655-1489 (570) 891-0979 (570) 208-0277 (570) 779-9503 (484) 681-5756 (610) 941-3611 (610) 941-0129 (570) 646-8040 (814) 642-2871 (814) 272-1006 (814) 713-8074 (814) 736-3044 (814) 736-4530 (610) 970-6970 (610) 705-3373 (484) 644-3120

4101 PENN AVE 2897 W LIBERTY AVE 201 S MAIN ST STE 2 32 N MAIN ST 209 ROBERTS RD SUITE TRINITY 220 S RIVER ST 159 E MAIN ST 5205 MILITIA HILL RD STE 200 2450 CHEMICAL RD 4000 CHEMICAL RD STE 100 393 ROUTE 940 54-56 MAIN ST 132 ABIGAIL LN 3692 PORTAGE ST 617 MAIN ST STE 1 619 MAIN ST 11 ROBINSON ST 86 GLOCKER WAY 1501 E HIGH ST

PITTSBURGH PITTSBURGH PITTSTON PITTSTON PITTSTON PLAINS PLYMOUTH PLYMOUTH MEETING PLYMOUTH MEETING PLYMOUTH MEETING POCONO LAKE PORT ALLEGANY PORT MATILDA PORTAGE PORTAGE PORTAGE POTTSTOWN POTTSTOWN POTTSTOWN

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

15224-1326 15216-2619 18640 18640-1916 18640-3111 18705 18651-3018 19462-1216 19462-1727 19462-1728 18347-7793 16743 16870-7153 15946-6540 15946-1578 15946-1539 19464-6421 19465-9657 19464-5005

PROF. PHCY & CONVALESCENT PRODUCTS SANATOGA PHARMACY THE MEDICINE SHOPPE CARESITE PHARMACY-PVL TOWNE DRUGS INC WEIS PHARMACY PUNXSUTAWNEY HOMETOWN THE MEDICINE SHOPPE THE MEDICINE SHOPPE GIANT PHARMACY SMALL TOWN PHARMACY WILEY'S PHARMACY OF QUARRYVILLE

(610) 323-2115 (484) 949-8505 (610) 326-9690 (570) 624-4120 (570) 622-2490 (570) 622-8150 (814) 938-9150 (814) 618-5957 (814) 938-3077 (215) 536-6679 (215) 538-8800 (717) 786-1191

920 N CHARLOTTE ST 1630 E HIGH ST BLDG 2 206 N CHARLOTTE ST 529 TERRY REILEY WAY 17 S CENTRE ST 500 POTTSVILLE PARK PLZ 203 HAMPTON AVE 200 PRUSHNOK DR STE 102 132 W MAHONING ST 901 S WEST END BLVD 1 N WEST END BLVD. 112 TOWNSEDGE DR

POTTSTOWN POTTSTOWN POTTSTOWN POTTSVILLE POTTSVILLE POTTSVILLE PUNXSUTAWNEY PUNXSUTAWNEY PUNXSUTAWNEY QUAKERTOWN QUAKERTOWN QUARRYVILLE

PA PA PA PA PA PA PA PA PA PA PA PA

19464-3959 19464-3244 19464-5308 17901-1774 17901-3003 17901-4104 15767-2133 15767 15767-2017 18951-2631 18951 17566-1300

PENN MEDICINE AT RADNOR PHARMACY SCOT'S LO-COST PHARMACY BERKS DISCOUNT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY OAKSIDE CARE PHARMACY PAGODA PHARMACY

(610) 902-1700 (570) 644-3990 (610) 373-1800 (610) 406-9644 (610) 777-0027 (610) 678-3335 (610) 670-5426 (484) 663-5760 (484) 577-4408

250 KING OF PRUSSIA RD RM 202 12 ANTHRA PLAZA CTR 500 PENN ST STE B 4655 PERKIOMEN AVE 600 E LANCASTER AVE 2641 SHILLINGTON RD 2104 VAN REED RD 440 LEHIGH ST 810 OLEY ST STE G-2

RADNOR RANSHAW READING READING READING READING READING READING READING

PA PA PA PA PA PA PA PA PA

19087-5220 17866-4199 19602 19606-3217 19607-1378 19608-1757 19609-1163 19601-1750 19604-2546

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Provider Phone Number

Provider Street

Page 540 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PATIENT CARE PHARMACY PENN PHARMACY READING DISCOUNT PHARMACY SAN JUAN DE DIOS PHARMACY ST. JOSEPH AMBULATORY PHARMACY THE COMMUNITY PHARMACY VCARE DISCOUNT PHARMACY WEIS PHARMACY GIANT PHARMACY WEIS PHARMACY MOUNTAIN VIEW PHARMACY MCCABE DRUG INC PHARMBLUE LLC PRESCRIPTION CTR-RIDGWAY KLINGENSMITH'S DRUG STORES ROCHESTER HEALTH MART PHARMACY THE MEDICINE SHOPPE ROSEMONT PHARMACY GIANT FOODS GIANT PHARMACY PALMER DRUG STORE LLC ST MARYS PHARMACY FHP PHARMACY SERVICES FOREST HILLS PHARMACY INC MODNURX INC PHARMACY SALTSBURG PHARMACY THE MEDICINE SHOPPE COLONIAL PHARMACY SAXONBURG DRUG MCCAHAN'S PHARMACY SAXTON STATION PHARMACY BERTS PHARMACY INC CLINIC PHARMACY KING'S PHARMACY GLAD RX REDNERS PHARMACY STINES PHARMACY INC SCOTTDALE PHARMACY INC STAYWELL RX ANDREW BROWNS DRUG STORE INC CARESITE PHARMACY-LS GERRITYS PHARMACY KEYSER

NR_0009_10823 10/2017

Provider Phone Number (610) 750-7800 (610) 374-1444 (610) 236-0911 (610) 743-4501 (610) 378-2863 (610) 208-4660 (610) 374-0911 (610) 929-4747 (717) 246-7478 (717) 246-4761 (570) 923-1922 (814) 653-8295 (800) 609-0821 (814) 773-3131 (814) 473-3141 (724) 987-6085 (215) 663-1755 (610) 525-0927 (610) 792-9388 (610) 831-5805 (724) 265-1632 (814) 834-3017 (814) 495-7127 (814) 495-9437 (717) 369-4636 (724) 639-9022 (724) 376-3805 (724) 353-1420 (724) 352-1900 (814) 635-2911 (814) 635-2221 (570) 888-2394 (570) 887-2800 (610) 799-2413 (570) 739-7142 (570) 385-8227 (570) 385-3570 (724) 887-6870 (724) 220-5424 (570) 346-7319 (570) 963-2305 (570) 342-4144

Provider Street 100 N 5TH ST 900 PENN ST 1220 CENTRE AVE 961 N 10TH STREET 2500 BERNVILLE RD FIRST FLOOR 145 N 6TH ST 108 S 5TH ST 2020 N 13TH ST 3175 CAPE HORN RD 693 LOMBARD RD 144 4TH ST 419 MAIN STREET 43 SERVIDEA DR STE 100 223 MAIN ST 650 MAIN ST 176 VIRGINIA AVE FL 3 400 A HUNTINGDON PIKE 1149 W LANCASTER AVE 967 S TOWNSHIP LINE RD 1824 E RIDGE PIKE STE 104 738 LITTLE DEER CREEK VALLEY R 4 RAILROAD ST 550 LOCUST ST 552 LOCUST ST 4495 LINCOLN WAY WEST 237 WASHINGTON ST 3289 S MAIN ST 708 EKASTOWN RD 115 PITTSBURGH ST 813A LOWER MAIN ST 509 MAIN ST 144 DESMOND ST 1 GUTHRIE SQ STE EC101 5020 ROUTE 873 216 N ROUTE 183 191 MANHEIM RD 1 E MAIN ST 222 PITTSBURGH ST 2578 KINGVIEW RD SUITE 103 1502 PITTSTON AVE 531 MT PLEASANT DR 1782 N KEYSER AVE

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Provider City READING READING READING READING READING READING READING READING RED LION RED LION RENOVO REYNOLDSVILLE RIDGWAY RIDGWAY RIMERSBURG ROCHESTER ROCKLEDGE ROSEMONT ROYERSFORD ROYERSFORD RUSSELLTON SAINT MARYS SAINT MICHAEL SAINT MICHAEL SAINT THOMAS SALTSBURG SANDY LAKE SARVER SAXONBURG SAXTON SAXTON SAYRE SAYRE SCHNECKSVILLE SCHUYLKILL HAVEN SCHUYLKILL HAVEN SCHUYLKILL HAVEN SCOTTDALE SCOTTDALE SCRANTON SCRANTON SCRANTON

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

19601 19602-1717 19601 19604 19605 19601-3501 19602 19604-1210 17356-8806 17356-9054 17764-1071 15851 15853 15853-1015 16248-4810 15074-1723 19046 19010-2722 19468-1823 19468-2819 15076-1333 15857-1729 15951-0000 15951-0000 17252-9603 15681-1131 16145-3739 16055-9724 16056-9563 16678-1139 16678-1050 18840 18840-1625 18078-2261 17972-8828 17972-9757 17972-1603 15683-1735 15683-2455 18505-1668 18503-1987 18508-1248

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GIANT PHARMACY LEONARD'S PHARMACY PRICE CHOPPER PHARMACY SHEELEY'S DRUG STORE THE MEDICINE SHOPPE THE PRESCRIPTION CENTER INC GIANT PHARMACY WEIS PHARMACY WEIS PHARMACY SELLERSVILLE PHARMACY THE MEDICINE SHOPPE TOM OLCESE PHARMACY WEIS PHARMACY SHARON PHARMACY EXTRACARE PHARMACY HOMETECH ADVANCED THERAPIES LIFE TREE PHARMACY SOLEO HEALTH COOK'S PHARMACY OF SHAVERTOWN SHEFFIELD PHARMACY KLINGENSMITH'S DRUG STORES REDNER'S PHARMACY THE MEDICINE SHOPPE SPROUTS DRUG STORE GIANT PHARMACY ROBERT T HENRY PHCY WEIS PHARMACY MARIANNE PHARMACY GIANT PHARMACY SAUBELS PHARMACY SHREWSBURY SKIPPACK PHARMACY BECHTELS PHARMACY SLIPPERY ROCK PHARMACY BUCHANAN BROTHERS PHARMACY INC SMITHFIELD PHARMACY MOSHANNON VALLEY PHARMACY FINDLEY'S PHARMACY INC SOMERSET DRUG

Provider Name

(570) 343-7940 (570) 342-6345 (570) 969-4920 (570) 342-8936 (570) 347-6575 (570) 343-2448 (570) 743-1608 (570) 374-1210 (570) 374-7433 (215) 257-9077 (570) 648-5242 (570) 648-7891 (570) 648-7669 (724) 347-7000 (484) 540-7917 (484) 494-3121 (610) 522-2010 (610) 586-2340 (570) 675-1191 (814) 968-3636 (724) 354-3494 (570) 462-9651 (610) 777-2313 (814) 697-6331 (717) 532-7170 (717) 532-5812 (717) 532-3432 (814) 226-5353 (717) 227-2017 (717) 235-7720 (610) 584-6544 (610) 767-4121 (724) 406-0800 (814) 887-5375 (724) 569-5280 (814) 387-4014 (814) 445-7939 (814) 445-6511

1600 NAY AUG AVE 107 W MARKET ST 1510 S MAIN AVE 539 LINDEN ST 2239 PITTSTON AVE 310 ADAMS AVE 330 MARKETPLACE BLVD 719 ROUTE 522 111 ROOSEVELT AVE 218 S MAIN ST 605 N SHAMOKIN ST 400 W SPRUCE ST 339 W WALNUT ST 197 E SILVER ST 1442A CHESTER PIKE 505 ELMWOOD AVE 800 CHESTER PIKE 950 CALCON HOOK RD STE 15 159 N MEMORIAL HWY 27 S MAIN ST 9605 US RT 422 HWY WEST 3 GOLD STAR PLZ 101 W LANCASTER AVE 122 E ACADEMY ST 397 BALTIMORE RD 54 E KING ST 1075 W KING ST 21159 PAINT BLVD STE 1 14635 MOUNT AIRY RD 65 E FORREST AVE 4118 W SKIPPACK PIKE 302 MAIN ST 116 NEW CASTLE ST 313 W MAIN ST 102 MAIN ST 402 E SYCAMORE RD 136 W MAIN ST 168 W MAIN ST

SCRANTON SCRANTON SCRANTON SCRANTON SCRANTON SCRANTON SELINSGROVE SELINSGROVE SELINSGROVE SELLERSVILLE SHAMOKIN SHAMOKIN SHAMOKIN SHARON SHARON HILL SHARON HILL SHARON HILL SHARON HILL SHAVERTOWN SHEFFIELD SHELOCTA SHENANDOAH SHILLINGTON SHINGLEHOUSE SHIPPENSBURG SHIPPENSBURG SHIPPENSBURG SHIPPENVILLE SHREWSBURY SHREWSBURY SKIPPACK SLATINGTON SLIPPERY ROCK SMETHPORT SMITHFIELD SNOW SHOE SOMERSET SOMERSET

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

18509-1868 18508-1947 18504-3242 18503-1605 18505 18503-1620 17870 17870-1211 17870-7961 18960-2529 17872-6719 17872-5716 17872-5225 16146-2186 19079 19079-1014 19079-1400 19079-1822 18708-1124 16347-3117 15774 17976-2530 19607 16748 17257-9567 17257-1308 17257-7900 16254-4023 17361-1433 17361 19474 18080-1537 16057 16749-1139 15478-1260 16874-0000 15501-2038 15501-2038

SOMERSET HOSPITAL OUTPATIENT PHCY THE MEDICINE SHOPPE GIANT PHARMACY

(814) 443-5352 (814) 443-9500 (215) 703-0169

225 S CENTER AVE STE 1049 131 S PLEASANT AVE 760 ROUTE 113

SOMERSET SOMERSET SOUDERTON

PA PA PA

15501 15501-2189 18964-1004

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 542 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PRESCRIPTION CENTER PLUS 5 STAR PHARMACY & MEDICAL SUPPLY SPARTANSBURG PHARMACY KENNIE'S PHARMACY-SPRING GROVE VILLAGE PHCY AT SPRINGHOUSE PENNS VALLEY PHARMACY GIANT PHARMACY GIANT PHARMACY SPRINGFIELD PHARMACY SPROUL PHARMACY GIANT PHARMACY GIANT PHARMACY THE BOALSBURG APOTHECARY

Provider Name

(412) 835-4552 (215) 355-2004 (814) 654-2333 (717) 225-9382 (215) 646-1691 (814) 422-8911 (610) 328-0033 (610) 604-0237 (610) 544-4645 (610) 543-1104 (814) 861-2790 (814) 237-1837 (814) 466-7936

2850 BROWNSVILLE RD 209 2ND STREET PIKE 317 MAIN ST 440 N MAIN ST 1121 N BETHLEHEM PIKE STE 40 4576 PENNS VALLEY RD 721 W SPROUL RD 950 BALTIMORE PIKE 1154 BALTIMORE PIKE 829 W SPROUL RD 2222 E COLLEGE AVE # 2250 255 NORTHLAND CTR 3901 S ATHERTON ST

SOUTH PARK SOUTHAMPTON SPARTANSBURG SPRING GROVE SPRING HOUSE SPRING MILLS SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD STATE COLLEGE STATE COLLEGE STATE COLLEGE

PA PA PA PA PA PA PA PA PA PA PA PA PA

15129-8530 18966 16434-1057 17362-1122 19477-1102 16875-8500 19064-1215 19064-2847 19064-2850 19064-1208 16801-7205 16803-2903 16801

UNIVERSITY ORTHOPEDICS CENTER LTD WEIS PHARMACY WEIS PHARMACY STEELTON PHARMACY & GIFT SHOP GIANT PHARMACY WILEYS PHARMACY POCONO PHARMACY STROUD CMPND & WELLNESS PHCY WEIS PHARMACY DARLING APOTHECARY LLC VALLEY PHARMACY CUSTOM CARE PHARMACY MEDICAP PHARMACY WEIS PHARMACY REDDON DRUG CO., INC. HOMETOWN VILLAGE PHARMACY SHAFER'S PHARMACY WEIS PHARMACY BLACKBURN'S PHYSICIANS PHCY OLEXY PHARMACY LANDIS PHARMACY GIANT PHARMACY GIANT PHARMACY QUICK-STOP PHCY-BARLEY STATION DARLING'S TIDIOUTE PHARMACY TIONESTA PHARMACY THE MEDICINE SHOPPE TORRANCE STATE HOSPITAL PHCY

(800) 505-2101 (814) 231-8399 (814) 237-4240 (717) 985-1300 (610) 705-0004 (717) 687-6058 (570) 421-6789 (570) 476-6936 (570) 421-8810 (814) 489-7777 (570) 788-4444 (570) 495-4950 (570) 286-6644 (570) 286-0276 (570) 853-3150 (570) 668-1900 (570) 668-0290 (570) 619-5413 (724) 224-9100 (570) 562-2626 (215) 723-2302 (610) 939-2644 (610) 383-5461 (610) 384-6100 (814) 484-7777 (814) 755-3557 (814) 827-1849 (724) 459-4522

101 REGENT COURT 110 ROLLING RIDGE DR 1471 MARTIN ST 15 N FRONT ST 180 UPLAND SQUARE DRIVE 300 HISTORIC DR 300 COMMERCE BLVD STE 130 1619 N 9TH ST STE 3 1070 N 9TH ST 17 FOREST ST 647 STATE ROUTE 93 STE 6 300 MARKET ST 1253 N 4TH ST 1100 N 4TH ST 177 ERIE BLVD STE 2 220 CLAREMONT AVE STE 2 11 CENTER ST 2836 ROUTE 611 301 CORBET ST 143 N MAIN ST 2685 COUNTY LINE RD 4320 5TH STREET HWY 3477 LINCOLN HWY 3506 LINCOLN HWY 115 MAIN ST 105 FAULKNER DR 206 S MARTIN ST RENNER BUILDING SR 1014

STATE COLLEGE STATE COLLEGE STATE COLLEGE STEELTON STOWE STRASBURG STROUDSBURG STROUDSBURG STROUDSBURG SUGAR GROVE SUGARLOAF SUNBURY SUNBURY SUNBURY SUSQUEHANNA TAMAQUA TAMAQUA TANNERSVILLE TARENTUM TAYLOR TELFORD TEMPLE THORNDALE THORNDALE TIDIOUTE TIONESTA TITUSVILLE TORRANCE

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

16801 16801-7674 16803-3066 17113-2367 19464 17579-1460 18360-6215 18360-6501 18360-1210 16350 18249-3121 17801 17801-5815 17801-1222 18847-2791 18252-4434 18252-1918 18372-7922 15084-1877 18517-1415 18969-1075 19560-1740 19372-1014 19372-1005 16351-1011 16353-9775 16354 15779

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Provider Phone Number

Provider Street

Page 543 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WILLIAMS VALLEY PHCY EDGEWOOD PHARMACY BANKS APOTHECARY TRANSITION PHARMACY GIANT PHARMACY BROWNS PHARMACY CARESITE PHARMACY-TUNK KEYSTONE PHARMACY COMMUNITY PHARMACY CORP TIPTON PHARMACY UNION CITY PHARMACY APOTHECARE PHCY AT SHOP & SAVE GABLERS DRUG HIXENBAUGH'S DRUG STORE LIZZA'S APOTHECARE PHARMACY ASSOCIATES HEMATOLOGY ONCOLOGY COMMUNITY RX PHARMACY HOPE PHARMACY KINGDOM PHARMACY PUBLIC DRUG SAV-ON PHARMACY SOLVENCY HEALTH PHARMACY UPPER DARBY FAMILY PHARMACY UPPER DARBY PHARMACY TRI-VALLEY PHARMACY ROSS GRANT AVENUE PHARMACY VANDERGRIFT PHARMACY

Provider Name

(717) 647-9523 (724) 646-2828 (215) 494-9403 (215) 639-6162 (610) 391-0254 (570) 297-5400 (570) 836-2273 (412) 646-2619 (814) 684-0230 (814) 684-7979 (814) 438-7570 (724) 438-7455 (724) 437-9700 (724) 437-2828 (724) 437-7801 (610) 619-7420 (610) 352-7500 (610) 352-7372 (484) 455-7915 (610) 352-5015 (610) 789-5700 (610) 713-5661 (610) 352-2121 (610) 352-3010 (570) 682-3145 (724) 568-1221 (724) 567-6615

226 E GRAND AVE 225 EDGEWOOD DRIVE SUITE 102 3800 HORIZON BLVD STE 103 2540 METROPOLITAN DR STE 2546 7150 HAMILTON BLVD 63 CANTON ST 10 TRIEBLE DR 106 PENN PLAZA 1256 PENNSYLVANIA AVE 4384 E PLEASANT VALLEY BLVD # 16395 ROUTE 8 150 WALNUT HILL RD 250 S MOUNT VERNON AVE 304 MORGANTOWN ST 173 MORGANTOWN ST 1 MEDICAL CTR BLVD, STE 341 800 GARRETT RD 7050 TERMINAL SQ STE 208 9014 W CHESTER PIKE 6925 LUDLOW ST STATE RD & LANSDOWNE AVE 725 LONG LN 6756 MARKET ST 119 LONG LN 301 W MAIN ST 114 GRANT AVE 224 LONGFELLOW ST STE 100

TOWER CITY TRANSFER TREVOSE TREVOSE TREXLERTOWN TROY TUNKHANNOCK TURTLE CREEK TYRONE TYRONE UNION CITY UNIONTOWN UNIONTOWN UNIONTOWN UNIONTOWN UPLAND UPPER DARBY UPPER DARBY UPPER DARBY UPPER DARBY UPPER DARBY UPPER DARBY UPPER DARBY UPPER DARBY VALLEY VIEW VANDERGRIFT VANDERGRIFT

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

17980-1124 16154 19053-4968 19053 18087-9725 16947-1417 18657-7054 15145-4200 16686-1618 16686-7027 16438 15401-5090 15401-3228 15401-4829 15401-4718 19013 19082 19082-2310 19082 19082-2304 19082 19082 19082-2432 19082-3112 17983 15690-1208 15690-1476

HORSHAM SQUARE PHARM AT ANNS CHOICE MAX-WELL PHARMACY SERVICES THE MEDICINE SHOPPE WARMINSTER SQUARE PHARMACY CRONES DRUG STORE DARLING'S PHARMACY GAUGHNS DRUG STORE PHARMBLUE LLC RX BLUE STAR SOLUTIONS LIFESTREAM PHARMACY LIFESTREAM RX CURTIS LTC PHARMACY CURTIS PHARMACY GENOA-QOL HEALTHCARE

(215) 674-5050 (215) 956-9280 (215) 675-0777 (215) 442-1300 (814) 723-1743 (814) 726-5784 (814) 723-2840 (855) 779-4720 (800) 985-7950 (215) 491-0999 (215) 491-0979 (724) 223-7710 (724) 225-1592 (724) 705-0012

30000 ANNS CHOICE WAY 375 WEST STREET RD 95 YORK RD 1535 W STREET RD 212 LIBERTY ST # 214 1885 MARKET ST EXT 348 PENNSYLVANIA AVE W 40 PENNWOOD PL STE 300 40 PENNWOOD PL # 200 847 EASTON RD 847 EASTON RD STE 2775 1100 W CHESTNUT ST 869 HENDERSON AVE 378 W CHESTNUT ST STE 205

WARMINSTER WARMINSTER WARMINSTER WARMINSTER WARREN WARREN WARREN WARRENDALE WARRENDALE WARRINGTON WARRINGTON WASHINGTON WASHINGTON WASHINGTON

PA PA PA PA PA PA PA PA PA PA PA PA PA PA

18974-3375 18974 18974-4501 18974-3100 16365-2347 16365 16365-2415 15086-6512 15086-6512 18976-2906 18976-2910 15301-4631 15301 15301-4661

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 544 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE MEDICINE SHOPPE WASHINGTON CARE PHARMACY WASHINGTON HOSPITAL PHARMACY HERITAGE PHARMACY WATERFORD PHARMACY BRUNDAGES WAYMART PHARMACY GIANT PHARMACY ANTIETAM PHARMACY SAVAGE FAMILY PHARMACY MCCRACKEN PHARMACY INC WEATHERLY AREA COMMUNITY PHCY BENNETTS VALLEY PHARMACY WEIS PHARMACY WERNERSVILLE STATE HOSP PHCY GIANT PHARMACY GIANT PHARMACY INTEGRATIVE PAIN CLINIC REGIONAL PHARMACY GIANT PHARMACY SOUTHERN CHESTER COUNTY PHCY. WEIS PHARMACY CENTURY SQUARE PHARMACY JOHNSONS PHARMACEUTICAL SVCS PRIMARY CARE PHARMACY SERVICES ESTERBROOK PHARMACY WEST READING DRUG STORE

Provider Name

(724) 222-0900 (724) 206-9432 (724) 223-3655 (215) 321-7670 (814) 796-6655 (570) 488-7979 (610) 263-2015 (717) 762-1164 (717) 762-2915 (724) 627-5454 (570) 427-4887 (814) 787-4400 (570) 724-6453 (610) 670-4115 (610) 430-6180 (610) 241-1061 (610) 732-4251 (610) 696-2020 (610) 345-1426 (610) 869-3200 (610) 775-3409 (412) 655-1919 (412) 655-2151 (412) 655-6445 (610) 376-6542 (610) 375-4366

400 JEFFERSON AVE 95 LEONARD AVE BLDG 2 STE 101 155 WILSON AVE 1091 GENERAL KNOX RD 216 HIGH ST 238 BELMONT ST 550 E LANCASTER AVE 730 S POTOMAC ST 604 E MAIN ST 595 E HIGH ST 202 CARBON ST 18496 BENNETTS VALLEY HWY 11798 ROUTE 6 160 MAIN ST 698 DOWNINGTOWN PIKE 1375 E BOOT RD 1572 MCDANIEL DR 510 E GAY ST UNIT 3 849 W BALTIMORE PIKE 1011 W BALTIMORE PIKE STE 109 1112 W WYOMISSING BLVD 2381 MOUNTAIN VIEW DR 2000 CLAIRTON RD 2027 LEBANON CHURCH RD 301 S 7TH AVE 538 PENN AVE

WASHINGTON WASHINGTON WASHINGTON WASHINGTON XING WATERFORD WAYMART WAYNE WAYNESBORO WAYNESBORO WAYNESBURG WEATHERLY WEEDVILLE WELLSBORO WERNERSVILLE WEST CHESTER WEST CHESTER WEST CHESTER WEST CHESTER WEST GROVE WEST GROVE WEST LAWN WEST MIFFLIN WEST MIFFLIN WEST MIFFLIN WEST READING WEST READING

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

15301-4261 15301-3368 15301 18977-1359 16441-0000 18472-9310 19087-5044 17268-2198 17268-2387 15370-1805 18255-1419 15868-3006 16901-6753 19565-9490 19380-2226 19380-5988 19380-6673 19380-2731 19390-9189 19390-9400 19609-2259 15122-2445 15122-3006 15122-2461 19611 19611-1036

BUCHANAN BROTHERS' PHARMACY INC AHN PHARMACY CONNECTED HEALTH PHARMACY MANNS DRUG STORE GIANT PHARMACY WEIS PHARMACY WHITEHALL PHARMACY BEDWICKS PHARMACY CARESITE PHARMACY-CWB CARESITE PHARMACY-GWV CARESITE SPECIALTY HARROLDS PHARMACY HARROLDS PHCY INFUSION SVCS PRICE CHOPPER PHARMACY SHEEHANS PHARMACY INC

(814) 367-2327 (878) 332-4118 (724) 933-4320 (412) 672-7617 (484) 245-0084 (610) 261-3600 (610) 440-6337 (570) 823-3818 (570) 821-0808 (570) 808-7969 (570) 208-4721 (570) 822-5794 (570) 822-5794 (570) 825-3037 (570) 823-3151

122 W MAIN ST 12311 PERRY HWY STE F 12620 PERRY HWY 1101 LINCOLN WAY 2641 MACARTHUR RD 3644 MACARTHUR RD 4117 MAIN ST 452 HAZLE ST 175 S WILKES BARRE BLVD 1000 E MOUNTAIN DR 25 CHURCH ST FL 4 250 OLD RIVER RD 250 OLD RIVER RD STE B 245 WILKES BARRE TOWNSHIP BLVD 79 E CAREY ST

WESTFIELD WEXFORD WEXFORD WHITE OAK WHITEHALL WHITEHALL WHITEHALL WILKES BARRE WILKES BARRE WILKES BARRE WILKES BARRE WILKES BARRE WILKES BARRE WILKES BARRE WILKES BARRE

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

16950-1522 15090-8344 15090 15131-1301 18052-3818 18052-2704 18052 18702-4627 18702-5040 18711-0027 18702-3507 18702-1621 18702-1621 18702-6705 18705-2007

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 545 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name THE MEDICINE SHOPPE DICK'S PHARMACY, INC. GIANT PHARMACY HEALTH SERVICES PHARMACY SUSQUEHANNA HEALTH PHARMACY THE MEDICINE SHOPPE WEIS PHARMACY WEIS PHARMACY ABINGTON HEMO/ONCOLOGY ASSOC CORNERSTONE PHARMACY GIANT PHARMACY WEIS PHARMACY MARTELLA'S PHARMACY SHAFER DRUG STORE WOODLYN PHARMACY MILLER'S PHARMACY GIANT PHARMACY MAIN LINE ONCOLOGY HEMA ASSOC PC TEPPER PHARMACY PRICE CHOPPER PHARMACY WEIS PHARMACY YARDLEY PHARMACY & SUPPLY HEALTHFAVOR PHARMACY LLC GREENWAY PHARMACY CANCER CARE ASSOCIATES OF YORK FAMILY HEALTH APOTHECARY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY MINNICHS PHARMACY SHURFINE PHARMACY SPRY THE MEDICINE SHOPPE UNION PRESCRIPTION CTR WEIS PHARMACY WEIS PHARMACY WEIS PHARMACY WEIS PHARMACY WELLSPAN INFUSION SERVICE WELLSPAN PHARMACY WELLSPAN PHARMACY YORK WELLNESS PHARMACY THE YOUNGSVILLE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (570) 823-0511 (814) 832-3653 (570) 329-3388 (570) 326-8109 (570) 321-2818 (570) 323-7733 (570) 326-5144 (570) 322-5597 (215) 706-2034 (215) 706-2001 (215) 784-1964 (717) 464-9613 (814) 467-9700 (814) 467-4200 (610) 833-5600 (570) 746-1004 (610) 602-8015 (610) 645-2494 (610) 649-0390 (570) 693-4572 (610) 736-9333 (267) 573-4555 (484) 461-9055 (717) 953-9534 (717) 741-5275 (717) 852-7766 (717) 755-1693 (717) 741-5309 (717) 718-7770 (717) 848-2312 (717) 741-5973 (717) 846-0500 (717) 845-5557 (717) 767-7009 (717) 757-5941 (717) 852-8665 (717) 845-1318 (717) 851-5891 (717) 851-2712 (717) 741-8150 (717) 747-3586 (814) 563-3400

Provider Street 100 HAZLE ST 318 E 1ST ST 1969 E 3RD ST 1201 GRAMPIAN BLVD 740 HIGH ST, STE 1001 507 HEPBURN ST 1916 LYCOMING CREEK RD 305 RIVER AVE 2510 MARYLAND RD STE 175 41 EASTON RD 315 YORK RD 2600 WILLOW STREET PIKE N 901 GRAHAM AVE 1328 GRAHAM AVE 1301 JEFFERSON AVE 41857 ROUTE 6 50 E WYNNEWOOD RD 100 E LANCASTER AVE 333 E LANCASTER AVE 1026 WYOMING AVE 2759 PAPERMILL RD 175 S MAIN ST 712 CHURCH LANE 310 S MAIN ST STE K 25 MONUMENT RD STE 294 25 MONUMENT RD STE 210 2415 E MARKET ST 275 PAULINE DR 1255 CARLISLE RD 976 S GEORGE ST 2720 S QUEEN ST 1698 S QUEEN ST 100 N BROAD ST 1800 ROOSEVELT AVE 2400 E MARKET ST 2065 SPRINGWOOD RD 2160 WHITE ST 304 SAINT CHARLES WAY 1001 S GEORGE ST 25 MONUMENT RD STE 265 605 S GEORGE ST STE 130 112 E MAIN ST

Page 546 of 679

Provider City WILKES BARRE WILLIAMSBURG WILLIAMSPORT WILLIAMSPORT WILLIAMSPORT WILLIAMSPORT WILLIAMSPORT WILLIAMSPORT WILLOW GROVE WILLOW GROVE WILLOW GROVE WILLOW STREET WINDBER WINDBER WOODLYN WYALUSING WYNNEWOOD WYNNEWOOD WYNNEWOOD WYOMING WYOMISSING YARDLEY YEADON YEAGERTOWN YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YORK YOUNGSVILLE

State

ZIP code

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

18702-4365 16693-1006 17701-3950 17701-1900 17701 17701-5004 17701-1205 17701-5419 19090 19090-3201 19090-2621 17584-9388 15963-1542 15963-1708 19094-1602 18853-9002 19096-2013 19096 19096 18644-1331 19610-3328 19067-1623 19050 17099 17403-5049 17403-5049 17402-2402 17402-4639 17404-4933 17403-3708 17403 17403-4610 17403-1525 17408 17402-2409 17403-4836 17404-4952 17402-4647 17403-3676 17403-5049 17401 16371-1161

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HAYDENS PHARMACY FARMACIA JENNY FARMACIA PROFESIONAL FARMACIA ORESTE FARMACIA PIEDRAS BLANCAS FARMACIA SAN CARLOS SUPER FARMACIA JAYLEEN FARMACIA LA MONSERRATE FARMACIA REY FARMACIA 129 FARMACIA DEL CARMEN FARMACIA DOMINGUITO INC. FARMACIA EL JUNCO FARMACIA VELEZ GOOD CARE PHARMACY ISLOTE DRUG JIREH PHARMACY PROFESSIONAL PHARMACY PROFESSIONAL PHARMACY SUPER FARMACIA PACO SUPER FARMACIA VILLA TOLEDO FARMACIA SAN CARLOS III FARMACIA CARIDAD OUTLET FARMACIA LA NUEVA BARCELONETA FARMACIA SAN MARTIN BARCELONTA TU FARMACIA FARMACIA DIAZ FARMACIA CANEY INC FARMACIA CARIDAD FARMACIA CARIDAD #6 FARMACIA CRISTINA FARMACIA GIUSTI FARMACIA LOMAS VERDES FARMACIA MAGDA FARMACIA MONTE VERDE FARMACIA SANTA OLAYA INC FARMACIAS PLAZA FARMACIAS PLAZA FARMACIAS PLAZA FARMACIAS PLAZA FARMACIAS PLAZA FARMACIAS PLAZA

NR_0009_10823 10/2017

Provider Phone Number (724) 925-1400 (787) 829-2480 (787) 829-3305 (787) 589-7281 (787) 252-5100 (787) 891-1830 (787) 891-4738 (787) 732-7744 (787) 735-5200 (787) 680-0029 (787) 878-3510 (787) 399-9900 (787) 816-5921 (787) 881-6300 (787) 878-9945 (787) 816-4338 (787) 680-7778 (787) 881-2440 (787) 879-4770 (787) 881-7872 (787) 817-4747 (787) 839-3331 (787) 786-6385 (787) 970-3542 (787) 846-3474 (787) 846-4848 (787) 857-7954 (787) 778-5313 (787) 269-3140 (787) 740-4000 (787) 786-1084 (787) 785-5487 (787) 787-2275 (787) 786-0755 (787) 780-7383 (787) 797-4966 (787) 620-9604 (787) 620-9613 (787) 620-9612 (787) 620-9618 (787) 620-9615 (787) 620-9609

Provider Street 505 N 4TH ST CALLE MUNOZ RIVERA 22 CALLE BARBOSA BARRIO JAGUEY CARR 411 KM 2.8 CARR 416 KM 0.9 B PIEDRAS BLAN URB SAN CARLOS # A-3 CRR 110 KM 0.3 BO CEIBA BAJA 34 CALLE MUNOZ RIVERA CARR 722 KM 7 3 REPARTO ROBLES CARR 129 KM 0.7 ESQ. AVE. PEDR 259 AVE JUAN ROSADO CARR 635 KM 2.0 DOMINGUITO CAR 651 KM 2.5 SECTOR EL JUNCO CARR 683 KM 0.5 BO FACTOR 1 CARR 2 KM 68 BO SANTANA CARR 681 KM 4.3 BO ISLOTE SAN RAFAEL CARR 492 KM 5.7 URB CARR #2 KM 62.7 SEC CANDELARIA CARR 653 AVE CATALINA 104 BO H CARR 662 KM 0.3 BO SANTANA 132 CALLE UMBRAL CALLE MORSE #212 CARR#2 KM 54.6 INT EST 140 CARR 140 KM 67.5 LLANADAS CALLE GEORGETTI #9 RO 140 KM 63.4 BO MAGUEYES CARRETERA 152 KM 2.8 BARRIO QU CALLE 2 BLG J23 URB HNO DAVILA CARR 862 KM 1.2 AVE PAJAROS VICTRY SHOPPING CTR PR 167 KM2 200 AVE ORQUIDEA LOCAL #5 SONIA ST AJ16 VILLA RICA 1A6 AVE LOMAS VERDES ROYAL PLM CALLE 30 ESQ 37 UU-48 CARR 174 KM 10 2 LA MORENITA CARRETERA 829 KM 6.7 2 URB RIVERVIEW BLQ L2 C10 CARR 167 KM156 BO BUENA VISTA DJ-8 IRLANDA AVE SAN JUANITA TENIENTE NELSON MART LOM VERDE DOMINICOS AVE 25 ST MIRAFLORES X1 LAS CUMBRES AVE ROYAL TOWN

Page 547 of 679

Provider City YOUNGWOOD ADJUNTAS ADJUNTAS AGUADA AGUADA AGUADILLA AGUADILLA AGUAS BUENAS AIBONITO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARECIBO ARROYO BARCELONETA BARCELONETA BARCELONETA BARCELONETA BARRANQUITAS BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON BAYAMON

State

ZIP code

PA PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR

15697-1558 601 00601-2209 602 602 603 603 00703-3208 705 612 00612-4857 613 612 612 612 612 612 612 612 612 00612-9689 714 617 617 00617-2712 617 794 959 961 957 959 00959-4918 956 956 956 956 956 956 956 956 957 957

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FARMACIAS PLAZA FARMACIAS PLAZA FARMACIAS PLAZA FARMACIAS PLAZA FARMACIA IRIZARRY FARMACIA CARIDAD FARMACIA JAYNI FARMACIA JIREH FARMACIA PROFESIONAL FARMACIA TU FAMILIA CORP FARMACIA VILLAS DE CASTRO SU FARMACIA AMIGA FARMACIA MORELL CORP FARMACIA NUEVA FARMACIA SOLMARI YUMAC DRUGS FARMACIA MEDINA FARMACIA MEDINA FARMACIA AMIGA INC FARMACIA CARIDAD FARMACIA CARIDAD FARMACIA CARIDAD FARMACIA LUIS DE PR FARMACIA MEDINA FARMACIA PUERTA DE CAROLINA FARMACIA REY FPC EXPRESO INC FARMACIA REYES FARMACIA VAZQUEZ FARMACIA VAZQUEZ FARMACIA AMERICA FARMACIA EXPRESO SUPER FARMACIA BELLA VISTA

Provider Name

(787) 620-9602 (787) 620-9601 (787) 620-9603 (787) 620-9606 (787) 851-1270 (787) 743-1273 (787) 745-9567 (787) 961-6030 (787) 258-3880 (787) 961-9796 (787) 746-0962 (787) 743-6434 (787) 898-3045 (787) 898-3690 (787) 898-5873 (787) 898-3530 (787) 256-3592 (787) 220-0706 (787) 752-6246 (787) 276-6000 (787) 791-5757 (787) 791-5757 (787) 791-2171 (787) 752-5111 (787) 768-6637 (787) 257-1444 (787) 276-2808 (787) 738-5343 (787) 263-2444 (787) 738-1444 (787) 885-3010 (787) 871-3105 (787) 871-2305

D32 EXT FOREST HILLS DR VEVE #76 57 BARBOSA ST CANTON MALL CALLE BARBOSA 38 PLAZA DEL CARMEN MALL CARR. 189 KM 2.2 CARR 172 KM 56 BO CANABONCITO #50 AVE LUIS MUNOZ MARIN #104 C11 AVE JOSE VILLARES CALLE 2 A 18 VILLAS DE CASTRO AVE LAS AMERICAS BU-1 BAIROA MUNOZ RIVERA #1 MUNOZ RIVERA STREET #16 CARR 119 BO PUENTO SEC ZARZA AVE MUNOZ RIVERA #7 CARR 185 KM 0.2 CARR 188 KM 1.5 SAN ISIDRO CENTRO CMRCIAL MONSERRATE PLZ S-C CARR 3 KM 14.7 CALLE 615 BLOQUE 297 #21 AVE LAS FLORES ESQ BEGONIA 10 AVE LAGUNA AVE COMANDANTE ESQ CAMPO RICO AVE PONTEZUELA K627 AVE SANCHEZ OSORIO AVE MONSERRATE ESQ MAIN CALDER MUNOZ RIVERA #56 SUR CALLE JOSE DE DIEGO #54 ESTE CARR #1 MARGINAL KM 56.5 AVE LAURO PINERO #266 CARR 149 KM 9.8 CARR 149 KM 18.0 BO PESAS

BAYAMON BAYAMON BAYAMON BAYAMON CABO ROJO CAGUAS CAGUAS CAGUAS CAGUAS CAGUAS CAGUAS CAGUAS CAMUY CAMUY CAMUY CAMUY CANOVANAS CANOVANAS CAROLINA CAROLINA CAROLINA CAROLINA CAROLINA CAROLINA CAROLINA CAROLINA CAROLINA CAYEY CAYEY CAYEY CEIBA CIALES CIALES

PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR

959 961 961 961 00623-4005 725 725 725 725 00725-2665 725 725 627 627 627 627 729 729 00985-5444 979 982 00979-1167 00979-6400 984 983 983 983 736 736 736 00735-2706 638 638

FARMACIA CTRO SVC AMBULATORIO CIDRA FARMAHORROS FARMACIA BETANCES FARMACIA ROMERO FARMACIA MARCE SUPER FARMACIA COROZAL AMISADAI PHARMACY ALLMED PHARMACY LLC

(787) 714-0410 (787) 739-3522 (787) 825-1268 (787) 875-2255 (787) 859-5639 (787) 859-2617 (787) 657-8577 (787) 686-6464

AVE. EL JIBARO KM 3.3 CTRO COMRCIAL VILLA DEL CARMEN JOSE 1 QUINTON #40 75 GEORGETTI ST CARR 818 KM 0.1 BO. CIBUCO CARR 159 COROZAL SHOPPING VIL #12 AVE. GARRIDO MORALES CARR #3 INT #54 COMMERCE PLZ

CIDRA CIDRA COAMO COMERIO COROZAL COROZAL FAJARDO GUAYAMA

PR PR PR PR PR PR PR PR

739 739 769 00782-2540 783 783 738 784

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 548 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FARMACIA MIRMAR SUPER FARMACIA DERKES INC SUPER FARMACIA RINA FARMACIA IVETTE FARMACIA PLAZA ALTA FARMACIA PUERTO RICO FARMACIA REY FARMACIA TU RECETA FIRST PHARMACY 6

Provider Name

(787) 864-1964 (787) 864-2112 (787) 866-4407 (787) 720-4035 (787) 272-1205 (787) 781-8179 (787) 720-2626 (787) 272-7788 (787) 782-1025

CALIMANO 44 O Y CCILIA DMGZ 1E CALLE DERKES #28 1 CALLE MCARTHUR AVE ESMERALDA PONCE DE LEON AVE SANTA ANA #262 GARDEN HILLS PLAZA #28 HERMINIO DIAZ NAVARRO #5 CARR 169 KM 7.2 #21 CAMARONES CARR 2 KM 7.2 BO JUAN DOMINGO

GUAYAMA GUAYAMA GUAYAMA GUAYNABO GUAYNABO GUAYNABO GUAYNABO GUAYNABO GUAYNABO

PR PR PR PR PR PR PR PR PR

784 784 00784-5117 969 969 966 969 969 00966-1806

PRESCRIPTION HEALTH RESOURCES OF PU FARMACIA DE TODOS FARMACIA LISYAI FARMACIA LISYAI II FARMACIA HATILLO INC FARMACIA LECHUGA SUPER FARMACIA CORCOVADA FARMACIA HOSP AUXILIO MUTUO FARMACIAS PLAZA FARMACIA CONSTANCIA LA NUEVA MONSERRATE FARMACIA CANDELERO FARMACIA CENTRAL FARMACIA ROSALINA FARMACIA LAS COLINAS ISABELA INC FARMACIA MORIAH ISABELA FARMA EXPRESS FARMACIA PADUA INC SUPER FARMACIA LIZETTE FARMACIA GUAYABAL FARMACIA GUAYABAL FARMACIA BORINQUEN FARMACIA LA CANDELARIA FARMACIA SAN PABLO SAN PEDRO LA CANDELARIA INC. FARMACIA DEL CARMEN FARMACIA YARIMAR PROFESSIONAL PHARMACY FARMACIA EL RIO INC FARMACIA LAGO VISTA FARMACIA MEDINA INC. , FARMACIA BRISAS DEL MAR

(787) 545-2073 (787) 737-3355 (787) 737-1133 (787) 687-2584 (787) 898-3343 (787) 898-5730 (787) 820-4747 (787) 758-2000 (787) 620-9608 (787) 849-1714 (787) 935-7272 (787) 850-7503 (787) 852-0520 (787) 850-2040 (787) 830-7777 (787) 872-0948 (787) 872-1930 (787) 828-4265 (787) 828-0755 (787) 837-5445 (787) 260-3804 (787) 734-5591 (787) 899-1585 (939) 214-7205 (787) 808-1585 (787) 897-2900 (787) 792-3196 (787) 827-0747 (787) 733-1003 (787) 784-4585 (787) 876-3500 (787) 889-4880

A1 CALLE ARPEGIO #2 HGHLD GARD SAN JOSE ST #4 CARR 189 KM 6.4MARINA SHOPPING CARR 931 KM 2.0 61 CALLE LUIS H LACOMBA ROAD 130 KM 4.9 CARR 492 KM 2.3 PNCE DE LEON #715 PRDA 37 1/2 AVE DOMENECH 394 CONSTANCIA PLACE CARR 2 KM 166 CARR 3344 KM 0.7 HGROS TWN PLZ CARR 3 KM 85.6 CANDELERO ARRIB NOYA Y HERNANDEZ #12 AVE FONT MARTELO # 344 CARR 4494 KM 1.3 BO ARENALES AVE AGUSTIN RAMOS CALERO 7342 AVE NOEL ESTRADA 1-350G 63 CALLE GUILLERMO ESTEVES CALLE GUILLERMO ESTEVES #103 CARR 149 KM 63.8 ROAD 1 KM 113.6 ESQ CORCHADO CALLE CONCORDIA #4 BAJOS CALLE UNION #152 CARR 116 K0.5 LA JAVILLA CALLE RAMIREZ #3 CALLE 31 SO #904 AVE MATIAS BRUGMAN #72 BO EL RIO CARR 31 KM 183 AVE BLVD #3385-86 VILLAS DE LOIZA CALLE 1 BLQ 1 CALLE 2 #901 BRISAS DEL MAR

GUAYNABO GURABO GURABO GURABO HATILLO HATILLO HATILLO HATO REY HATO REY HORMIGUEROS HORMIGUEROS HUMACAO HUMACAO HUMACAO ISABELA ISABELA ISABELA JAYUYA JAYUYA JUANA DIAZ JUANA DIAZ JUNCOS LAJAS LAJAS LAJAS LARES LAS LOMAS LAS MARIAS LAS PIEDRAS LEVITTOWN LOIZA LUQUILLO

PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR

969 778 778 778 00659-1838 659 659 917 00918-3716 660 660 791 00791-4155 791 662 00662-3466 662 664 00664-1457 795 795 777 667 667 667 669 921 00670-2005 771 949 772 773

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 549 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FARMACIA SAN MARTIN MANATI PHARMAMAX MAYAGUEZ PHARMAMAX MAYAGUEZ 2 BEST PHARMA FARMACIA EL BUEN PASTOR FARMACIA MOCA II LIFE PHARMACY FARMACIA SAN ANDRES FARMACIA SAN MIGUEL SUPER FARMACIA NUEVA INC FARMACIA OROCOVIS GENESIS PHARMACY SUPER FARMACIA SANTA ANA FARMACIA QUINONES FARMACIA GABRIELA FARMACIA HOSPITAL DAMAS FARMACIA LORRAINE INC FARMACIA LOURDES FARMACIA VIDA FARMACIA GLORIANA FARMACIA SAN ANTONIO FARMACIA SAN RAFAEL FARMACIA CARIBE FARMACIA CARIBE MEDI PHARMACY EAST INC PHARMACY EXPRESS FARMACIA MEDINA #5 INC FARMACIA REYES SUPER FARMACIA ARZUAGA, INC. FARMACIA SAGRADO CORAZON FARMACIA SAGRADO CORAZON 2 FARMACIA REY #15 FARMACIA MARTIN FARMACIA SAN AGUSTIN CA PHARMACY FARMA ENTREGA

Provider Name

(787) 884-4445 (787) 805-4000 (787) 832-5555 (787) 551-8005 (787) 877-9922 (787) 877-2589 (787) 818-5433 (787) 869-3345 (787) 869-2460 (787) 869-2290 (787) 867-2450 (787) 839-5075 (787) 839-5025 (787) 836-1042 (787) 259-3854 (787) 840-8686 (787) 843-1838 (787) 842-1314 (787) 840-2015 (787) 895-1067 (787) 895-6707 (787) 895-2121 (787) 887-3060 (787) 887-4444 (787) 888-1888 (787) 657-3555 (787) 763-0255 (787) 764-2899 (787) 767-2626 (787) 873-7676 (939) 910-7920 (787) 824-2076 (787) 892-1122 (787) 892-1164 (787) 705-3900 (787) 233-9922

PRT DEL SOL #54 CRR 2 STE 3 CARR #2 KM 156.7 BO SABALO CARR #2 KM 1495 BO SABANETAS CARR 111 KM 5.2 BO. PUEBLO CARR 420 KM 2.2 BO VOLADORAS CARR 444 KM 0.7 CARR 110 KM 11.2 CARRETERA 164 KM 0.2 CALLE GEORGETTI #109 91 GEORGETTI STREET CALLE 4 DE JULIO #17 CARR NUM 3 KM 1230 SECTOR URBA MUNOZ RIVERA #38 CALLE MUNOZ RIVERA #418 CARR 132 KM 22.1 A-80 2213 PONCE BY PASS 1681 PASEO VILLA FLORES 14 CARR 123 CTR D.SUR BLVD MIGUEL POU 26.4 CARR #2 KM 96.8 CARR 113 KM 13.6 BARRIO SAN AN CALLE SAN JUSTO #165 CTRO COM VILLAS DE RIO GRANDE CENTRO COM ALTURAS AVE 65TH INT KM 263 CARR #3 KM 24.5 SECTOR I CALLE DE DIEGO # 486 AVE PARANA CENTRO COMERCIAL CALLE ARZUAGA #108 ED DORA PAGANELLI LOCAL 2 AVE CALLE ANGEL G MARTINEZ #3 CALLE AGUSTIN COLON PACHECO #8 CALLE RUIZ BELVIS #22 9 CALLE CONCEPCION 1507 CALLE PRF AUGUSTO RODRIG UR CLUB MANOR C-JOSE ABAD 1217

MANATI MAYAGUEZ MAYAGUEZ MOCA MOCA MOCA MOCA NARANJITO NARANJITO NARANJITO OROCOVIS PATILLAS PATILLAS PENUELAS PONCE PONCE PONCE PONCE PONCE QUEBRADILLAS QUEBRADILLAS QUEBRADILLAS RIO GRANDE RIO GRANDE RIO GRANDE RIO GRANDE RIO PIEDRAS RIO PIEDRAS RIO PIEDRAS SABANA GRANDE SABANA GRANDE SALINAS SAN GERMAN SAN GERMAN SAN JUAN SAN JUAN

PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR

00674-4973 682 682 676 676 676 676 719 719 719 720 723 723 624 728 00717-1310 00716-2953 00728-2708 731 678 678 00678-1739 745 745 745 745 923 926 00925-3705 637 00637-1914 751 00683-4067 00683-3905 00909-2214 924

FARMACIA AMIGA DE MONTECARLO INC FARMACIA BORINQUEN TOWERS FARMACIA CARIDAD #7 FARMACIA FATIMA FARMACIA LAUREL

(787) 762-1616 (787) 783-4510 (787) 740-7000 (787) 753-0794 (787) 726-0295

800 AVE RAFAEL HDEZ MARIN STE5 AVE FD ROOSEVELT BORNQUEN TWRS CMNO ALEJANDRINO C 838 KM 3.4 224 AVE DOMENECH 2428 CALLE LOIZA

SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN

PR PR PR PR PR

00924-5288 920 921 00918-3507 00913-4731

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 550 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FARMACIA LOS MAESTROS FARMACIA NUEVA BORINQUEN FARMACIA REY FARMACIA REYES FARMACIA SAN RAFAEL FARMACIA SIEMPREABIERTA FARMACIA VARGAS FARMACIA VILLA ANDALUCIA FARMACIAS PLAZA FARMATODO PHARMAXPRESS PROFESSIONAL DRUG FARMACIA ESPINO INC

Provider Name

(787) 765-8811 (787) 726-7558 (787) 741-8397 (787) 782-6403 (787) 724-3307 (787) 764-1194 (787) 782-6129 (787) 761-7605 (787) 726-3085 (787) 523-3555 (787) 332-1280 (787) 783-4285 (787) 736-0069

MUNIZ SOUFFRONT AVE #459 2039 AVE BORINQUEN PO BOX 260310 1320 SAN ALFONSO AVE 851 CALLE LAFAYETTE 370 CALLE MANUEL DOMENECH 1000 AVE JESUS T PINERO CENTRO COMERCIAL VILLA ANDALUC 2263 BORINQUEN AVE BO OBRERO 282 AVE JESUS T PINERO STE 101 CARR 176 ESQ AVE 733 DE DIEGO AVE CARR 181 KM 02 RAMAL 745 BO ES

SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN JUAN SAN LORENZO

PR PR PR PR PR PR PR PR PR PR PR PR PR

923 00915-3812 00926-2621 921 00909-2627 00918-3720 00921-1819 926 00915-4412 00927-3915 926 920 754

FARMACIA RUIZ BELVIS DE SAN LORENZO FARMACIA SAMARITANA FARMACIA SAN MIGUEL FARMACIA EL BUEN PASTOR FARMACIA NUEVA PHARMAMAX SAN SEBASTIAN FARMACIA REY #16 FARMACIA AMERICANA INC FARMACIA LUIS PR INC FARMACIA MERCIER FARMACIA NIEVES FARMACIA PINA INC. FARMACIA SAN FERNANDO INC FARMACIAS PLAZA FARMACIA CARRAIZO FARMACIA DOS BOCAS FARMACIA EL CONQUISTADOR FARMACIA REY #17 FARMACIA CAGUANA FARMACIA CINTRON INC FARMACIA MONTE REY FARMACIA VEGA ALTA FARMACIA CARIDAD FARMACIA JARDINES, INC FARMACIA MONARCA HIS PHARMACY FARMACIA EL PASEO FARMACIA LA AURORA

(787) 715-3800 (787) 736-7100 (787) 736-2900 (787) 896-6340 (787) 896-2080 (787) 896-4141 (787) 845-4245 (787) 728-6095 (787) 722-1590 (787) 728-0800 (787) 797-7615 (787) 279-0731 (787) 870-2460 (787) 620-9611 (787) 760-2650 (787) 283-1920 (787) 755-2060 (787) 292-7993 (787) 894-8283 (787) 894-2190 (787) 270-1816 (787) 883-4140 (787) 858-8037 (787) 807-7979 (787) 369-6868 (787) 965-7999 (787) 856-1175 (787) 856-0023

CARR 181 KM 1.0 BO QUEMADOS URB EL PARQUE CALLE 4 STE 150 CARRT 181 KM 0.6 INT CARRT 183 CARR 111 KM 14.5 URB RAHOLISA #3 CARR 111 KM 18.7 BO BAHOMAMEY CALLE LUIS MUNOZ RIVERA #37 CALLE LOIZA #1854 1501 PONCE DE LEON 1511 LOIZA ST AVE PRINCIPAL N15 TOA ALTA HTS 17 CALLE LUIS MUNOZ RIVERA CALLE MUNOZ RIVERA 17 CARR 863 KM 0.6 BO PAJAROS CARR 844 KM 5.6 CARR 181 KM 9.1 BO DOS BOCAS CARR 175 KM 3.8 CARR 852 KM 01 BO DOS BOCAS CARR 111 KM 8.3 BO CAGUANA CALLE DR CUETO #74 CARR 694 KM 1.1 BO ESPINOSA MUNOZ RIVERA #36 PLAZA LAS VEGAS BO. ALGARROBOS 11 AVE GUARICO CARR 160 KM 4.4 BO.ALMIRANTE N CARR 137 KM 7.2 LOCAL 2 BO PUG 35 PROL 25 DE JULIO ST CARR 128 KM 3.3

SAN LORENZO SAN LORENZO SAN LORENZO SAN SEBASTIAN SAN SEBASTIAN SAN SEBASTIAN SANTA ISABEL SANTURCE SANTURCE SANTURCE TOA ALTA TOA ALTA TOA ALTA TOA BAJA TRUJILLO ALTO TRUJILLO ALTO TRUJILLO ALTO TRUJILLO ALTO UTUADO UTUADO VEGA ALTA VEGA ALTA VEGA BAJA VEGA BAJA VEGA BAJA VEGA BAJA YAUCO YAUCO

PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR PR

754 754 754 685 00685-2415 685 757 00911-1824 909 911 953 00953-2424 953 951 976 977 976 976 641 641 692 692 693 00693-4037 693 00693-0000 698 698

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 551 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FARMACIA LA CONCEPCION GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE STOP & SHOP PHARMACY PHREDS DRUG STOP & SHOP PHARMACY STOP & SHOP PHARMACY CHAPEL PHARMACY INC STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY BAKERS PHARMACY ATWOOD PRESCRIPTION CENTER GENOA-QOL HEALTHCARE STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY SHAWS PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY BLACKSTONE HEALTH MART PHCY BLACKSTONE VALLEY COMMUNITY PHARMAC GENOA-QOL HEALTHCARE HOWELL SMITH DRUGGISTS SIMPSONS PHARMACY STOP & SHOP PHARMACY

Provider Name

(787) 856-0233 (401) 237-4125 (401) 782-3511 (401) 823-4343 (401) 463-6300 (401) 944-2669 (401) 943-8285 (401) 333-5858 (401) 722-3401 (401) 431-0476 (401) 949-1848 (401) 423-2800 (401) 831-0100 (401) 667-7607 (401) 861-3150 (401) 334-0754 (401) 849-9640 (401) 783-7768 (401) 353-4075 (401) 727-3900 (401) 765-6722 (401) 475-5655

CALLE COMERCIO #9 2 OLD COUNTY RD 4705 OLD POST RD UNIT A 900 TIOGUE AVE 1300 OAKLAWN AVE 200 ATWOOD AVE 204 GARFIELD AVE 2081 DIAMOND HILL RD 70 MENDON RD 1925 PAWTUCKET AVE 446 PUTNAM PIKE 53 NARRAGANSETT AVE 1524 ATWOOD AVE 1443 HARTFORD AVE STE 120 11 COMMERCE WAY 622 GEORGE WASHINGTON HWY # 71 1360 W MAIN RD 91 POINT JUDITH RD 15 SMITHFIELD RD 1128 MINERAL SPRING AVE 595 SMITHFIELD RD 465 LONSDALE AVE STE B

YAUCO BARRINGTON CHARLESTOWN COVENTRY CRANSTON CRANSTON CRANSTON CUMBERLAND CUMBERLAND EAST PROVIDENCE GREENVILLE JAMESTOWN JOHNSTON JOHNSTON JOHNSTON LINCOLN MIDDLETOWN NARRAGANSETT NORTH PROVIDENCE NORTH PROVIDENCE NORTH SMITHFIELD PAWTUCKET

PR RI RI RI RI RI RI RI RI RI RI RI RI RI RI RI RI RI RI RI RI RI

00698-3629 02806-1600 02813-1842 02816-6301 02920-2635 02920-4053 02920-7803 02864-5123 02864-5327 02914-1642 02828-3027 02835-1100 02919-3228 02919-3224 02919-4613 02865-4211 02842-6301 02882-3468 02904-5312 02904-4104 02896-7226 02860-1848

(401) 642-2093 (401) 722-0299 (401) 725-7711 (401) 722-7600 (401) 722-6538

39 EAST AVE. SUITE 100 101 BACON ST 749 CENTRAL AVE 10 NEWPORT AVE 640 BROADWAY

PAWTUCKET PAWTUCKET PAWTUCKET PAWTUCKET PAWTUCKET

RI RI RI RI RI

2860 02860-5542 02861-2101 02861-4414 02860-1233

BROWN UNIVERSITY HEALTH SVCS PHCY GENOA-QOL HEALTHCARE JB PHARMACY II LLC LIFESPAN PHARMACY LIFESPAN PHARMACY STOP & SHOP PHARMACY

(401) 863-7882 (401) 276-6370 (401) 861-1194 (401) 444-4909 (401) 793-5500 (401) 453-0288

13 BROWN ST 530 N MAIN ST STE 124 1017 SMITH ST 593 EDDY ST 164 SUMMIT AVE 850 MANTON AVE

PROVIDENCE PROVIDENCE PROVIDENCE PROVIDENCE PROVIDENCE PROVIDENCE

RI RI RI RI RI RI

02912-9006 02904-5762 02908-2737 02903-4923 02906-2853 02909-5649

WHITE CROSS PROFESSIONAL SERVICES OPTION CARE BAYVIEW PHARMACY INC GREEN LINE APOTHECARY WAKEFIELD PRESCRIPTION CENTER DELEKTA PHARMACY

(401) 351-5900 (401) 431-1300 (401) 284-4505 (401) 307-2555 (401) 789-9791 (401) 245-6767

1 RANDALL SQ 66 AMARAL ST 3045 TOWER HILL RD UNIT 3 203 MAIN STREET 580 KINGSTOWN RD 496 MAIN ST

PROVIDENCE RIVERSIDE SAUNDERSTOWN WAKEFIELD WAKEFIELD WARREN

RI RI RI RI RI RI

02904-2709 02915-2205 02874-1504 2879 02879-3612 02885-4369

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 552 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GENOA-QOL HEALTHCARE HORIZON PHARMACY STOP & SHOP PHARMACY STOP & SHOP PHARMACY SUBURBAN PHARMACY TOLL GATE APOTHECARY MC QUADES MARKETPLACE SEASIDE PHARMACY SAVITZ DRUG STORE INC AIKEN DRUG COMPANY CLYBURN CENTER FOR PRIMARY CARE FAMILY PHARMACY FAMILY PHARMACY SOUTH AIKEN HAWTHORNE AIKEN PHARMACY INGATE PROFESSIONAL PHARMACY LOMINICK'S PHARMACY MEDICINE MART TLC MEDICAL CENTRE INC ANMED HEALTH PHCY OGLESBY CTR BRYANT PHARMACY & SUPPLY DIXON POWERS DRUG COMPANY INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY PRESCRIPTION SHOP, INC. PROFESSIONAL PHARMACY PROPP DRUGS THE MEDICINE MART FREDS PHARMACY REYNOLDS DRUG STORE SUPRX PHARMACY AYNOR FAMILY PHARMACY HIERS DRUG STORE BARNWELL FAMILY MEDICINE PHCY BERLEY'S PHARMACY INC DANIEL'S PHARMACY OF BARNWELL OWEN DRUG COMPANY

Provider Name

(401) 287-4990 (401) 681-4220 (401) 828-0533 (401) 732-4060 (401) 781-2110 (401) 732-0400 (401) 596-0277 (401) 637-4577 (864) 366-2165 (803) 649-6286 (803) 508-7139 (803) 649-1776 (803) 648-1776 (803) 648-2985 (803) 648-8330 (803) 648-8328 (803) 649-7437 (803) 648-7800 (864) 512-1109 (864) 224-0711 (864) 224-1684 (864) 225-9528 (864) 226-2398 (864) 332-0552 (864) 225-8246 (864) 224-3581 (864) 226-8383 (864) 225-3119 (843) 264-6656 (843) 264-5454 (843) 264-3291 (843) 358-2000 (803) 245-4334 (803) 591-7891 (803) 259-3541 (803) 259-1234 (803) 532-6581

75 LAMBERT LIND HWY STE 125 2756 POST RD STE 105 300 QUAKER LN 2485 WARWICK AVE 242 PAWTUXET AVE 176 TOLL GATE RD STE 302 106 MAIN ST 224 POST RD STE 7 815 W GREENWOOD ST STE 4 101 LAURENS ST SW 1000 CLYBURN PL 333 NEWBERRY ST NW 110 PRICE AVE 410 UNIVERSITY PKWY STE 2800 400 LAURENS ST NW 839 RICHLAND AVE W 1020 RICHLAND AVE W 190 CREPE MYRTLE CT 2000 E GREENVILLE ST STE 1000 1901 N MAIN ST 805 N FANT ST 2404 N HIGHWAY 81 4396 HWY 24 1900 N MAIN ST 1217 N FANT ST 1409 N MAIN ST 1529 N FANT ST 2627 S MAIN ST 311 E MAIN ST 7 S MORGAN AVE 15 W ASHLAND ST 240 8TH AVENUE 12253 HERITAGE HWY 86 WREN STREET 16 BURR ST 178 WREN ST 501 W RAILROAD AVE

WARWICK WARWICK WARWICK WARWICK WARWICK WARWICK WESTERLY WESTERLY ABBEVILLE AIKEN AIKEN AIKEN AIKEN AIKEN AIKEN AIKEN AIKEN AIKEN ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDERSON ANDREWS ANDREWS ANDREWS AYNOR BAMBERG BARNWELL BARNWELL BARNWELL BATESBURG

RI RI RI RI RI RI RI RI SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

02886-1163 02886-3003 02886-0159 02889-4262 02888-1933 02886-4481 02891-2114 02891-2682 29620-2552 29801-3887 29801-4193 29801-3929 29803-7395 29801-6827 29801-3916 29801-3833 29801 29803-7543 29621-1714 29621-3868 29621-5707 29621 29626 29621-3849 29621-4821 29621-4732 29621-4707 29624-3241 29510-2641 29510-2645 29510 29511 29003-1678 29812 29812-2533 29812-1527 29006-1732

BEAUFORT PHARMACY AND COMPOUDING MARGARET J WESTON HEALTH CTR CLINKSCALES DRUGS INGLES PHARMACY

(843) 729-5583 (803) 380-7000 (864) 338-8217 (864) 338-3184

968 RIBAUT RD STE 1 4645 AUGUSTA RD 727 ANDERSON ST, STE C 426 S MAIN ST

BEAUFORT BEECH ISLAND BELTON BELTON

SC SC SC SC

29902-8003 29842-7265 29627 29627-1524

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 553 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CSC COMMUNITY PHCY BENNETTSVILLE FOWLER PHARMACY MARLBORO DRUG COMPANY MEDCARE PHARMACY BISHOPVILLE DRUG COMPANY INC

Provider Name

(843) 309-8335 (843) 479-3831 (843) 479-4248 (843) 479-7101 (803) 484-3784

999 CHERAW ST 301 E MARKET ST 113 N MARLBORO ST 1114 COTTINGHAM BLVD N STE B 302 S MAIN ST

BENNETTSVILLE BENNETTSVILLE BENNETTSVILLE BENNETTSVILLE BISHOPVILLE

SC SC SC SC SC

29512 29512-3136 29512-3142 29512-2856 29010-1422

CSC COMMUNITY PHARMACY-BISHOPVILLE MCLEOD PHARMACY, INC. IRON CITY PHCY MEDICINE SHOPPE DANIELS' PHARMACY-BLACKVILLE BLUFFTON PHARMACY

(803) 588-7960 (843) 484-6115 (864) 416-7277 (803) 284-3372 (843) 757-4999

545 SUMTER HWY 127 N MAIN ST 301-B W CHEROKEE ST 19354 SOLOMON BLATT AVE N 167 BLUFFTON RD STE B

BISHOPVILLE BISHOPVILLE BLACKSBURG BLACKVILLE BLUFFTON

SC SC SC SC SC

29010 29010-1413 29702-1558 29817 29910-6228

ULMER FAMILY PHARMACY AND WELLNESS

(843) 473-4496

68 BLUFFTON RD SUITE 6

BLUFFTON

SC

29910

BLYTHEWOOD PHCY & HOME MED EQUIP RONS PHARMACY INC RX CARE PLUS PHCY BOILING SPRINGS UPSTATE PHARMACY BOILING SPRINGS BOLAND PHARMACY BRANCHVILLE PHARMACY FREDS PHARMACY HAWTHORNE CAMDEN PHARMACY MEDI-SAVE PHARMACY AGAPE RX BI LO PHARMACY BI LO PHARMACY CHAPIN PHARMACY CHARLESTON CANCER CENTER CHARLESTON ENT PHARMACY CHARLESTON HEMATOL & ONCOLOGY CHARLESTON HEMATOLOGY ONC PHCY

(803) 786-8110 (864) 599-0889 (864) 253-8600 (864) 578-9524 (803) 829-2547 (803) 274-8585 (803) 425-8240 (803) 425-8378 (803) 424-0064 (803) 451-7289 (803) 926-4974 (803) 345-0679 (803) 345-1114 (843) 572-9211 (843) 793-6402 (843) 577-6957 (843) 577-6957

710C UNIVERSITY VILLAGE DR 2212 OLD FURNACE RD 2510 BOILING SPRINGS RD UNIT A 2400 BOILING SPRINGS ROAD 7107 CHARLESTON HWY 7615 FREEDOM RD 1521 JEFFERSON DAVIS HWY 2534 BROAD ST 1023A W DEKALB ST 615 KNOX ABBOTT DR STE B 300 KNOX ABBOTT DR 1419 CHAPIN RD 138A AMICKS FERRY 2910 TRICOM STREET 1849 SAVAGE RD 2085 HENRY TECKLENBURG DR FL 2 2085 HENRY TECKLENBURG DR FLR2

BLYTHEWOOD BOILING SPRINGS BOILING SPRINGS BOILING SPRINGS BOWMAN BRANCHVILLE CAMDEN CAMDEN CAMDEN CAYCE CAYCE CHAPIN CHAPIN CHARLESTON CHARLESTON CHARLESTON CHARLESTON

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29016-7611 29316-5782 29316-5305 29316 29018-8552 29432-2315 29020-3908 29020-2238 29020-4162 29033-4126 29033-4395 29036-8874 29036 29406 29407-4726 29414-5733 29414

CHARLESTON HEMATOLOGY ONCOLOGY

(843) 577-2276

125 DOUGHTY ST STE 500

CHARLESTON

SC

29403-5744

DELTA PHARMACY AND MEDICAL SUPPLY DOTTIE'S PHARMACY FETTER HEALTH CARE NETWORK FOCUS: MEDS PHCY AND WELLNESS HEROLD'S PHARMACY LCR SPECIALTY PHARMACY MUSC ASHLEY RIVER TOWER PHCY MUSC HOLLINGS CANCER CTR PHCY

(843) 761-5255 (843) 501-9500 (843) 720-5655 (843) 818-4638 (843) 637-3037 (843) 572-4840 (843) 876-0199 (843) 876-0199

320 E BAY ST STE A 354 FOLLY ROAD BUILDING # 1 51 NASSAU ST 2000 SAM RITTENBERG BL STE 134 2057 CHARLIE HALL BLVD 2860 TRICOM ST 25 COURTENAY DRIVE RM M104 86 JONATHAN LUCAS RM 114

CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON

SC SC SC SC SC SC SC SC

29401-1681 29412 29403-5500 29407-4629 29414-5834 29406 29425 29425

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 554 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name MUSC RUTLEDGE TOWER PHARMACY MUSC UNIVERSITY HOSPITAL PHCY PLANTATION PHARMACY PLANTATION PHARMACY LLC HARSEY'S PHARMACY P & H PHARMACY WANNAMAKERS DRUG STORE BLACK'S DRUG STORE COMMUNITY MEDICINE PHARMACY CHESTERFIELD DRUG COMPANY WANNAMAKER DRUG HUBBARD YOUNG PHARMACY INC INGLES PHARMACY CLINTON DISCOUNT PHARMACY SADLER-HUGHES APOTHECARY MEDCARE PHARMACY AHF PHARMACY BI LO PHARMACY FINKLIN PHARMACY GENOA-QOL HEALTHCARE HAWTHORNE LAUREL PHARMACY HAWTHORNE PHARMACY LANDY'S PHARMACY LONGS CLOSED DOOR PHARMACY INC LONG'S DRUGS OF IRMO LONGS KILBOURNE RD. DRUGSTORE LONG'S MILLWOOD DRUGS STORE LONGS PHARMACY AT GATEWAY MEDICINE MART PHARMACY PALMETTO HEALTH PHARMACY 10 MP SC ONCOLOGY RETAIL PHARMACY MEDICINE MART NYE'S PHARMACY RIVERTOWN PHARMACY INC SOUTHSIDE PHARMACY DELTA PHCY & MEDICAL SUPPLY CAROLINA DRUG STORE, INC. MEDICAP PHARMACY PALMETTO BREATHING SOLUTIONS PROFESSIONAL PHARMACY DANIELS PHARMACY INC DENMARK MEDICAL CENTER PHCY

NR_0009_10823 10/2017

Provider Phone Number (843) 876-0199 (843) 876-0199 (843) 556-1994 (843) 795-9554 (843) 537-9991 (843) 537-3801 (843) 537-3221 (803) 581-2102 (803) 581-7209 (843) 623-2632 (843) 623-2999 (864) 654-1771 (864) 654-3094 (864) 387-7151 (864) 833-4000 (803) 222-6060 (803) 509-5676 (803) 699-8332 (803) 735-0525 (803) 731-0203 (803) 254-2761 (803) 256-3440 (803) 567-3107 (803) 217-1088 (803) 404-6700 (803) 254-4619 (803) 256-7481 (803) 736-5975 (803) 231-2003 (803) 434-6482 (803) 461-3197 (843) 248-4609 (843) 248-5015 (843) 488-4400 (843) 248-6550 (843) 761-5255 (843) 393-2865 (843) 395-6020 (843) 393-1001 (843) 393-6591 (803) 793-3804 (803) 793-4282

Provider Street 135 RUTLEDGE AVE RM 106 169 ASHLEY AVE RM 149 531 WAPPOO RD 776 DANIEL ELLIS DR # 2C 280 US HWY 1 700 CHESTERFIELD HWY 154 MARKET ST 121 CHURCH ST 117 CESTRAIN SQ 139 MAIN ST 107 WEST BLVD 402 COLLEGE AVE STE 1 864 OLD GREENVILLE HWY 202 N BROAD ST 216 S BROAD ST 723 BETHEL ST 3025 FARROW RD 120 FORUM DRIVE 4100 MAIN ST 16 BERRYHILL RD STE 109 2761 LAUREL ST 1520A TAYLOR ST 110A CLEMSON RD 111 EXECUTIVE CENTER DR #222 7163 SAINT ANDREWS RD 630 KILBOURNE RD 2801 MILLWOOD AVE 8810 FARROW RD STE C 3729 ROSEWOOD DR 10 RICHLAND MEDICAL PARK DR 166 STONERIDGE DR 1401 MAIN ST 1600 10TH AVE 2219 MAIN ST 3320 4TH AVE STE F 162 SEVEN FARMS DR STE 125 52 PUBLIC SQ 203 S MAIN ST 18 PUBLIC SQ 201 CASHUA ST STE 2 5036 CAROLINA HWY 1241 SOLOMON BLATT BLVD

Page 555 of 679

Provider City CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHERAW CHERAW CHERAW CHESTER CHESTER CHESTERFIELD CHESTERFIELD CLEMSON CLEMSON CLINTON CLINTON CLOVER COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA COLUMBIA CONWAY CONWAY CONWAY CONWAY DANIEL ISLAND DARLINGTON DARLINGTON DARLINGTON DARLINGTON DENMARK DENMARK

State

ZIP code

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29425 29425 29407-2223 29412-3034 29520-0000 29520-7001 29520-2412 29706 29706-1979 29709-1597 29709-1528 29631 29631-1228 29325-2304 29325-2505 29710-1157 29203 29229 29203-5800 29210-6433 29204-2021 29201-2919 29229-6544 29210 29212-1146 29205-2827 29205-1257 29203-9727 29205-3531 29203-6864 29210-8239 29526-3568 29526 29526-3340 29527-6057 29492-8034 29532-3216 29532-3953 29532-3212 29532 29042-1678 29042

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DILLON COMMUNITY PHARMACY DILLON FAMILY PHARMACY INGLES PHARMACY EASLEY HEALTHMART PHARMACY EXIGO PHARMACEUTICALS FLEETWOOD PHARMACY INGLES PHARMACY INGLES PHARMACY KELLYS FAMILY PHARMACY MEIYA PHARMACY BANKS PHARMACY EHRHARDT PHARMACY LLC ELGIN PHARMACY ELLOREE PHARMACY ESTILL COMMUNITY PHARMACY DELTA OF EUTAWVILLE FAIRFAX PHARMACY INC GP PHARMACY K J PHARMACY LOWCOUNTRY PHARMACY LLC MCLEOD REGIONAL MEDICAL CENTER MEDICINE MART PALMETTO PRESCRIPTION CENTER SUP-RX PHARMACY THE PHARMACY BI LO PHARMACY FORT MILL PHARMACY PALMETTO FAMILY PHARMACY TEGA CAY FAMILY PHARMACY BESTRX BUFORD STREET DRUG STORE MEDICINE MART GAFFNEY PRESCRIPTIONS PLUS FREDS PHARMACY GASTON FAMILY PHARMACY CARE PHARMACY LLC FAMILY PHARMACY AT GMH PRESCRIPTION SHOPPE THE MEDICINE SHOPPE MORGANS PHARMACY GRAY COURT PHARMACY GREAT FALLS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (843) 774-4749 (843) 774-1816 (864) 433-0422 (864) 642-4879 (864) 855-2666 (864) 442-5192 (864) 855-9790 (864) 855-6856 (864) 343-0540 (864) 810-3833 (803) 637-5757 (803) 267-2121 (803) 438-5735 (803) 897-2131 (803) 625-9001 (843) 761-5255 (803) 632-2055 (843) 407-7637 (843) 468-9803 (843) 656-2973 (843) 777-2166 (843) 667-0759 (843) 292-9783 (843) 673-9107 (843) 773-2821 (803) 548-6877 (803) 548-2851 (803) 396-1092 (803) 547-6100 (864) 210-1811 (864) 488-3036 (864) 489-5198 (864) 487-0407 (803) 794-5233 (803) 939-8489 (843) 545-9292 (843) 520-8550 (843) 546-2222 (843) 546-2880 (803) 892-5572 (864) 876-3837 (803) 482-2249

Provider Street 200 W HARRISON ST STE A 603 N 6TH AVE 2120 E MAIN ST 401 HILLCREST DR 115 BRUSHY CREEK RD 121 FLEETWOOD DR 5251 CALHOUN MEMORIAL HWY 410 PELZER HWY 704 BRUSHY CREEK RD 1040 S PENDLETON ST SUITE E 100 RIDGE MEDICAL PLAZA RD # 1 12930 BROXTON BRIDGE RD 1107 ROSE ST 2611 CLEVELAND ST 136 MARTIN L KING JR BLVD N 226 PORCHER AVE 1275 ALLENDALE FAIRFAX HWY 500 W PALMETTO ST 2300 PAMPLICO HWY 1530 MCLURE CT 555 E CHEVES ST 1337 S IRBY ST 1304 CELEBRATION BLVD 1945 W PALMETTO ST STE 32 2500 HOFFMEYER RD 1329 HIGHWAY 160 W 601 SPRINGCREST DR 1046 REGENT PARKWAY SUITE 104 1741 GOLD HILL RD STE 106 1103 N MAIN ST STE E 113 W BUFORD ST 305 N LIMESTONE ST 311 CHESNEE HWY STE C 106 JIMMY MARTIN CIR 1118 MACK ST 1111 MEMORIAL LN 606 BLACK RIVER RD 1743 N FRASER ST 1047 N FRASER ST 309 BROAD ST 345 W MAIN ST 503 CHESTER AVE STE A

Page 556 of 679

Provider City DILLON DILLON DUNCAN EASLEY EASLEY EASLEY EASLEY EASLEY EASLEY EASLEY EDGEFIELD EHRHARDT ELGIN ELLOREE ESTILL EUTAWVILLE FAIRFAX FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FLORENCE FORT MILL FORT MILL FORT MILL FORT MILL FOUNTAIN INN GAFFNEY GAFFNEY GAFFNEY GASTON GASTON GEORGETOWN GEORGETOWN GEORGETOWN GEORGETOWN GILBERT GRAY COURT GREAT FALLS

State

ZIP code

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29536-3331 29536-2503 29334-9456 29640-1221 29642-1120 29640-2019 29640-3865 29642-2106 29642-2200 29642 29824-4537 29081 29045-8339 29047 29918-5146 29048-8557 29827-9124 29501-4428 29505-6834 29505 29506-2617 29505-2784 29501-5495 29501 29501-7407 29715-8498 29715 29715 29708 29644-1336 29340-3001 29340-3137 29341 29053-9242 29053-8713 29440-3311 29440-3304 29440-6407 29440-2848 29054-8587 29645-5604 29055-1207

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GREELEYVILLE PHARMACY ADVANCED PHARMACY LLC CHARLESTON RX, LLC FIRSTCHOICE PHARMACY FOWLERS PHARMACY INGLES PHARMACY INGLES PHARMACY KASH & KARRY PHARMACY LLC MEDSCRIPTS MEDICAL PHARMACY MEMORIAL PHARMACY INC NETWORK HEALTH CARE SC NEW HORIZON PHARMACY NEW HORIZON PHARMACY PARKER ROAD DRUG STORE PHARMACY INNOVATIONS PICKWICK PHARMACY SAM PHARMACY & HEALTH FOOD SHAWS PHARMACY ST. FRANCIS CANCER CENTER PHCY STONE PLAZA PHARMACY UPSTATE MEDICAL PHARMACY UPSTATE PHARMACY CROSS CREEK UPSTATE PHARMACY EASTSIDE UPSTATE PHARMACY IMA UPSTATE PHCY CTR FOR FAMILY MEDI WELCOME PHARMACY INC. CAROLINA COMMUNITY PHARMACY

Provider Name

(843) 426-2170 (770) 339-1190 (864) 212-2967 (864) 370-7857 (864) 288-5920 (864) 235-7183 (864) 322-2813 (864) 232-6711 (866) 840-4067 (864) 295-1113 (864) 288-0816 (864) 751-3200 (864) 233-1534 (864) 232-4662 (864) 241-0477 (864) 277-4180 (864) 233-9532 (864) 235-0361 (864) 603-6392 (864) 233-7940 (864) 455-8910 (864) 797-7170 (864) 454-2369 (864) 286-7545 (864) 455-6330 (864) 671-0300 (864) 330-8230

105 S MAIN ST 350 FEASTER RD STE D 2498 N PLEASANTBURG DR SUITE A 1005 GROVE RD 1908 LAURENS RD 1500 POINSETT HWY 1335 STALLINGS RD 101 PETE HOLLIS BLVD 1325 MILLER RD STE K 100A SIMPSON ST 1200 WOODRUFF RD STE C28 811 PENDLETON ST STE 11 130 MALLARD ST 1319 WOODSIDE AVE 604 GROVE RD 3219 AUGUSTA ST 1803 AUGUSTA ST STE F 1633 E NORTH ST 104 INNOVATION DR STE 1050 1164 RUTHERFORD RD 701 GROVE RD 111 DOCTORS DR 200 PATEWOOD DR STE B150 1025 VERDAE BLVD STE A 877 W FARIS RD 3405 WHITE HORSE RD, STE F 113 LINER DR

GREELEYVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENVILLE GREENWOOD

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29056-8903 29615-6176 29609-3029 29605 29607-2913 29609-2929 29609-6946 29601-1107 29607-6541 29605-4413 29607-5751 29601-3232 29601-4046 29611-3738 29605-4209 29605-2145 29605-2980 29607-1374 29607-5253 29609-3906 29605-5611 29605-5608 29615-3593 29607-4032 29605-4289 29611-5947 29646-2311

CAROLINA COMMUNITY PHARMACY NW FOOD LION PHARMACY WINGARDS PHARMACY ASSOCIATE FAMILY PHARMACY INGLES PHARMACY MCLESKEY TODD PHARMACY NEW HORIZON PHARMACY PROFESSIONAL PHARMACY OF GREER PROFESSIONAL PHCY AT MT VIEW UPSTATE PHARMACY GREER BI LO PHARMACY CAROLINA PHCY OF THE LOWCOUNTRY

(864) 889-9300 (864) 943-0151 (864) 223-6120 (864) 801-0411 (864) 801-3508 (864) 877-0753 (864) 801-2035 (864) 877-3386 (864) 877-4281 (864) 522-1700 (803) 943-0683 (803) 914-0318

577 BYPASS 72 NW 1605 BYPASS 72 NE 202 SEABOARD AVE 415 BROCKMAN MCCLIMON RD STE B 1524 LOCUST HILL RD 109 N MAIN ST 111 BERRY AVE # A 320 MEMORIAL DR 428 MEMORIAL DRIVE EXT 845 S BUNCOMBE RD STE B 1703 ELM ST WEST 810 ELM ST E

GREENWOOD GREENWOOD GREENWOOD GREER GREER GREER GREER GREER GREER GREER HAMPTON HAMPTON

SC SC SC SC SC SC SC SC SC SC SC SC

29649-1301 29649-1606 29646-2201 29651-6608 29651-6042 29650-1921 29651-1333 29650-1521 29651-1818 29650-2432 29924 29924-2610

HARDEEVILLE MEDICAL CENTER PHARMACY

(843) 784-2181

552 STINEY RD

HARDEEVILLE

SC

29927-5228

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 557 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RICK'S CAROLINA PHARMACY BOLAND PHARMACY CSC COMMUNITY PHARMACY HARTSVILLE DRUG COMPANY INC STUCKEY PHARMACY

Provider Name

(843) 784-2390 (843) 462-7646 (843) 339-5530 (843) 332-6581 (843) 558-1010

22546 WHYTE HARDEE BLVD 108 W MAIN ST 1268 S 4TH ST 134 W CAROLINA AVE 475 N MAIN ST STE A

HARDEEVILLE HARLEYVILLE HARTSVILLE HARTSVILLE HEMINGWAY

SC SC SC SC SC

29927-5738 29448-3700 29550-0703 29550-4216 29554-9191

ST JOSEPHS CANDLER OUTPATIENT PHCY BURKES MAIN STREET PHARMACY HOLLY HILL PHARMACY DELTA PHARMACY & MEDICAL SUPPLY PREFERRED CARE PHARMACEUTICAL SV FREDS PHARMACY LONGS DRUGS GARNERS FERRY HEALTHPOINT PHARMACY INGLES PHARMACY KEMPSON REXALL DRUGS IRMO DRUG DELTA PHARMACY & MEDICAL SUPPLY JEFFERSON DRUG GILDER AND WEEKS INC VINCENTS DRUG STORE WALL DRUGS OF JOHNSONVILLE INC MAXWELL & HALFORD DRUG FREDS PHARMACY KERSHAW FAMILY PHARMACY WILLIAMSBURG PHARMACY BI LO PHARMACY KJ'S PHARMACY #129 M & D DRUG COMPANY THE MEDICINE CABINET CENTRAL PHARMACY LAKE WYLIE PHARMACY PIGGLY WIGGLY PHARMACY BARNETT-HONEYCUTT PHARMACY CARE HEALTH PHARMACY LANCASTER PHARMACY & WELLNESS LR FAMILY PHARMACY MOBLEY DRUGS, INC. INGLES PHARMACY LANDRUM DRUG COMPANY LANGLEY DRUG COMPANY CSC COMMUNITY PHARMACY-LATTA

(843) 689-2895 (843) 681-2622 (803) 496-0007 (843) 564-5720 (843) 769-6522 (864) 369-0707 (803) 227-6890 (803) 393-4611 (864) 814-3643 (864) 472-2136 (803) 749-7485 (843) 885-8008 (843) 658-3006 (864) 697-6580 (843) 243-0033 (843) 386-6135 (803) 275-2021 (803) 475-9665 (803) 475-6979 (843) 355-3300 (843) 797-8510 (843) 374-1110 (843) 374-3711 (843) 374-2825 (843) 759-2800 (803) 831-2044 (843) 326-5231 (803) 286-8444 (803) 285-2273 (803) 286-6262 (803) 289-0000 (803) 285-2021 (864) 457-4598 (864) 457-2401 (803) 593-3411 (843) 627-6261

45 HOSPITAL CENTER COMMONS 1101 MAIN ST 904 HOLLY ST 6251 HIGHWAY 162 4794-A HWY 162 518 E GREER ST 9019 GARNERS FERRY RD 1028 EDGEWATER CORP PKWY 4600 HIGHWAY 9 27 N MAIN ST 1009 LAKE MURRAY BLVD STE B 1400 PALM BLVD STE E 409 E CHURCH ST 200 N MAIN ST 110 PLANTED ROW LANE 239 STUCKEY ST 432 CALHOUN ST 203 W MARION ST 605 S HAMPTON ST 411 THURGOOD MARSHALL HWY 9616 HIGHWAY 78 240 KELLEY ST 117 E MAIN ST 319 MERCY ST 303 N MAIN ST 221 LATITUDE LN STE 109 100 N RAILROAD AVE 1228 COLONIAL COMMONS CT 838 W. MEETING ST BLDG 5 STE H 108 N WOODLAND DR STE C 1755 AIRPORT RD STE 100 1073 W MEETING ST 1851 HIGHWAY 14 E 104 W RUTHERFORD ST 2820 AUGUSTA RD 122 LATIMER ST

HILTON HEAD HILTON HEAD ISLAND HOLLY HILL HOLLYWOOD HOLLYWOOD HONEA PATH HOPKINS INDIAN LAND INMAN INMAN IRMO ISLE OF PALMS JEFFERSON JOANNA JOHNS ISLAND JOHNSONVILLE JOHNSTON KERSHAW KERSHAW KINGSTREE LADSON LAKE CITY LAKE CITY LAKE CITY LAKE VIEW LAKE WYLIE LAMAR LANCASTER LANCASTER LANCASTER LANCASTER LANCASTER LANDRUM LANDRUM LANGLEY LATTA

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29926 29926-1624 29059-0370 29449-5782 29449 29654-1823 29061-9687 29707-4503 29349-8001 29349-1425 29063-2824 29451-2280 29718-8701 29351-1030 29455 29555-6448 29832-1317 29067-1412 29067-2002 29556-4032 29456-3545 29560-2416 29560-2626 29560-2331 29563-3034 29710-8117 29069 29720-2215 29720 29720-4779 29720-4800 29720-2205 29356-9698 29356-1526 29834 29565

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 558 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LATTA DRUG CO., INC. INGLES PHARMACY LAURENS DRUG COMPANY APOTHECARE PHARMACY LONGS DRUGS LEXINGTON MEDICINE MART RILEY'S DRUGS INC SOUTH LAKE DRUG STERLING PHARMACY SYSTEMS LLC INGLES PHARMACY LIBERTY FAMILY PHARMACY SEASHORE DRUGS WATERWAY PHARMACY LORIS DRUG STORE SHERRYS MEDS AND MORE PHARMACY THE MEDICINE SHOPPE HAWTHORNE LUGOFF PHARMACY SANDHILLS MEDICAL PHARMACY LYMAN DRUG INC ANDERSON PHARMACY BRUNSON'S PHARMACY SUP-RX PHARMACY BRIDGERS DRUG STORE DRUG-LO DISCOUNT DRUGS MAULDIN DISCOUNT PHARMACY MAULDIN FAMILY PHARMACY STROMS DRUG STORE SANDHILLS MEDICAL PHARMACY BERKELEY HOME PHARMACY DELTA PHARMACY EAST COOPER FAMILY PHCY LONG POINT PHARMACY

Provider Name

(843) 752-0023 (864) 984-1492 (864) 984-6023 (803) 532-7222 (803) 358-3030 (803) 957-5969 (803) 359-2587 (803) 399-7701 (803) 808-0688 (864) 843-9326 (864) 843-9207 (843) 281-9797 (843) 734-0612 (843) 756-4021 (843) 756-4664 (843) 756-1600 (803) 408-9589 (803) 438-5537 (864) 439-6127 (803) 435-2212 (803) 435-2511 (803) 433-2412 (843) 423-2682 (864) 288-0911 (864) 412-7775 (864) 288-2600 (864) 465-2011 (843) 335-8291 (843) 899-4722 (843) 761-5255 (843) 881-0478 (843) 884-8806

106 E MAIN ST 901 E MAIN ST 923 W MAIN ST 134 E COLUMBIA AVE 1216 W MAIN ST 348 COLUMBIA AVE STE B 304 COLUMBIA AVE 1856 S LAKE DR STE K 125 PARK PLACE CT 429 E MAIN ST 115 W MAIN ST 1304 HIGHWAY 17 3373 HIGHWAY 9 E 4125 MAIN ST 3914 MAIN ST 3985 MEETING ST 814 HIGHWAY 1 S 40 BALDWIN AVE 204 SPARTANBURG HWY 419 S MILL ST 12 N BROOKS ST 36 SUNSET DR 305 N MAIN ST 10B WINCHESTER CT 300 W BUTLER RD STE A 505 N MAIN ST STE A 124 S MAIN ST 645 S 7TH ST 102 REMBERT C DENNIS BLVD # B 402 E MAIN ST 913 BOWMAN RD STE A 616 LONG POINT RD UNIT H

LATTA LAURENS LAURENS LEESVILLE LEXINGTON LEXINGTON LEXINGTON LEXINGTON LEXINGTON LIBERTY LIBERTY LITTLE RIVER LITTLE RIVER LORIS LORIS LORIS LUGOFF LUGOFF LYMAN MANNING MANNING MANNING MARION MAULDIN MAULDIN MAULDIN MC CORMICK MCBEE MONCKS CORNER MONCKS CORNER MOUNT PLEASANT MOUNT PLEASANT

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29565-1617 29360-3636 29360-2605 29070-8004 29072-2406 29072-2657 29072-2614 29073-7225 29072-6690 29657-1574 29657-1140 29566-9215 29566-7826 29569-3023 29569-3018 29569-3053 29078-8855 29078-9406 29365-1808 29102-2918 29102-3206 29102-2927 29571-3027 29662-2627 29662-2585 29662-2344 29835-8345 29101 29461 29461-3616 29464-3235 29464-8222

SWEETGRASS PHCY AND COMPOUNDING TIDEWATER PHARMACY BLUE SKY SPECIALTY PHARMACY MULLINS DISCOUNT DRUG FAMILY PHARMACY AT WCH LEES INLET APOTHECARY & GIFTS CAROLINA HEALTH PHARMACY PHARMACISTS CARE GIANT DISCOUNT PHARMACY

(843) 654-4013 (843) 375-6310 (843) 352-7662 (843) 464-1757 (843) 652-1545 (843) 651-7979 (843) 215-8200 (843) 236-7733 (803) 247-2135

1952 LONG GROVE DR STE 5 421 JOHNNIE DODDS BLVD STE 100 712 S SHELMORE BLVD STE 101 310 S MAIN ST 4070 HIGHWAY 17 BYPASS 3579 HIGHWAY 17 BUSINESS 5405 DICK POND RD 4999 CAROLINA FOREST BLVD 6611 SAVANNAH HWY

MOUNT PLEASANT MOUNT PLEASANT MT PLEASANT MULLINS MURRELLS INLET MURRELLS INLET MYRTLE BEACH MYRTLE BEACH NEESES

SC SC SC SC SC SC SC SC SC

29464-7579 29464-2911 29464-6728 29574-3112 29576-5033 29576-6176 29588-6836 29579-3587 29107

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 559 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HIBBITTS DRUG CO LLC LONG'S DRUGS OF NEWBERRY LOREX FAMILY PHARMACY R AND J DRUGS CTR FOR PRMY CARE N AUGUSTA FOOD LION PHARMACY GEORGE PARKS PHARMACY HEROLD'S PHARMACY NORTH NC CHARLESTON ENT PHARMACY F & L DRUG STORE GROVE PARK PHARMACY HF MABRY CANCER CENTER JAMISON'S PHARMACY MEDICAP PHARMACY ORANGE CUT RATE DRUGS INC ORANGE NURSING HOME SERVICES RMC PHARMACY PAGELAND FAMILY PHARMACY PAMPLICO PHARMACY PAWLEY'S ISLAND PHARMACY PAWLEYS ISLAND PHCY OF LITCHFIELD PEAK PHARMACY INC BIG S DRUGS CORNER DRUG STORE INGLES PHARMACY

Provider Name

(803) 443-0077 (803) 276-2936 (803) 276-0990 (864) 543-2852 (803) 247-2133 (803) 349-8040 (803) 278-2476 (803) 279-7450 (843) 628-3330 (843) 793-6402 (843) 396-4431 (803) 536-0007 (803) 395-2730 (803) 536-2165 (803) 539-0694 (803) 534-5931 (803) 534-5931 (803) 395-2507 (843) 675-2323 (843) 493-2311 (843) 235-4666 (843) 314-0498 (803) 945-7923 (803) 894-4010 (864) 878-6357 (864) 878-2464

735 MAIN ST N 1729 MAIN ST 1233 WILSON RD 206 N CAMBRIDGE ST 4633 SAVANNAH HWY 105 HUGH ST 135 MARKET PLAZA DR 437 GEORGIA AVE 8983 UNIVERSITY BLVD STE 105 9185 UNIVERSITY BLVD 223 N JONES RD 1324 GROVE PARK DR 1161 COOK RD 1225 GOFF AVE 3160 NORTH RD 1144 RUSSELL ST 145 SMOAK ALLEY 3000 ST MATTHEWS RD 214 S VAN LINGLE MUNGO BL 616 S WALNUT ST 9710 OCEAN HWY 115 WILLBROOK BLVD UNIT A 22 RIVER ST 8073 EDMUND HWY 205 W CEDAR ROCK ST 502 ANN ST STE A

NEW ELLENTON NEWBERRY NEWBERRY NINETY SIX NORTH NORTH AUGUSTA NORTH AUGUSTA NORTH AUGUSTA NORTH CHARLESTON NORTH CHARLESTON OLANTA ORANGEBURG ORANGEBURG ORANGEBURG ORANGEBURG ORANGEBURG ORANGEBURG ORANGEBURG PAGELAND PAMPLICO PAWLEYS ISLAND PAWLEYS ISLAND PEAK PELION PICKENS PICKENS

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29809-2518 29108-3557 29108-4000 29666 29112 29841-2925 29860 29841-3851 29406-7102 29406-9120 29114-9493 29115-2455 29118-8204 29115-3671 29118-2805 29115-4762 29115 29118-1442 29728 29583-0637 29585-7585 29585-6542 29122 29123-9805 29671-2451 29671-2267

PORT ROYAL MEDICAL CENTER PHARMACY PROSPERITY DRUG COMPANY BANKS DRUGS CHELSEA CENTER PHARMACY MAIN STREET PHARMACY APOTHECORP LLC BI LO PHARMACY CAROLINA PHARMACY COMMUNITY MEDICINE PHARMACY FAMILY CARE SPECIALTY PHARMACY FOOD LION PHARMACY GOOD PHARMACY INC PALMETTO FAMILY PHARMACY SOUTH END PHARMACY RX CARE PLUS PHCY ROEBUCK

(843) 322-1832 (803) 364-2310 (803) 685-5326 (843) 987-7431 (843) 726-5444 (803) 326-3380 (803) 980-3600 (803) 327-1640 (803) 412-3352 (803) 981-5330 (803) 327-2049 (803) 327-2081 (803) 980-7272 (803) 366-3784 (864) 253-8600

1320 RIBAUT RD 101 N MAIN ST 630 E MAIN ST 721 OKATIE HWY 7752 W MAIN ST 1393 CELANESE RD 1401 E MAIN ST 725 CHERRY RD STE 103 1131 SALUDA ST 2760 CELANESE RD STE 102 1260 E MAIN ST 1237 EBENEZER RD 1030 OAKLAND AVE STE 101 1401 ALBRIGHT ROAD 4795 S CHURCH STREET EXT STE 1

PORT ROYAL PROSPERITY RIDGE SPRING RIDGELAND RIDGELAND ROCK HILL ROCK HILL ROCK HILL ROCK HILL ROCK HILL ROCK HILL ROCK HILL ROCK HILL ROCK HILL ROEBUCK

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29935-1118 29127-9303 29129-9139 29936 29936-6362 29732-1722 29730-5951 29732-3143 29730-5776 29732-9406 29730-5948 29732-2353 29732-3035 29730 29376-3202

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 560 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WESTBURY PHARMACY INC BOLAND PHARMACY ST MATTHEWS PHARMACY LONGS DRUGS OF SALUDA INGLES PHARMACY SENECA PHARMACY UPSTATE PHARMACY OCONEE UPSTATE PHARMACY SENECA SHELDON MEDICAL CENTER PHARMACY BI LO PHARMACY GREENHILL SPECIALTY PHARMACY HOWARD'S PHARMACY SOCIETY HILL PHARMACY CAROLINAS UPSTATE PHCY AT GIBB FAMILY PHYS OF SPARTNBURG PHCY FORDS HEALTHWISE PHCY & MED INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY INGLES PHARMACY SMITHS DRUG STORE SMITH'S DRUG STORE SPARTANBURG REGIONAL O/P PHCY SRHS EMPLOYEE PHARMACY THE PRESCRIPTION CENTER U SAVE IT PHARMACY MORGANS PHARMACY ST MATTHEWS MEDICAL CENTER PHCY SANTEE DRUG CENTER SUMMERTON DRUG COMPANY SUMMERTON DRUGS COMP AND DISP GUERINS PHARMACY INC ALDERMAN DRUG CO. COLONIAL RX MEDICAL COURT PHARMACY PRESCRIPTIONS, INC. SANDHILLS MEDICAL PHARMACY SIBERTS DRUG STORE SUMTER CUT RATE DRUG STORE SUP-RX PHARMACY SUP-RX PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (843) 563-9384 (803) 655-7753 (803) 655-7800 (864) 445-7415 (864) 886-0615 (864) 985-1359 (864) 885-7338 (864) 886-1982 (843) 846-8148 (864) 967-9017 (864) 520-1550 (864) 963-5303 (843) 378-0200 (864) 560-1864 (864) 576-9201 (864) 585-3325 (864) 574-3130 (864) 542-1426 (864) 573-9408 (864) 578-6243 (864) 599-0668 (864) 583-4521 (864) 582-8474 (864) 560-6779 (864) 560-9200 (864) 582-3659 (229) 435-4571 (803) 258-3356 (803) 874-2006 (843) 567-3291 (803) 485-2555 (803) 485-8725 (843) 873-2531 (803) 773-8666 (803) 774-2126 (803) 773-5605 (803) 778-5005 (803) 773-8148 (803) 773-7283 (803) 773-8432 (803) 773-6378 (803) 775-3020

Provider Street 701 N PARLER AVE 715 HARRY C RAYSOR DR 708 F R HUFF DR 307 W BUTLER AVE 211 INGLES PL 15891 WELLS HWY 298 MEMORIAL DR 131 LILA DOYLE DR 211 PAIGE POINT RD 120 HIGHWAY 14 2531 WOODRUFF RD STE 107 102 S MAIN ST 268 S MAIN ST 380 SERPENTINE DR STE 201 3021 REIDVILLE RD 435 E MAIN ST STE 2 8004 WARREN H ABERNATHY HWY 2000 S PINE ST 2375 CHESNEE HWY 8650 ASHEVILLE HWY 2120 BOILING SPRINGS RD 142 E MAIN ST 441 E HENRY ST 101 E WOOD ST 100 E WOOD ST STE 101 1931 CANNONS CAMPGROUND RD 2306 CHESNEE HWY STE 1 7300 FESTIVAL TRAIL RD 558 CHESTNUT ST 3931 BYRNES DR STE D 115 MAIN ST 115 E MAIN ST 140 S MAIN ST 40 N MAIN ST 325 BROAD ST STE 100 776 W LIBERTY ST STE A 240 CHURCH ST 425 N SALEM AVE 35 W LIBERTY ST 32 S MAIN ST 1011 BROAD ST 114 E CALHOUN ST

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Provider City SAINT GEORGE SAINT MATTHEWS SAINT MATTHEWS SALUDA SENECA SENECA SENECA SENECA SHELDON SIMPSONVILLE SIMPSONVILLE SIMPSONVILLE SOCIETY HILL SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPARTANBURG SPRINGFIELD ST MATTHEWS ST STEPHEN SUMMERTON SUMMERTON SUMMERVILLE SUMTER SUMTER SUMTER SUMTER SUMTER SUMTER SUMTER SUMTER SUMTER

State

ZIP code

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC

29477-2233 29135-8403 29135-1278 29138-1309 29678-0848 29678-1078 29672 29672-9495 29941 29681-6050 29681-5465 29681-2628 29593-8901 29303-3066 29301-5643 29302 29301-2448 29302-3315 29303-5506 29316-4606 29316-5301 29306 29302-2609 29303-3040 29303-3001 29307-1510 29303 29146-0000 29135 29479 29148-0000 29148-6904 29483-6008 29150-4946 29150-4167 29150-4748 29150-4256 29150-4115 29150-5240 29150-5245 29150-2504 29150-4318

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SUP-RX PHARMACY CARE PHARMACY OF SURFSIDE LLC OCEAN LAKES PHARMACY DISCOUNT DRUG OF SWANSEA TIMMONSVILLE PHARMACY INGLES PHARMACY MCLESKEY TODD PHCY OF TRAVELER NEW HORIZON PHARMACY

Provider Name

(803) 778-5758 (843) 238-9292 (843) 238-5159 (803) 568-3251 (843) 346-5410 (864) 834-4409 (864) 834-4678 (864) 836-1109

1455 S GUIGNARD PKWY 320 HIGHWAY 17 N 1415 HIGHWAY 17 N 290 W THIRD ST 309 E SMITH ST 1500 GEER HWY 32 S MAIN ST 1588 GEER HWY

SUMTER SURFSIDE BEACH SURFSIDE BEACH SWANSEA TIMMONSVILLE TRAVELERS REST TRAVELERS REST TRAVELERS REST

SC SC SC SC SC SC SC SC

29150-7900 29575-6031 29575-6012 29160 29161-1821 29690-9204 29690-1810 29690-9204

COMMUNITY PHARMACY OF TURBEVILLE UNION FAMILY PHARMACY FREDS PHARMACY TYLER BROS PRESCRIPTION SHOPPE WAGENER DRUG CO KEN'S THRIFTEE PHARMACY INC WALHALLA PHARMACY WALHALLA PHARMACY HIOTTS PHARMACY THE MEDICINE SHOPPE FREDS PHARMACY HAWTHORNE PHARMACY SUNSET MEDICINE MART PINE RIDGE PHARMACY PRIVILEGE PHARMACY SPRINGDALE SUNSET PHARMACY INC TRIANGLE PHARMACY INGLES PHARMACY MOON'S DRUG STORE ROCHE PHARMACY INC MORGAN'S DRUGS HAWTHORNE WINNSBORO PHARMACY FREDS PHARMACY WOODRUFF DIABETIC SUPP AND PHCY WOODRUFF FAMILY PHARMACY LLC BI LO PHARMACY MEDICAP PHARMACY YORKVILLE PHARMACY JONES DRUG KESSLER'S PHARMACY PLAZA PHARMACY STATE STREET PHARMACY UNITED CLINIC PHARMACY

(843) 659-2204 (864) 427-3700 (803) 943-2136 (803) 218-9030 (803) 564-5381 (864) 638-9553 (864) 916-0680 (864) 916-0680 (843) 549-7222 (843) 549-9565 (864) 456-7512 (803) 794-7990 (803) 791-7043 (803) 955-3404 (803) 708-1226 (803) 794-6440 (803) 794-4840 (864) 638-3976 (864) 647-5941 (803) 694-2445 (803) 266-3356 (803) 635-3565 (864) 476-3725 (864) 670-9455 (864) 476-2800 (803) 628-6372 (803) 684-9096 (803) 628-7934 (605) 225-3010 (605) 225-6673 (605) 225-6344 (605) 225-1945 (605) 225-4001

942 SMITH ST 528A RICE AVE 181 W CAROLINA AVE 123 EARLE ST S 129 MAIN ST N 112 E MAIN ST 206 E MAIN ST 206 E MAIN ST 373 E WASHINGTON ST 1315 N JEFFERIES BLVD 734 N GREENWOOD AVE 2854 SUNSET BLVD 1300 SUNSET BLVD 634 PINE RIDGE DR # A 3321 PLATT SPRINGS RD 101 PROFESSIONAL AVE 1239 D AVE 180 SCENIC PLAZA DR 132 W MAIN ST 303 MAIN ST 12935 MAIN ST 110 S CONGRESS ST 505 LAURENS RD 116 W HAYNE ST 914 N MAIN ST 1131 US HIGHWAY 321 S 1007 CREEKSIDE MEDICAL DR 822 E LIBERTY ST STE B 816 6TH AVENUE SE SUITE 1 621 6TH AVE SE 2201 6TH AVE SE STE 23 105 S STATE ST STE 111 3015 3RD AVE SE # 110

TURBEVILLE UNION VARNVILLE WAGENER WAGENER WALHALLA WALHALLA WALHALLA WALTERBORO WALTERBORO WARE SHOALS WEST COLUMBIA WEST COLUMBIA WEST COLUMBIA WEST COLUMBIA WEST COLUMBIA WEST COLUMBIA WEST UNION WESTMINSTER WHITMIRE WILLISTON WINNSBORO WOODRUFF WOODRUFF WOODRUFF YORK YORK YORK ABERDEEN ABERDEEN ABERDEEN ABERDEEN ABERDEEN

SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SC SD SD SD SD SD

29162 29379-1839 29944-4748 29164-8742 29164-9571 29691-1925 29691 29691-1927 29488-3919 29488-2732 29692-1233 29169-3420 29169-5914 29172-1830 29170 29169-4711 29169-6307 29696-2536 29693-1667 29178-1321 29853-2321 29180 29388-2209 29388 29388-9023 29745-8500 29745 29745-3501 57401-6315 57401-4500 57401 57401-4500 57401-5418

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 562 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PRAIRIE PHARMACY LYNNS DAKOTAMART PHARMACY BELL BRANDON PHARMACY HERITAGE PHARMACY BROTHERS PHARMACY BROTHERS PHARMACY LTC SDSU JACKRABBIT PHARMACY BURKE COMMUNITY PHARMACY INC HAISCH PHARMACY CENTERVILLE COMMUNITY PHARMACY CLARK COMMUNITY PHARMACY PRAIRIE PHARMACY WHITE DRUG VILAS PHARMACY VILAS PHARMACY VILAS PHARMACY SHANES PHARMACY HERITAGE PHARMACY NORMS THRIFTY WHITE PHARMACY VILAS PHARMACY GREGORY DRUG LORI'S PHARMACY MEDICAP PHARMACY VILAS PHARMACY LYNNS DAKOTAMART PHARMACY RAFFERTY-ROBBINS DRUG STORE NORTHSIDE PHARMACY VILAS PHARMACY VILAS PHARMACY MARTIN DRUG & MERCANTILE BIEN PHARMACY MILLER REXALL DRUG MISSION COMMUNITY PHARMACY AVERA GRASSLAND PHARMACY FAMILY PHARMACY OF MOBRIDGE INC. DUNES FAMILY PHARMACY REDLERS LONG TERM CARE LLC PARKER PHARMACY PARKSTON DRUG INC DAKOTA COUNTRY PHARMACY, INC. AVERA ST MARYS CAMPUS PHARMACY LYNN'S DAKOTAMART PHCY PIERRE

NR_0009_10823 10/2017

Provider Phone Number (605) 724-2970 (605) 892-2666 (605) 582-6000 (605) 729-2744 (605) 692-2088 (605) 692-2088 (605) 688-5410 (605) 775-2294 (605) 987-2661 (605) 563-2243 (605) 532-3400 (605) 946-5690 (605) 578-1512 (605) 964-8955 (605) 284-2752 (605) 967-2123 (605) 223-9200 (605) 925-4510 (605) 925-7059 (605) 765-9458 (605) 835-8198 (605) 397-2363 (605) 528-2000 (605) 852-2890 (605) 745-3110 (605) 772-5581 (605) 352-9222 (605) 426-6551 (605) 717-2496 (605) 685-6200 (605) 432-5781 (605) 853-3647 (605) 856-2120 (605) 995-5670 (605) 845-8140 (605) 242-5050 (605) 235-1552 (605) 297-3235 (605) 928-3125 (605) 859-2833 (605) 224-7334 (605) 224-7396

Provider Street 1311 BRADDOCK AVE 600 NATIONAL ST 116 E HOLLY BLVD 206 N MAIN AVE 1004 6TH ST 1004 6TH ST STE B SDSU WELLNESS CENTER ROOM 119 814 JACKSON STREET 303 E 5TH ST 513 BROADWAY 211 N COMMERCIAL ST 230 MAIN ST 71 CHARLES ST 123 MAIN ST 712 7TH ST 100 MAIN 202 ISLAND DR STE 2 609 S US HIGHWAY 81 389 S MAIN ST 103 E COMMERCIAL AVE 604 MAIN ST 1205 N 1ST ST 304 W HIGHWAY 38 STE 102 120 COMMERCIAL STREET SE 505 S 6TH ST 108 S MAIN ST 100 DAKOTA AVE N STE A 401 5TH AVENUE 95 E MAIN ST 304 MAIN ST 222 S MAIN ST 209 N BROADWAY 161 S MAIN ST 1900 GRASSLAND DR 1317 10TH AVE W 101 TOWER RD STE 130 317 DAKOTA DUNES BLVD STE A 27516 SD HWY 19, STE 2 112 WEST MAIN 130 S CENTER AVENUE 100 MAC LN STE 101 120 W SIOUX AVE

Page 563 of 679

Provider City ARMOUR BELLE FOURCHE BRANDON BRIDGEWATER BROOKINGS BROOKINGS BROOKINGS BURKE CANTON CENTERVILLE CLARK CORSICA DEADWOOD EAGLE BUTTE EUREKA FAITH FORT PIERRE FREEMAN FREEMAN GETTYSBURG GREGORY GROTON HARTFORD HIGHMORE HOT SPRINGS HOWARD HURON IPSWITCH LEAD MARTIN MILBANK MILLER MISSION MITCHELL MOBRIDGE NORTH SIOUX CITY NORTH SIOUX CITY PARKER PARKSTON PHILIP PIERRE PIERRE

State

ZIP code

SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD SD

57313-2136 57717-2002 57005-1114 57319 57006-2205 57006-2205 57007 57523 57013-1735 57014 57225-1525 57328 57732-1303 57625 57437-0000 57626 57532-7303 57029-2000 57029 57442-1101 57533-1349 57445 57033 57345 57747-2318 57349 57350-1630 57451 57754-1418 57551-0050 57252-1809 57362 57555 57301 57601-1146 57049-5098 57049-5341 57053 57366 57567-0640 57501 57501-2425

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HOFFMAN DRUG PRESHO COMMUNITY PHARMACY BOYDS DRUG MART (EAST) BOYDS DRUG MART (WEST) BOYD'S DRUG RX EXPRESS CHCBH PHARMACY FAMILY THRIFT CENTER FAMILY THRIFT CENTER FTC EXPRESS PHCY MEDICAP PHARMACY

Provider Name

(605) 337-3662 (605) 775-2294 (605) 348-0741 (605) 343-4445 (605) 718-4040 (605) 721-8939 (605) 343-8542 (605) 343-6214 (605) 348-4414 (605) 388-3622

408 MAIN ST 116 NORTH MAIN ST STE 2 909 E SAINT PATRICK ST 655 MOUNTAIN VIEW RD 2650 MOUNT RUSHMORE RD 350 PINE ST 855 OMAHA ST 1516 E SAINT PATRICK ST 3464 STURGIS RD 339 SAINT PATRICK ST

PLATTE PRESHO RAPID CITY RAPID CITY RAPID CITY RAPID CITY RAPID CITY RAPID CITY RAPID CITY RAPID CITY

SD SD SD SD SD SD SD SD SD SD

57369-0110 57568 57701-5728 57702-2518 57701-5442 57701 57701-2655 57703-4136 57702-2361 57701-4645

REGIONAL HEALTH HOME PLUS LTC PHY

(605) 755-3060

1906 LOMBARDY DR STE 101

RAPID CITY

SD

57703

REGIONAL HEALTH HOME PLUS PHARMACY

(605) 755-8184

353 FAIRMONT BLVD

RAPID CITY

SD

57701

REGIONAL HEALTH HOME PLUS SPECIALTY THE MEDICINE SHOPPE SALEM COMMUNITY DRUG AVERA 69TH ST. PHARMACY AVERA DERMATOLOGY PHARMACY AVERA LONG TERM CARE PHARMACY

(605) 755-3065 (605) 348-6305 (605) 425-2827 (605) 322-5948 (605) 322-7695 (605) 322-1450

1906 LOMBARDY DR STE 102 1304 MOUNT RUSHMORE RD 300 N MAIN ST 4400 W 69TH ST STE 300 6701 S MINNESOTA AVE 3820 N POTSDAM AVE STE 2

RAPID CITY RAPID CITY SALEM SIOUX FALLS SIOUX FALLS SIOUX FALLS

SD SD SD SD SD SD

57703 57701-3667 57058-8829 57108-8170 57108 57104-7057

AVERA MCKENNAN CAMPUS PHARMACY AVERA SPECIALTY PHARMACY CARETRENDS PHARMACY DAN'S DRUGSTORE PHCY SPECIALTIES & CLINIC INC PRESCRIPTION SHOP

(605) 322-8326 (605) 322-8360 (605) 338-9383 (605) 275-9442 (605) 331-3190 (605) 336-1816

1325 S CLIFF AVE STE CP 1301 S CLIFF AVE STE 200 6709 S MINNESOTA AVE STE 105 5028 SOUTH CLIFF AVENUE 2333 W 57TH ST STE 109 1200 S 7TH AVE

SIOUX FALLS SIOUX FALLS SIOUX FALLS SIOUX FALLS SIOUX FALLS SIOUX FALLS

SD SD SD SD SD SD

57105 57105 57108-2593 57108-5432 57108-5046 57105-0912

SANFORD CANCER CENTER CLINIC PHCY TRUE CARE FAMILY PHARMACY

(605) 328-8040 (605) 280-2601

1309 W 17TH ST STE 101 1120 E 10TH ST

SIOUX FALLS SIOUX FALLS

SD SD

57104-8805 57103-1617

REGIONAL HEALTH HOME PLUS PHARMACY COUNTY DRUG INC BON HOMME PHARMACY DAVIS PHARMACY JAMES DRUG WALL DRUGSTORE INC BROWN CLINIC PHARMACY GENOA-QOL HEALTHCARE PRAIRIE LAKES CAMPUS PHARMACY CORNWELL DRUG

(605) 717-8741 (605) 347-2466 (605) 589-4418 (605) 624-4444 (605) 384-3541 (605) 279-2175 (605) 884-4234 (605) 882-9400 (605) 882-7790 (605) 345-3351

1420 N 10TH ST STE 1 1111 LAZELLE ST 410 W 16TH AVE 5 W CHERRY ST 201 SOUTH MAIN 510 MAIN STREET 506 1 ST AVE SE 123 19TH ST NE 401 9TH AVE NW 701 MAIN ST

SPEARFISH STURGIS TYNDALL VERMILLION WAGNER WALL WATERTOWN WATERTOWN WATERTOWN WEBSTER

SD SD SD SD SD SD SD SD SD SD

57783-1532 57785-1206 57066 57069 57380 57790 57201-0000 57201-2823 57201-1548 57274-1305

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 564 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WINNER HEALTH MART PHCY, INC AVERA SACRED HEART HOSP PHCY ROGER'S FAMILY PHARMACY YANKTON DRUG COMPANY YANKTON MEDICAL CLINIC PHARMACY EAST MAIN PHARMACY PETTIGREW DRUGS TODD'S DISCOUNT DRUGS CAVALIER PHARMACY BLOUNT DISCOUNT PHARMACY, INC. F Z WEBB & SONS OF ALEXANDRIA WILEY'S PHARMACY ANDERSON CROSSING PHARMACY THE WELLNESS PHARMACY RESTORE RX, INC EMPSON DRUG COMPANY GENOA-QOL HEALTHCARE INGLES PHARMACY MADISON AVENUE PHARMACY BOATWRIGHT PHARMACY ATOKA BARTLETT PRESCRIPTION SHOP NUNALLY DRUG STORE DOWN HOME PHARMACY RAINES PHARMACY PREFERRED PHARMACY INC THE DRUG STORE FOOD CITY PHARMACY OKIE'S PHARMACY II, INC FOOD CITY PHARMACY HCCHC PHARMACY HUDSON DRUG STORE THE HATCHIE PHARMACY INCEPTION RX BRIGHTON PHARMACY

Provider Name

(605) 842-7777 (605) 668-8372 (605) 665-8042 (605) 665-7865 (605) 665-2929 (731) 632-3278 (731) 632-3118 (731) 632-0995 (731) 696-4000 (865) 984-7704 (615) 529-2160 (931) 692-3888 (865) 494-8444 (615) 941-8333 (901) 388-0507 (615) 792-4644 (423) 745-3367 (423) 744-1085 (423) 746-2626 (901) 837-8801 (901) 372-0787 (931) 858-3714 (865) 993-4074 (731) 663-3333 (423) 338-5095 (423) 338-2521 (865) 933-0762 (865) 932-7775 (423) 323-3312 (731) 658-3388 (731) 658-5207 (731) 659-3740 (629) 203-6022 (901) 837-8981

702 W 2ND 501 SUMMIT ST 218 WEST 4TH STREET 109 W 3RD ST 1104 W 8TH ST 712 E MAIN ST 139 W MAIN ST 347 E MAIN ST 8 N CAVALIER DR STE A 129 GILL ST 105 S PUBLIC SQ 1595 MAIN ST 3318 ANDERSONVILLE HWY 5801 CROSSINGS BLVD 5197 BRUNSWICK RD 212 N MAIN ST 1805 INGLESIDE AVE 917 DECATUR PIKE 1001 W MADISON AVE 139 WESLEY REED DR STE F 5675 STAGE RD 226 MAIN ST 1034 MAIN ST 13049 HIGHWAY 79 6206 HIGHWAY 411 119 MAIN STREET 180 RUTLEDGE PIKE 1050 RUTLEDGE PIKE 1921 HIGHWAY 394 629 NUCKOLLS ROAD 600 NUCKOLLS RD 640 NUCKOLLS RD 134 FRANKLIN RD STE 200 1880 OLD HWY 51

WINNER YANKTON YANKTON YANKTON YANKTON ADAMSVILLE ADAMSVILLE ADAMSVILLE ALAMO ALCOA ALEXANDRIA ALTAMONT ANDERSONVILLE ANTIOCH ARLINGTON ASHLAND CITY ATHENS ATHENS ATHENS ATOKA BARTLETT BAXTER BEAN STATION BELLS BENTON BENTON BLAINE BLAINE BLOUNTVILLE BOLIVAR BOLIVAR BOLIVAR BRENTWOOD BRIGHTON

SD SD SD SD SD TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

57580-1113 57078-3855 57078-4301 57078-4320 57078-3306 38310-2458 38310-2203 38310-2321 38001-6468 37701-2656 37012-2140 37301-3639 37705-3816 37013 38002-7000 37015-1305 37303-2105 37303-3037 37303-3433 38004-4918 38134-4552 38544-5200 37708 38006-3917 37307-3622 37307 37709 37709-3027 37617-5454 38008 38008-1532 38008-1532 37027-4637 38011

ANDERSON COMPOUNDING PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY GENOA-QOL HEALTHCARE H JOHNSON PHARMACY BROWNSVILLE APOTHECARY INC DOWLING PHARMACY

(423) 764-4136 (423) 274-0166 (423) 968-2222 (423) 845-4475 (423) 968-2895 (731) 772-5238 (731) 772-2389

310 BLUFF CITY HWY STE 1 1317 VIRGINIA AVE 1430 VOLUNTEER PKWY 26 MIDWAY ST STE 100 520 BLUFF CITY HWY 2565 N WASHINGTON AVE 2571 N WASHINGTON AVE

BRISTOL BRISTOL BRISTOL BRISTOL BRISTOL BROWNSVILLE BROWNSVILLE

TN TN TN TN TN TN TN

37620-4602 37620-5158 37620-6067 37620-1706 37620 38012-1610 38012-1610

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 565 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HOMETOWN DRUG COMPANY MAIN ST. PHARMACY CASE DRUG CO. BULLS GAP DRUGS CAMPBELL'S HOMETOWN PHARMACY DAVIDSON'S DISCOUNT DRUGS INC GARRETTS DRUG CENTER HERNDON PHARMACY LLC HACKETT'S DISCOUNT DRUG SMITH COUNTY DRUG CENTER ANDERSON HOMETOWN PHARMACY CLAY COUNTY XPRESS PHCY, LLC

Provider Name

(731) 772-4300 (731) 858-0500 (731) 586-2931 (423) 235-4600 (423) 235-6263 (931) 864-3166 (931) 864-3136 (731) 584-4711 (615) 735-1616 (615) 735-2223 (931) 243-6337 (931) 243-3784

2280 NORTH WASHINGTON 200 E MAIN ST 121 MAPLE ST 412 HWY 11 E 272 HIGHWAY 11 E 110 HILLCREST DR 8456 HWY ONE ELEVEN 175 W MAIN ST 70 DIXON SPRINGS HWY 1210 MAIN ST N 151 MCARTHUR AVE 651 BROWN ST

BROWNSVILLE BROWNSVILLE BRUCETON BULLS GAP BULLS GAP BYRDSTOWN BYRDSTOWN CAMDEN CARTHAGE CARTHAGE CELINA CELINA

TN TN TN TN TN TN TN TN TN TN TN TN

38012 38012-2147 38317-1819 37711 37711-3416 38549-2323 38549-6001 38320-1621 37030-1063 37030-1037 38551-4003 38551

DALE HOLLOW HEALTH MART PHARMACY LIBERTY CLINIC PHARMACY LIBERTY PHARMACY H & S PHARMACY OF CHAPEL HILL PREFERRED FAMILY PHARMACY LLC CHARLOTTES HOMETOWN PHARMACY ACCESS DRUGS LLC BRAINERD PHARMACY CAMERON HILL PHARMACY EASTSIDE PHARMACY ERLANGER PHARMACY EXPRESS RX INC FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY GALEN PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE HAMILTON DISCOUNT PHARMACY MAX DISCOUNT PHARMACY MOORE & KING PHARMACY PULMONAIRE PHARMACY RAPID RX THE WELLNESS CENTER PHARMACY INC CHURCH HILL DRUG STORE INC FOOD CITY PHARMACY CLARKRANGE DRUG CENTER

(931) 243-3434 (931) 729-2999 (931) 729-3541 (931) 364-2236 (423) 336-5522 (615) 789-9393 (423) 877-3568 (423) 305-1858 (423) 535-5500 (423) 386-5066 (423) 386-1000 (423) 899-3278 (423) 629-4155 (423) 821-0038 (423) 855-0351 (423) 855-3000 (423) 899-7708 (888) 385-5973 (423) 954-7694 (423) 648-4310 (423) 892-5955 (423) 803-5990 (423) 778-3446 (423) 265-3333 (423) 510-2788 (423) 954-2585 (423) 357-7441 (423) 357-0493 (931) 863-3779

201 MCARTHUR AVE 146 E SWAN ST 401 W PUBLIC SQ 4708 NASHVILLE HWY 8897 HIWASSEE ST NW 3369 HIGHWAY 48 N 4062 HIXSON PIKE 3602 BRAINERD RD 1 CAMERON HILL CIR 6857 LEE HIGHWAY 1751 GUNBARREL RD STE G5 7032 E BRAINERD RD STE B 1600 EAST 23RD STREET 3801 TENNESSEE AVENUE 4510 HIGHWAY 58 7804 E BRAINERD ROAD 6951 LEE HWY 2200 E 3RD ST STE 200 601 CUMBERLAND ST STE A 420 W BELL AVE STE P 6851 SHALLOWFORD RD 4531 HIGHWAY 58 STE 105 632 MORRISON SPRINGS RD 821 MCCALLIE AVE 4335 RINGGOLD RD 7304 JARNIGAN RD 104 E MAIN BLVD 731 HIGHWAY 11 W 6404 S YORK HWY

CELINA CENTERVILLE CENTERVILLE CHAPEL HILL CHARLESTON CHARLOTTE CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHATTANOOGA CHURCH HILL CHURCH HILL CLARKRANGE

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38551 37033-1446 37033-1606 37034-2110 37310-5339 37036-4853 37415-3110 37411-3601 37402-9815 37421-6406 37421-7246 37421-3882 37404 37409 37416 37421 37421-2447 37404-2745 37404-1922 37405-3404 37421-6758 37416-3010 37415-3416 37403-2613 37412-2740 37421-3042 37642-3724 37642-3146 38553-5138

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 566 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HALL FAMILY PHCY AT CLARKRANGE ANDYS PHARMACY ANDY'S PHARMACY CENTERSTONE PHARMACY

Provider Name

(931) 863-3323 (931) 802-5386 (615) 330-8485 (931) 920-7200

6845 S YORK HWY 801 N 2ND ST 801 N 2ND ST 511 8TH ST

CLARKRANGE CLARKSVILLE CLARKSVILLE CLARKSVILLE

TN TN TN TN

38553-5154 37040-2909 37040-2909 37040

COMPREHENSIVE WELLNESS PHARMACY COX FAMILY PHARMACY DIXIE PHARMACY DIXIE VITAL CARE DUNLOP PHARMACY HARRIS FAMILY PHARMACY LLC SANGO PHARMACY ST. BETHLEHEM DRUGS THE MEDICINE SHOPPE THE MEDICINE SHOPPE TOWN & COUNTRY DRUGS

(855) 806-6042 (931) 802-6825 (931) 241-5688 (931) 241-5655 (931) 278-6422 (931) 278-6171 (931) 919-2491 (931) 647-6561 (931) 552-2552 (931) 552-2558 (931) 648-2657

495 DUNLOP LANE STE 106 1849 MADISON ST 311 LANDRUM PL SUITE 600-A 311 LANDRUM PLACE SUITE 600 620 DUNLOP LN STE 111 1157 FORT CAMPBELL BLVD 2197 MADISON ST STE 109 800 WEATHERLY DR SUITE 101A 1500 MADISON ST 1756 HIGHWAY 48 226 DOVER RD #C

CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE CLARKSVILLE

TN TN TN TN TN TN TN TN TN TN TN

37040 37043-4903 37043-6319 37043-6319 37040-5000 37042-6426 37043-5253 37043 37040-3846 37040-9204 37042-4156

TOWN AND COUNTRY DRUGS AND HOME CENTRAL DRUG COMPANY CENTRAL DRUG PEERLESS CROSSING CHEROKEE PHARMACY CHEROKEE VITAL CARE COOKE'S PHARMACY COOKE'S PHARMACY CRAWFORD'S PHARMACY FOOD CITY PHARMACY GENOA-QOL HEALTHCARE LTC PHARMACY SERVICES MEDICAL CENTER PHARMACY OCOEE PROFESSIONAL PHARMACY P. H. PHARMACY PHARMACY HOME DELIVERY LLC THE MEDICINE SHOPPE WILLOUGHBY DRUGS APPLE DISCOUNT DRUGS CLINTON DRUG STORE COMPREHENSIVE CARE PHARMACY FOOD CITY PHARMACY HOSKINS DRUG STORE BENEVERE PHARMACY BENEVERE SPECIALTY PHARMACY PATTON PHARMACY

(931) 645-2494 (423) 476-4597 (423) 339-3363 (423) 559-3000 (423) 559-3013 (423) 472-6478 (423) 599-7053 (423) 479-8601 (423) 473-2066 (423) 790-1342 (844) 778-0700 (423) 476-5547 (423) 472-3561 (423) 614-6610 (423) 614-6650 (423) 476-1919 (931) 676-3318 (865) 457-0300 (865) 457-1421 (865) 264-4829 (865) 457-5259 (865) 457-4340 (901) 861-3000 (901) 316-5752 (901) 854-1112

1051 S RIVERSIDE DR 1805 KEITH ST NW 1075 PEERLESS XING NW 1690 25TH ST NW STE A 1690 25TH ST NW 3400 KEITH STREET 2010 BROOMFIELD RD SE 2260 CHAMBLISS AVE NW 255 OCOEE CROSSING NW 940 S OCOEE ST 3915 ADKISSON DR NW 2401 N OCOEE ST 2401 N OCOEE ST STE A 110 KEITH ST SW STE 3 110 KEITH ST SW 2414 N OCOEE ST 104 MAIN ST 520 CLINCH AVE 1130 N CHARLES G SEIVERS BLVD 910 N CHARLES G SEIVERS BLVD 507 S CHARLES G SEIVERS BLVD 111 N MAIN ST 1162 W POPLAR AVE 60 MARKET CENTER DR STE103 264 MARKET BLVD

CLARKSVILLE CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLEVELAND CLIFTON CLINTON CLINTON CLINTON CLINTON CLINTON COLLIERVILLE COLLIERVILLE COLLIERVILLE

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37040-4303 37311-4306 37312-3764 37311-3613 37311-3613 37312 37323-3301 37311-3843 37312 37311-2601 37312-2821 37311-3853 37311-3853 37311-5868 37311-5868 37311-3854 38425-5544 37716 37716-3937 37716-3816 37716-2723 37716-3607 38017-3196 38017 38017-6519

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 567 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

COLLINWOOD DRUGS FISHER PHARMACY & GIFTS HOLLAND'S APOTHECARY HOLLAND'S PHARMACY MOORE PHARMACY INC ALGOOD DRUGS ANDYS PHARMACY COOKEVILLE MEDICAL FAMILY PHCY COOKEVILLE REG MEM OUT PHCY FAMILY WELLNESS PHARMACY GENOA-QOL HEALTHCARE INFINITY PHARMACY LLC KIDS KARE LARCO PHARMACY LARCO PHARMACY SATELLITE MED KIMSEY PHARMACY TALLENT DRUG STORE

Provider Name

(931) 724-9197 (931) 381-1395 (931) 388-8833 (931) 388-4233 (931) 548-8308 (931) 537-3211 (931) 372-2700 (931) 284-4084 (931) 783-2552 (931) 559-6337 (931) 432-0890 (931) 520-1001 (931) 526-6173 (931) 528-7573 (931) 528-7573 (931) 528-7312 (423) 496-5831 (423) 496-5241

313 HIGHWAY 13 S 1396 HATCHER LN 1114 W 7TH ST 1608 HATCHER LN 1860 SHADY BROOK ST 606 W MAIN ST STE A 305 WEST SPRING ST 225 N WILLOW AVE 1 MEDICAL CENTER BLVD 330 N OAK AVE 1200 S WILLOW AVE 1080 NEAL ST STE 100 758 S WILLOW AVE 406 N WHITNEY STE 1 406 N WHITNEY AVE STE 1 1120 SAMS ST 125 FIVE POINTS DR 116 W OCOEE ST

COLLINWOOD COLUMBIA COLUMBIA COLUMBIA COLUMBIA COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COOKEVILLE COPPERHILL COPPERHILL

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38450-4609 38401-3568 38401-1810 38401-4827 38401-3944 38506-5395 38501 38501-2335 38501-4294 38501-2440 38506-4157 38501-0907 38501-3840 38501 38501-4243 38506-4006 37317-5218 37317

FIRST PHARMACY SVCS OF COUNTRY VLG FIRST PHCY SRVCS HEALTH QUEST BRADFORD FAMILY PHARMACY MILLER'S PHARMACY THE MEDICINE SHOPPE THOMAS DRUG COMPANY FOOD CITY PHARMACY FOOD CITY PHARMACY JOHN SMITH PROF PHARMACY MITCHELL DRUG COMPANY, INC. RIDDLE EXPRESS PHARMACY TENNESSEE PLATEAU ONC PLLC YOUNG PHARMACY FOOD CITY PHARMACY TINSLEY BIBLE DRUG CO INC DAYTON DRUG AND WELLNESS FOOD CITY PHARMACY RIDDLE EXPRESS WIL-SAV DRUGS CORNERSTONE FAMILY PHARMACY DICKSON APOTHECARY DICKSON MEDICAL PHARMACY FACTOR ONE SOURCE OF TENNESSEE

(901) 590-3069 (901) 753-2972 (901) 475-6300 (901) 475-0535 (901) 476-3245 (615) 654-3877 (931) 707-3620 (931) 484-1368 (931) 484-1434 (931) 484-5117 (931) 456-4564 (931) 484-7596 (931) 456-8165 (865) 484-0263 (865) 397-3444 (423) 775-5511 (423) 775-5051 (423) 334-8099 (423) 334-5223 (731) 852-4111 (615) 446-5585 (615) 446-9865 (844) 773-6779

8130 COUNTRY VILLAGE DR 58 TIMBER CREEK 1500 HIGHWAY 51 S 110 STAR SHOPPING CTR ST 730 HIGHWAY 51 N 7802 HIGHWAY 25 E 1180 WEST AVE 141 TOWN CENTRE DR 100 LANTANA RD STE 201 97 N MAIN ST 1645 S MAIN ST STE 102 49 CLEVELAND ST STE 270 23 WOODMERE MALL 123 W HYW 25-70 1224 GAY ST 6985 RHEA COUNTY HWY 420 MARKET STREET, #3 392 N MAIN ST 17619 STATE HIGHWAY 58 N 9 WEST MAIN ST 104 HIGHWAY 70 E 758 HIGHWAY 46 SOUTH 318 EAST COLLEGE ST STE 102

CORDOVA CORDOVA COVINGTON COVINGTON COVINGTON CROSS PLAINS CROSSVILLE CROSSVILLE CROSSVILLE CROSSVILLE CROSSVILLE CROSSVILLE CROSSVILLE DANDRIDGE DANDRIDGE DAYTON DAYTON DECATUR DECATUR DECATURVILLE DICKSON DICKSON DICKSON

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38016 38018-4233 38019-3212 38019-3000 38019-2035 37049-4848 38555-4148 38571-7997 38555-1903 38555-4500 38555-5998 38555-2856 38555-4231 37725 37725-0280 37321-6208 37321 37322-7759 37322-7835 38329 37055-2034 37055 37055

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 568 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name GOODLARK PHARMACY DOVER FAMILY PHARMACY TRUECARE PHARMACY BOB'S DISCOUNT PHARMACY FREDS PHARMACY CATES STREET PHARMACY DUNCANS PHARMACY C & C PHARMACY LLC JAMES & WILKS PHARMACY LONG & GIBSON PHARMACY NEIGHBORHOOD PHARMACY SUPER D DRUGS WELLS PHARMACY NETWORK LLC EAGLEVILLE DRUG CENTER FOOD CITY PHARMACY STOP-N-GO DISCOUNT PHARMACY BURGIE DRUG STORE FOOD CITY PHARMACY INGLES PHARMACY LINGERFELT PHARMACY REED PHARMACY WILSON DRUGS MITCHUM DRUG COMPANY ROLLER PHARMACY, INC. BRADFORDS PHARMACY ANDERSON DRUGS FOOD CITY PHARMACY FREDS PHARMACY FAMILY PHARMACY CARTERS AT STONEBRIDGE CARTERS DRUG STORE DCA PHARMACY FRESENIUS MEDICAL CARE RX PHARMBLUE TENNESSEE LLC PROHEALTH PHARMACY RURAL PHYSICIAN PARTNERS PHCY QUALITY DRUG STORE ANDERSON & HAILE DRUG CO GAINESBORO DRUGS PERKINS DRUGS & GIFT SHOPPE TRICARE PHARMACY LLC UNITED RX LLC

NR_0009_10823 10/2017

Provider Phone Number (615) 446-8043 (931) 232-0123 (931) 232-4008 (731) 364-2207 (731) 364-2009 (423) 949-5722 (731) 692-3578 (731) 285-0844 (731) 286-2025 (731) 285-1711 (731) 259-0404 (731) 285-7267 (731) 882-7000 (615) 274-6868 (423) 622-7354 (423) 468-7161 (423) 542-4622 (423) 542-4925 (423) 542-2002 (423) 542-2138 (423) 518-1088 (423) 887-7293 (931) 289-4231 (423) 743-7105 (931) 649-5050 (423) 263-7824 (423) 263-5481 (463) 263-2202 (423) 348-6101 (931) 438-0760 (931) 433-1511 (615) 832-7232 (615) 764-6500 (615) 656-5417 (615) 212-9915 (615) 739-6501 (731) 677-2155 (931) 268-0233 (931) 268-9919 (615) 452-6111 (615) 461-7078 (615) 502-4040

Provider Street 127 CRESTVIEW PARK DR STE 100 1307 DONELSON PKWY 477 HIGHWAY 79 8720 HIGHWAY 22 STE A 8487 HIGHWAY 22 402 RANKIN AVE N 137 S MAIN ST 2490 PARR AVE STE 9 620 MALL BLVD STE A 303 E TICKLE ST 1954 SAINT JOHN AVE STE B 1501 BRAYTON AVE 450 US HIGHWAY 51 BYP N 1005 S MAIN ST 3715 RINGGOLD ROAD 3984 RINGGOLD RD 1000 W G ST 920 BROAD ST 768 W ELK AVE 609 E ELK AVE 851 W ELK AVE 18 CHURCH ST SPRING AND FRONT ST 109 N MAIN AVE 104 HUDGINS ST 725 TENNESSEE AVE 841 US 411 NORTH 733 LAWRENCE ST 1714 HWY 93 STE 11 6 ELDAD RD 106 ELK AVE S 233 BEDFORD WAY 1000 CORPORATE CENTRE DR #400 1113 MURFREESBORO RD STE 319-B 1325 W MAIN ST 361 MALLORY STATION RD STE 108 548 MAIN ST 101 W GORE AVE 100 HULL AVE 532 HARTSVILLE PIKE 179 HANCOCK ST STE 301 553 E BLEDSOE ST

Page 569 of 679

Provider City DICKSON DOVER DOVER DRESDEN DRESDEN DUNLAP DYER DYERSBURG DYERSBURG DYERSBURG DYERSBURG DYERSBURG DYERSBURG EAGLEVILLE EAST RIDGE EASTRIDGE ELIZABETHTON ELIZABETHTON ELIZABETHTON ELIZABETHTON ELIZABETHTON ENGLEWOOD ERIN ERWIN ESTILL SPRINGS ETOWAH ETOWAH ETOWAH FALL BRANCH FAYETTEVILLE FAYETTEVILLE FRANKLIN FRANKLIN FRANKLIN FRANKLIN FRANKLIN FRIENDSHIP GAINESBORO GAINESBORO GALLATIN GALLATIN GALLATIN

State

ZIP code

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37055 37058-3724 37058-6941 38225-4348 38225-2355 37327-6027 38330-1815 38024-2076 38024-1649 38024-3117 38024-2199 38024-3158 38024-3655 37060 37412 37412 37643-2959 37643-2315 37643-2517 37643-3329 37643-2946 37329-3301 37061-0000 37650-1255 37330 37331-1305 37331 37331-2712 37656 37334-7005 37334-3050 37064-5527 37067-2663 37064-1306 37064-3786 37067 38034-1966 38562-0000 38562-0000 37066-2450 37066-6347 37066-3003

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FOOD CITY PHARMACY ANOVORX GROUP LLC GASTRO ONE PHARMACY

Provider Name

(865) 430-9844 (901) 201-5470 (901) 708-2960

1219 E PARKWAY 7945 WOLF RIVER BLVD STE 200 1324 WOLF PARK DR

GATLINBURG GERMANTOWN GERMANTOWN

TN TN TN

37738-5643 38138-1768 38138-1741

JONES PROFESSIONAL BLDG PHARMACY REGEL PHARMALAB GLEASON CITY DRUG ROMAN PHARMACY GORDONSVILLE DRUGS GRAY PHARMACY

(901) 685-5969 (901) 757-9434 (731) 648-5146 (615) 859-8999 (615) 683-4400 (423) 239-6521

7710 WOLF RIVER CIR 1352 CORDOVA CV 102 MAIN ST 300 FRANCES ST 8 NEW MIDDLETON HWY 208 SUNCREST ST

GERMANTOWN GERMANTOWN GLEASON GOODLETTSVILLE GORDONSVILLE GRAY

TN TN TN TN TN TN

38138-1734 38138-2200 38229 37072-1828 38563-6516 37615-3494

GREENBRIER PHARMACY AND FOUNTAIN ATCHLEY DRUG CENTER CENTRAL DRUG STORE COMMUNITY PHCY OF GREENEVILLE CORLEY'S PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY GREENE COUNTY DRUG INGLES PHARMACY TOWN & COUNTRY PHARMACY GREENFIELD FAMILY PHARMACY ARNOLD DRUG COMPANY HAMPTON PHARMACY CHASE DRUGS & CLINICAL SERVICES FOOD CITY PHARMACY RIDDLE DRUGS FOOD CITY PHARMACY HEARTLAND PHARMACY THE PRESCRIPTION SHOP HARTSVILLE PHARMACY LLC CITY DRUG STORE HENDERSON CITY DRUG XPRESS DEE'S DISCOUNT DRUGS BENZER PHARMACY FIRST CHOICE HOME INFUSION HENDERSONVILLE HEALTH MART ADVANCED RX PHARMACY PROFESSIONAL ARTS PHARMACY INC FOOD CITY PHARMACY FOOD CITY PHARMACY DUREN APOTHECARY

(615) 643-6979 (423) 639-5155 (423) 639-3881 (423) 588-5099 (423) 638-7552 (423) 525-4221 (423) 638-8689 (423) 638-7101 (423) 638-7021 (423) 798-9000 (731) 678-0201 (731) 836-7211 (423) 725-2327 (865) 882-2421 (865) 882-0117 (865) 882-3441 (423) 344-7106 (423) 869-7790 (423) 869-4707 (615) 374-4353 (731) 989-2166 (731) 989-7884 (731) 989-7180 (615) 826-1183 (615) 562-3244 (615) 824-2179 (615) 515-9375 (615) 885-9010 (423) 843-9407 (423) 842-3500 (931) 295-3406

2239 HIGHWAY 41 S STE A 511 ASHEVILLE HWY 239 W SUMMER ST 1402 TUSCULUM BLVD 1004 SNAPPS FERRY RD 2755 E. ANDREW JOHNSON HIGHWAY 905 SNAPPS FERRY RD 906 TUSCULUM BLVD # 2 2845 E ANDREW JOHNSON HWY 910A TUSCULUM BLVD 108 S FRONT ST 112 E MAIN ST 339 HIGHWAY 321 319 N ROANE ST 1130 S ROANE ST 520 DEVONIA ST 8634 HIGHWAY 58 170 BEECH ST 7030 CUMBERLAND GAP PKWY 207 MCMURRY BLVD E 118 E MAIN ST 226 NORTH AVE 689 KIMBERLY DR 295 NEW SHACKLE ISLAND ROAD 107 IMPERIAL BLVD STE 9 247 W MAIN ST 5651 FRIST BLVD STE 717 5655 FRIST BLVD 8530 HIXSON PIKE 5604 HIXSON PIKE 110 KITTRELL ST

GREENBRIER GREENEVILLE GREENEVILLE GREENEVILLE GREENEVILLE GREENEVILLE GREENEVILLE GREENEVILLE GREENEVILLE GREENEVILLE GREENFIELD HALLS HAMPTON HARRIMAN HARRIMAN HARRIMAN HARRISON HARROGATE HARROGATE HARTSVILLE HENDERSON HENDERSON HENDERSON HENDERSONVILLE HENDERSONVILLE HENDERSONVILLE HERMITAGE HERMITAGE HIXSON HIXSON HOHENWALD

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37073-4536 37743-4669 37743-4925 37745-4279 37745 37745-0955 37745-4026 37745-4004 37745-0957 37745-4004 38230-1925 38040-1523 37658-3277 37748 37748-7446 37748-2115 37341 37752-8206 37752-8232 37074-1109 38340-2335 38340-1816 38340-2009 37075-2349 37075-3492 37075-7320 37076-2061 37076-2053 37343 37343 38462-1363

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 570 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JONES HOMETOWN PHARMACY DUVALL DRUGS INC SUPER D DRUGS CITY DRUG COMPANY SCOTT COUNTY PHARMACY, INC. RIGGS DRUG JACKSBORO TERRY'S PHARMACY ADVANCE PHARMACY SERVICES COST-PLUS PHARMACY EAST JACKSON FAMILY MEDICAL CTR HEALTH CARE PHARMACY JACKSON NORTH CLINIC PHARMACY KIRKLAND CANCER CENTER PHCY MEDICAL CENTER INFUSION SERVICES PHIPPS PHARMACY PHIPPS PHARMACY VANTREESE DISCOUNT PHCY INC BURDEN DRUG CENTER HALL FAMILY PHARMACY MED-I-THRIFT DISCOUNT DRUGS JASPER DRUG LLC FOOD CITY PHARMACY JEFFCO DRUG CENTER M D PHARMACY STORE 2 MURPHY'S SAV-MOR PHARMACY,INC. JELLICO DRUG STORE WINDHAM DRUG JELLICO JOELTON PRESCRIPTION SHOP

Provider Name

(931) 796-5901 (731) 784-3610 (731) 784-2613 (731) 986-2228 (423) 663-9355 (423) 566-1967 (423) 563-7455 (615) 396-9080 (731) 661-0333 (731) 425-7909 (731) 423-2273 (731) 664-8046 (731) 541-1725 (731) 660-6954 (731) 668-9072 (731) 512-1002 (731) 423-0316 (931) 879-8312 (931) 879-9997 (931) 879-8133 (423) 942-5636 (865) 471-0366 (865) 471-5111 (865) 262-9777 (865) 475-3836 (423) 784-6226 (423) 784-3630 (615) 876-0633

121 W MAIN ST 1616 E MAIN ST 2401 N CENTRAL AVE 630 RB WILSON DR 950 BAKER HWY UNIT 1 2636 JACKSBORO PIKE 3088 APPALACHIAN HWY 371 N PARKWAY 104 W UNIVERSITY PKWY STE A 655 LEXINGTON AVE 505 ROLAND AVE 2863 HIGHWAY 45 BYP 720 W FOREST AVE 1061 W FOREST AVE 19 HUGHES DR 10 CHANNING WAY 1463 S HIGHLAND AVE STE A 418A W CENTRAL AVE 433 W CENTRAL AVE 346 W CENTRAL AVE 17 COURTHOUSE SQ 1507 ODELL AVE 127 W MEETING ST 657 E BROADWAY BLVD STE B 1403 RUSSELL AVE 229 S MAIN ST 1184 5TH ST 7164 WHITES CREEK PIKE

HOHENWALD HUMBOLDT HUMBOLDT HUNTINGDON HUNTSVILLE JACKSBORO JACKSBORO JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JACKSON JAMESTOWN JAMESTOWN JAMESTOWN JASPER JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JEFFERSON CITY JELLICO JELLICO JOELTON

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38462-1404 38343-2904 38343-1753 38344 37756-4169 37757 37757-2526 38305 38305-1635 38301-5075 38301-4301 38305-3618 38301-3904 38301-3879 38305-1510 38305-2010 38301-7543 38556 38556-3004 38556-3407 37347-3531 37760-2604 37760 37760-4949 37760-2530 37762-2018 37762-2629 37080-8632

A HEALTHPLUS AND PHARMACY@ JCMC BLANKENSHIP PHARMACY BOONES CREEK PHARMACY INC FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FREDS PHARMACY GENOA-QOL HEALTHCARE INGLES PHARMACY MOONEYS PHARMACY INC MOUNTAIN STATES PHARMACY PRINCETON DRUG

(423) 431-2140 (423) 926-4801 (423) 283-0911 (423) 232-9015 (423) 979-0373 (423) 952-0088 (423) 467-0023 (423) 928-3130 (423) 930-8999 (423) 282-0055 (423) 926-7333 (423) 926-6154 (423) 282-1178

400 N STATE OF FRANKLIN RD 222 E WATAUGA AVE 4729 N ROAN ST STE 2 920 N. STATE OF FRANKLIN RD 2120 S ROAN ST STE 100 4307 N ROAN ST 125 JUDGE GRESHAM RD 1301 N ROAN ST 109 W WATAUGA AVE STE 129 4470 N ROAN ST 1107 N ROAN ST 523 N STATE OF FRANKLIN RD 105 BROYLES ST

JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY JOHNSON CITY

TN TN TN TN TN TN TN TN TN TN TN TN TN

37604-6035 37601-4630 37615-3886 37604 37601-7675 37615-4973 37615-6213 37601 37604-5621 37615-4922 37601-3901 37604 37601-2517

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 571 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PROCOMPOUNDING PHARMACY VAL-U-PHARMACY WEST TOWNE PHARMACY INC FOOD CITY PHARMACY INGLES PHARMACY MEDICINE SHOPPE OLDE TOWNE PHARMACY INC KENTON DRUG COMPANY BERRYS PHARMACY BLOOMINGDALE DRUG OF KINGSPORT BROOKSIDE DISCOUNT PHARMACY CAVE'S DRUG STORE COLONIAL HEIGHTS PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY INGLES PHARMACY KINGSPORT DERMATOLOGY MAC'S MEDICINE MART, INC MARCUMS PHARMACY MOUNTAIN STATES PHCY KINGSPORT P & S PHARMACY PINNEY'S PRESCRIPTION SHOP PREMIER PHARMACY INC ROWE'S PHARMACY SULLIVAN SPECIALTY PHCY LLC BAGGETT PHARMACY FOOD CITY PHARMACY KINSER DRUGS INC KINGSTON SPRINGS PHARMACY AASC PHARMACY SERVICES BELEW DRUGS BELEW DRUGS ASHEVILLE HWY LLC BELEW DRUGS WASHINGTON PIKE CAREMAX EXTENDED CARE PHARMACY CAREMAX SPECIALTY PHARMACY CHEROKEE HEALTH PHARMACY FARRAGUT PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (423) 975-0597 (423) 928-8004 (423) 926-9137 (423) 753-3468 (423) 753-9730 (423) 753-2441 (423) 753-4446 (731) 749-5951 (423) 247-3124 (423) 288-4812 (423) 246-2424 (423) 245-1341 (423) 239-9191 (423) 246-0047 (423) 239-0679 (423) 247-1961 (423) 247-9048 (423) 246-4961 (423) 245-2181 (423) 246-6166 (423) 247-2126 (423) 246-8351 (423) 247-8188 (423) 245-1022 (423) 245-5191 (423) 392-6109 (865) 376-6452 (865) 717-7085 (865) 376-5157 (615) 952-3690 (865) 231-9330 (865) 525-4189 (865) 933-3441 (865) 525-4967 (865) 692-1605 (865) 540-1002 (865) 934-6786 (865) 966-9728 (865) 692-5183 (865) 689-8955 (865) 686-1761 (865) 922-9683

Provider Street 527 N STATE OF FRANKLIN RD 2811 W MARKET ST 1619 W MARKET ST 500 FOREST DR 1200 W JACKSON BLVD 1238 E JACKSON BLVD 102 W JACKSON BLVD 116 E COLLEGE ST 1717 FORT HENRY DR 2900 BLOOMINGDALE RD 1901 BROOKSIDE DR 1328 S JOHN B DENNIS HWY STE B 4221 FORT HENRY DR 300 CLINCHFIELD ST 1911 MORELAND DR 1205 N EASTMAN RD 4335 FORT HENRY DR 2300 W STONE DR 1455 E CENTER ST 121 E RAVINE RD 1657 E STONE DR SUITE A 613 WATAUGA ST 1201 N WILCOX DR 109 JACK WHITE DR 2416 MEMORIAL BLVD 2204 PAVILION DR STE 105 133 E RACE ST 1000 LADD LANDING BLVD 142 E CUMBERLAND ST 111 W KINGSTON SPRINGS RD #103 801 WEISGARBER RD STE 200 2021 N BROADWAY ST 8622 ASHEVILLE HWY 5908 WASHINGTON PIKE STE 102 418 S GAY ST # 104 3218 MORRIS AVE STE B 2018 WESTERN AVE 11424 KINGSTON PIKE 11501 HARDIN VALLEY RD 5078 CLINTON HWY 4216 N BROADWAY ST 7202 MAYNARDVILLE PIKE

Page 572 of 679

Provider City JOHNSON CITY JOHNSON CITY JOHNSON CITY JONESBOROUGH JONESBOROUGH JONESBOROUGH JONESBOROUGH KENTON KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSPORT KINGSTON KINGSTON KINGSTON KINGSTON SPRINGS KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE

State

ZIP code

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37604-8210 37604-5127 37604-6018 37659-1510 37659-5294 37659 37659-1224 38233-1336 37664-3228 37660-1957 37660-4617 37660-5472 37663-2227 37660-3604 37663-3018 37664-3159 37663-2268 37660-2360 37664-2501 37660-3816 37660-4669 37660-4429 37660-4922 37664-2364 37664-3343 37660-4651 37763-2824 37763-2367 37763-2811 37082-9121 37909 37917-5808 37924-4107 37918-7100 37902-1134 37909 37921-5718 37934-3915 37932 37912-3953 37917-2205 37918-5740

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY FOUR WAY PRESCRIPTION SHOP GENOA-QOL HEALTHCARE GORDONS DRUG COMPANY HEARTLAND APOTHECARY INGLES PHARMACY INGLES PHARMACY MAC'S PHARMACY MUGFORD PHARMACY NATIONAL RX NORWOOD PHARMACY P3 COMPOUNDING PHARMACY

Provider Name

(865) 281-0286 (865) 691-1153 (865) 588-0972 (865) 573-5090 (865) 584-0115 (865) 525-6350 (865) 633-5008 (865) 933-4635 (865) 539-0580 (865) 933-2451 (865) 312-7278 (865) 691-8822 (865) 909-9713 (865) 769-8326 (865) 777-2469 (865) 524-3453 (865) 577-5533 (865) 392-1770 (865) 688-0388 (865) 769-5180

4805 N BROADWAY ST 284 MORRELL RD 5941 KINGSTON PIKE 7608 MOUNTAIN GROVE DR 5801 WESTERN AVE 1950 WESTERN AVE 2712 LOVES CREEK RD 7510 ASHEVILLE HWY 9565 MIDDLEBROOK PIKE 8707A ASHEVILLE HWY 205 W SPRINGDALE AVE 7255 OAK RIDGE HWY 1709 MIDPARK RD STE A 7466 OAK RIDGE HWY 11847 KINGSTON PIKE 2419 WASHINGTON PIKE 3909 MARTIN MILL PIKE 11134 KINGSTON PIKE 815 MERCHANTS DR 8848 CEDAR SPRINGS LN STE 100

KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37918-8706 37919-5876 37919-6344 37920-6755 37921-2208 37921-5716 37924-2027 37924-3811 37931-4708 37924-4502 37917-5158 37931-2614 37921-5983 37931-3480 37934-3833 37917-3321 37920-2456 37934-2806 37912-3817 37923-5415

PENINSULA OUTPATIENT PHARMACY KNOX TENNESSEE CANCER SPECIALISTS PHCY THE COMPOUNDING PHARMACY OF AMERICA THE MEDICINE SHOPPE THE PHOENIX PHARMACY UNIVERSITY PHARMACY UT STUDENT HLTH CTR PHARMACY VICTORY PHARMACY VITAL CARE OF KNOXVILLE VOLUNTEER PHARMACY FOOD CITY PHARMACY FOOD CITY PHARMACY RIGGS DRUG STORE TERRYS PHARMACY INC FICHTEL PHARMACY CORNER DRUG COMPANY LASCASSAS DRUGS FRISBIE APOTHECARY HOLLANDS DRUG CO HOLLANDS PHARMACY

(865) 374-7200 (865) 934-5800

1451 DOWELL SPRINGS BLVD 1415 OLD WEISGARBER RD STE 200

KNOXVILLE KNOXVILLE

TN TN

37909-2450 37909

(888) 972-7239 (865) 579-4547 (865) 692-1603 (865) 305-7420 (865) 974-5932 (865) 922-5234 (865) 862-4557 (865) 560-0135 (865) 933-4676 (423) 566-2033 (423) 562-5235 (423) 562-4928 (615) 462-6031 (865) 426-2851 (615) 896-9808 (931) 762-7223 (931) 762-5551 (931) 762-2220

6216 HIGHLAND PLACE WAY #101A 4206 CHAPMAN HWY 418 S GAY ST STE 104 1924 ALCOA HWY STE NP100 1800 VOLUNTEER BLVD 4127 E EMORY RD 9943 KINGSTON PIKE 2559 WILLOW POINT WAY 2946 WINFIELD DUNN PKWY 2221 JACKSBORO PIKE STE B1 502 W CENTRAL AVE 310 E CENTRAL AVE 405 OLD NASHVILLE HWY 414 MAIN STREET 4702 LASCASSAS PIKE 726 N LOCUST AVE STE C 11 PUBLIC SQ 1333 S LOCUST AVE

KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KNOXVILLE KODAK LA FOLLETTE LA FOLLETTE LA FOLLETTE LA VERGNE LAKE CITY LASCASSAS LAWRENCEBURG LAWRENCEBURG LAWRENCEBURG

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37919 37920-4251 37902-1134 37920 37996-4522 37938-4229 37922-6923 37931-3162 37764-4309 37766-3063 37766-3400 37766-3617 37086-3332 37769 37085-4582 38464-2802 38464-3331 38464-4040

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 573 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LIBERTY DRUG STORE INC BUCKEYE'S DISCOUNT DRUG CENTER GIBBS PHARMACY CHEROKEE HEALTH PHARMACY EAST TENN DISCOUNT DRUGS FOOD CITY PHARMACY INGLES PHARMACY H & S PHARMACY PARSONS PHARMACY FAMILY PHARMACY JONES PHARMACY LEXINGTON DISCOUNT DRUGS PROFESSIONAL ARTS PHARMACY DURENS HEALTH MART PHARMACY R & M FAMILY PHARMACY FOOD CITY PHARMACY PREFERRED PHARMACY ROCKY TOP PHARMACY OF LOUDON RX-PERTS EAST HICKMAN PHARMACY LYNCHBURG DRUG STORE CENTERSTONE PHARMACY GOODLETTSVILLE PEDIATRICS DISP RAMS PHARMACY WIL-SAV DRUGS BAKER BROS DRUG COMPANY MARCROM'S PHARMACY VANS INSTITUTIONAL PHARMACY BLOUNT DISCOUNT PHARMACY BLOUNT DISCOUNT PHCY-WEST CITY DRUG COMPANY FOOD CITY PHARMACY LOWES DRUGS FOOD CITY PHARMACY OKIE'S PHARMACY UNION DISCOUNT PHARMACY INC MCEWEN PRESCRIPTION SHOP PHIPPS PHARMACY SUPER DRUGS

Provider Name

(931) 762-6902 (615) 444-2999 (615) 449-3355 (865) 986-4530 (865) 988-0000 (865) 986-7032 (865) 986-0947 (931) 359-2534 (931) 359-4066 (731) 968-6979 (731) 968-8653 (731) 968-4201 (731) 968-5474 (931) 589-2146 (931) 403-2552 (865) 458-5312 (865) 458-1113 (865) 657-3500 (865) 458-1102 (931) 670-6035 (931) 759-7329 (615) 460-4358 (615) 851-7810 (615) 454-3438 (423) 442-9727 (931) 728-3226 (931) 728-1100 (731) 588-5138 (865) 983-9795 (865) 681-0520 (865) 982-7162 (865) 981-4347 (865) 982-3020 (865) 992-0534 (865) 992-9455 (865) 992-9993 (931) 582-8808 (731) 352-0820 (731) 352-3242

1400 N LOCUST AVE 315 N CUMBERLAND ST 1427 W BADDOUR PKWY STE B 501 ADESSA PKWY STE A150 721A HIGHWAY 321 N 300 MARKET DRIVE 404 HIGHWAY 321 N 521 WEST COMMERCE ST 117 W COMMERCE ST 6 HOSPITAL DR 101 LEXINGTON PLZ 148 W CHURCH ST 270 W CHURCH ST STE C 119 S MILL ST 1970 BRADFORD HICKS DR STE B 2799 HIGHWAY 72 N 101 CHEEYO WAY STE A 702 GROVE ST 2350 HIGHWAY 72 N 7723 CLEARVIEW CHURCH LN 47 MECHANIC STREET 620 GALLATIN PIKE S 200 GLEAVES ST STE A 412 GALLATIN RD N 4249 HIGHWAY 411 STE 5 120 E MAIN ST 1277 MCARTHUR ST 154 MOUNT PELIA RD 152 BMH PHYSICIAN OFFICE BLDG 131 MONTGOMERY LN 1612 E LAMAR ALEXANDER PKWY 2135 E BROADWAY AVE 1536 E BROADWAY 4344 MAYNARDVILLE HWY 4221 MAYNARDVILLE HWY 2959 MAYNARDVILLE HWY 10033 US HIGHWAY 70 E 205 HOSPITAL DR # B 2340 CEDAR ST

LAWRENCEBURG LEBANON LEBANON LENOIR CITY LENOIR CITY LENOIR CITY LENOIR CITY LEWISBURG LEWISBURG LEXINGTON LEXINGTON LEXINGTON LEXINGTON LINDEN LIVINGSTON LOUDON LOUDON LOUDON LOUDON LYLES LYNCHBURG MADISON MADISON MADISON MADISONVILLE MANCHESTER MANCHESTER MARTIN MARYVILLE MARYVILLE MARYVILLE MARYVILLE MARYVILLE MAYNARDVILLE MAYNARDVILLE MAYNARDVILLE MC EWEN MC KENZIE MC KENZIE

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38464-2210 37087-2720 37087-3062 37771-6719 37771-5008 37771 37771-2065 37091 37091-3343 38351-1422 38351-1505 38351-2069 38351-2077 37096-6457 38570-2232 37774-5725 37774-2737 37774-1481 37774-5718 37098 37352 37115-4013 37115 37115 37354-1544 37355-1533 37355-2423 38237-3812 37804 37803-5649 37804-6206 37804-3034 37804-3202 37807-3618 37807-3555 37807-3217 37101-4442 38201-1649 38201-2249

F Z WEBB & SONS PHCY OF MCMINNVILLE MCMINNVILLE DRUG CENTER

(931) 474-9322 (931) 473-4471

835 SMITHVILLE HWY STE 25 1500 SPARTA ST

MC MINNVILLE MC MINNVILLE

TN TN

37110-1669 37110-1317

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 574 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FISHER DISPENSARY GENOA-QOL HEALTHCARE STACY'S WELLNESS PHARMACY INC

Provider Name

(931) 473-4441 (931) 473-1066 (931) 474-0600

140 VO TECH DR STE 6 120 OMNI DR 485 N CHANCERY ST STE 1

MCMINNVILLE MCMINNVILLE MCMINNVILLE

TN TN TN

37110-1329 37110-1331 37110-8903

SULLIVANS HOMETOWN PHARMACY LLC HOMETOWN PHARMACY OF MEDINA THREE OAKS PHARMACY BENSONS PHARMACY & GIFTS BIG BEND PHARMACY LLC CHRIST COM HLTH SVCS 3RD ST PH CHRIST COMM HEALTH SERVICES INC CHRIST COMM HLTH SVC INC DARSALUD PHARMACY DNL PHARMACY FIRST PHCY SVCS OF PARK AVE FREDS PHARMACY GETWELL PHARMACY HICKORY HILL PHARMACY MADISON PHARMACY MEDPLEX PHARMACY REG MED CTR ORANGE MOUND PHARMACY PEOPLES CUSTOM RX REGIONAL ONE HEALTH TAYLOR BROWN APOTHECARY

(931) 474-5050 (731) 783-0777 (731) 783-3300 (901) 590-3116 (844) 646-2279 (901) 701-8500 (901) 260-8475 (901) 701-2545 (901) 683-0024 (901) 474-7737 (901) 821-8330 (901) 624-5720 (901) 308-1035 (901) 271-6170 (901) 274-4334 (901) 545-6980 (901) 271-6275 (901) 682-2273 (901) 515-5600 (901) 794-3690

231 NORTHGATE DR STE 100 107 S MAIN ST 259 THREE OAKS DR STE A 3081 S PERKINS RD 6045 E SHELBY DR SUITE 1A 3362 S 3RD ST 2861 BROAD AVE 969 FRAYSER BOULEVARD 1068 CRESTHAVEN STE 300 2900 KIRBY PARKWAY STE #5 6005 PARK AVE STE 630B 6500 QUINCE RD 3960 KNIGHT ARNOLD RD STE 112 5366 WINCHESTER RD 1750 MADISON AVE STE 110 877 JEFFERSON AVE 2569 DOUGLASS AVE 785 E BROOKHAVEN CIR 6555 QUINCE 3333 E SHELBY DR

MCMINNVILLE MEDINA MEDINA MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37110-1436 38355 38355 38118 38141-7601 38109-2944 38112-2903 38127 38119-0809 38119 38119-5226 38119-8211 38118-3001 38115 38104-6428 38103-2807 38114 38117-4501 38119-8031 38118-7256

THE DIABETES AND RESPIRATORY STORE THE MEDICINE SHOPPE THE MEDICINE SHOPPE THE RX SHOPPE VITAL RX OF TENNESSEE LLC WALNUT GROVE PLAZA PHARMACY WALNUT GROVE PLAZA PHARMACY WHITNEY PHARMACY MICHIE PHARMACY MILAN HOMETOWN PHARMACY SUPER D DRUGS BOATWRIGHT DRUG COMPANY, INC. FREDS PHARMACY MONTEREY DRUGS COLLEGE PARK PHARMACY CRESCENT CENTER DRUG STORE FOOD CITY PHARMACY

(901) 312-3150 (901) 363-0750 (901) 683-3511 (901) 737-9797 (901) 443-2500 (844) 605-5496 (901) 226-5754 (901) 354-7621 (731) 239-2100 (731) 686-0899 (731) 686-1557 (901) 872-2214 (931) 924-4700 (931) 839-6777 (423) 586-0721 (423) 586-6263 (423) 318-7431

1760 MORIAH WOODS BLVD STE 2 4770 KNIGHT ARNOLD RD 920 ESTATE DR 3315 HACKS CROSS RD STE 111 150 COLLINS ST 6025 WALNUT GROVE RD STE 108 6025 WALNUT GROVE RD 2150 WHITNEY AVE 5823 HIGHWAY 22 S 3107 HIGHLAND ST 6066 S 1ST ST 7899 C ST 829 W MAIN ST 201 N ELMORE ST STE F 2106 E ANDREW JOHNSON HWY 228 N FAIRMONT AVE 1105 E MORRIS BLVD

MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MEMPHIS MICHIE MILAN MILAN MILLINGTON MONTEAGLE MONTEREY MORRISTOWN MORRISTOWN MORRISTOWN

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38117-7128 38118-3201 38119-0601 38125-8801 38112-3814 38120-2116 38120-2131 38127-6662 38357-7033 38358-3113 38358-3131 38053-2137 37356-3022 38574-1260 37814 37814-3768 37813

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 575 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FOOD CITY PHARMACY FOOD CITY PHARMACY FOUNTAIN PLAZA PHARMACY HOWARD'S PHARMACY INGLES PHARMACY M.D. PHARMACY MCFARLAND APOTHECARY MCFARLAND PHARMACY MIKE'S DISCOUNT PHARMACY INC MORRISTOWN PHARMACY PHARMACY EXPRESS INC THE MEDICINE SHOPPE ATHENA PHARMACY PHARMACARE PRESCRIPTION INC ADAMS PHARMACY LLC FAMILY PRESCRIPTION CENTER MOUNTAIN CITY PHARMACY EXPRESS PHARMACY BECKMANS PRESCRIPTION SHOP GENOA-QOL HEALTHCARE LIFEPOINT PHARMACY MILLS FAMILY PHARMACY PRIMARY CARE & HOPE CLINIC PHCY REEVES SAIN DRUG STORE TERRACE PHARMACY THE WELLNESS PHCY MURFREESBORO TWELVESTONE MEDICAL INC US PHARMACY 001 ADVANCED RX PHARMACY 060 AFFORDABLE PHARMACY SERVICES APOTHECARY BAPTIST RX EXPRESS BELMONT UNIV HLTH SRVCS PHCY BRADLEY DRUG COMPANY

Provider Name

(423) 587-9792 (423) 317-5020 (423) 307-5757 (423) 581-8436 (423) 586-4077 (423) 289-1111 (423) 581-1118 (423) 254-3062 (423) 587-4107 (423) 587-4949 (423) 839-2401 (423) 422-2829 (615) 288-4037 (615) 758-4750 (423) 727-1210 (423) 727-6501 (423) 727-0039 (901) 840-1998 (615) 893-6661 (615) 867-6764 (615) 225-8870 (615) 895-1641 (615) 893-9390 (615) 896-5731 (615) 893-7971 (615) 867-6060 (844) 893-0012 (615) 530-5600 (925) 621-2900 (615) 622-2700 (615) 645-9680 (615) 320-8410 (615) 460-6040 (615) 383-2741

2310 SANDSTONE DRIVE 4100 COOL SPRINGS RD 2825 W ANDREW JOHNSON HWY 3336 W ANDREW JOHNSON HWY 3980 W ANDREW JOHNSON HWY 1467 W MORRIS BLVD 167 W MAIN ST 167 W MAIN ST 3606 W ANDREW JOHNSON HWY 925 W 4TH NORTH ST 1732 BUFFALO TRL 6766 W ANDREW JOHNSON HWY 2025 N MOUNT JULIET RD STE 100 1097 WESTON DR 851 S SHADY ST 129 W MAIN ST 1641 S SHADY ST 99 DOCTORS DRIVE STE 100 120 E COLLEGE ST 2126 N THOMPSON LN 3163 S CHURCH ST #A 2994 S CHURCH ST 1453 HOPE WAY 1801 MEMORIAL BLVD 502 HIGHLAND TER 1547 WARRIOR DR 352 W NORTHFIELD BLVD STE 3A 440 SAINT ANDREWS DR 1410 DONELSON PIKE STE B6 3139 LEBANON PIKE 226 11TH AVE S 300 20TH AVE N STE 105 1900 BELMONT BLVD 5208 CHARLOTTE PIKE

MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MORRISTOWN MOSHEIM MOUNT JULIET MOUNT JULIET MOUNTAIN CITY MOUNTAIN CITY MOUNTAIN CITY MUNFORD MURFREESBORO MURFREESBORO MURFREESBORO MURFREESBORO MURFREESBORO MURFREESBORO MURFREESBORO MURFREESBORO MURFREESBORO MURFREESBORO NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37814 37814 37814-3216 37814-3621 37814-1103 37813-2828 37814-4628 37814-4628 37814-3603 37814-3814 37814-4250 37818-3836 37122-3934 37122-3493 37683-1831 37683-1307 37683-2015 38058 37130-3723 37129-6025 37127-7175 37127 37129-3140 37129-1522 37130-2419 37128-0913 37129-1539 37128-6531 37217-2952 37214-2314 37203-4021 37203-2162 37212-3758 37209-3321

BRADLEY PHARMACY AT METRO CENTER CENTERSTONE PHARMACY - LUTON CHANE PHARMACY COMMUNITY PHARMACY DEAL DRUGS DRUGPLACE OF TN GREEN HILLS PHARMACY

(615) 687-4938 (615) 279-6721 (615) 948-1695 (615) 341-4415 (615) 834-1398 (615) 620-4438 (615) 292-3359

131 FRENCH LANDING DR 1921 RANSOM PL 2510 MURFREESBORO PIKE 1818 ALBION ST 397 WALLACE RD BLDG C # 405 617 AIRPARK CENTER DR 2140 BANDYWOOD DR

NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE

TN TN TN TN TN TN TN

37228-1511 37217-3841 37217-3582 37208 37211-4854 37217-2923 37215-2703

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 576 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HERITAGE PHARMACY HLTH & WELLNESS CMPNDNG PHCY JOHN HOLLIS PHARMACY MEDICAL CENTER EAST PHARMACY NASHVILLE ONCOLOGY ASSOCIATES PC NASHVILLE PHARMACY AT SKYLINE NASHVILLE PHARMACY SERVICES NPS PHARMACY PLAZA PHARMACY PRUITTS DISCOUNT PHARMACY, LLC RIVERSIDE VILLAGE PHARMACY TURENNE PHARMEDCO INC VANDERBILT OUTPATIENT PHARMACY CASE DRUG CO CUNNINGHAM DRUG COMPANY MEDICAL CENTER PHARMACY STANIFER DRUGS NEWBERN DRUG HEALTH MART FOOD CITY PHARMACY FOOD CITY PHARMACY FREDS PHARMACY JABOS PHARMACY TOWN & COUNTRY DRUGS WILSON'S SAV-MOR DRUGS, LLC PHARMACY CARE OF TENNESSEE FOOD CITY PHARMACY GENOA-QOL HEALTHCARE MUNSEYS PHARMACY RIDDLE EXPRESS PHARMACY COOKE'S PHARMACY- OCOEE FIRST CARE PHARMACY FOOD CITY PHARMACY RIDDLE DRUGS DANNYS DRUGS INC MARKS FAMILY PHARMACY PLATEAU DRUGS, INC. ROARK'S PHARMACY INC FOOD CITY PHARMACY FOOD CITY PHARMACY THRIFTY MED PLUS PHARMACY PALMER DRUG EASTWOOD PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (844) 865-8363 (615) 383-3784 (615) 327-3234 (615) 936-1040 (615) 284-2310 (615) 724-0066 (615) 371-1210 (615) 743-1617 (615) 222-6216 (615) 562-6337 (615) 650-4444 (866) 720-7626 (615) 322-6480 (931) 535-3233 (423) 626-3151 (423) 626-5411 (423) 626-7337 (731) 627-9573 (423) 613-9106 (423) 623-9533 (423) 625-6178 (423) 623-3088 (423) 623-1500 (423) 623-3456 (615) 283-8035 (865) 483-2889 (865) 272-6662 (865) 483-8429 (865) 425-1260 (423) 216-0050 (423) 299-9029 (865) 435-1187 (865) 435-3333 (423) 569-8652 (423) 569-7800 (423) 569-5555 (423) 569-9000 (423) 238-5594 (423) 893-3362 (423) 396-6963 (931) 779-3966 (731) 642-0451

Provider Street 4230 HARDING PIKE STE 601E 329 21ST AVE N STE 3 1923 HAYES ST 1215 21ST AVE SO RM 1006 2011 CHURCH ST STE 701 3443 DICKERSON PIKE STE 110 719 THOMPSON LN STE 57100 275 CUMBERLAND BND 4230 HARDING PIKE STE A-214 811-C DICKERSON PIKE 1406 MCGAVOCK PIKE STE A 2525 PERIMETER PLACE DR 1211 MEDICAL CENTER SR RM 1815 990 BROADWAY AVE 201 N BROAD ST 606 N BROAD ST 420 N BROAD ST 625 W MAIN ST 181 WESTERN PLAZA WAY 416 EASTERN PLAZA SHOPPING CTR 702 W HIGHWAY 25-70 602 E BROADWAY 771 COSBY HIGHWAY 243 E MAIN ST 934 OLDHAM DR SUITE 100 A 1199 OAK RIDGE TPKE 240 W TYRONE RD 106 ADMINISTRATION RD STE 1 1050 OAK RIDGE TPKE 116 WHITE WATER DR 186 CREEKSIDE DR 508 E TRI COUNTY BLVD 616 E TRI COUNTY BLVD 20029 ALBERTA ST 279 UNDERPASS DR 18157 ALBERTA ST 19118 ALBERTA ST 6043 RELOCATION WAY 1667 OOLTEWAH RINGGOLD RD 5032 OOLTEWAH-RINGGOLD RD#100 571 MAIN STREET 1325 E WOOD ST

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Provider City NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NASHVILLE NEW JOHNSONVILLE NEW TAZEWELL NEW TAZEWELL NEW TAZEWELL NEWBERN NEWPORT NEWPORT NEWPORT NEWPORT NEWPORT NEWPORT NOLENSVILLE OAK RIDGE OAK RIDGE OAK RIDGE OAK RIDGE OCOEE OCOEE OLIVER SPRINGS OLIVER SPRINGS ONEIDA ONEIDA ONEIDA ONEIDA OOLTEWAH OOLTEWAH OOLTEWAH PALMER PARIS

State

ZIP code

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

37205-2013 37203-1856 37203-2316 37232 37203-2038 37207-2521 37204-3609 37228-1803 37205-2013 37207-5612 37216-3233 37214-3727 37232 37134-2148 37825-6603 37825-6610 37825 38059-1572 37821-2215 37821-3108 37821 37821-3246 37821-3496 37821-3126 37135 37830-6442 37830-6517 37830-6954 37830-6804 37361-3644 37361-3655 37840-2018 37840-5413 37841 37841-5885 37841-6201 37841-6003 37363 37363 37363 37365 38242-4421

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HENRY COUNTY MEDICAL CENTER MEDICAL CENTER PHARMACY PARIS PHARMACY PERKINS DRUG CITY DRUG STORE FREDS PHARMACY VISE'S DISCOUNT PHARMACY STEWARTS DRUG STORE STANDEFER PHARMACY STEPHENS PHARMACY FOOD CITY PHARMACY PLEASANT VIEW PHARMACY PORTLAND PRESCRIPTION SHOP FOOD CITY PHARMACY INGLES PHARMACY MAC'S EDGEMOOR PHARMACY MCFARLAND PHARMACY KNOXVILLE RIGGS DRUG STORE VAUGHN PHARMACY REEVES DRUG STORE FOOD CITY PHARMACY THE PRESCRIPTION SHOP TAYLOR BROTHERS PHARMACY CHRISTIAN FAMILY PHARMACY RIPLEY DRUGS LLC ROAN MOUNTAIN PHARMACY LIVE & LET LIVE DRUG FOOD CITY PHARMACY MEDICAL CENTER PHARMACY LLC RURAL HEALTH SERVICES PHARMACY THE MEDICINE SHOPPE U-SAVE DISCOUNT DRUGS EAST END PHARMACY HESTER DRUG COMPANY SMITH DRUG STORE FIRST CARE PHARMACY BOB'S DISCOUNT PHARMACY CARROLL PHARMACY HARDIN MEDICAL CENTER MAIN STREET PHARMACY THE PRESCRIPTION SHOP FAMILY PHARMACY SCOTTS HILL

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Provider Phone Number (731) 644-8578 (731) 642-2451 (731) 407-7220 (731) 642-3531 (731) 847-6337 (731) 847-3851 (731) 847-3784 (865) 453-9096 (423) 447-2134 (423) 447-2434 (423) 538-0253 (615) 746-8432 (615) 323-5050 (865) 938-2838 (865) 947-5929 (865) 945-3333 (423) 581-1118 (865) 947-5235 (865) 947-1581 (931) 363-2561 (423) 877-9516 (615) 699-2509 (731) 264-5651 (731) 635-1569 (731) 635-4545 (423) 772-3591 (865) 354-0234 (423) 272-3790 (423) 272-8104 (423) 272-3214 (423) 272-0777 (423) 272-6408 (423) 289-1755 (731) 665-6176 (865) 828-5222 (423) 486-9404 (731) 925-1152 (731) 925-5551 (731) 926-8171 (731) 925-6246 (731) 925-3956 (731) 549-2887

Provider Street 301 TYSON AVE 234 TYSON AVE 1025B MINERAL WELLS AVE 110 E WASHINGTON ST 18 W MAIN ST 501 TENNESSEE AVE NORTH 179 TENNESSEE AVE N 3120 PARKWAY 3051 MAIN ST 3135 MAIN ST 6681 BRISTOL HWY, STE 300 6361 HIGHWAY 41A 705 S BROADWAY ST 7350 CLINTON HWY 430 E EMORY RD 643 EDGEMOOR RD 7565 DANNAHER DR 604 E EMORY RD 2141 W EMORY RD 125 N 1ST ST 3901 DAYTON BLVD 126 MARKET ST 109 N MAIN 79 HIGHWAY 51 S STE 2 315 CLEVELAND ST 8251 HIGHWAY 19 E 225 W ROCKWOOD ST 1287 E MAIN ST 900 W MAIN ST 4966 HWY 11 WEST 921 E MAIN ST STE 2 4017 HIGHWAY 66 S STE 7 5630 E ANDREW JOHNSON HWY 114 E MAIN ST 8120 RUTLEDGE PIKE 14821 DAYTON PIKE STE 115 555 PICKWICK ST 835 PICKWICK ST 935 WAYNE RD 110 MAIN STREET 765 FLORENCE RD STE B 10091 HIGHWAY 100

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Provider City PARIS PARIS PARIS PARIS PARSONS PARSONS PARSONS PIGEON FORGE PIKEVILLE PIKEVILLE PINEY FLATS PLEASANT VIEW PORTLAND POWELL POWELL POWELL POWELL POWELL POWELL PULASKI RED BANK RED BOILING SPRNGS RIDGELY RIPLEY RIPLEY ROAN MOUNTAIN ROCKWOOD ROGERSVILLE ROGERSVILLE ROGERSVILLE ROGERSVILLE ROGERSVILLE RUSSELLVILLE RUTHERFORD RUTLEDGE SALE CREEK SAVANNAH SAVANNAH SAVANNAH SAVANNAH SAVANNAH SCOTTS HILL

State

ZIP code

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38242-4544 38242-4575 38242 38242-4017 38363 38363 38363-2002 37863-3310 37367-5745 37367-5752 37686 37146-8179 37148-1628 37849-5205 37849-3517 37849-7146 37849 37849 37849-3704 38478-3214 37415 37150 38080-1316 38063-4580 38063-1205 37687-3343 37854-2243 37857-6922 37857-2448 37857-0850 37857-2833 37857-3196 37860-9416 38369-9711 37861-3033 37373-5752 38372 38372-3006 38372-1937 38372 38372-5219 38374

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DEBERRY DRUGS MID-TOWN PHARMACY EDDIE'S DRUG STORE FOOD CITY PHARMACY LEES TOTAL HEALTH PHARMACY PREFERRED PHARMACY SEVIERVILLE REAMS DRUG STORE STEWARTS DRUG INC FOOD CITY PHARMACY SEYMOUR ADVALUE PHARMACY BEDFORD DRUGS LLC MCGEES PRESCRIPTION SHOP SIGNAL MOUNTAIN PHARMACY CALDWELL'S DRUGSTORE, INC. F.Z. WEBB & SONS PHARMACY JOHNNY'S DRUGS KEYSTONE COMMUNITY PHARMACY NISSAN FAMILY PHARMACY SMYRNA PHARMACY AND WELLNESS WELLSPRING PHARMACY INC SMITH-TURNER DRUG STORE VALUE RX DJB PHARMACY LANDRYS PHARMACY SUPER DRUGS PHL INC DBA THE DRUGSTORE PAYLESS FAMILY PHARMACY SPENCER DRUG CO LLC HASSLER'S DRUGS INC SPRING CITY PHARMACY INC B & B PHARMACY PLLC ENTRUSTRX SOUTHSIDE DRUG COMPANY SPRINGFIELD DRUGS INC EAST TENNESSEE DISCOUNT DRUG SURGOINSVILLE PHARMACY LITTLE DRUGS WIL SAV DRUGS OF SWEETWATER VALUE RX FOOD CITY PHARMACY TAZEWELL DRUG VALUE RX

NR_0009_10823 10/2017

Provider Phone Number (731) 645-6100 (731) 645-7008 (865) 286-9079 (865) 908-5018 (865) 428-7252 (865) 366-1770 (865) 453-5160 (865) 453-7121 (865) 579-4728 (865) 577-0471 (931) 680-1035 (931) 684-7936 (423) 886-2135 (615) 597-1988 (615) 597-4185 (615) 597-7822 (615) 459-5335 (615) 355-7635 (615) 462-6031 (615) 462-5093 (423) 733-2322 (865) 585-8555 (901) 235-7188 (901) 466-1127 (901) 465-9888 (423) 837-6855 (931) 836-3187 (931) 946-7900 (423) 365-9202 (423) 365-6351 (931) 451-7785 (855) 273-3924 (615) 384-3546 (615) 384-4561 (865) 933-4149 (423) 345-0333 (423) 337-7933 (423) 337-9381 (423) 839-1663 (423) 626-2344 (423) 259-8661 (423) 626-7455

Provider Street 834 MULBERRY AVE 270 E COURT AVE STE C 1240 FOX MEADOWS BLVD STE 3 741 DOLLY PARTON PKWY 725 PARKWAY STE 11 1024 MIDDLE CREEK RD STE 1 1787 VETERANS BLVD STE 103 229 FORKS OF THE RIVER PKWY 11503 CHAPMAN HWY 10721 CHAPMAN HWY 629 N MAIN ST 842 UNION ST 804 RIDGEWAY AVE 511 W MAIN ST 608 S CONGRESS BLVD 516 W MAIN ST STE B 300 STONECREST BLVD STE 130 608 ENON SPRINGS RD 361 ENON SPRINGS RD E 599 SAM RIDLEY PKWY STE 103 140 CHURCH ST 1400 MAIN ST 305 LAKE RD 25 WOODBRIDGE STE B 13092 N MAIN ST 335 S CEDAR AVE 285 W TURNTABLE RD 120 COLLEGE ST 401 FRONT ST 171 CLINTON AVE 5407 MAIN ST STE 101 2001 CAMPBELL STATION PKWY #A5 1000 S MAIN ST 511 MEMORIAL BLVD 524 ANDREW JOHNSON HWY 114 BELLAMY AVE 510 S MAIN ST 787 NEW HWY 68 6161 W ANDREW JOHNSON HWY 1410 N BROAD ST 951 N BROAD ST 1613 N BROAD ST

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Provider City SELMER SELMER SEVIERVILLE SEVIERVILLE SEVIERVILLE SEVIERVILLE SEVIERVILLE SEVIERVILLE SEYMOUR SEYMOUR SHELBYVILLE SHELBYVILLE SIGNAL MOUNTAIN SMITHVILLE SMITHVILLE SMITHVILLE SMYRNA SMYRNA SMYRNA SMYRNA SNEEDVILLE SNEEDVILLE SOMERVILLE SOMERVILLE SOMERVILLE SOUTH PITTSBURG SPARTA SPENCER SPRING CITY SPRING CITY SPRING HILL SPRING HILL SPRINGFIELD SPRINGFIELD STRAWBERRY PLAINS SURGOINSVILLE SWEETWATER SWEETWATER TALBOTT TAZEWELL TAZEWELL TAZEWELL

State

ZIP code

TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN TN

38375 38375-2304 37862-6928 37862-3617 37862-4319 37862-6921 37862-6938 37862-3418 37865-5045 37865-4766 37160-3235 37160-2608 37377-3065 37166-1117 37166-2016 37166-1142 37167-5689 37167 37167-3012 37167 37869 37869-3648 38068 38068 38068 37380-1305 38583 38585-3214 37381-5197 37381-4037 37174-4412 37174 37172-3508 37172-2905 37871-1015 37873 37874-2705 37874-1921 37877 37879-4350 37879-4323 37879-4339

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TELLICO FAMILY WELLNESS CENTER TAYLOR BROTHERS PHCY TIPTONVILLE MIKE'S PHARMACY DUNCAN'S EXPRESS PHARMACY EDDIES PHARMACY TROY PHARMACY COMMUNITY PHARMACY TULLAHOMA DRUG STORE INC KIZER PHARMACY LLC FOOD CITY PHARMACY

Provider Name

(423) 253-6003 (731) 253-0153 (931) 592-9190 (731) 855-0500 (731) 855-1000 (731) 536-4848 (931) 571-8644 (931) 455-5409 (731) 885-2226 (423) 442-4501

707 VETERANS MEMORIAL DR 650 CARL PERKINS PKWY 740 MAIN ST 2017 S COLLEGE ST STE B 114 DAVY CROCKETT MALL 404 E HARPER ST 211 W CARROLL ST 100 WESTSIDE DR 1117 S MILES AVE STE 1 2120 HIGHWAY 411

TELLICO PLAINS TIPTONVILLE TRACY CITY TRENTON TRENTON TROY TULLAHOMA TULLAHOMA UNION CITY VONORE

TN TN TN TN TN TN TN TN TN TN

37385-4844 38079 37387-4020 38382-3934 38382-2934 38260-5946 37388-3401 37388-3253 38261-5439 37885

VONORE DRUG FAMILY WELLNESS CENTER APOTHECARE PHARMACY RIDDLE EXPRESS PHARMACY WARTBURG PHARMACY WATERTOWN DRUGS MAIN STREET DRUG DUREN PHARMACY DURENS CLINIC PHARMACY BROWN PHARMACY

(423) 884-6274 (423) 346-7800 (423) 346-7600 (423) 346-2700 (615) 237-0054 (931) 296-3703 (931) 722-5466 (931) 722-2296 (615) 644-0102

1121 HWY 411 1236 KNOXVILLE HWY 825 MAIN ST 1006 MAIN ST 406 PUBLIC SQ 211 W MAIN ST 215 DEXTER L WOODS MEMORIAL BL 107 JV MANGUBAT DR 1198 NEW HIGHWAY 52 E STE 100

VONORE WARTBURG WARTBURG WARTBURG WATERTOWN WAVERLY WAYNESBORO WAYNESBORO WESTMORELAND

TN TN TN TN TN TN TN TN TN

37885 37887-4200 37887-4145 37887-4150 37184-1421 37185-1510 38485-2416 38485-2440 37186-5032

THE PHARMACY AT HOPE FAMILY HEALTH WHITE BLUFF PRESCRIPTION LLC ESCUE FAMILY PRESCRIPTION SHOP WHITE HOUSE PHARMACY PLLC FOOD CITY PHARMACY SANITARY DRUG COMPANY WHITEVILLE COMMUNITY PHARMACY WHITWELL PHARMACY BENNETTS PHARMACY BLUE FRONT DRUG WOODSONS PHARMACY KING PHARMACY BARNES & WILLIAMS DRUG CENTER BARNES & WILLIAMS DRUG CENTER BIG COUNTRY PHARMACY DRUG EMPORIUM JAMES MC COY'S DRUG STORE JAMES MCCOYS DRUG STORE SOUTH OWEN PHARMACY SAV-ON PHARMACY TAYLOR COUNTY PHARMACY

(615) 644-6979 (615) 797-5899 (615) 672-7954 (615) 334-1212 (865) 674-7517 (865) 674-2526 (731) 859-5016 (423) 658-6939 (931) 967-2777 (931) 967-2251 (615) 563-4542 (806) 298-2222 (325) 677-9191 (325) 695-3781 (325) 704-5222 (325) 698-0442 (325) 677-2300 (325) 676-8900 (325) 691-9000 (325) 695-4690 (325) 704-4207

1124 NEW HIGHWAY 52 E 4516 HIGHWAY 70 E 614A HIGHWAY 76 491 SAGE RD N STE 1200 1212 STATE ST 1627 MAIN ST 2060 US HIGHWAY 64 STE G 13810 HIGHWAY 28 1201 DINAH SHORE BLVD 107 1ST AVE NW 304 W MAIN ST 920 AVENUE D 701 HICKORY ST 4601 S 14TH ST 3190 ANTILLEY RD STE B 2550 BARROW ST 839 N JUDGE ELY BLVD 1725 ANTILLEY RD 2125 S 20TH ST 4450 BUFFALO GAP RD 1640 STATE HWY 351

WESTMORELAND WHITE BLUFF WHITE HOUSE WHITE HOUSE WHITE PINE WHITE PINE WHITEVILLE WHITWELL WINCHESTER WINCHESTER WOODBURY ABERNATHY ABILENE ABILENE ABILENE ABILENE ABILENE ABILENE ABILENE ABILENE ABILENE

TN TN TN TN TN TN TN TN TN TN TN TX TX TX TX TX TX TX TX TX TX

37186-5060 37187-9220 37188-9354 37188-9363 37890-3467 37890-3302 38075-7476 37397-5365 37398-1107 37398-1643 37190-1125 79311-3437 79601-5005 79605-4734 79606-5015 79605-6235 79601-4624 79606-5204 79605-6066 79606-2703 79601-4746

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 580 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY AMERICARE INFUSION CENTERS LLC ASCRIPT RX METROCARE PHARMACY AT MIDWAY

Provider Name

(325) 673-4737 (325) 677-1362 (325) 698-7801 (972) 661-2273 (214) 643-6287 (972) 331-6370

2160 PINE ST 920 N WILLIS ST 3301 S 14TH ST 15800 DOOLEY RD STE 185 17051 DALLAS PKWY # 110 16160 MIDWAY RD STE 200

ABILENE ABILENE ABILENE ADDISON ADDISON ADDISON

TX TX TX TX TX TX

79601-2436 79603-4621 79605-5015 75001-4284 75001-7109 75001-4230

PHARMACY CARE USA OF ADDISON, LLC SANDERS DRUG STORE ALEDO MEDICINE STORE INC HALL'S LONGTERM CARE PHCY RUSHING AND GONZALEZ DRUG ALLEN FAMILY DRUG COLLIN DRUGS UNITED MARKET STREET PHARMACY CITY DRUG STORE HIGHLAND DRUG INC PRESCRIPTION SHOP B & B PHARMACY HEALTH PLUS PHARMACY RICHARDS PHARMACY WELL-CARE PHARMACY & DME ALVARADO PHARMACY ALVIN CARE PHARMACY MEDIC ONE PHARMACY PARKWOOD PHARMACY #1000 2136807O PHARMACEUTICAL CARE ADC RX INC AMARILLO PHARMACY AVONDALE PHARMACY, INC CASH SAVER COST PLUS PHARMACY CATCHINGS PRESCRIPTION CENTRX PHARMACY AT NW TX DRUG EMPORIUM GRAND PHARMACY

(972) 388-1800 (325) 762-3979 (817) 441-2702 (817) 441-5211 (361) 664-4368 (972) 390-9888 (214) 383-2444 (972) 908-3840 (432) 837-2252 (432) 837-3931 (432) 837-3498 (936) 858-4311 (956) 424-3535 (956) 584-7772 (956) 271-1555 (817) 783-2727 (281) 698-0987 (281) 824-0222 (281) 968-7946 (806) 356-4620 (806) 358-0331 (806) 803-9401 (806) 352-2708 (806) 359-8528 (806) 355-1922 (806) 553-2455 (806) 358-1800 (806) 350-7455

4500 RATLIFF LN STE 102 104 S MAIN ST 621 N FM 1187 621 #A FM 1187 301 E MAIN ST 317 CENTRAL EXPWY N 600 W MCDERMOTT DR STE A 985 W BETHANY DR 202 E AVENUE E 504 E AVENUE E 909 E HOLLAND AVE 272 N MARCUS ST 1315 W MAIN AVE STE 12 3509 E MAIN AVE STE 102 8115 N LOS EBANOS STE 5 208 N PARKWAY DR 204 E HOUSE ST 400 MEDIC LN STE C 104 W SEALY ST 1400 S COULTER ST 6700 W 9TH AVE 6010 S WESTERN ST STE 100 5135 PLAINS BLVD 2200 BELL ST 1900 S COULTER ST STE F 1501 S COULTER ST STE A 4210 W 45TH AVE STE B 3500 NE 24TH AVE

ADDISON ALBANY ALEDO ALEDO ALICE ALLEN ALLEN ALLEN ALPINE ALPINE ALPINE ALTO ALTON ALTON ALTON ALVARADO ALVIN ALVIN ALVIN AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75001-3272 76430-2575 76008-4384 76008 78332-4966 75013 75013-2798 75013-3740 79830-4728 79830-4816 79830-5023 75925-2148 78573-1643 78573-1562 78573 76009 77511-3544 77511 77511 79106-1786 79106-1729 79110-3612 79106-4515 79106-4602 79106-1793 79106 79109-0400 79107-6920

JO WYATT COMMUNITY HEALTHCARE CLNC KINGS COMPOUNDING PHARMACY MARTIN-TIPTON PHARMACY LLC MEDICAL SQUARE PHARMACY MEDI-PARK PHARMACY PRO MED LTC

(806) 351-7240 (806) 358-4576 (806) 373-2812 (806) 350-7451 (806) 359-5496 (806) 379-6966

1411 E AMARILLO BLVD 1600 S COULTER ST STE 307 1501 S TYLER ST 1215 S COULTER STE 101 1920 MEDI PARK DR 704 N POLK ST

AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO

TX TX TX TX TX TX

79107-5555 79106-1774 79101-4240 79106-1761 79106-2111 79107

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 581 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SOUTHPARK PHARMACY SOUTHPARK PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY NEIGHBORHOOD PHARMACY PRESCRIPTION SHOP ANGLETON HEALTH MART MEDICINE SHOPPE ANNA FAMILY PHARMACY ANSON PLAZA PHARMACY S & J ARGYLE PHARMACY A-CLASS PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ARLINGTON CANCER CENTER PHCY BALLPARK PHARMACY BECO PHARMACY DFW WELLNESS PHARMACY EXPRESS CARE PHARMACY GEESONS PHARMACY HCP PHARMACY IMIX RX PHARMACY KOHLER HOMECARE PHARMACY INC KVN PHARMACY M & A PHARMACY MATLOCK SPECIALTY PHARMACY MERIDIAN PHARMACY NEXGEN SPECIALTY PHARMACY NORTH COLLINS PHARMACY PATIENT RX SOLUTIONS PHARMACY PHARMACIA HENRIQUE PHARMACY DEPOT PHARMACY SOLUTIONS PRIMECARE PHARMACY RANDOL MILL LTC PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (806) 353-2428 (806) 358-2428 (806) 373-8722 (806) 352-6650 (806) 383-3345 (806) 373-7057 (806) 468-9911 (806) 353-7201 (806) 373-3341 (806) 467-6815 (432) 523-7000 (432) 523-4861 (979) 848-8878 (979) 849-9391 (972) 885-8812 (325) 823-3203 (940) 464-4500 (817) 466-7420 (817) 478-1313 (817) 478-4238 (817) 472-6458 (682) 236-7575 (682) 323-5258 (817) 419-2804 (817) 459-8400 (817) 861-2273 (817) 419-2688 (817) 349-6299 (817) 617-3460 (817) 861-4631 (817) 962-0417 (682) 222-7830 (817) 701-2535 (469) 330-8300 (817) 583-6611 (817) 795-8884 (817) 522-7005 (817) 701-1930 (682) 322-5528 (817) 274-0050 (817) 538-9767 (682) 235-1025

Provider Street 3324 S GEORGIA ST 5901 BELL ST STE C-32 3300 I-40 E 5601 W AMARILLO BLVD 3400 RIVER RD 1501 E AMARILLO BLVD 2530 S GEORGIA ST 5807 SW 45TH AVE STE 100 4701 S WASHINGTON ST 3552 S SONCY RD 801 N MAIN ST STE F 813 HOSPITAL DR 1104 E MULBERRY ST STE E 933 E MULBERRY ST 813 W WHITE ST STE 200 1150 W COURT PLZ 101 OLD TOWN BLVD SUITE 102 4907 S COLLINS ST STE 141 6220 US HWY 287 301 SOUTHWEST PLZ 5950 S COOPER ST 906 W RANDOL MILL RD STE 200 1900 BALLPARK WAY STE 104 3340 S WATSON RD 711 E LAMAR BLVD STE 101 905 MEDICAL CENTRE DR STE B 5201 S COOPER ST STE 117 3148 MATLOCK RD STE 507 1102 ORCHARD DR SUITE B 2204 PARK SPRINGS BLVD 4860 MATLOCK RD STE 120 8200 MATLOCK ROAD STE 150 3295 S COOPER ST STE 107 613 E ABRAM ST STE C 2233 AVENUE J STE 103 1915 E MAYFIELD RD STE 109 6407 SOUTH COOPER ST STE 113B 4201 INTERWAY PL STE A 1119 W RANDOL MILL RD STE 104 1921 W PIONEER PKWY 611 W MAIN ST 1014 N FIELDER RD STE 110

Page 582 of 679

Provider City AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO AMARILLO ANDREWS ANDREWS ANGLETON ANGLETON ANNA ANSON ARGYLE ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

79109-3446 79109-6263 79103-4801 79106-4141 79107-1800 79107-5554 79109-1927 79109-5291 79110-2619 79119-6672 79714-4029 79714-3618 77515-3952 77515-5075 75409-2613 79501-4315 76226 76018-1159 76001 76016-4438 76017-4456 76012-2510 76006 76014-2803 76011 76012-4755 76017-5964 76015-2923 76012 76013-5642 76018-5657 76002 76015-2359 76010-1253 76006-5884 76014-2605 76001-5813 76018 76012-6509 76013 76010-1008 76012-3149

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name RANDOL MILL PHARMACY RAY'S TOWN NORTH PHARMACY REMCO PHARMACY INC. REVCO HEALTHCARE PHARMACY TREASURE PHARMACY ASPERMONT PHARMACY ANDERSON DRUG GIBSON PRESCRIPTION PHARMACY RED RIVER PHARMACY OF ATLANTA ROBINSON FAMILY PHARMACY AUBREY PHARMACY SAVANNAH PHARMACY AM PHARMACY ASPCARES AURO PHARMACY AUSTIN CANCER CENTER PHARMACY AUSTIN COMPOUNDING PHARMACY AUSTIN DIAGNOSTIC CLINIC PHCY AVELLA OF AUSTIN INC COMMUNITYCARE CENTRAL PHARMACY EAST AUSTIN MEDICINE SHOP ECO PHARMACY OF SOUTH AUSTIN FARMACIA LIBERTAD FORTY ACRES PHARMACY GENORITE PHARMACY HEPCARE PHARMACY HILL COUNTRY APOTHECARY LAKE HILLS PHARMACY LAMAR FAMILY PHARMACY LAMAR PLAZA DRUG STORE LIBERTY PHARMACY LIBERTY PHARMACY LIFECARE PHARMACY OF AUSTIN NAUS ENFIELD LEGEND DRUG NORTHWEST HILLS AT DAVENPORT PAIN SPECIALISTS OF AUSTIN PHCY PEOPLES PHARMACY PEOPLES PHARMACY PEOPLES PHARMACY PEOPLES PHARMACY PILLPACK AUSTIN RITE AWAY PHCY & MED SUPPLY 3

NR_0009_10823 10/2017

Provider Phone Number (817) 274-1883 (817) 274-8221 (817) 460-4400 (817) 303-5100 (817) 617-3598 (940) 989-2139 (903) 675-5040 (903) 675-7069 (903) 799-7737 (903) 796-1730 (940) 440-0400 (940) 343-5069 (512) 270-4899 (214) 919-2520 (512) 206-3150 (512) 505-5500 (512) 327-7455 (512) 901-4797 (512) 368-2962 (512) 978-9011 (512) 643-0999 (512) 519-9248 (737) 202-4753 (512) 471-1824 (512) 351-9160 (512) 381-1708 (512) 487-5759 (512) 608-9355 (512) 765-5831 (512) 442-6777 (512) 249-7500 (512) 249-7500 (512) 953-0949 (512) 476-1221 (512) 329-8667 (512) 485-7207 (512) 459-9090 (512) 444-8866 (512) 327-8877 (512) 219-9499 (512) 537-3205 (512) 827-2600

Provider Street 1014 N FIELDER RD 975 N COOPER ST 1633 W DIVISION ST 2505 E ARKANSAS LN #133 2625 MATLOCK RD STE 102 616 S WASHINGTON 419 S PALESTINE ST 890 W CORSICANA ST 102 E ALLDAY ST 213 N PINECREST DR 701 S HIGHWAY 377 26795 E HWY 380 STE 800 10401 ANDERSON MILL RD #112B 13831 HIGHWAY 183 1139 W BRAKER LN STE 102 9715 BURNET RD STE 200 BLDG 7 3010 BEE CAVE RD STE 100 12221 N MOPAC EXPY STE 100 3016 GUADALUPE ST 2901 MONTOPOLIS DR 2115 E MARTIN LUTHER KING JR B 2555 WESTERN TRLS BLVD STE 103 9414 PARKFIELD DR UNIT A 100 W DEAN KEETON 5200 DAVIS LANE STE 110B 2200 PARK BEND DR BLDG 1 # 300 6611 RIVER PLACE BLVD STE 103 12005 BEE CAVE RD STE 1A 8738 N LAMAR BLVD STE C 1509 S LAMAR BLVD STE 550 8650 SPICEWOOD SPRINGS RD #106 8650 SPICEWOOD SPGS RD #106 1301 W 38TH ST STE 135 1115 W LYNN ST 3801 CAPITAL OF TX HWY N #D120 4100 DUVAL RD BLDG 3 STE 201 4018 N LAMAR BLVD 3801B S LAMAR BLVD 4201 WESTBANK DR 13860 N US HWY 183 STE C 220 INDUSTRIAL BLVD STE 100 730 W STASSNEY LN #160

Page 583 of 679

Provider City ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ASPERMONT ATHENS ATHENS ATLANTA ATLANTA AUBREY AUBREY AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

76012-3149 76011-5781 76012-3821 76010-8700 76015-2527 79502-0000 75751-2506 75751-2260 75551 75551-3130 76227 76227-7853 78750-2579 78750-1202 78758 78758-5390 78746-5526 78758-2494 78705-2861 78741-6411 78702-1341 78745 78758 78712 78749 78758-5387 78730 78738-6387 78753-5424 78704 78759-4323 78759-4323 78705-1033 78703-3951 78746 78759-4275 78756-3714 78704-7943 78746-4454 78750-1203 78745 78745

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RITE CARE PHARMACY II RITE-AWAY PHARMACY SETON CENTRAL OUTPATIENT PHCY SOUTH AUSTIN PHARMACY

Provider Name

(512) 717-9988 (512) 827-2250 (512) 324-7365 (512) 383-9000

3706 GUADALUPE ST STE C 2410 E RIVERSIDE DR STE D4 601 E 15TH ST 4203A JAMES CASEY ST

AUSTIN AUSTIN AUSTIN AUSTIN

TX TX TX TX

78705 78741-3053 78701 78745-1108

SPECIALTY PHARMACEUTICAL SOLUTIONS STONEGATE PHARMACY STONEGATE PHCY AT THE VILLAGE TARRYTOWN PHARMACY INC TARRYTOWN SPECIALTY PHARMACY THE DAILY DOSE PHARMACY VICTORY MEDICAL CENTER PHCY VINA PHARMACY ALBERTSON'S PHARMACY LAURA'S PHARMACY SULLIVAN PHARMACY FIESTA LIFECARE PHARMACY LLC BANDERA DRUG LLC RIPPETOE PHARMACY LOCK DRUG HIBBS PHARMACY MUECKE PRESCRIPTION SHOPPE BIRDSONGS PHARMACY BLUE RIBBON PHARMACY GOOSE CREEK PHARMACY LLC GR CURE MD PHARMACY SOUTHSIDE PHARMACY WELLNESS PHARMACY CHILDREN'S SPECIALTY PHARMACY COMMUNITY UNITED DRUGS GENOA-QOL HEALTHCARE KINGS PHARMACY BEAUMONT LUPARELLO'S CORNER PHARMACY MALLEYS FAMILY PHARMACY MARKET BASKET PHARMACY MARKET BASKET PHARMACY MARKET BASKET PHARMACY PECCIO PHARMACY PLUS PHARMBLUE TEXAS LLC ALBERTSON'S PHARMACY GREEN CROSS PHARMACY

(210) 375-4620 (512) 707-2300 (512) 693-4222 (512) 478-6419 (512) 617-3530 (512) 334-9697 (512) 279-0985 (512) 977-8844 (817) 270-1120 (817) 406-4546 (281) 339-4577 (972) 557-3535 (830) 796-3111 (325) 752-6133 (512) 321-2551 (979) 245-5501 (979) 244-1772 (281) 628-7186 (281) 838-8025 (281) 838-8640 (281) 428-0009 (281) 576-0106 (832) 831-8031 (281) 428-4705 (409) 838-5552 (409) 832-6539 (409) 203-7469 (409) 860-0040 (409) 842-3222 (409) 866-1429 (409) 835-4558 (409) 833-1298 (409) 892-2282 (409) 813-1717 (409) 299-8575 (817) 354-0991 (817) 354-7771

11209 METRIC BLVD STE B-4 2501 W WILLIAM CANNON DR # 203 5625 EIGER RD STE 150 2727 EXPOSITION BLVD STE 105 2727 EXPOSITION BLVD STE 100 4534 W GATE BLVD STE 111 4303 VICTORY DR 11207 N LAMAR BLVD STE A 480 NORTHWEST PKWY 605 NORTHWEST PKWY STE 150 1140 GRAND AVE 4202 PIONEER 1100 MULBERRY STREET 205 EAST HALL ST 103 HWY 71 WEST 1415 AVENUE G 2808 7TH ST 4002 GARTH RD STE 140A 3517 N MAIN ST 2007 N MAIN ST 1658 W BAKER STE C 11540 EAGLE DE STE A 2802 GARTH ROAD, STE 101 3007 GARTH RD 490 INTERSTATE 10 N STE 400 365 FORSYTHE ST 2750 S 8TH ST 3610 N MAJOR DR 3570 FANNETT RD 3110 CALDER AVE 655 LAVACA ST 3955 PHELAN BLVD 5960 HIGHWAY 105 3035 COLLEGE ST # B 1495 N 7TH ST STE B 1300 AIRPORT FWY 1305 AIRPORT FWY STE 110

AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AUSTIN AZLE AZLE BACLIFF BALCH SPRINGS BANDERA BANGS BASTROP BAY CITY BAY CITY BAYTOWN BAYTOWN BAYTOWN BAYTOWN BAYTOWN BAYTOWN BAYTOWN BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEAUMONT BEDFORD BEDFORD

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78758 78745-5253 78735-8980 78703-1227 78703-1229 78745-1468 78704-7507 78753 76020-3150 76020-2915 77518-2760 75180 78003 76823-0000 78602 77414-3505 77414-5306 77521-3179 77521-4117 77520-2746 77521-2271 77523 77521 77521 77702-1822 77701-3304 77701-7719 77713-9573 77705-1365 77702 77705-3811 77707-2223 77708-3700 77701-4607 77702 76022-6700 76021-6603

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 584 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

IMPULSE PHARMACY PHYSICIANS CHOICE INFUSION SCHULZ & WROTEN LEGEND PHCY

Provider Name

(682) 200-7869 (817) 484-0233 (361) 358-1150

3901 AIRPORT FWY 2700 TIBBETS DR STE 205 122 N WASHINGTON ST

BEDFORD BEDFORD BEEVILLE

TX TX TX

76021 76022-5928 78102-4509

TLC PHARMACY & MEDICAL EQUIPMENT AMEX PHARMACY AVITA PHARMACY CUSTOM MEDS PHARMACY, INC. MEDLEY COMPOUNDING PHARMACY PIN OAK PHARMACY PLATINUM RX WESTLANDS PHARMACY BELLS FAMILY DRUG WALTER'S PHARMACY INC BAYLOR SCOTT AND WHITE PHCY BENBROOK PHARMACY BIG LAKE PHARMACY NEIGHBORHOOD PHARMACY LEONARDS PRESCRIPTION PHARMACY WESTOVER PHARMACY STRICKLAND DRUGS BOERNE DRUG COMPANY RIVER ROAD PHARMACY ROCK PHARMACY LLC BONHAM FAMILY DRUG FANNIN PHARMACY BORGER PHARMACY UNITED PHARMACY BOWIE PHARMACY BOYD MEDICINE STORE CLINIC PHARMACY CITY DRUG OF BRADY INC MEDICINE MAN PHARMACY BRAZORIA UNITED PHARMACY MEDICAL ARTS DRUG COMPANY NORMAN'S PHARMACY BRIDGE CITY FAMILY PHARMACY GAIL'S PHARMACY VALU-RITE PHARMACY LIFECARE PHARMACY NELSON PHARMACY UNITED PHARMACY

(361) 362-9984 (832) 778-0400 (713) 592-0211 (832) 431-5449 (713) 838-1500 (713) 668-8686 (713) 667-6777 (713) 664-1400 (903) 965-7383 (979) 865-3696 (254) 933-6000 (817) 249-9595 (325) 884-2579 (325) 716-1800 (432) 263-7344 (432) 267-1611 (830) 833-4815 (830) 331-8183 (830) 816-5312 (830) 357-5052 (903) 583-7325 (903) 583-8017 (806) 274-9635 (806) 273-6427 (940) 872-1140 (940) 433-8056 (830) 563-9334 (325) 597-2325 (361) 894-6430 (254) 559-4080 (979) 836-3687 (979) 836-5264 (409) 735-5555 (940) 683-4011 (940) 683-2950 (806) 636-8000 (806) 637-3533 (806) 637-7597

200 S HILLSIDE DR 5420 BELLAIRE BLVD 6800 W LOOP S SUITE 225 4805 BISSONNET ST 5711 BISSONNET ST STE F 6700 WEST LOOP S STE 325 5420 WEST LOOP S STE 1500 5819 BISSONNET ST 103 W BELLS BLVD 250 W PALM ST 309 LAKE RD STE B 410 MERCEDES STREET 903 N MAIN AVE 116 N MAIN AVE 701 SCURRY ST 710 W MARCY DR 316 PECAN ST 725 N MAIN ST STE 2 910 RIVER RD STE 103 1201 S MAIN ST STE 121 100 E SAM RAYBURN DR 2108 N CENTER ST 524 W 10TH ST 1414 W WILSON ST 503 E LONDON 113 E ROCK ISLAND AVE 201 JAMES STREET 704 W 17TH ST 102 E SAN BERNARD ST 2802 W WALKER ST 207 E ACADEMY ST 2105 S DAY ST 1910 TEXAS AVE 810 W RAY CIRCLE 709 WOODROW WILSON RAY CIR 706 E FELT ST 805 TAHOKA RD 1401 TAHOKA RD

BEEVILLE BELLAIRE BELLAIRE BELLAIRE BELLAIRE BELLAIRE BELLAIRE BELLAIRE BELLS BELLVILLE BELTON BENBROOK BIG LAKE BIG LAKE BIG SPRING BIG SPRINGS BLANCO BOERNE BOERNE BOERNE BONHAM BONHAM BORGER BORGER BOWIE BOYD BRACKETTVILLE BRADY BRAZORIA BRECKENRIDGE BRENHAM BRENHAM BRIDGE CITY BRIDGEPORT BRIDGEPORT BROWNFIELD BROWNFIELD BROWNFIELD

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78102-5349 77401-3906 77401 77401-4028 77401-4724 77401-4104 77401-2116 77401 75414-3574 77418-1361 76513-1513 76126 76932-3201 76932-5211 79720-2722 79720-4122 78606-2607 78006-1623 78006 78006-2839 75418-4333 75418-2627 79007-2802 79007-4420 76230 76023-3070 78832-0000 76825-6936 77422-5647 76424-4000 77833-3207 77833-5512 77611-2834 76426 76426 79316-3440 79316 79316-4828

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 585 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name AUTREY PHARMACY AUTREY PHARMACY 2 AUTREY PHARMACY 3 AUTREY PHARMACY 4 COMPLETE RX PHARMACY GENOA-QOL HEALTHCARE LAS PALMAS PHARMACY LOS EBANOS PHARMACY, LLC OCEAN PLAZA PHARMACY PETES PHARMACY II THE FRIENDLY PHARMACY THE PHARMACY AT UPTOWN UNITED CARE PHARMACY VALLEYWIDE PHARMACY AND DME DOCS DRUGSTORE JACOBS FAMILY PHARMACY LIVE OAK PHCY UNITED PHARMACY ST JOSEPH PHARMACY THE PHARMACY CORNER LTD VILLAGE FOODS BUNA FAMILY PHARMACY BOOMTOWN DRUG UNITED PHARMACY ALBERTSON'S PHARMACY BEST VALUE WEST RON'S APOTHECARY SHOP LAKES AREA PHARMACY BAYLOR SCOTT & WHITE PHCY MEDIC PHARMACY & GIFTS PEACE PHARMACY INC MEDI DRIVE PHARMACY UNITED PHARMACY LONE STAR PHARMACY LIFECHEK DRUG #52 ALBERTSON'S PHARMACY BAYLOR MED PLAZA PHCY CAROLTON CARE RX PHARMACY EXPRESS CARE PHARMACY GENERX DISCOUNT PHARMACY HEBRON PHARMACY PEOPLE FIRST PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (956) 548-0801 (956) 542-5100 (956) 230-3200 (956) 621-1000 (956) 554-3532 (956) 404-0202 (956) 542-7400 (956) 542-8542 (956) 504-1290 (956) 504-9555 (956) 544-1200 (956) 544-0237 (956) 546-0444 (956) 372-1405 (325) 643-3800 (325) 646-1100 (915) 643-2648 (325) 510-3400 (979) 690-4801 (979) 776-0902 (979) 846-8199 (409) 994-3535 (940) 569-5600 (940) 569-3319 (817) 447-8060 (817) 295-6128 (817) 295-2273 (512) 756-8550 (254) 605-1150 (806) 323-6171 (903) 567-4129 (806) 655-1024 (806) 655-5757 (830) 964-3615 (830) 876-2516 (972) 446-8231 (972) 512-1581 (469) 758-2240 (214) 800-5526 (972) 417-8895 (972) 394-7015 (972) 300-4130

Provider Street 1205 CENTRAL BLVD 1365 E RUBEN TORRES BLVD 800 E. ALTON GLOOR BLVD UNIT B 3503 BOCA CHICA BLVD STE 1 1885 E PRICE RD STE B 861 OLD ALICE RD STE 109 864 CENTRAL BLVD STE 1200 1134 E LOS EBANOS BLVD 1740 BOCA CHICA BLVD STE 400 5235 SOUTHMOST RD STE C 3302 BOCA CHICA BLVD STE 107 100 UPTOWN AVE # 110-B 1755 W PRICE RD 680 PAREDES LINE RD STE B 3800 HIGHWAY 377 S 2701 AUSTIN AVE 3707 AUSTIN AVE 300 E COMMERCE ST 2601 OSLER BLVD 3201 UNIVERSITY DR E STE 145 1760 BRIARCREST DR 351 TX ST HWY 62 514 S OKLAHOMA CUT OFF 311 S AVENUE D 833 NE ALSBURY BLVD 124 W RENFRO ST 117 W RENFRO ST 608 BUCHANAN DR 101 LAFFERTY STE A 200 CHEYENNE AVE 300 S BUFFALO ST 507 23RD ST 201 N 23RD ST 1395 SATTLER RD #8 314 N 5TH ST 2150 N JOSEY LN STE 400 4323 N JOSEY LN STE 102 2138 N JOSEY LN STE 100 3648 OLD DENTON RD STE 104 1235 S JOSEY LN STE 533 4100 FAIRWAY DR STE 500 2501 E HEBRON PKWY # 100A

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Provider City BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNSVILLE BROWNWOOD BROWNWOOD BROWNWOOD BROWNWOOD BRYAN BRYAN BRYAN BUNA BURKBURNETT BURKBURNETT BURLESON BURLESON BURLESON BURNET CAMERON CANADIAN CANTON CANYON CANYON CANYON LAKE CARRIZO SPRINGS CARROLLTON CARROLLTON CARROLLTON CARROLLTON CARROLLTON CARROLLTON CARROLLTON

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78520-7531 78521-0964 78526 78521 78521-3193 78520-8551 78520-7501 78520-8730 78520 78521-8056 78521-4271 78520-7559 78520-8602 78521-2482 76801-5120 76801-5834 76801-6626 76801-1824 77802-2516 77802-3481 77802-2711 77612 76354-3600 76354-3541 76028-2659 76028-4260 76028-4233 78611-2306 76520-3685 79014-3018 75103-1316 79015-4043 79015-2516 78133 78834-3100 75006-2993 75010-4630 75006-3034 75007-7977 75006-7665 75010-6525 75010-4403

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SMILE PHARMACY TRINITY APOTHECARY TRINITY PHARMACY VITAL CARE PHARMACY II QRC HEALTHMART PHARMACY ALBERTSON'S PHARMACY SPECIALTY COMPOUNDING, LLC CELINA DRUG CAROL'S PHARMACY CHANDLER DRUG LLC CHANNELVIEW PHARMACY LLC CHILDRESS OUTPOST PHARMACY UNITED PHARMACY CHINA FAMILY PHARMACY CLARENDON OUTPOST INC MIKES PHARMACY BLACKMON PHARMACY ALBERTSON'S PHARMACY BEST VALUE ROYCE'S CLEBURNE DRUG CLEVELAND PHARMACY ALBRECHT'S PHARMACY INC PILL BOX DRIVE IN PHCY UNITED PHARMACY OWL DRUG STORE TYSON PHARMACY BAYLOR SCOTT & WHITE PHARMACY GOLDSTAR PHARMACY SCOTT & WHITE PHARMACY SCOTT AND WHITE PHCY ALBERTSON'S PHARMACY UNITED PHARMACY VILLAGE LANE APOTHECARY CORNER DRUG THE MEDICINE PLACE COMANCHE COUNTY MEDICAL CENTER COMANCHE PHARMACY THE DRUG SHOP TOTAL CARE PHARMACY COLLEGE PARK PHARMACY GENOA-QOL HEALTHCARE GHPMA PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (972) 446-9191 (972) 492-2151 (214) 521-9991 (214) 483-5700 (830) 931-2116 (214) 324-1491 (512) 219-0724 (972) 382-2832 (903) 536-7326 (903) 849-6442 (281) 457-0523 (940) 937-9030 (940) 937-8242 (409) 752-3450 (806) 874-5202 (806) 874-3554 (903) 427-2805 (817) 641-6030 (817) 645-2445 (817) 645-2415 (281) 593-3800 (254) 675-8398 (254) 675-8659 (325) 893-4297 (325) 625-2178 (325) 625-4136 (979) 207-0120 (979) 690-9112 (979) 207-3900 (979) 207-6333 (817) 354-0109 (817) 577-5030 (817) 717-2000 (325) 728-8030 (325) 728-3489 (254) 879-4980 (325) 356-2585 (800) 597-5459 (903) 886-8888 (936) 321-4011 (281) 602-0100 (936) 788-7700

Provider Street 2625 OLD DENTON RD STE 586 2501 E HEBRON PKWY STE 100B 1925 E ROSEMEADE PKY 1927 E BELTLINE RD STE 146 408 US HIGHWAY 90 W STE B 427 E FM 1382 211 S BELL BLVD 701 N PRESTON RD STE 210 316 SOUTH COMMERCE 201 STATE HIGHWAY 31 E 441 SHELDON RD STE C 1103 AVENUE F NW 2105 AVENUE F NW 207 E RAILROAD ST 619 W 2ND 501 W 2ND 201 S WALNUT ST 210 W KATHERINE P RAINS RD 502 N MAIN ST 501 N RIDGEWAY DR 111 S WILLIAM BARNETT AVE 506 W 5TH ST 210 POSEY AVE 505 S ACCESS RD 312 S COMMERCIAL AVE 215 W PECAN ST 700 SCOTT & WHITE DR STE 1.112 4421 STATE HWY 6 S STE 300 1110 EARL RUDDER FWY S 1296 ARRINGTON RD STE 200 4000 GLADE RD 5605 COLLEYVILLE BLVD 60 VILLAGE LN 1001 HICKORY 2250 CHESTNUT ST 10201 HIGHWAY 16 1001 N AUSTIN ST 404 HIGHWAY 27 1607 LIVE OAK ST 3115 COLLEGE PARK DR STE 103A 233 SGT ED HOLCOMB BLVD S #100 3251 I-45 NORTH STE 190

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Provider City CARROLLTON CARROLLTON CARROLLTON CARROLLTON CASTROVILLE CEDAR HILL CEDAR PARK CELINA CENTERVILLE CHANDLER CHANNELVIEW CHILDRESS CHILDRESS CHINA CLARENDON CLARENDON CLARKSVILLE CLEBURNE CLEBURNE CLEBURNE CLEVELAND CLIFTON CLIFTON CLYDE COLEMAN COLEMAN COLLEGE STATION COLLEGE STATION COLLEGE STATION COLLEGE STATION COLLEYVILLE COLLEYVILLE COLLEYVILLE COLORADO CITY COLORADO CITY COMANCHE COMANCHE COMFORT COMMERCE CONROE CONROE CONROE

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75007-5125 75010-4468 75007-2438 75006-5814 78009-4548 75104-6027 78613-2909 75009-3814 75833 75758-2378 77530-3542 79201-3409 79201-2219 77613 79226-0000 79226 75426-3737 76033-5018 76033-3806 76033-5111 77327-4541 76634-1615 76634 79510 76834-4214 76834-4147 77845-6441 77845-6176 77840-2626 77845-8653 76034-5901 76034-6022 76034-2928 79512 79512 76442-4462 76442-1701 78013-2173 75428-4441 77384-4173 77304 77304-2185

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LIFECHEK DRUG MEDICAP PHARMACY

Provider Name

(936) 441-4900 (936) 494-4002

690 S LOOP 336 W STE 100 2105 W DAVIS ST STE A

CONROE CONROE

TX TX

77304-3320 77304-2062

RICHIE'S PHARMACY & MEDICAL SUPPLY ROBERDS PHARMACY VILLAGE PHARMACY DAVITA RX FIFTY50 PHARMACY PHARMACY PLUS UNITED MARKET STREET PHARMACY MEDICAL ARTS PHARMACY ALBERTSON'S PHARMACY ASPCARES DELEONS PHARMACY INC MEDICAL PLAZA PHARMACY NICHOLS SOUTHSIDE PHARMACY INC PEDIATRIC PHARMACY PROVIDENCE CARE PHARMACY PROVIDENCE CARE PHARMACY RC PHARMACY SUNRISE PHARMACY INC HOMETOWN PHARMACY OLE PHARMACY P & S REXALL PHARMACY P AND S REXALL PHARMACY INC GADDIS PHARMACY CRANDALL PHARMACY CRANE PHARMACY DAVY CROCKETT DRUG REGIONAL PHARMACY LARSONS PHARMACY SHAW'S PHARMACY-CROWELL GATEWAY PHARMACY LIFECHEK DRUG REUSS PHARMACY A PLUS PHARMACY CY SPRINGS PHARMACY CYPRESS PHARMACY FAIRFIELD PHCY/COMPOUNDING MEDI PRO INTERNATIONAL NORTH CYPRESS VILLAGE PHARMACY BOWERS PRESCRIPTION SHOP

(936) 588-6337 (936) 756-4254 (936) 756-7456 (972) 538-8100 (972) 243-2727 (972) 462-9400 (469) 322-6815 (254) 547-4146 (940) 321-4361 (361) 221-4778 (361) 882-3636 (361) 387-0005 (361) 852-8288 (361) 855-3811 (361) 991-0251 (361) 991-2191 (361) 334-3493 (361) 887-9226 (903) 872-3784 (903) 874-2152 (903) 874-5691 (903) 874-5121 (830) 879-2323 (972) 427-6442 (432) 558-2411 (936) 544-2275 (806) 675-2001 (940) 657-3210 (940) 684-1581 (817) 297-2000 (830) 374-3436 (361) 275-3411 (281) 858-5353 (832) 427-6694 (281) 213-3490 (281) 758-4040 (281) 277-0111 (832) 912-6210 (806) 249-4343

12820 HIGHWAY 105 W 503 MEDICAL CENTER BLVD STE 13 1336 LEAGUE LINE RD STE 100 1234 LAKESHORE DR STE 200 440 WRANGLER DR #500 580 S DENTON TAP RD STE 121 700 N DENTON TAP RD 806 E AVENUE D STE A 4351 FM 2181 1521 S STAPLES ST STE 605 613 ELIZABETH ST STE 103 13725 NORTHWEST BLVD STE 130 3141 GOLLIHAR RD 3435 S ALAMEDA ST 4613 S STAPLES ST STE E 6434 SARATOGA BLVD 5633 S STAPLES ST STE 700A 2601 HOSPITAL BLVD 2800 W STATE HIGHWAY 22 100 N 15TH ST 829 N MAIN ST 829 N MAIN ST STE C 302 N MAIN ST 1317 E US HIGHWAY 175 STE 1000 515 S ALFORD ST 107 S 4TH ST 622 W MAIN ST 109 NE 2ND ST 102 E COMMERCE 921 E FM 1187 E STE A 224 E ZAVALA ST 515 N ESPLANADE ST 8190 BARKER CYPRESS RD STE 800 7630 FRY RD STE 500 17330 SPRING CYPRESS RD #160 15201 MASON RD STE 700 13203 FRY RD STE 400 21212 NORTHWEST FWY STE 101 121 E TEXAS BLVD

CONROE CONROE CONROE COPPELL COPPELL COPPELL COPPELL COPPERAS COVE CORINTH CORPUS CHRISTI CORPUS CHRISTI CORPUS CHRISTI CORPUS CHRISTI CORPUS CHRISTI CORPUS CHRISTI CORPUS CHRISTI CORPUS CHRISTI CORPUS CHRISTI CORSICANA CORSICANA CORSICANA CORSICANA COTULLA CRANDALL CRANE CROCKETT CROSBYTON CROSS PLAINS CROWELL CROWLEY CRYSTAL CITY CUERO CYPRESS CYPRESS CYPRESS CYPRESS CYPRESS CYPRESS DALHART

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77304-1574 77304-2928 77304-3457 75019-4971 75019 75019-4072 75019-2162 76522-2231 76210-4215 78404-3166 78404 78410-5123 78415-5057 78411-1728 78411-2605 78414-3425 78411-4646 78405-1815 75110-2454 75110-5115 75110-3048 75110-3048 78014-2153 75114-2548 79731-2517 75835-2024 79322-2243 76443 79227 76036-4364 78839-3512 77954-3603 77433-2280 77433-3376 77429 77433-5978 77433-3690 77429-5884 79022-4319

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 588 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

UNITED PHARMACY AA PHARMACY LLC ACORN PHARMACY INC AHF PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALDRIDGE'S FMLY UNTDDRUG ALTA CARE PHARMACY AVITA DRUGS BAYLOR MEDICAL PLAZA PHARMACY

Provider Name

(806) 249-4772 (469) 351-3462 (214) 887-0744 (214) 599-7020 (214) 319-8221 (972) 732-6863 (214) 943-2322 (214) 330-5700 (214) 943-5187 (214) 820-3451

1601 TENNESSEE AVE 17826 DAVENPORT RD STE B 5315 ROSS AVE 3920 CEDAR SPRINGS RD 320 CASA LINDA PLZ 4625 FRANKFORD RD 1408 BONNIE VIEW RD 3434 W ILLINOIS AVE STE 7 219 SUNSET AVE STE 118-A 3600 GASTON AVE STE 109

DALHART DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS

TX TX TX TX TX TX TX TX TX TX

79022-5110 75252-5876 75206-7418 75219-3518 75218-3414 75287-7108 75203-4507 75211-8709 75208-4599 75246-1801

BAYLOR SCOTT & WHITE PHARMACY #111 BLUITTS PHARMACY BUCKEYE PHARMACY BUCKNER NEIGHBORHOOD PHARMACY CHB PHARMACY DALLAS HEALTHCARE PHARMACY DALLAS MENTAL HEALTH CENTER PHCY DALLAS MH CLINIC PHARMACY DEVONSHIRE PHARMACY DOUGHERTYS PHARMACY, INC.

(214) 818-1611 (214) 941-1258 (214) 391-7441 (214) 321-3002 (972) 661-1293 (214) 388-5334 (214) 275-7393 (214) 743-1229 (214) 812-9399 (214) 373-5300

3417 GASTON AVE STE 195 2809 CEDAR CREST BLVD 1401 S BUCKNER BLVD #127 3535 N BUCKNER BLVD STE 106 14211 COIT RD 4131 S BUCKNER BLVD STE A 4645 SAMUELL BLVD STE 107 1380 RIVER BEND DR STE 140-P 5445 LA SIERRA DR STE 202 5959 ROYAL LN STE 515

DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS

TX TX TX TX TX TX TX TX TX TX

75246-2016 75203-4009 75217-1704 75228-5633 75254-2862 75227 75228-6885 75247-4914 75231 75230-3890

DOUGHERTYS PHCY @ PRESTON & CAMPBEL ELAM ROAD PHARMACY EXTENDCARE PHARMACY SERVICES FAMILY PHARMACY #3 FAMILYCARE PHARMACY FIESTA LIFECARE PHARMACY 3, LLC FIESTA LIFECARE PHARMACY LLC FIRST PHARMACY FIRST PHARMACY PAVILION FOREST DRUG STORE LLC FORNEY PHARMACY GASTON PHARMACY GASTON PHARMACY GLOBE PHARMACY GROVE PHARMACY HAMPTON PHARMACY INFUSION SPECIALISTS KK'S PHARMACY LA PLAZA PHARMACY LANCASTER ADULT OP DCMHMR

(972) 860-0229 (214) 391-6363 (214) 521-9991 (469) 917-9300 (214) 357-3303 (972) 289-9083 (214) 421-1067 (214) 456-2879 (214) 456-0641 (469) 729-2968 (972) 552-2666 (469) 466-1242 (214) 434-1964 (972) 290-0862 (214) 391-2414 (972) 707-8248 (877) 778-9001 (214) 337-7770 (214) 654-0046 (214) 371-6639

6090 CAMPBELL RD STE 100 9209 ELAM RD STE 105 6901 PRESTON RD 5101 ROSS AVE STE 100 9991 MARSH LN STE 200 10121 E LAKE JUNE ROAD 3230 MARTIN LUTHER KING 1935 MEDICAL DISTRICT DR 2350 STEMMONS FREEWAY # F1510 9550 FOREST LN STE 606 13601 PRESTON RD STE 720 E 1260 W SPRING VALLEY RD STE B 712 N WASHINGTON AVE STE 500 2223 SINGLETON BLVD 1143 S BUCKNER BLVD 2701 SOUTH HAMPTON RD #100 5442 LA SIERRA DR STE 200 2480 W ILLINOIS AVE 9616 WEBB CHAPEL RD 3330 S LANCASTER AVE

DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75248-1222 75217-7359 75205-1136 75206-7762 75220-1709 75217 75210 75235-7701 75207 75243-6176 75240 75080 75246-1645 75212-3783 75217-4304 75224-2368 75231-4108 75233-1106 75220-4940 75216-4531

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 589 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

LIFECARE PHARMACY LLC LIFECARE PHCY OF DALLAS LLC LONGHORN PHARMACY LORD AND A. PHARMACY INC. LOT PHARMACY MAPLEWOOD PHARMACY MARK'S PHARMACY MD KIDS PEDIATRICS PHARMACY MEDPHARMA PHARMACY MERIDIAN PHARMACY GROUP METROCARE PHARMACY AT LIFENET MEYERLAND PHARMACY MI DOCTOR PHARMACY WYNNEWOOD MI DOCTOR PHCY SPRING VALLEY MI DOCTOR WEBB CHAPEL MINYARD PHARMACY MINYARD PHARMACY MINYARD PHARMACY 40 N TEXAS INFUSN & SPCIALTY PHCY OAK CLIFF PHARMACY OMEGA PHARMACY OUTPATIENT PHCY AT THE CANCER CTR PALMER PHARMACY PLUS INC PANACEA RX PHARMACY PARAGON HLTHCARE SPECIALTY LLC PARAGON INFUSION CARE PHAM FAMILY PHARMACY INC PHARMACARE DRUG

Provider Name

(214) 351-0007 (214) 942-7300 (214) 330-2253 (214) 421-3133 (214) 888-8100 (844) 627-9663 (469) 547-2419 (214) 331-0567 (972) 498-1818 (214) 333-1600 (469) 899-3200 (713) 728-8000 (214) 845-4001 (972) 957-3000 (972) 957-3000 (214) 374-3559 (214) 376-2709 (972) 387-8977 (214) 276-5616 (214) 371-2815 (214) 599-8844 (214) 820-8400 (214) 765-9238 (214) 339-2352 (888) 588-1072 (972) 588-1000 (210) 366-1212 (972) 247-5670

3630 FOREST LN 9709 BRUTON RD STE 900 2301 S HAMPTON RD STE 850 2949 M L KING JR BLVD 5710 LYNDON B JOHNSON FWY STE 2515 INWOOD RD STE 107 8150 BROOKRIVER DR STE 107 3201 W SANER AVE 2600 N STEMMONS FWY STE 164 2815 S HAMPTON RD 9708 SKILLMAN ST 4043 TRINITY MILLS RD STE 112 655 W ILLINOIS BLD 900 #916 8112 SPRING VALLEY RD 9753 WEBB CHAPEL RD STE 900 2130 E LEDBETTER 1201 W CAMP WISDOM 7007 ARAPAHO RD 3409 WORTH ST STE 725 3436 S POLK ST 4507 MAPLE AVE STE 100 3410 WORTH STREET STE 240 2731 W NORTHWEST HWY STE 105 1050 N WESTMORELAND RD 17111 PRESTON RD STE 150 17111 PRESTON RD STE 160 11722 MARSH LN STE 343 2552 ROYAL LN

DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75229 75217 75224 75215 75240-6324 75235-7400 75247 75233-1430 75207-2107 75224-2329 75243-5150 75287-6758 75224 75240-3829 75220-3513 75216-7435 75232-3405 75248-4158 75246 75224-3804 75219-1830 75246 75220-4782 75211-2444 75248 75248-1232 75229-2682 75229-3417

PHARMACY AND SURGICAL SUPPLIES INC PLAZA MEDICAL PHARMACY

(469) 283-8878 (214) 855-0606

10300 SCYENE RD # 102 700 N PEARL ST STE N208

DALLAS DALLAS

TX TX

75227-4932 75201-7430

PRESBYTERIAN VILLAGE NORTH PHARMACY PRESTON ROAD APOTHECARY PRESTON ROAD PHARMACY PRESTON VILLAGE PHARMACY PRIDE PHARMACY-CARLISLE LLC RAVENS PHARMACY REDBIRD PHARMACY RITE CARE PHARMACY RX SQUARE PHARMACY SAFEMED PHARMACY

(214) 355-9082 (214) 361-6172 (214) 521-9991 (972) 866-0017 (214) 954-7389 (214) 946-1700 (972) 982-2970 (214) 421-2210 (214) 238-3619 (972) 412-7373

8600 SKYLINE DR 9301 N CENTRAL EXPY STE 110 6901 PRESTON RD 12606 GREENVILLE AVE #175 4015 LEMMON AVE # 4001 820 N ZANG BLVD STE 120 1251 E RED BIRD LN STE 120 7560 GREENVILLE AVE 4305 W WHEATLAND RD STE 110 6300 SAMUELL BLVD STE 116

DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS

TX TX TX TX TX TX TX TX TX TX

75243-4198 75231-0802 75205-1136 75243 75219-3737 75208-4233 75241-2008 75231-3802 75237 75228

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 590 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SALUD PHARMACY SALUD PHARMACY SILVA PHARMACY SINA RX PHARMACY SINA RX PHARMACY SMA PHARMACY SMU HEALTH CENTER PHARMACY THE FARMACY

Provider Name

(214) 946-3886 (972) 283-0730 (214) 484-4130 (214) 350-6600 (214) 570-1610 (972) 274-0256 (214) 768-2149 (469) 814-0919

611 W JEFFERSON #800 2225 W LEDBETTER DR STE 500 939 W JEFFERSON BLVD STE 101 3460 WEBB CHAPEL EXT 8060 SPRING VALLEY RD 1110 E PLEASANT RUN RD 6211 BISHOP BLVD. 18484 PRESTON RD STE 112

DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS

TX TX TX TX TX TX TX TX

75208-4873 75224-4713 75208-5050 75220-6751 75240-3827 75115 75205 75252-5474

TX HEALTH PRESCRIPTION SHOP - PEROT

(214) 345-2595

8160 WALNUT HILL LN STE 112

DALLAS

TX

75231-4340

UT SOUTHWESTERN CAMPUS PHARMACY UT SOUTHWESTERN SPEC RET PHCY VITAL CARE PHARMACY WALNUT PLACE PHARMACY WESTMORELAND ADULT OC DCMHMR WHITE ROCK PHARMACY W-TEE PHARMACY GR CURE PHARMACY DEKALB PHARMACY DE LEON PHARMACY BEST VALUE RENSHAW S & J MEDICAL CENTER PHARMACY ALBERTSON'S PHARMACY CENTRX PHARMACY AT TEXOMA MED CHOICE PHARMACY MEDICINE SHOPPE PARKS DRUG ADDIS PHARMACY INC ALBERTSON'S PHARMACY ASPCARES COMMUNITY PHARMACY DENTON PHARMACY DENTON PRESCRIPTION SHOP DRUG EMPORIUM PREMIUM FAMILY PHARMACY S & J SCRIPTURE ST PHARMACY DENVER CITY PHARMACY LIBERTY DRUG ADAMS PHARMACY ALBERTSON'S PHARMACY GREENCARE PHARMACY

(214) 633-4600 (214) 645-6828 (214) 324-5100 (214) 361-8923 (214) 330-0036 (214) 660-1603 (214) 467-9009 (936) 681-8335 (903) 667-0880 (254) 893-2666 (940) 627-5343 (940) 627-5400 (903) 465-6182 (903) 327-8808 (903) 463-6979 (903) 463-3985 (903) 465-0048 (940) 382-0079 (940) 383-1696 (940) 383-1222 (940) 382-1618 (940) 600-5484 (940) 382-6758 (940) 387-1290 (940) 442-6767 (940) 484-0100 (806) 592-3333 (806) 592-2765 (972) 223-0444 (972) 223-3134 (972) 780-5999

5303 HARRY HINES BLVD 6333 FOREST PARK STE BLA 126 3453 SAINT FRANCIS AVE 5515 GLEN LAKES DR 1350 N WESTMORELAND RD 9037 GARLAND RD 2409 ALCO AVE 108-B NORTH MAIN 120 W FRONT ST 309 S TEXAS ST 800 MEDICAL CENTER DR STE A 1101 W EAGLE DR STE C 200 W CRAWFORD ST 5012 S US HIGHWAY 75 STE 140 2300 W MORTON ST STE 121 2810 W MORTON ST STE 102 1926 W MORTON ST 3305 S MAYHILL ROAD #101 2321 W UNIVERSITY DR 2436 S I-35 E STE 360 4400 TEASLEY LN STE 100 1620 W UNIVERSITY DR 2501 W OAK ST STE 100 824 W UNIVERSITY DR 1512 TEASLEY LANE STE A 1612 SCRIPTURE ST 105 E BROADWAY ST 403 MUSTANG DR 309 N HAMPTON RD 1300 W BELT LINE RD 941 YORK DR STE 201

DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DALLAS DAYTON DE KALB DE LEON DECATUR DECATUR DENISON DENISON DENISON DENISON DENISON DENTON DENTON DENTON DENTON DENTON DENTON DENTON DENTON DENTON DENVER CITY DENVER CITY DESOTO DESOTO DESOTO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75390-7208 75390 75228-7199 75231-4309 75211-1654 75218-3919 75211 77535 75559-1308 76444-1945 76234-3844 76234-3721 75020-4604 75020-4599 75020-1600 75020-3251 75020-1617 76208 76201-1649 76205-4900 76210-3403 76201-1765 76201-2331 76201-1846 76205 76201-3809 79323-3225 79323-2749 75115-4915 75115-3628 75115-2066

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 591 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HEALTHFIRST PHARMACY SANTA FE PHARMACY DILLEY DRUG STORE LC O K PHARMACY INC RICHARDS PHARMACY DRIPPING SPRINGS PHARMACY SOLUTIONS PHARMACY BEST VALUE DUBLIN PHCY ROGERS PHARMACY INC ROGERS PHARMACY INC BEN FRANKLIN APOTHECARY PRUDENTIAL PHARMACY INC TEXAS HEALTH RX EAGLE LAKE UNITED DRUG LUNAS FRIENDLY PHARMACY DOCS DRUGSTORE OF EARLY SAVON DRUGS BEST MED EAST LOVE OAK PHARMACY CCH PHARMACY EDGEWOOD LEGEND DRUG ANGELES PHARMACY CANTU'S PHARMACY CONQUEST PLAZA PHARMACY GARZA PHARMACY GENOA-QOL HEALTHCARE GPS PHARMACY

Provider Name

(469) 297-5022 (832) 340-7230 (830) 965-1666 (956) 464-2200 (956) 464-4131 (512) 858-7935 (512) 382-9381 (254) 445-3679 (806) 935-7494 (806) 935-7494 (972) 298-4936 (972) 709-4500 (972) 298-2540 (979) 234-2502 (830) 752-6088 (325) 646-2500 (979) 335-4810 (254) 629-1000 (254) 629-1791 (325) 869-8760 (903) 896-1473 (956) 329-6890 (956) 383-1239 (956) 287-2882 (956) 383-5314 (956) 289-7225 (956) 287-4242

424 E PLEASANT RUN RD 2251 FM 646 RD W # 155A 106 N MAIN 122 S MAIN ST 605 N MAIN ST STE E 100 COMMONS RD STE 1 13830 SAWYER RANCH RD # 104 604 N PATRICK ST 1021 E 1ST ST 1021 E 1ST ST 302 N MAIN ST 777 E WHEATLAND RD STE 100 119 W WHEATLAND RD 702 S MCCARTY AVE 2176 E GARRISON ST STE D 1210 C C WOODSON RD 123 LEVERIDGE ST 905 E MAIN ST 805 W MAIN ST 614 EAKER ST SUITE 100 115 N HOUSTON ST 2601 CORNERSTONE BLVD STE A 504 S CLOSNER BLVD 316 CONQUEST 1200 S 10TH AVE 1901 S 24TH AVE 3521 W FREDDY GONZALEZ DR # A

DESOTO DICKINSON DILLEY DONNA DONNA DRIPPING SPRINGS DRIPPING SPRINGS DUBLIN DUMAS DUMAS DUNCANVILLE DUNCANVILLE DUNCANVILLE EAGLE LAKE EAGLE PASS EARLY EAST BERNARD EASTLAND EASTLAND EDEN EDGEWOOD EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75115-3936 77539-3251 78017-3800 78537-3218 78537-2726 78620-3966 78620-5246 76446 79029-3340 79029-3340 75116-3651 75116-4918 75116-4725 77434-3212 78852-5072 76802-8204 77435-7477 76448-3014 76448-2536 76837 75117-2502 78539-8479 78539 78539 78539-5516 78539-6533 78539-8391

INVERNESS APOTHECARY SOUTH TEXAS JUNIORS PHARMACY LINDBERG PHARMACY MED CARE PHARMACY OCHOA'S PHARMACY CENTRAL OCHOA'S PHARMACY SOUTH RICHARDS PHARMACY RIDGEPOINT MEDICAL PHARMACY SAENZ MEDICAL PHARMACY SOUTH TEXAS VALLEY PHARMACY UNITED SPECIALTY PHARMACY ROGERS PHARMACY EL CAMPO PROFESSIONAL PHARMACY ADVANT EDGE PHARMACY

(956) 467-0264 (956) 383-4441 (956) 687-6204 (956) 383-2600 (956) 381-0967 (956) 318-5159 (956) 289-1880 (956) 686-5100 (956) 618-4500 (956) 217-7000 (956) 393-2222 (361) 782-7822 (979) 543-2761 (915) 852-8884

5009 S MCCOLL RD STE A 1313 S CLOSNER BLVD STE B 5203 S MCCOLL RD 802A E UNIVERSITY DR 1002 S 10TH AVE STE A 301 CONQUEST 4630 S CLOSNER BLVD 4955 S JACKSON RD 2821 MICHAEL ANGELO STE 103 2717 MICHAEL ANGELO STE 200 230 CONQUEST SUITE H-2 1013 S WELLS ST BLDG B 1264 N MECHANIC ST 14476 HORIZON BLVD

EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDINBURG EDNA EL CAMPO EL PASO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78539 78539 78539 78539-3632 78539-5514 78539-3040 78539 78539 78539-1405 78539-1412 78539 77957-4045 77437-2614 79928-8578

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 592 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ADVANT EDGE PHARMACY INC ALAMEDA THRIFTY PHARMACY L.P. ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ASPCARES BANK 1 PHARMACY

Provider Name

(915) 595-0409 (915) 772-5331 (915) 351-1183 (915) 845-1422 (915) 584-9481 (915) 751-8808 (915) 591-8157 (915) 860-7225 (915) 562-4000

1576 LOMALAND DR 4900 ALAMEDA AVE 3100 N MESA ST 5630 N DESERT BLVD 7022 N MESA ST 9111 DYER ST 2200 N YARBROUGH DR 1015 N ZARAGOZA ST 4000 MONTANA AVE

EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO

TX TX TX TX TX TX TX TX TX

79935-4202 79905-2830 79902-2333 79912-1636 79912-3649 79924-6401 79925-6337 79907 79903-4510

EAST EL PASO PHYSICIANS MED CENTER

(915) 857-4135

1400 GEORGE DIETER STE 190

EL PASO

TX

79936

EL PASO INTG PHYS GR SURECARE PHARM EL PASO PAIN CENTER FAMILY PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GRACE PHARMACY MCCRORY'S PHARMACY MED TIME PHARMACY MEDICINE SHOPPE MEDICINE SHOPPE MESA HILLS PHARMACY PRIMEMED PHARMACY SAV-ON DRUGS SAV-ON DRUGS SAV-ON DRUGS SURECARE SPECIALTY PHARMACY THE FAMILY PHARMACY THE PHARMACY CENTER THE PHARMACY CENTER EAST TIGUA PHARMACY

(915) 703-6302 (915) 500-6078 (915) 591-8000 (915) 235-0060 (915) 257-6167 (915) 593-0603 (915) 581-9655 (915) 584-6337 (915) 544-6605 (915) 564-5451 (915) 308-2050 (915) 595-1300 (915) 778-0680 (915) 821-3031 (915) 855-9761 (915) 532-2400 (915) 857-5510 (915) 313-9870 (915) 595-1177 (915) 590-2800

4532 N MESA ST 3215 GATEWAY BLVD W STE A 2931 GEORGE DIETER STE C 1601 EAST YANDELL ST STE 119 2400 TRAWOOD DR STE 303A 11140 LA QUINTA PL STE 101A 6151 DEW DR STE 100 641 N RESLER DR STE 306-07 2002 GRANT AVE STE A 3310 FORT BLVD 310 S MESA HILLS DR STE C 7812 GATEWAY BLVD E #100 5200 MONTANA AVE 10765 KENWORTHY ST 11320 MONTWOOD DR 4005 N MESA ST 12371 EDGEMERE BLVD STE 210 1700 MURCHISON SUITE A 3100 N LEE TREVINO DR STE F 8269 N LOOP DR

EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

79912 79903-4225 79936-2942 79902 79936-4122 79936-5221 79912-3912 79912-2270 79930-1017 79930-4710 79912-5881 79915 79903-4906 79924-1747 79936-4383 79902-1526 79938-4879 79902-2921 79936-2099 79907-4234

UNIVERISTY MEDICAL CENTER EAST PHCY UNIVERSITY MEDICAL CNTR PHCY UNIVERSITY MEDICAL CNTR PHCY UNVSTY MD CENTER OF EL PASO PH UNVSTY MD CNTR NE PHARMACY UNVSTY MD CNTR YSLETA PHCY VIP PHARMACY GOLDSMITH'S DRUG ELGIN MEDICINE SHOP

(915) 521-7602 (915) 521-2263 (915) 521-2261 (915) 521-7602 (915) 521-7602 (915) 521-7602 (915) 629-2020 (940) 495-2335 (512) 285-6308

1485 GEORGE DIETER STE 107 6600 N DESERT BLVD 1521 JOE BATTLE BLVD 4815 ALAMEDA AVE 9839 KENWORTHY ST 300 S ZARAGOZA RD BLDG B 1891 LEE TREVINO STE 200 111 W CLEVELAND AVE 15 N MAIN ST

EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO EL PASO ELECTRA ELGIN

TX TX TX TX TX TX TX TX TX

79936 79912 79936 79905-2705 79924-4402 79907-6635 79936 76360-2603 78621-2657

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 593 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ELKHART PHARMACY ELSA PHARMACY SERVICES ENNIS PHARMACY HOMETOWN DRUG QLTY CARE PHCY & COMPOUNDING ALBERTSON'S PHARMACY SUPER VALUE PHARMACY TRAIL CREEK PHARMACY UNITED SPECIALTY PHARMACY MEDICINE SHOPPE

Provider Name

(903) 764-2355 (956) 262-6400 (972) 346-1234 (972) 875-6798 (972) 875-5200 (817) 354-2427 (817) 283-5308 (817) 684-9464 (888) 470-0573 (915) 764-2739

306 S US HIGHWAY 287 205 W EDINBURG DR 800 W ENNIS AVE #A 507 S CLAY ST 601 S CLAY STE 108 1155 N MAIN ST 720 N INDUSTRIAL BLVD 2700 TIBBETS DR 425 WESTPARK WAY STE 2 1330 FABENS ST

ELKHART ELSA ENNIS ENNIS ENNIS EULESS EULESS EULESS EULESS FABENS

TX TX TX TX TX TX TX TX TX TX

75839-6726 78543 75119 75119 75119-5771 76039-2730 76039-7439 76040 76040-3751 79838

UNIVERSITY MEDICAL CTR FABENS PHCY HOMETOWN PHARMACY L.C. FREDS PHARMACY DYER DRUG STORE U S DRUG MART MAIN STREET PHARMACY WILSON COUNTY PHARMACY FLOWER MOUND PHCY & HERBAL ALT KK'S PHARMACY LONG PRAIRIE PHARMACY PAYNE FAMILY PHARMACY BAGGETT PHARMACY NOLEN PHARMACY STOCKTON PHARMACY A & P PHARMACY INC AHF PHARMACY-FT WORTH ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALTIMATE CARE PHARMACY LLC BEACH STREET PHARMACY BEST VALUE COUNTRY DAY PHCY BEST VALUE RIDGLEA DRUG CARE SPECIALTY PHARMACY COOK CHILDREN'S PHARMACY

(915) 521-7602 (903) 389-2541 (361) 325-3651 (972) 782-6262 (972) 544-3660 (361) 865-3554 (830) 542-6499 (972) 355-4614 (972) 539-1777 (972) 410-3773 (806) 983-5111 (432) 336-2297 (432) 336-2201 (432) 336-2200 (817) 838-2319 (817) 831-1814 (817) 246-4909 (817) 429-2571 (817) 451-1637 (817) 377-8078 (817) 423-9556 (817) 346-4457 (817) 232-1023 (817) 428-0371 (817) 431-8985 (682) 385-9100 (817) 427-8774 (817) 738-0722 (817) 737-6655 (817) 849-9811 (682) 885-4183

101 POTASIO 201 E COMMERCE ST 202 W RICE ST 133 MCKINNEY ST 103 S MAIN ST 109 E NORTH MAIN ST 495 10TH ST # 106 1001 CROSS TIMBERS RD STE 1170 2201 LONG PRAIRIE RD STE 101 4921 LONG PRAIRE RD STE 105 200 S MAIN ST 509 N MAIN ST 700 W DICKINSON BLVD 616 W DICKINSON BLVD 2329 N RIVERSIDE DR 400 N BEACH ST STE 102 9300 CLIFFORD ST 3563 ALTON RD 850 E LOOP 820 6700 WEST FWY 7400 OAKMONT BLVD 3525 SYCAMORE SCHOOL RD 4400 WESTERN CENTER BLVD 6249 RUFE SNOW DR 10800 N BEACH ST 2813 N COMMERCE ST STE 115 7630 N BEACH ST STE 170 6020 HARRIS PKWY 5932 LOVELL AVE 7520 N BEACH ST STE 100 801 7TH AVE STE 1700

FABENS FAIRFIELD FALFURRIAS FARMERSVILLE FERRIS FLATONIA FLORESVILLE FLOWER MOUND FLOWER MOUND FLOWER MOUND FLOYDADA FORT STOCKTON FORT STOCKTON FORT STOCKTON FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

79838 75840-1509 78355-3704 75442-2213 75125-2523 78941 78114-3162 75028-8817 75022-4963 75028 79235-2726 79735-5623 79735-4230 79735-4229 76111-2904 76111-7010 76108-4426 76109-2834 76112-1796 76116-2160 76132-3904 76133-7805 76137-2044 76148-3316 76244-8541 76106-7245 76137-3017 76132-4102 76107-5030 76137-1680 76104-2733

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 594 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name COURTYARD PHARMACY DANIEL DRUG FORT WORTH PHARMACY HALL'S PHARMACY HALLS PHARMACY #2 HOVIC PHCY AND MED SUPPLIES HULEN PHARMACY JAMORX PHARMACY INC LAKE WORTH PHARMACY LEGACY PHARMACY MBS PHARMACY MCCART PHARMACY LLC MEADOWBROOK PHARMACY MIRA VISTA PHARMACY, LLC NEW CARE PHARMACY NUCARE PHARMACY PARK PLACE PHARMACY PERRONE PHARMACY PERRONERX, LLC RIDGMAR PHARMACY SAFEMED PHARMACY SUPER ONE PHARMACY TOWER MEDIC PHARMACY US PHARMACY WELLCARE PHARMACY WESTLAKE HEALTH MART PHARMACY FOREST HILL PHARMACY DUFFEY DRUG COMPANY INC MAXWELL PHARMACY INC PRESCRIPTION LABORATORY VALU-MED PHARMACY FREEPORT PHARMACY EDGEWOOD PHARMACY PARKWOOD PHARMACY FRISCORX PHARMACY STONEBRIAR PHARMACEUTICAL UNITED MARKET STREET PHARMACY FRITCH DRUG & GIFT SHOPPE TEXAS ONCOL PHCY SW FT WORTH FULSHEAR PHARMACY AMERICARE PHARMACY INC HOMETOWN PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (817) 922-3800 (817) 332-6386 (817) 361-9960 (817) 877-3677 (817) 244-3300 (817) 888-3132 (817) 361-7777 (817) 810-9278 (817) 237-7877 (817) 924-3200 (817) 286-2161 (817) 924-7200 (817) 451-6900 (817) 292-3800 (817) 924-7000 (817) 238-7773 (817) 924-9292 (817) 738-2135 (817) 731-5899 (817) 737-7377 (817) 969-4096 (817) 568-9623 (817) 336-8133 (817) 478-9191 (817) 263-5050 (817) 893-5182 (817) 887-9434 (979) 828-3536 (903) 876-2323 (830) 997-2163 (830) 997-8155 (979) 871-9189 (281) 993-4779 (832) 569-4059 (469) 888-4190 (214) 618-2486 (214) 872-1515 (806) 857-3176 (817) 263-2650 (281) 346-2020 (940) 668-6868 (940) 668-7384

Provider Street 1250 8TH AVE STE 125 3409 W 7TH ST 7833 OAKMONT BLVD STE 120 708 PENNSYLVANIA AVE 8808 CAMP BOWIE WEST BLVD STE 6306 MEADOWBROOK DR 6249 GRANBURY RD 650 ST LOUIS AVE 4504 BOAT CLUB RD STE 200 1307 8TH AVE SUITE 501 2601 GRAVEL DR 4237 MCCART AVE 6624 MEADOWBROOK DR 5701 BRYANT IRVIN RD STE 104 900 JEROME ST STE 100 6050 LAKE WORTH BLVD 1601 PARK PLACE AVE STE B 3921 BENBROOK HWY 3923 HWY 377 SOUTH 2524 MALL CIRCLE 4245 E BERRY ST 6750 FOREST HILL DR 607 W MAGNOLIA AVE 6619 FOREST HILL DR STE 20 6901 MCCART AVE STE 225 5421 BASSWOOD BLVD STE 700 3403 MANSFIELD HWY 311 N CENTER ST 626 STATE HIGHWAY 155 205 W WINDCREST ST STE 160 707 N LLANO ST 323 S BRAZOSPORT BLVD 120 S FRIENDSWOOD DR 405 E PARKWOOD AVE 7227 W MAIN ST STE 201 5575 WARREN PKWY STE 216 11999 NORTH DALLAS PARKWAY 105 BROADWAY 6500 HARRIS PKWY STE 100 29818 FM 1093 STE B 217 N WEAVER ST 1201 OLIVE ST

Page 595 of 679

Provider City FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORT WORTH FORTWORTH FRANKLIN FRANKSTON FREDERICKSBURG FREDERICKSBURG FREEPORT FRIENDSWOOD FRIENDSWOOD FRISCO FRISCO FRISCO FRITCH FT WORTH FULSHEAR GAINESVILLE GAINESVILLE

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

76104-4156 76107-2718 76132-4204 76104 76116-6000 76112-5121 76133-3401 76104-3346 76135-2084 76104 76118 76115-1020 76112-5241 76132 76104-3937 76135-3706 76110-1303 76116-7802 76116-7802 76116 76105-5002 76140-1210 76104-4608 76140-1260 76133-6379 76137-4482 76119 77856 75763-9755 78624-4478 78624-3943 77541-4506 77546-3915 77546-5149 75034-5794 75034-4062 75033 79036 76132 77441 76240-3953 76240

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PLAZA PHARMACY INC BROADWAY DRUG ALBERTSON'S PHARMACY

Provider Name

(940) 665-8401 (409) 765-7701 (972) 240-7438

411 N GRAND AVE 2027 BROADWAY ST 5710 BROADWAY BLVD

GAINESVILLE GALVESTON GARLAND

TX TX TX

76240-4323 77550-4635 75043-5818

BAYLOR MEDICAL PLAZA PHCY AT GARLAN BRANDY PHARMACY BROADWAY PHARMACY CARE PLUS PHARMACY CARECHOICE PHARMACY CHEBYCARE PHARMACY GARLAND INDEPENDENT PHARMACY HERITAGE PHARMACY INC PHARMAX PHARMACY TOTAL PHARMACY ENNIS GATESVILLE DRUG CO COBB'S PHARMACY BAYLOR SCOTT AND WHITE PHCY GUS'S DRUG LSCC GEORGETOWN PHARMACY MCCLURES COMPOUNDING PHARMACY PIERATTS PHARMACY THE MED SHOP PHARMACY WALKER PHARMACY BEST VALUE MEDICAL CENTER PHCY FIRST LONE STAR PHARMACY GROUP GOLIAD LEGEND PHARMACY MOHRMANNS DRUG STORE JORDAN PHARMACY MEDICINE CHEST PHARMACY UNITED MARKET STREET PHARMACY BEST VALUE RON'S GRANBURY DRUG PECAN DISCOUNT DRUG ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY DFW LEGEND PRESCRIPTIONS INC GIBSON PHARMACY LAKE RIDGE PHARMACY LAKEPOINTE PHARMACY METROCARE PHARMACY PROFESSIONAL PHARMACY PLUS THI PHARMACY

(972) 485-3100 (972) 272-6300 (972) 278-9742 (972) 468-0001 (469) 909-6430 (972) 675-1100 (972) 864-1110 (214) 703-9000 (972) 487-2252 (972) 276-7071 (254) 865-2417 (361) 449-2631 (512) 942-3302 (512) 863-2506 (512) 686-0155 (512) 819-9848 (979) 542-3164 (903) 680-2600 (903) 845-2573 (254) 897-9917 (254) 897-2711 (361) 645-3261 (830) 672-2317 (940) 549-1011 (940) 549-8360 (940) 549-3000 (817) 573-1143 (817) 573-1164 (817) 573-9344 (972) 642-8888 (972) 642-0488 (972) 647-2721 (972) 264-0268 (972) 522-7606 (469) 733-1033 (214) 330-2424 (972) 809-0984 (972) 213-1328

601 CLARA BARTON BLVD STE 140 2241 PEGGY LN STE B 3334 BROADWAY BLVD STE 412 1401 NORTHWEST HWY STE 107 4750 N JUPITER RD STE 123 1421 BUCKINGHAM RD 3641 BROADWAY BLVD STE 100 2636 W WALNUT ST STE 300 3504 W WALNUT ST 2046 FOREST LANE STE 140 2401 S HIGHWAY 36 STE 100 510 HOUSTON ST 4945 WILLIAMS DR 702 E UNIVERSITY AVE 2423 WILLIAMS DR STE 109 105 WILDWOOD DR STE 101 233 S MANSE AVE 825 US HWY 271 N 402B W UPSHUR AVE 1100 BLUEBONNET ST 906 NE BIG BEND TRL 236 S COMMERCIAL ST 2405 WINDING WAY DR 1332 HIGHWAY 16 S 814 MONTGOMERY RD 1229 STATE HIGHWAY 16 S 420 W PEARL ST 602 S MORGAN ST 9203 PLANTATION BLVD STE 1 215 N CARRIER PKWY 4126 S CARRIER PKWY 2701 OSLER DR STE 1 2505 S CARRIER PKWY 4927 LAKE RIDGE PKWY STE 180 2715 OSLER DR 832 S CARRIER PKWY 2771 SHERMAN ST STE B 200 N CARRIER PKWY STE 112

GARLAND GARLAND GARLAND GARLAND GARLAND GARLAND GARLAND GARLAND GARLAND GARLAND GATESVILLE GEORGE WEST GEORGETOWN GEORGETOWN GEORGETOWN GEORGETOWN GIDDINGS GILMER GLADEWATER GLEN ROSE GLEN ROSE GOLIAD GONZALES GRAHAM GRAHAM GRAHAM GRANBURY GRANBURY GRANBURY GRAND PRAIRIE GRAND PRAIRIE GRAND PRAIRIE GRAND PRAIRIE GRAND PRAIRIE GRAND PRAIRIE GRAND PRAIRIE GRAND PRAIRIE GRAND PRAIRIE

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75042-5755 75042-5709 75043-1575 75041-5264 75044-5860 75042 75043-1676 75042-6441 75042-6234 75042-7939 76528-2517 78022-3663 78633-2008 78626-7036 78628-3269 78633-1344 78942-3440 75644 75647-2124 76043-5013 76043-4909 77963-4305 78629-3246 76450-4202 76450-4225 76450-3809 76048-2411 76048-1962 76049-4152 75050-5425 75052-3214 75051-8351 75052-5017 75052-3072 75051 75051-0942 75051-6018 75050-5476

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 596 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ZING PHARMACY ECONOMY DRUG BAYLOR MED PLZA PHCY GRPVINE GRAPEVINE DRUG RX MEDICINE SHOPPE

Provider Name

(214) 788-2826 (903) 962-3900 (817) 388-3090 (817) 481-5780 (903) 455-7200

2615 W PIONEER PKWY STE 139 511 E GARLAND ST 1600 W COLLEGE ST STE 110 1115 W NORTHWEST HWY STE H 3001 JOE RAMSEY BLVD E

GRAND PRAIRIE GRAND SALINE GRAPEVINE GRAPEVINE GREENVILLE

TX TX TX TX TX

75051-3618 75140-1984 76051 76051-5029 75401-7714

METROCARE PHARMACY AT GREENVILLE SUPER 1 PHARMACY TOTAL CARE PHARMACY GROESBECK CITY DRUG PHARMACY PLUS BRUCE'S PHARMACY B & B PHARMACY GUN BARREL CITY PHARMACY HALE CENTER CLINICAL PHARMACY HALTOM PHARMACY MED STORE LLP HAMILTON CITY DRUG JORDAN PHARMACY CARE RX PHARMACY GENOA-QOL HEALTHCARE HARLINGEN PHARMACY MUNIZ RIO GRANDE PHARMACY LLC PETES PHARMACY SALINAS PHARMACY SMALL FRY'S PHARMACY THE DRUG STORE HASLET PHARMACY RED DOOR PHARMACY AND GIFTS WILSON DRUG COUNTY PHARMACY K-C DRUGS RAY PHARMACY STRONG-HURT PHARMACY HENRIETTA PHARMACY HEREFORD HEALTH MART PHARMACY

(214) 331-6330 (903) 454-8701 (903) 583-2828 (254) 729-3092 (254) 729-3375 (409) 962-4431 (936) 642-1174 (903) 887-3606 (806) 839-2466 (817) 838-2500 (817) 834-3001 (254) 386-3121 (254) 386-3111 (956) 365-4677 (956) 230-7017 (956) 230-3200 (956) 423-1753 (956) 425-2424 (956) 425-1156 (956) 423-1200 (940) 864-2673 (817) 945-2608 (817) 259-2636 (979) 279-2173 (361) 527-3231 (409) 787-2345 (903) 657-2588 (903) 657-3587 (940) 538-4361 (806) 364-3400

4200 STUART ST 4811 WESLEY ST 5127 WESLEY ST 404 S DR J B RIGGS DR 209 N ELLIS ST 6001 39TH ST 520 W 1ST ST 300 N GUN BARREL LN 601 AVENUE G 5310 E BELKNAP ST STE E 4004 E BELKNAP ST 105 E HENRY ST 107 N RICE ST 4501 HALE AVE STE 1 103 N LOOP 499 1616 ED CAREY DR 1117 S COMMERCE 721 W HARRISON AVE STE A 1022 S F ST 321 S 21ST ST # B 100 S AVENUE E 1205 AVONDALE HASLET RD # 200 2488 AVONDALE HASLET RD # 168 118 W 4TH ST 602 E GALBRAITH ST 2155 WORTH ST 220 ZEID BLVD 111 E MAIN ST 124 N BRIDGE ST 809 S 25 MILE AVE

GREENVILLE GREENVILLE GREENVILLE GROESBECK GROESBECK GROVES GROVETON GUN BARREL CITY HALE CENTER HALTOM CITY HALTOM CITY HAMILTON HAMILTON HARLINGEN HARLINGEN HARLINGEN HARLINGEN HARLINGEN HARLINGEN HARLINGEN HASKELL HASLET HASLET HEARNE HEBBRONVILLE HEMPHILL HENDERSON HENDERSON HENRIETTA HEREFORD

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75401-5759 75401-5649 75402-6315 76642 76642-1310 77619-4651 75845 75156-3846 79041-1450 76117-4625 76111-6609 76531-1909 76531-1857 78550-9242 78550-2509 78550-8286 78550 78550-6005 78550-6749 78550-7430 79521-5711 76052-3512 76052-3220 77859-2506 78361-3400 75948 75652-6068 75652-3116 76365-2804 79045-4801

HEREFORD HEALTH MART PHARMACY LTC LYNN'S PHARMACY HEWITT HICO DISCOUNT PHARMACY HIGHLANDS COMMUNITY PHARMACY EAGLE DRUG

(806) 364-3400 (254) 666-5000 (254) 796-4271 (832) 838-8560 (254) 582-5363

809 S 25 MILE AVE 511 N HEWITT DR STE 1 W 1ST & WALNUT 607 E WALLISVILLE RD BLDG #1 101 JANE LN

HEREFORD HEWITT HICO HIGHLANDS HILLSBORO

TX TX TX TX TX

79045-4801 76643-3093 76457-0000 77562-3831 76645-2673

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 597 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name T.B. BOND PHARMACY WHISENHUNT'S CITY PHARMACY BAY PHARMACY 1960 FAMILY PHARMACY 1960 PHARMACY 1ST CHOICE PRESCRIPTIONS AAPEX PHARMACY ACARIAHEALTH PHARMACY, INC. ADVANCE PHARMACY LLC AFFINITY RX AFRA PHARMACY INC AKO PHARMACY A-LIST PHARMACY LLC ALLIANCE PHARM D ALPHA PHARMACY ALTUS PHARMACY AMBER JAR PHARMACY AMEX PHARMACY AMEX UNITED DRUG APOTEK PHARMACY ASSURANCE INFUSION ASTRO PHARMACY AWESOME CARE PHARMACY AZMO PHARMACY / COMPOUNDING AZTECA PHARMACY BAIJES BISSONNET PHARMACY INC BAO CHAU PHARMACY BARKER CYPRESS PHARMACY BARKER CYPRESS PHCY & COMPDNG BEECHNUT PROFESSIONAL PHARMACY BELLAIRE DISCOUNT PHARMACY BELLAIRE MEDICAL PHARMACY BEMAJ PHARMACY BERRY PROF UNITED DRUGS BEST CARE PHARMACY BEST RX PHARMACY BIOCARE PHARMACY BIOCURE, LLC BIZMART PHARMACY BIZMART PHARMACY BLUEBONNET APOTHECARY SERVICES BLUEBONNET PHARMACY INC

NR_0009_10823 10/2017

Provider Phone Number (254) 582-2561 (903) 547-2782 (830) 598-1900 (281) 453-7205 (281) 893-6000 (832) 582-8109 (713) 270-7771 (800) 511-5144 (713) 661-5711 (281) 444-5200 (832) 831-9694 (832) 478-5771 (713) 529-2728 (281) 591-0900 (713) 935-9800 (281) 481-0398 (713) 893-5993 (713) 451-8400 (713) 237-9301 (713) 928-3210 (713) 533-8800 (713) 957-4600 (281) 501-1008 (281) 861-9000 (713) 644-3600 (281) 974-3573 (281) 631-0600 (281) 579-9393 (713) 631-3117 (713) 988-1103 (281) 568-1888 (713) 457-3600 (713) 774-7200 (713) 697-9750 (713) 644-2424 (281) 484-0022 (281) 530-5800 (713) 360-2100 (832) 767-2438 (713) 465-2300 (713) 691-6200 (713) 864-0100

Provider Street 60 W ELM ST 102 MAIN ST 7405 W FM 2147 837 CYPRESS CREEK PKY STE 105A 724 CYPRESS CREEK PKWY STE 100 2056 ANTOINE AVE #120 6065 HILLCROFT ST 1311 W HOUSTON PKWY N #130 2646 S LOOP W STE 330 11003 ANTOINE DR STE F 8141 LONG POINT RD 11811 FALLBROOK DR STE B1 5205 DOWLING ST STE B 13734 STATE HIGHWAY 249 STE C 5445 ALMEDA RD 10851 SCARSDALE BLVD STE 160B 6160 RICHMOND AVE 12605 EAST FWY 3030 CANAL ST 5201 HARRISBURG BLVD 2626 S LOOP W #555 9801 LONG POINT RD STE 101 8101 AIRPORT BLVD STE 3 7825 HIGHWAY 6 N STE 106 3100 BROADWAY ST STE 105F 9801 BISSONNET ST STE F 12002 VETERANS MEMORIAL DR # C 1855 BARKER CYPRESS RD STE 140 8300 HOMESTEAD RD STE 1 7500 BEECHNUT ST STE 151 10515 BELLAIRE BLVD STE L 12924 BELLAIRE BLVD SUITE 100A 10039 BISSONNET ST STE 100 8520 JENSEN DR 7338 MCHENRY ST STE 6 13630 BEAMER RD STE 103 10603 BELLAIRE BLVD STE B114 8700 COMMERCE PARK DR STE 241 1919 WIRT ROAD SUITE B 9504 LONG POINT RD 9000 RICHMOND AVE STE 200 1919 NORTH LOOP W STE 280

Page 598 of 679

Provider City HILLSBORO HOOKS HORSESHOE BAY HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

76645-2036 75561-5155 78657 77090-3422 77090-3402 77055 77081-1087 77007 77054-2773 77086-1428 77055-2032 77065 77004-7411 77086 77004-7434 77089-5737 77057 77015-5625 77003-1627 77011-4227 77054-2652 77055-4189 77061-4138 77095-1705 77017-2338 77036-8224 77067-1089 77084-4557 77028-2149 77074-4310 77072-5235 77072 77036-7838 77093-7510 77087-3633 77089-6038 77072-5229 77036-7432 77055 77055-4226 77063 77008-1374

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BOTICA FAMILIAR PHARMACY BRETSHIRE PHARMACY INC. BRIARGROVE PHARMACY BRIGHTMED PHARMACY BVM PHARMACY INC. BWM PHCY AND MEDICAL SUPPLY C & C PHARMACY CAMPBELL'S COMPOUNDING INC CANAL RX CANAL UNITED PHARMACY CARE PLUS PHARMACY CARECO PHARMACY CAREPOINT PHARMACY CEDRA PHARMACY CEGO INFUSION PHARMACY CHCS PHARMACY CHOICE PHARMACY CITIZENS PROF UNITEDDRUGS CLINICAL CARE PHARMACY LLC COMMUNITY EXPRESS PHARMACY

Provider Name

(713) 918-6402 (713) 635-8800 (713) 783-5704 (713) 772-7700 (713) 460-5100 (281) 469-1882 (713) 641-6300 (713) 668-4833 (713) 547-0752 (713) 227-5583 (713) 778-1773 (832) 803-0388 (832) 742-0410 (713) 621-0621 (713) 541-6000 (713) 924-6067 (713) 778-0463 (713) 695-7316 (281) 272-8700 (832) 941-0901

12333 SOUTH MAIN STREET 7030 BRETSHIRE DR 6435 SAN FELIPE ST 9630 CLAREWOOD DR STE A3 9325 KEMPWOOD DR STE B 11850 FM 1960 RD WEST 8208 GULF FWY STE 102 6603 KIRBY DR 3311 CANAL ST 2502 CANAL ST 10301 CLUB CREEK RD STE I 15003 FM 529 RD STE H 1801 S DAIRY ASHFORD RD 1607 POST OAK BLVD 6300 RICHMOND AVE STE 300A 7648 CANAL ST 9207 COUNTRY CREEK DR STE 202 7333 NORTH FWY STE 110 2770 N SAM HOUSTON PKWY W 9820 GULF FWY STE A-10

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77035 77016-3704 77057-2705 77036-3535 77080-2813 77065 77017-4531 77005-3900 77003-1847 77003-1523 77036 77095-3247 77077-4776 77056-2902 77057-5931 77012-1144 77036-7711 77076-1318 77038-1206 77034-1020

COMPOUNDING PHARMACY SOLUTIONS COMPOUNDING SHOP PHARMACY CONTENTS TRADER INC CONVERSIO HEALTH CPRX PHARMACY CROSSWAY PHARMACY LLC CULLEN CARE PHARMACY INC CULLEN CARE PHARMACY INC. CUNNINGHAM AIRLINE PHCY

(713) 783-2836 (281) 495-2230 (713) 461-3344 (713) 335-8880 (832) 249-8551 (713) 290-0322 (713) 747-2100 (713) 747-2100 (713) 697-3261

6105 BEVERLY HILL ST STE 201 11851 WILCREST DR STE A 10026 LONGPOINT RD. STE A 1050 N OAK POST RD STE 130 850 FM 1960 W STE J 3044 ANTOINE DR 5751 BLYTHEWOOD ST STE 300 9406 CULLEN BLVD STE C 6033 AIRLINE DR

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX

77057-6716 77031-1914 77055 77055 77090-3413 77092-7053 77021-5401 77051-3321 77076-4209

CUNNINGHAM PHARMACY NORTHWEST CUNNINGHAM PHARMACY-GULFBANK CYPRESS COMPOUNDING PHARMACY D.N.A. PHARMACY INC DARCY PHARMACY DB PHARMACY DISCOUNT PHARMACY DOLLAR RX PHARMACY DR RITA'S PHARMACY INC EAGLE PHARMACY ECO PHARMACY OF KATY WEST

(713) 683-8600 (713) 921-7500 (832) 617-0290 (713) 633-3362 (281) 988-8300 (281) 397-7711 (281) 780-2328 (713) 694-1470 (281) 531-5965 (210) 949-0228 (281) 206-7388

2925 W TC JESTER BLVD STE 2B 7101 LAWNDALE ST 9511 HUFFMEISTER RD STE 104 9419 MESA DR 11210 BELLAIRE BLVD STE 130 12100F VETERANS MEMORIAL 8213 HOMESTEAD RD STE D 8721 JENSEN DR STE H 12289 W HOUSTON CENTER BLVD ST 11329 BISSONNET ST 19255 PARK ROW STE 103

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX TX

77018-7050 77023-4248 77095-2865 77028-1202 77072-2528 77067-1126 77028-2153 77093-7655 77082-3157 77099 77084-7309

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 599 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ECO PHARMACY OF WILLOWBROOK ELITE PHARMACY EMMONS PHARMACY EMPIRICAL PHARMACY ENNIS STREET PHARMACY EPC PHARMACY LLC EVERGREEN PHARMACY EXCEL PHARMACY INC EXPERIENCECARE PHARMACY EXPRESS DRUGS FAIRWAY PHARMACY FALCON PHARMACY OF TX. INC. FALLBROOK PHARMACY FAMILY CARE PHARMACIES FAMILY PHARMACY CARE FARMACIA DEL SOL FARMACIA ETC FRIENDLY PHARMACY FRIENDSWOOD HEALTH MART PHCY GALAXY PHARMACY GENESIS PHARMACY INC GILLTOP PHARMACY LLC GREENSPOINT PHARMACY GROVEWAY PHARMACY HEALTH FIT PHARMACY HEALTH RX SCRIPTS HEALTHCHOICE PHARMACY HEALTHCO PHARMACY HEALTHCO PHARMACY CORP HEALTHY STRIDES RX HEIGHTS PHARMACY HEIGHTS STUDEWOOD PHARMACY HELPING HAND PHARMACY #4 HICARE PHARMACY HILLCROFT PHARMACY HOUSTON MIDTOWN PHARMACY LLC HPB PHARMACY IDEAL PHARMACY LLC INTRACARE COMMUNITY PHARMACY INWOOD PHARMACY IRVINGTON FAMILY PHARMACY J AND I PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (281) 955-7500 (832) 230-5229 (832) 582-8758 (713) 991-0072 (713) 524-7600 (281) 861-5512 (713) 541-1234 (713) 995-1272 (713) 524-3330 (713) 673-6060 (713) 454-0211 (281) 776-9600 (832) 237-4800 (281) 589-7670 (281) 315-3990 (713) 776-0806 (713) 771-0061 (832) 351-2000 (281) 315-1300 (281) 496-6600 (281) 999-4210 (832) 831-7381 (281) 872-4177 (713) 644-9400 (713) 802-2441 (832) 740-4353 (281) 741-8358 (713) 640-5575 (713) 218-6337 (281) 888-2235 (713) 487-3310 (713) 869-2225 (346) 204-4576 (713) 799-8880 (713) 988-9996 (832) 831-0346 (713) 799-1472 (832) 834-7463 (713) 790-7821 (281) 664-8829 (713) 694-8399 (281) 372-6526

Provider Street 13325 HARGRAVE RD STE 260 11569 S WILCREST DR 9555 W SAM HOUSTON PKWY S # 18 9715 TELEPHONE RD STE 105 4702 ENNIS ST 9539 HUFFMEISTER RD STE C 9180 BELLAIRE BLVD STE A 8600 W AIRPORT BLVD STE B 3730 KIRBY DR STE 111 10909 EAST FWY 4912 TELEPHONE RD 8145 HIGHWAY 6 S STE 114A 11780 FM 1960 W 12350 WESTHEIMER RD STE D 12121 RICHMOND AVE STE 126 6420 HILLCROFT ST STE 101 6430 HILLCROFT ST STE 100B 3533 S DAIRY ASHFORD RD STE G 4606 FM 1960 RD W STE 250 12303-D WESTHEIMER RD 302B W GULF BANK RD 14522 S POST OAK RD STE 108A 165 GREENS RD 4501 GROVEWAY DR 1307 YALE ST STE H 900 S WAYSIDE DR STE 400 A 10001 W BELLFORT ST STE K 8604 MLK BLVD 5730 CHIMNEY ROCK RD 4401 DOWLING ST 5225 KATY FREEWAY STE 105A 427 W 20TH ST 2811 TEAGUE RD STE 1303 7814 ALMEDA 6400 HILLCROFT ST 6609 W SAM HOUSTON PKWY S 6410 FANNIN ST STE 116 2904 FULTON ST STE A 1120 CYPRESS STATION DR #110 13300 HARGRAVE RD STE 180 3815 IRVINGTON BLVD STE E 13249 BELLAIRE BLVD

Page 600 of 679

Provider City HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77070-4539 77099-4752 77099-2132 77075-2056 77004-6132 77095-2856 77036-4600 77071 77098-3930 77029-1911 77087-3504 77083-5763 77065-3514 77077-6068 77082-2453 77081-3103 77081 77082 77069-4617 77077-6059 77037-2325 77045-6038 77060-1330 77087-1122 77008-4265 77023-3427 77031-2559 77033-2308 77081-2713 77004-5221 77007-2292 77008-2441 77080-2502 77054-3235 77081-3106 77072 77030-3006 77009-5792 77090 77070-4479 77009-4843 77083-2635

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name J DYKES PHARMACY JACINTO PHARMACY JACK'S APOTHECARY JAMES PHARMACY JL WELLNESS PHARMACY KASE RX PHARMACY KASHMERE UNITED DRUGS KB PHARMACY KC PHARMACY KEYSTONE PHARMACY KHARISMA PHARMACY KIM LONG PHARMACY KIMMY PHARMACY KINGSBRIDGE RX PHARMACY KWIK MEDS PHARMACY LLC LA PLAZA PHARMACY LA RX LEADCARE PHARMACY INC LELAND PHARMACY LIFE DRUGS RX LIFE PHARMACY LIFECARE PHARMACY LIVING WELL SPECIALTY PHARMACY LOTUS PHARMACY LOTUS RX PHCY & MEDICAL SUPPLIES LOVING CARE PHARMACY LYONS PHARMACY MACE RX PHARMACY, LLC MAIN MEDICAL PLAZA PHARMACY MARITIME PHARMACY MAS PHARMACY RX LLC MAXIMUM CARE PHARMACY MAYFLOWER PHARMACY MCA PHARMACY MED RX PHARMACY MED SCRIPTS PHARMACY MED SOLUTION PHARMACY INC MED VALT PHARMACY LLC MEDCARE RX PHARMACY MEDCO SPECIALTY PHARMACY MEDEX PHARMACY MEDEX PLUS, INC

NR_0009_10823 10/2017

Provider Phone Number (713) 691-5100 (713) 455-1361 (713) 733-7424 (713) 721-3800 (281) 741-1960 (713) 777-9200 (713) 674-6916 (346) 888-5452 (713) 808-9704 (832) 834-3312 (832) 409-5586 (713) 777-1414 (281) 564-5400 (281) 495-3500 (281) 501-2228 (713) 541-6655 (832) 426-4616 (713) 774-8180 (713) 673-8000 (713) 462-7029 (281) 859-8700 (713) 772-3000 (832) 756-2930 (281) 983-9382 (281) 983-0399 (713) 808-9103 (713) 675-9667 (832) 917-5550 (713) 667-5003 (713) 921-1052 (713) 465-6113 (281) 438-6161 (281) 983-5900 (713) 482-4444 (713) 695-5000 (832) 371-6100 (281) 890-9922 (713) 349-9882 (713) 272-9600 (713) 980-2814 (713) 771-3800 (713) 664-8800

Provider Street 4901 YALE ST 10805 MARKET STREET RD 8109 CULLEN BLVD 12950 S POST OAK RD STE H 9210 HWY 6 SOUTH STE C 8353 SOUTHWEST FWY 6402 LYONS AVE 11035 RESOURCE PKWY SUITE 100 6061 BISSONNET ST 9301 GULF FWY 8608 S BRAESWOOD BLVD 7601 W SAM HOUSTON PKWY S 8388 W SAM HOUSTON PKWY S STE 6720 HWY 6 S 1900 NORTH LOOP W # 170 6655 HILLCROFT ST STE 108 3744 BROADWAY ST STE C 9908 S GESSNER DR 5412 FARMER ST 12015 LOUETTA RD STE 300 5800 BELLAIRE BLVD STE 108 7135 SOUTHWEST FWY 13333 DOTSON RD STE 120 8200 WILCREST DR STE 8 11704 S WILCREST DR 4406 AIRLINE DR 5602 LYONS AVE STE 610 8775 S GESSNER RD 10019 S MAIN ST STE A10 900 BROADWAY ST 9355 LONG POINT RD STE L 16251 S POST OAK RD STE A 8323 SOUTHWEST FWY STE 115 1201 DAIRY ASHFORD RD STE 200 4000 FULTON ST STE C 10039 BISSONNET ST #116 10680 JONES RD 9117 STELLA LINK RD 7050 BISSONNET ST 10305 ROUND UP LN STE 200 9600 FONDREN RD STE B3 5420 DASHWOOD DR STE 201

Page 601 of 679

Provider City HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77018-2203 77029-2338 77051-2064 77045-2019 77083 77074-1602 77020-4917 77089 77081-6903 77017-7023 77031-1301 77072-5218 77072-5081 77083 77018-8100 77081-4815 77017-3046 77071-1008 77020-4720 77070-1148 77081-5537 77074-2001 77070-4303 77072-4328 77099-4757 77022-2901 77020 77074-2915 77025-5209 77012-2127 77055-4481 77053-4397 77074-1615 77079-3017 77009 77036 77065 77025-3900 77074-6010 77064-5560 77096-3682 77081-5332

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDI SCRIPT PHARMACY MEDICAL PLZ UNITED DRUGS MEDICAL SQUARE PHARMACY MEDICINE CHEST PLUS PHARMACY MEDICINE MAN PHARMACY MEDICINE SHOPPE MEDICINE SHOPPE MEDLITE MED-PHARMACY I MEDPLUS RX INC. MEDRX COMPNDNG & PHCY LTD CO MEDSAVER PHARMACY MEDSTAR PHARMACY MEMORIAL CARE PHARMACY MEMORIAL PHARMACY MIDTOWN SPECIALTY RX PHARMACY MOBILECARE PHARMACY NAHS PHARMACY NEXTCARE PHARMACY NNWOOD PHARMACY LLC

Provider Name

(713) 910-3774 (713) 654-4137 (713) 468-3236 (832) 328-0923 (713) 644-1343 (713) 741-5104 (713) 641-3414 (281) 815-7366 (713) 694-4618 (713) 779-5400 (832) 767-5466 (281) 988-0880 (281) 933-4449 (281) 484-1600 (832) 358-8500 (713) 874-9190 (713) 600-0075 (281) 498-5700 (713) 492-2088 (281) 448-8836

8121 BROADWAY ST #105 2101 CRAWFORD ST 1401 WIRT RD STE E 256 N SAM HOUSTON PKWY E #203 7652 BELLFORT ST 5910 SCOTT ST STE M 5600 MYKAWA RD 16506 FM 529 RD STE 108 3302 ORLANDO ST 5950 S GESSNER STE D 601 WAYSIDE DR STE D 10701 W BELLFORT STE B172 14629 BEECHNUT ST 11035 RESOURCE PKWY STE A 10101 SOUTHWEST FWY STE 315 1701 WEBSTER ST STE D 3918 LEELAND ST 12000 WILCREST DR STE # 206 10021 S MAIN ST STE B-2A 8240 ANTOINE DR STE 108

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77061 77002-8942 77055-4905 77060-2006 77061-1704 77021-1457 77033-1045 77095-1462 77093-4855 77036 77011-3614 77099 77083-4436 77089-6071 77074-1111 77003-5800 77003-5648 77031-1924 77025 77088-2522

NORTH HOUSTON MEDICAL PHARMACY NORTHSIDE PHARMACY LLC NW ACP ON TIME PHARMACY OPTION CARE PARAGON INFUSION CARE PARK PLAZA LEGEND PHCY PATIENT CARE PHARMACY PAVILION PHARMACY PECAN PARK PHARMACY PEDIACARE PHARMACY PHARMACIA LATINA PHARMACY & MARKETPLACE CAFE PHARMACY 45 PHARMACY INNOVATIONS PHARMACY PLUS PHARMACY TEXAS LLC PHAR-MILES PHARMACY PHARMSCRIPT OF TEXAS LLC PLATINUM RX NORTH PLAZA PHARMACY

(713) 694-3131 (832) 940-0424 (281) 602-3487 (713) 731-0880 (713) 794-0599 (713) 860-1750 (713) 524-2828 (281) 501-2325 (713) 868-1601 (713) 861-4300 (832) 770-9383 (713) 683-6004 (713) 520-0500 (713) 847-9900 (281) 251-0888 (713) 782-0558 (346) 206-4333 (832) 410-8123 (908) 389-1818 (281) 227-1010 (281) 880-8300

7007 NORTH FWY STE 115 4712 AIRLINE DR STE F 800 PEAKWOOD DR STE 4A 14455 CULLEN BLVD STE C1 9315 KIRBY DR STE G 6721 PORTWEST DR STE 100 1213 HERMANN DR STE 140 6366 MARTIN LUTHER KING JR BLV 1740 W 27TH ST STE 150 906 WAYSIDE DR 13711 WALLISVILLE RD 1826 WIRT RD STE P 5927 ALMEDA RD STE G 8221 GULF FWY 10130 LOUETTA RD STE C 6776 SOUTHWEST FWY STE 102 10490 HUFFMEISTER RD STE B 16840 BUCCANEER LN STE P 1718 FRY RD STE 125 5627 ALDINE BENDER RD STE 7 17030 NANES DR STE 106

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77076-1326 77022-3076 77090 77047-4824 77054-2516 77024-8057 77004-7008 77021 77008-1439 77011-2518 77049-3908 77055-2400 77004-7791 77017 77070-2118 77074-2100 77065 77058 77084-5845 77032-4534 77090-2531

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 602 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

POWER CENTER PHARMACY POWER CENTER PHARMACY,INC PREFERRED PHARMACY PRESCRIPTION SOLUTIONS PRESTIGE PHARMACY, INC PRIMARY CARE PHARMACY PRIMECARE PHARMACY PRIMESOURCE RX PRIMEWAY PHARMACY PROCARE RX PRO-MED PHARMACY PROSCRIPT AMERICA PROVEN CARE PHARMACY, LLC PUBLIC PHARMACY PYRAMIDS PHARMACY R AND Y COMMUNITY PHARMACY RAPID PHARMACY RELIANCE PHARMACY RICHMOND PHARMACY RITEMED PHARMACY LLC ROSA PHARMACY RUSHMED PHARMACY RX PHARMACY INC RXCARE PHARMACY S & K MED PHARMACY SAFEGUARD PHARMACY SAGE PHARMACY AND STORES, LLC SAIGON PHARMACY SANTA MARIA PHARMACY SAV PHARMACY SCOTT PLACE PHARMACY LLC

Provider Name

(713) 731-8999 (713) 721-3303 (713) 465-8100 (713) 790-1222 (832) 778-6552 (832) 433-7346 (713) 661-7746 (832) 464-7616 (713) 491-2600 (281) 580-4500 (713) 694-8933 (281) 816-6501 (281) 983-9333 (713) 663-7800 (281) 589-2400 (713) 777-7002 (832) 962-4991 (713) 797-1107 (832) 991-8997 (713) 772-4242 (281) 481-6602 (832) 582-8542 (713) 723-4600 (281) 444-6359 (281) 752-7244 (713) 433-1212 (713) 339-1855 (281) 741-4537 (713) 592-5300 (713) 467-3311 (713) 660-9920

8803 SCOTT ST 12401 S POST OAK RD STE E 3939 HILLCROFT ST STE 120 7501 FANNIN ST STE 701 6550 MAPLERIDGE ST STE 116 6612 HORNWOOD DR STE C 5900 CHIMNEY ROCK RD STE AC 2656 S LOOP W STE 574 6520 TIDWELL RD 16300 KUYKENDAHL RD STE 370 2421 ALDINE MAIL RD STE B 4151 SOUTHWEST FWY STE 373 10950 BISSONNET ST STE 220 6510 HILLCROFT ST STE 100 1201 DAIRY ASHFORD STE 114 12659 BISSONNET ST 6120 RICHMOND AVE STE A 7707 FANNIN ST STE 105 9536 RICHMOND AVE STE I 10301 HARWIN DR STE 3 11002 SCARSDALE BLVD STE A 5326 WEST BELLFORT STE 101 5600 S WILLOW STE #113 11511 VETERANS MEMORIAL DR # 9 1396 ELDRIDGE PKWY STE D 3121 W OREM DR STE C 3730-D S GESSNER RD 11209 BELLAIRE BLVD STE C14A 5727 RAMPART ST. STE, A8 1823 WIRT RD 8990 KIRBY DR STE 240

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77051-2453 77045-2021 77057 77054 77081-4648 77074-5010 77081-2706 77054-2664 77016-4822 77068-2751 77039-5509 77027-7312 77099-1707 77081-4771 77079-3023 77099-1331 77057-6210 77054-1918 77063-3845 77036-1501 77089-5973 77035 77035 77067-2603 77077-2545 77045-4641 77063-5132 77072 77081 77055-2406 77054-2852

SEM PHARMACY & MEDICAL SUPPLY LLC SENA RX PHARMACY SIMON'S UNITED DRUG SOLUTIONS IN PHARMACY SOUTH BELT PHARMACY SOUTHEND PHARMACY SOUTHSIDE INFUSION SOUTHSIDE PHARMACY SOUTHSIDE PHARMACY SOUTHSIDE PHARMACY 8

(281) 988-6726 (281) 440-0018 (713) 222-6650 (713) 957-8000 (281) 481-6600 (281) 498-1450 (713) 660-8888 (713) 660-8890 (832) 553-1374 (409) 497-2767

16316 FM 529 RD STE D 5050 FM 1960 RD W STE 125 3303 N MAIN ST 7951 KATY FWY STE M 12600-B SCARSDALE BLVD 415 WESTHEIMER RD STE 103 7700 MAIN ST STE 210 7700 MAIN ST STE 100 7700 MAIN ST STE 260 707 23RD ST STE F

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX

77095-1418 77069-4525 77009-5637 77024-1947 77089-6271 77006 77030-4457 77030-4406 77030-4456 77008

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 603 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SOUTHSIDE PHARMACY 9 SOUTHSIDE PHARMACY II SOUTHWEST COMMUNITY PHARMACY SOUTHWEST PHARMACY SPECIALTY THERAPEUTIC CARE LP SPRING BRANCH PHARMACY STAR REX PHARMACY STEEPLE CHASE EXPRESS RX STERLING PHARMACY STUDENT HEALTH PHARMACY SUMMERWOOD PHARMACY SUPERCARE PHARMACY SUPREME PHARMACY LLC T & S PHARMACY TABB PHARMACY TEJAS PHARMACY TEXAS INFUSION PHARMACY TEXAS UNICARE PHARMACY THE MENNINGER CLINIC PHARMACY THE PEOPLES PHARMACY TIDWELL PHARMACY TIDWELL PHARMACY TIDWELL RX LLC TN PHARMACY TONNA PHARMACY TOTAL CARE PHARMACY TOTAL PHARMACY CENTER ONE TRACE PHARMACY TRINITY PHARMACY SOLUTIONS TRUCARE PHARMACY TWIN LAKES PHARMACY

Provider Name

(713) 661-2500 (832) 553-1315 (713) 272-7734 (713) 270-7366 (832) 300-1200 (713) 690-0001 (832) 767-0816 (281) 894-9900 (713) 995-8885 (713) 743-5125 (281) 225-4300 (281) 880-4800 (281) 550-2100 (832) 655-7118 (713) 772-8222 (281) 741-3385 (713) 636-2290 (832) 834-3222 (713) 275-5000 (713) 378-4450 (713) 884-8807 (713) 694-5977 (866) 852-7405 (281) 561-0101 (281) 953-0030 (281) 377-8137 (713) 864-0808 (713) 981-6600 (713) 697-8082 (832) 466-2907 (281) 815-2352

9150 S MAIN ST STE H 1200 BINZ ST STE 260 9769 BEECHNUT 8282 BELLAIRE BLVD STE 154A 1311 W SAM HOUSTON PKWY N #150 2600 GESSNER DR STE 162 11110 EAST FWY STE 100B 10694 JONES RD STE 115 9798 BELLAIRE BLVD STE B 4800 CALHOUN RD 13176 W LAKE HOUSTON PKWY #1 13480 VETERANS MEMORIAL DR 4544 HWY 6 NORTH 2345 ALDINE MAIL RT STE A 9730 SOUTHWEST FWY STE UC100 5228 ALDINE MAIL RT 9100 SOUTHWEST FWY #207 2424 W HOLCOMBE BLVD STE 101 12301 MAIN ST 8503 GULF FWY 509 W TIDWELL RD 2310 TIDWELL RD 712 E TIDWELL RD UNIT C 12989 BELLAIRE BLVD STE 1A 5225 KATY FWY STE 101A 14755 N FREEWAY STE 200 4302 CENTER ST 8104 SOUTHWEST FWY STE B 5815 AIRLINE DR STE B 2000 CRAWFORD ST STE 105 15462 FM 529 RD

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77025 77004-6925 77036-6503 77036-4031 77043 77080-3839 77029-1914 77065 77036-3428 77204 77044-5381 77014-1696 77084 77039-5528 77074-1352 77039 77074 77030-1933 77035 77017-5086 77091-4352 77093-6731 77022 77072-5134 77007-2292 77090-6503 77007-5616 77074-1704 77076-4922 77002-9000 77095-2702

TX RX SOLUTIONS AND COMPDING PHCY UNICARE PHARMACY INC USPS HEALTHCARE PHARMACY VAC PHARMACY INC VALENCIA PHARMACY,INC. VALUE RX PHARMACY VALUSTAR PHARMACY VILLAGE COMPOUNDING PHARMACY VILLAGE FAMILY PHARMACY VINTAGE PHARMACY PLUS

(713) 790-1228 (281) 498-1141 (713) 325-2700 (281) 495-4331 (713) 995-1900 (281) 501-3151 (844) 843-0101 (713) 464-5069 (713) 373-3300 (281) 251-3911

7505 FANNIN ST STE 140 11847 BISSONNET ST 11777 KATY FWY STE 250-S 10550 W BELLFORT STE 150 7330 SOUTHWEST FWY STE A2 138 E LITTLE YORK RD 7227 FANNIN ST STE 103 975 CORBINDALE RD STE 100 9055 KATY FWY STE 101 11550 LOUETTA RD STE 1600

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON

TX TX TX TX TX TX TX TX TX TX

77054 77099 77079-1703 77031 77074-2092 77076-1412 77030-4848 77024-2810 77024-1663 77070-1388

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 604 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

VITA-CARE PHARMACY VITAL CARE OF NORTH HOUSTON VITAL STAR PHARMACY WALLIS PHARMACY WASHINGTON AVE PHARMACY CENTER WELLNESS PHARMACY WEST AVE PHARMACY WESTLAKE PHARMACY SERVICES WESTVIEW PHARMACY WILLOWBROOK PHARMACY CMPDING WINSTON'S PHARMACY XAVIER PHARMACY AND MED SUPPLY XAVIER PHARMACY III XPRESS PHARMACY YELLOW OLIVE PHARMACY YOUR PHARMACY INC ZOETIC COMPOUNDING PHARMACY HUBBARD CITY DRUG TACKETT COMPOUNDING PHARMACY LIFECHEK PHARMACY #43 THE MED SHOP PHARMACY DEERBROOK PHARMACY SERVICES

Provider Name

(713) 781-8675 (832) 487-9746 (713) 785-1960 (281) 457-3838 (713) 864-2401 (713) 532-0008 (832) 831-9480 (281) 579-1310 (713) 365-9393 (281) 894-3103 (713) 944-6000 (713) 645-3344 (713) 697-1400 (713) 541-3300 (832) 446-6832 (713) 781-1010 (832) 487-9287 (254) 576-2241 (817) 441-7046 (281) 324-1960 (903) 639-3508 (281) 446-0061

2500 FONDREN RD 1125 CYPRESS STATION DR 7207 REGENCY SQUARE BLVD #203 5620 E SAM HOUSTON PKWY N 2515 WASHINGTON AVE STE 1401 1480 WILCREST DR 2800 KIRBY DR STE A200 2430 NORTH FRY ROAD #104 2323 WIRT RD STE F 8945 HWY 6 NORTH STE 255 8405 ALMEDA GENOA RD STE U&S 4040 BROADWAY ST 96 BERRY RD 7555 BELLAIRE BLVD STE B 1646 FM 1960 RD W 7400 HARWIN DR STE 253 10674 WESTHEIMER RD 200 N MAGNOLIA AVE 3500 FORT WORTH HWY 12315 FM 1960 RD STE A 111 E 2ND 9816 MEMORIAL BLVD STE 105

HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HOUSTON HUBBARD HUDSON OAKS HUFFMAN HUGHES SPRINGS HUMBLE

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77063-2319 77090-3054 77036 77015-3249 77007-6342 77042-2229 77098-1736 77084 77055-1231 77095 77075-2503 77087-4704 77022-3057 77036-5055 77090 77036-2030 77042-3486 76648-2446 76087-8781 77336-2450 75656 77338-4205

DOUGHERTY'S PHARMACY HUMBLE, LLC DOYFRAN PHARMACY GREATER TEXAS PHARMACY HUMBLE PHARMACY PRIZE PHARMACY PRO SCRIPT SOLUTIONS PHARMACY SOUTHSIDE PHARMACY WELLCARE SPECIALTY PHCY LLC LOPERS FAMILY PHARMACY MCNEASE DRUGS CARIE BOYDS PRESCRIPTION SHOP MIDCITIES PHARMACY DRISCOLL PHARMACY JERRYS PHARMACY HUGHES PHARMACY IOWA PARK PHARMACY AJRX AMERICA FIRST PHARMACIES ARRAY PHARMACY

(281) 446-9191 (281) 973-8129 (832) 644-9895 (281) 540-4441 (281) 973-8683 (281) 570-6707 (832) 831-8010 (281) 973-4731 (936) 422-4440 (936) 293-8333 (817) 282-9376 (817) 605-3500 (806) 892-2561 (361) 776-2577 (940) 592-4191 (940) 592-2731 (972) 254-0011 (972) 947-2400 (214) 379-2780

211 FM 1960 BYPASS RD E 9701 N SAM HOUSTON PKWY E 1485 FM 1960 BYPASS RD E #120 19333 HIGHWAY 59 N 9761 FM 1960 BYPASS RD W 6730 ATASCOCITA RD SUITE 111 18648 MCKAY DR STE 110 18321 W LAKE HOUSTON PKWY #280 116 N US HIGHWAY 69 103B MEDICAL PARK 122 GRAPEVINE HWY 2000 PRECINCT LINE RD STE 102 816 FRONTAGE RD 2793 MAIN ST 120 W PARK AVE 405 SE ACCESS RD 1901 W IRVING BLVD 7801 MESQUITE BEND DR #108 7415 LAS COLINAS BLVD STE 100

HUMBLE HUMBLE HUMBLE HUMBLE HUMBLE HUMBLE HUMBLE HUMBLE HUNTINGTON HUNTSVILLE HURST HURST IDALOU INGLESIDE IOWA PARK IOWA PARK IRVING IRVING IRVING

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77338-3605 77396-4636 77338-3909 77338-4204 77338-4067 77346 77338 77346-3587 75949-8910 77340-4972 76054-2406 76054-3185 79329-9100 78362-5901 76367-2805 76367 75061-6823 75063 75063-7569

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 605 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BAYLOR MED PLZA PHCY AT IRVING BOARDWALK PHARMACY BROWN'S PHARMACY DOCTOR'S SPECIALTY PHARMACY FARMACIA CENTRAL FIESTA LIFECARE PHARMACY LLC GENERX DISCOUNT PHARM GIBSON PHARMACY IRVING PHARMACY LAS COLINAS PHARMACY LINDSEYS PHARMACY

Provider Name

(972) 579-4074 (972) 812-7559 (817) 274-1883 (469) 906-2002 (972) 253-3455 (972) 790-3753 (972) 259-3094 (972) 579-0511 (972) 313-0585 (972) 580-1814 (972) 252-8644

1901 N MACARTHUR BLVD STE 1001 1110 COTTONWOOD LN STE 115 2021 N MACARTHUR BLVD STE 120 8600 FREEPORT PARKWAY STE 110 504 N O CONNOR RD 2200 W SHADY GROVE 1202 W POINEER DR STE 140 815 N O CONNOR RD 2000 ESTERS RD STE 202 6420 N MACARTHUR BLVD STE 100 2616 TEXAS DR

IRVING IRVING IRVING IRVING IRVING IRVING IRVING IRVING IRVING IRVING IRVING

TX TX TX TX TX TX TX TX TX TX TX

75061 75038-6113 75061-2222 75063 75061-7528 75060 75061 75061-4510 75061-8019 75039-2848 75062-7058

MACARTHUR HEALTH MART PHARMACY MERIDIAN PHARMACY GROUP OPTION CARE PHARMACIA SANA PHARMACY PLUS PHARMACY TOI SILVERPOINT PHCY SERVICES SS PHARMACY TOTAL PHARMACY & COMPOUNDING MERCURY DRIVE PHARMACY REDI-MED PHARMACY LLC CITY DRUG STORE PORTER PHARMACY VCARE PHARMACY GEE SHIPMAN LEGEND PHARMACY MEDICINE SHOPPE CITY DRUG COMPANY JERSEY VILLAGE PHCY COMPOUNDING B AND B PHARMACY JOHNSON CITY PHARMACY BEST VALUE DAN'S PHARMACY JOSHUA PHARMACY CITY PHARMACY JUSTIN FAMILY PHARMACY JAY'S CITY PHARMACY

(972) 756-9515 (214) 492-0123 (972) 536-7355 (469) 647-5291 (972) 401-7455 (972) 807-2663 (214) 260-6900 (817) 632-7779 (972) 570-4800 (713) 674-6122 (281) 428-1212 (940) 567-5576 (903) 586-9804 (903) 284-6256 (409) 384-4646 (409) 384-3432 (903) 665-2521 (281) 416-5800 (903) 626-5414 (830) 868-7185 (817) 484-3267 (817) 295-8531 (325) 446-2511 (940) 648-2222 (830) 780-2224

5477 N MACARTHUR BLVD 1111 S IRVING HEIGHTS DR 6611 N BELT LINE RD STE 100 1111 W AIRPORT FWY #151 7200 STATE HIGHWAY 161 STE 110 8300 N MACARTHUR BLVD STE 130 8300 ESTERS BLVD STE 950 2625 TEXAS DR 3636 N MACARTHUR BLVD STE 100 918 MERCURY DR 1520 HOLLAND ST 104 E BELKNAP ST 308 W LARISSA 1729 S JACKSON ST 140 W LAMAR ST 494 SPRINGHILL ST 109 W LAFAYETTE ST 17400 HWY 290 STE 400 1117 N MAIN ST 405 S US HIGHWAY 281 3521 SW WILSHIRE BLVD STE B 504 N BROADWAY ST 1610 MAIN ST 120 W 4TH ST 214 E CALVERT AVE

IRVING IRVING IRVING IRVING IRVING IRVING IRVING IRVING IRVING JACINTO CITY JACINTO CITY JACKSBORO JACKSONVILLE JACKSONVILLE JASPER JASPER JEFFERSON JERSEY VILLAGE JEWETT JOHNSON CITY JOSHUA JOSHUA JUNCTION JUSTIN KARNES CITY

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75038-3165 75060-6237 75063-6001 75062-6216 75039-3800 75063-4892 75063-2292 75062-7016 75062 77029-2041 77029 76458-2401 75766 75766-5832 75951-4015 75951-4922 75657-2205 77040 75846 78636-4950 76058-6195 76058-3414 76849-3535 76247-0007 78118-3210

CARECOM PHARMACY & COMPOUNDING CONTROLLED RX PHARMACY FULTON PHARMACY GREENBUSCH PHARMACY

(832) 437-3397 (281) 208-7138 (832) 437-8425 (832) 437-1130

6630 FM 1463 RD STE 400A 403 W GRAND PKWY S STE E 1331 W GRAND PKWY N STE 111 25757 WESTHEIMER PKWY STE 150

KATY KATY KATY KATY

TX TX TX TX

77494-4304 77494-8358 77493-2710 77494-5382

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 606 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name HEALTH-RITE PHARMACY HELPING HAND PHARMACY HOMETOWN PHARMACY HQ PHARMACY KATY MEDICAL COMPLEX PHARMACY KATY MEMORIAL PHARMACY KATY PHARMACY I KINGSLAND PHARMACY MEDICINE + PHARMACY NOELAS PHARMACY PREMIER PHARMACY PSC PHARMACY RITE CHOICE PHARMACY LLC SINA PHARMACY SPRING GREEN PHARMACY MEDICATION STATION KEENE PHARMACY HERITAGE PHARMACY KELLER PHARMACY KEMP FAMILY PHARMACY FRONTIER PHARMACY THE PRESCRIPTION SHOP RAYS PHARMACY HILLIARD DRUGS KERMIT PHARMACY LOWES MARKETPLACE PHCY GENOA-QOL HEALTHCARE KERRVILLE DRUG COMPANY MEDICAL ARTS PHARMACY MEDICINE STOP BAYLOR SCOTT AND WHITE PHCY METROPLEX PHARMACY KINGSLAND HEALTHMART PHARMACY HARREL'S KINGSVILLE PHARMACY GREENPATH PHARMACY MILLENNIUM PHARMACY #2 PATIENT DIRECT PHARMACY INC S & R DRUG CO DBA S & R PHCY KNOX COUNTY PHARMACY & SUPPLY LIFECHEK HEALTH MART DRUG S & J PHARMACY KRUM KYLE CARE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (832) 437-2216 (281) 492-0031 (832) 437-2877 (281) 579-2700 (281) 829-6497 (832) 437-7864 (281) 578-1515 (281) 599-7880 (281) 724-5820 (832) 321-4459 (281) 579-0550 (281) 665-8899 (832) 913-6905 (281) 717-4521 (281) 942-4330 (972) 932-6855 (817) 645-7534 (817) 741-7100 (682) 593-0461 (903) 498-8523 (830) 583-2115 (830) 583-9652 (817) 478-8225 (903) 396-2214 (432) 586-2556 (432) 586-3479 (830) 896-0256 (830) 895-3784 (830) 214-2150 (830) 896-7440 (254) 953-7777 (254) 519-8272 (325) 388-4593 (361) 592-3355 (832) 445-0500 (281) 312-8585 (281) 312-8590 (409) 423-2215 (940) 657-4036 (409) 246-3492 (940) 482-1972 (512) 256-0129

Provider Street 1801 N MASON RD STE B 529 MASON RD 1251 PIN OAK RD STE 127 21214 KINGSLAND BLVD STE B 21700 KINGSLAND BLVD STE 105 23920 KATY FWY STE 112 20005 KATY FWY 21214 KINGSLAND BLVD 705 S FRY RD SE 105 942 S FRY RD 3616 N FRY RD STE 220 23510 KINGSLAND BLVD STE 104 9727 SPRING GREEN BLVD #150 3815 N FRY RD STE 600 1443 FM 1463 RD SUITE 650 700 ED HALL DR 114 S OLD BETSY RD 3529 HRTGE TRACE PKWY STE 141 1200 KELLER PKWY STE 200 1224 S ELM ST 103 W MAIN ST 143 N CRAIG ST 301 W MANSFIELD HWY 1001 NW 2ND STE #300 810 MYER LN 310 E AUSTIN ST 500 THOMPSON DR 1050 JUNCTION HWY 200 WESLEY DR UNIT A 1000 MAIN ST 2500 CROSS DR 2201 S CLEAR CREEK RD 306 RANCH RD 2900 204 E KLEBERG AVE 24000 HIGHWAY 59 N 22730 PROFESSIONAL DR STE 110 22710 PROFESSIONAL DR 1606 S MARGARET AVE 712 SE 5TH ST 800 S PINE ST 820 E MCCART STE C 575 E FM 150 UNIT L

Page 607 of 679

Provider City KATY KATY KATY KATY KATY KATY KATY KATY KATY KATY KATY KATY KATY KATY KATY KAUFMAN KEENE KELLER KELLER KEMP KENEDY KENEDY KENNEDALE KERENS KERMIT KERMIT KERRVILLE KERRVILLE KERRVILLE KERRVILLE KILLEEN KILLEEN KINGSLAND KINGSVILLE KINGWOOD KINGWOOD KINGWOOD KIRBYVILLE KNOX CITY KOUNTZE KRUM KYLE

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77449 77450 77494-5659 77450 77450-2513 77494-0881 77450-2238 77450-5898 77450-2252 77450 77449-8668 77494-4125 77494 77449-6735 77494-5479 75142-1859 76059-2425 76244 76248-3615 75143-7708 78119-2717 78119-2227 76060-2421 75144-2424 79745-4634 79745-3023 78028-5144 78028-4902 78028-5809 78028-3507 76543-5256 76549-4110 78639-6063 78363-4573 77339 77339-6004 77339 75956-2633 79529-2105 77625-9391 76249 78640-6264

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

STAGECOACH PHARMACY LA FERIA DRUG LIFECHEK LA JOYA FAMILY PHARMACY DEANGELO PHARMACY MEDICINE SHOPPE PRUDENT PHARMACY MEDICAL CENTER PHARMACY MEDICINE SHOPPE STARR PLUS PHARMACY ALBERTSON'S PHARMACY HILL COUNTRY APOTHECARY PURE PHARMACY JONES-MCCALL PHARMACY CATTLES PHARMACY INC HODGES & SARGENT PHARMACY AMERICAN SPECIALTY PHARMACY FIESTA LIFECARE PHARMACY LLC MORNING STAR PHCY & MED SPPLY RITE CARE PHARMACY III GATEWAY COMM HLTH CTR INC

Provider Name

(512) 746-1888 (956) 277-0329 (979) 968-5835 (956) 583-7845 (281) 842-8500 (281) 471-1241 (281) 867-0040 (979) 297-1776 (979) 297-9503 (979) 297-3800 (817) 237-8128 (832) 794-3229 (817) 528-7197 (806) 872-5453 (512) 556-5141 (512) 556-3392 (972) 232-7458 (972) 227-2126 (972) 224-1340 (214) 331-4500 (956) 795-8100

1300 DACY LN STE 225 510 N MAIN ST 110 E TRAVIS ST 802 E EXPRESSWAY 83 STE B 1309 W FAIRMONT PKWY STE P 800 S BROADWAY ST 10407 W FAIRMONT PKWY STE C 215 OAK DR S 109 ABNER JACKSON PKWY STE B 208 OAK DR S STE 302 6308 LAKE WORTH BLVD 1310 RANCH ROAD 620 S #A01 1927 LOHMANS CROSSING STE 203 1605 N BRYAN AVE 202 N KEY AVE 210 S KEY AVE 2600 W PLEASANT RUN RD # 1-173 1450 W PLEASANT RUN STE 200 2700 W PLEASANT RUN RD # W250 3250 W PLEASANT RUN RD STE 165 2007 SOUTH ZAPATA HWY

KYLE LA FERIA LA GRANGE LA JOYA LA PORTE LA PORTE LA PORTE LAKE JACKSON LAKE JACKSON LAKE JACKSON LAKE WORTH LAKEWAY LAKEWAY LAMESA LAMPASAS LAMPASAS LANCASTER LANCASTER LANCASTER LANCASTER LAREDO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78640-4196 78559-5213 78945-2615 78560-4126 77571-6123 77571-5324 77571-6018 77566-5629 77566-5159 77566-5640 76135-3602 78734-6300 78734-5243 79331-3144 76550-1843 76550-2721 75146-1114 75146-1392 75146-1079 75146 78046

GATEWAY COMMUNITY HEALTH CTR INC HEALTHVILLE PHARMACY LAKESIDE PHARMACY SOUTH LAN RX PHARMACY II LANRX PHARMACY LAREDO DOWNTOWN PHARMACY LAREDO PHARMACY MARTINEZ PHARMACY MEDCENTER PHARMACY MEDICAL PLAZA PHARMACY LIFECHEK

(956) 795-8100 (956) 701-3349 (956) 724-2090 (956) 725-6000 (713) 662-0200 (956) 726-4512 (956) 729-9993 (956) 722-7600 (956) 791-1991 (956) 718-2770 (830) 779-2219

1515 PAPPAS ST 1029 BOB BULLOCK LOOP STE 2 4151 JAIME ZAPATA MEM HWY 208 2110 LOMAS DEL SUR SUITE 105 1901 FREES ST STE 2 1219 MATAMOROS ST 3507 LOOP 20 STE 4 1407 JACAMAN RD 1419 E BUSTAMANTE ST 10710 MCPHERSON RD STE 102 13250 C HWY 87

LAREDO LAREDO LAREDO LAREDO LAREDO LAREDO LAREDO LAREDO LAREDO LAREDO LAVERNIA

TX TX TX TX TX TX TX TX TX TX TX

78041 78043-4399 78043-4782 78046 78046-7129 78040-5053 78043-4743 78041-6198 78041-5303 78045-6363 78121

DEVEREUX TEXAS TREATMENT NETWORK RX TO GO PHARMACY LEONARD PHARMACY SOUTH PLAINS RURAL HEALTH UNITED PHARMACY COMMUNITY CARE PHARMACY FIRST STOP PHARMACY LEWISVILLE MEDICAL PHARMACY

(800) 373-0011 (281) 557-0220 (903) 587-3363 (806) 894-7842 (806) 894-7315 (972) 317-5599 (972) 299-8990 (972) 906-0800

1150 DEVEREUX DR 1100 GULF FWY 122 W COLLINS ST 1000 FM RD 300 511 COLLEGE AVE 1301 JUSTIN RD STE 212 101 E CORPORATE DR STE 220A 560 W MAIN ST STE 105

LEAGUE CITY LEAGUE CITY LEONARD LEVELLAND LEVELLAND LEWISVILLE LEWISVILLE LEWISVILLE

TX TX TX TX TX TX TX TX

77573-2043 77573 75452-2642 79336 79336-4805 75077-2184 75067-6603 75057-3665

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 608 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name RODGER'S PHARMACY TPS/LIBERTY RX LIBERTY HILL PHCY & COMPOUNDING EAGLE PHARMACY ELLIOTT'S PHARMACY INC POWERS PHARMACY LITTLE ELM PHARMACY LOWES MARKETPLACE PHARMACY PRESCRIPTION SHOP RX PLUS PHARMACY OF LIVE OAK LIVINGSTON PHARMACY CORNER DRUG STORE WESTYS PHARMACY HOMETOWN PHARMACY ALBERTSON'S PHARMACY DRUG EMPORIUM LONGVIEW DRUGS LOUIS MORGAN DRUG LOUIS MORGAN DRUGS MEDICAL PARK PHARMACY MEDICAL PLAZA PHARMACY SPRING HILL PHARMACY SUPER 1 PHARMACY SUPER 1 PHARMACY LOS FRESNOS PHARMACY BEST DISCOUNT PHARMACY BRIOVARX CAPROCK PHARMACY DRUG EMPORIUM PARKWAY PHARMACY RAFF & HALL FAMILY PARK SPECIAL CARE PHARMACY TEXAS TECH STUDENT HEALTH PHCY TTUHSC PHARMACY TWIN OAKS PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (936) 776-5228 (936) 334-8000 (512) 766-5479 (903) 881-5752 (903) 882-3312 (903) 756-7923 (972) 294-2877 (806) 385-4250 (806) 385-4491 (210) 646-0207 (832) 563-1050 (325) 247-4155 (512) 398-2114 (806) 652-3353 (903) 663-2056 (903) 297-0558 (903) 291-1730 (903) 758-8286 (903) 758-6164 (903) 234-8326 (903) 757-3477 (903) 212-7900 (903) 753-1964 (903) 234-2785 (956) 233-3400 (806) 795-4353 (888) 456-2401 (806) 589-6333 (806) 794-0022 (806) 767-9999 (806) 744-8477 (806) 741-1777 (806) 743-2636 (806) 743-3270 (806) 799-3636 (806) 763-9999 (806) 765-7014 (806) 788-2015 (806) 747-3503 (806) 791-0972 (806) 763-5908 (806) 796-1895

Provider Street 1909 GRAND AVE 1710 N MAIN ST 13740 W STATE HIGHWAY 29 STE 4 1404 S MAIN ST 14077 FM 849 702 W HOUSTON ST 800 W ELDORADO PKWY STE 100 102 W WAYLON JENNINGS BLVD 1506 S SUNSET AVE 12315 JUDSON RD STE 108 714 W CHURCH ST 600 BESSEMER AVE 113 S MAIN ST 309 N MAIN 3603 MCCANN RD 2321 W LOOP 281 1751 W LOOP 281 1900 S HIGH ST 110 JOHNSTON ST 709 HOLLYBROOK DR STE 101 707 E MARSHALL AVE STE 7 3600 GILMER RD 1217 E MARSHALL AVE 1800 S HIGH ST 810 W OCEAN BLVD 2316 34TH ST 6310 GENOA AVE 3007 50TH ST 5109 82ND ST 1824 PARKWAY DR STE 100 3404 INTSTE 27 3406 INTERSTATE 27 1003 FLINT AVE 3601 4TH ST # 1A150 3436 34TH ST 1318 BROADWAY 2630 PARKWAY DR 4425 19TH ST 1701 50TH ST 3405 50TH ST 112 N UNIVERSITY AVE 401 SLIDE RD

Page 609 of 679

Provider City LIBERTY LIBERTY LIBERTY HILL LINDALE LINDALE LINDEN LITTLE ELM LITTLEFIELD LITTLEFIELD LIVE OAK LIVINGSTON LLANO LOCKHART LOCKNEY LONGVIEW LONGVIEW LONGVIEW LONGVIEW LONGVIEW LONGVIEW LONGVIEW LONGVIEW LONGVIEW LONGVIEW LOS FRESNOS LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUBBOCK

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77575-4803 77575-3728 78642-6283 75771 75771-5160 75563-5441 75068-5134 79339-3806 79339-4899 78233-3263 77351-3109 78643-2058 78644-2740 79241 75605-5309 75604-2563 75604-2734 75602-3212 75601-3909 75605-2412 75601-5563 75604 75601-5604 75602-3210 78566-3636 79411-1634 79424-2706 79413-4101 79424-3028 79403-4406 79404 79404-2346 79415 79430-0002 79410-2830 79401-3206 79403-4100 79407-2408 79412-2701 79413-4001 79415-2822 79416-4315

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY ABELDTS GASLIGHT PHARMACY INC MEDICINE SHOPPE KING'S PHARMACY OF LUMBERTON MARKET BASKET PHARMACY SUPER DRUG MART MABANK FAMILY PHARMACY B AND B PHARMACY MAGNOLIA PHARMACY TEXAS PROFESSIONAL PHCY MAGNOLIA TRIUMPH PHARMACY MALAKOFF PHARMACY MANOR PHARMACY BROAD STREET PHARMACY KK'S PHARMACY #251 MELROSE PHARMACY RAYS PHARMACY INC MANVEL PHARMACY INC ATKINS EXPRESS PHARMACY ATKINS PHARMACY LTC ATKINS PHARMACY SERVICES SANITARIUM DRUG COMPANY MATTHEWSON DRUG COMPANY SCRIPT SHOPPE PHARMACY MATHIS CARE PHARMACY APPLE PHARMACY ASPCARES DLS PHARMACY JAY'S PHARMACY LEE'S LEGEND PHARMACY NORTH LEE'S PHARMACY & MED. EQUIP. LIFECHEK DRUG MCALLEN PHARMACY MED AID PHARMACY- BICENENNIAL QUEEN PHARMACY SAENZ MEDICAL PHARMACY INC SAENZ MEDICAL PHARMACY NOLANA SAENZ MEDICAL PHARMACY NORTH LL SAENZ MEDICAL PHCY RIDGE INC

NR_0009_10823 10/2017

Provider Phone Number (806) 745-3907 (806) 798-6115 (806) 776-8915 (806) 783-0241 (936) 639-2346 (936) 634-3006 (409) 755-1145 (409) 755-4932 (830) 709-0360 (903) 887-3711 (281) 356-4303 (281) 356-9089 (281) 356-2216 (281) 252-4200 (903) 489-1909 (512) 642-8000 (817) 225-4136 (817) 453-5700 (817) 453-4444 (817) 473-1145 (281) 489-3210 (830) 693-3784 (830) 693-2972 (830) 693-2972 (254) 883-3541 (903) 938-6741 (325) 347-6248 (361) 678-4302 (956) 627-6652 (956) 284-6687 (956) 631-7900 (956) 682-4525 (956) 630-5500 (956) 686-3716 (956) 683-1777 (956) 668-1100 (956) 618-3100 (713) 498-0705 (956) 630-6465 (956) 687-2500 (956) 928-0911 (956) 630-2500

Provider Street 2703 82ND ST 4205 98TH ST 12815 INDIANA AVE 8010 FRANKFORD AVE 200 GASLIGHT BLVD 903 W FRANK AVE 139 N LHS DRIVE STE 211 421 S MAIN ST 19010 PRIEST BLVD STE 101 207 N 3RD ST 18640C FM 1488 RD 18230 FM 1488 RD STE 100 18602 FM 1488 RD STE 700 7030 FM 1488 RD STE 110 409 W ROYALL BLVD 14008 SHADOW GLEN BLVD #102 2771 E BROAD ST STE 219 980 N WALNUT CREEK DR # 118 2860 N FM 157 STE 120 1831 E BROAD ST STE 101 20226 HIGHWAY 6 STE C 2607 US HWY 281 NORTH 701 3RD ST 701 3RD ST 156 COLEMAN ST 717 S WASHINGTON AVE 211 MOODY ST 217 SOUTH HIGHWAY 359 2501 N 23RD ST STE B 1401 E RIDGE RD STE B 1301 E FERN AVE STE B1 610 S BROADWAY ST 5120 N 10TH ST 1901 S 1ST ST STE 100 1623 PECAN BLVD 4420 N MCCOLL RD 400 S BICENTENNIAL BLVD 1001 S 10TH ST STE H 212 LINDBERG AVE 801 E NOLANA AVE STE 22 6900 N 10TH ST STE 6 1200 E RIDGE RD STE 13

Page 610 of 679

Provider City LUBBOCK LUBBOCK LUBBOCK LUBBOCK LUFKIN LUFKIN LUMBERTON LUMBERTON LYTLE MABANK MAGNOLIA MAGNOLIA MAGNOLIA MAGNOLIA MALAKOFF MANOR MANSFIELD MANSFIELD MANSFIELD MANSFIELD MANVEL MARBLE FALLS MARBLE FALLS MARBLE FALLS MARLIN MARSHALL MASON MATHIS MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN MCALLEN

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

79423-1462 79423-3971 79423-5677 79424-2626 75904-3166 75904-3318 77657 77657-7374 78052-0000 75147-8610 77354-8561 77354-4529 77354-8510 77354 75148-9499 78653 76063-9157 76063-8019 76063 76063-9171 77578-3804 78654-3807 78654-5720 78654-5720 76661-2851 75670-5337 76856-0000 78368 78501 78503-1525 78501-1467 78501-4906 78504-2834 78503-1215 78501-4214 78504 78501-5199 78501-5045 78501-2920 78504-6106 78504-3151 78503-1528

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SOUTHSIDE PHARMACY

Provider Name

(956) 627-3259

300 S 2ND STREET SUITE B

MCALLEN

TX

78501

SPECTRUM(RX) CUSTOMIZED PHARMACEUTI ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY APOLLO PHARMACY BAYLOR MED PLAZA PHCY MCKINNEY MCKINNEY MEDICAL ARTS PHCY MCKINNEY PHARMACY

(956) 928-1280 (972) 548-1088 (972) 542-0010 (972) 542-6337 (469) 764-7100 (469) 714-0286 (972) 562-8700

1100 E JASMINE STE 106 3001 S CENTRAL EXPY 6800 VIRGINIA PKWY 4987 W UNIVERSITY DR STE 120 5236 W UNIVERSITY DR STE 1900 4201 MEDICAL CENTER DR STE 320 1601 W UNIVERSITY DR

MCALLEN MCKINNEY MCKINNEY MCKINNEY MCKINNEY MCKINNEY MCKINNEY

TX TX TX TX TX TX TX

78501 75070-4345 75071-5516 75071-5072 75071 75069 75069-3445

MCKINNEYCARE PHCY & COMPOUNDING NORTH CENTRAL PHARMACY PHARMA PLUS PHARMACY UNITED MARKETSTREET PHARMACY PRIMETOUCH PHARMACY

(972) 325-2273 (972) 540-9900 (214) 585-4600 (972) 548-5150 (281) 302-5494

4601 MEDICAL CNTR DR STE B 2741 VIRGINIA PKWY STE 800 5881 VIRGINIA PKWY STE 400 6100 ELDORADO PKWY 11611 W AIRPORT BLVD STE B2

MCKINNEY MCKINNEY MCKINNEY MCKINNEY MEADOWS PLACE

TX TX TX TX TX

75069 75071-5027 75071-5402 75070-5622 77477-3042

MEDPRO PHARMACY AND WELLNESS CTR MEMPHIS DRUG COACHS PHARMACY MID-VALLEY PHARMACY MERKEL DRUG COMPANY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY APPLE DRUGS, PLLC. BENZER PHARMACY CROSSROADS PHARMACY, LLC ELITE PHARMACY FAMILY PHARMACY #2 GALLOWAY PHARMACY KEARNEY PARK PHARMACY SAFECARE PHARMACY VERDE PHARMACY GRAHAM PHARMACY GRAHAM PHARMACY NORTH MEDICAL CENTER PHARMACY PROVIDE RX SAV-ON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY SUPER MERCADO PHARMACY ALL CARE PHARMACY US DRUG MART

(972) 837-2900 (806) 259-5067 (956) 514-2420 (956) 565-4111 (325) 928-5012 (972) 285-1352 (972) 270-4448 (972) 270-0041 (972) 285-1761 (972) 682-4971 (866) 985-8025 (972) 270-5600 (972) 216-7000 (972) 329-1168 (972) 525-2226 (972) 807-2493 (432) 684-0569 (432) 242-8833 (432) 697-7500 (432) 689-3355 (432) 694-9673 (432) 699-7578 (432) 689-8708 (432) 682-9501 (972) 775-5222 (972) 775-1180

2212 SAM RAYBURN HWY STE 100 506 W NOEL ST 100 N TEXAS STE A 805 W 2ND ST 121 EDWARDS ST 1500 S BELT LINE RD 2828 MOTLEY DR 1900 OATES DR STE 138 1320 N GALLOWAY AVE STE 102 3220 GUS THOMASSON RD STE 237 3141 INTERSTATE 30 STE C 2698 N GALLOWAY AVE STE 108 910 N GALLOWAY AVE # 100 502 W KEARNEY ST STE 900 3201 INTERSTATE 30 STE B2 2929 N GALLOWAY AVE STE 116 1601 W WALL ST 4906 BRIARWOOD 3510 N MIDKIFF RD STE 100 2208 N LOOP 250 W # 101 1002 ANDREWS HWY 4706 N MIDKIFF RD 3317 N MIDLAND DR 2208 N BIG SPRING ST 1441 S MIDLOTHIAN PKWY #140 540 GEORGE HOPPER RD

MELISSA MEMPHIS MERCEDES MERCEDES MERKEL MESQUITE MESQUITE MESQUITE MESQUITE MESQUITE MESQUITE MESQUITE MESQUITE MESQUITE MESQUITE MESQUITE MIDLAND MIDLAND MIDLAND MIDLAND MIDLAND MIDLAND MIDLAND MIDLAND MIDLOTHIAN MIDLOTHIAN

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75454-2675 79245-3328 78570-2729 78570-2607 79536-3801 75149-5943 75150-3425 75150-6802 75149-2440 75150 75150 75150-6390 75149-2409 75149-3401 75150-2602 75150-4800 79701-6549 79707 79705 79707-6011 79701-3825 79705-2522 79707-4602 79705-8823 76065-5592 76065

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 611 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KELLY DRUG, INC. BEST VALUE WADDY'S DIAMOND PHARMACY AG PHARMACY HEALTH PLUS PHARMACY LETDIN PHARMACY MISSION PLAZA PHARMACY NUESTRA CLINICA DEL VALLE RICHARDS PHARMACY

Provider Name

(903) 569-3882 (940) 325-0734 (940) 325-2541 (956) 580-7791 (956) 424-3535 (956) 581-9566 (956) 581-8833 (956) 580-3304 (956) 581-4200

125 E BROAD ST 106 SW 6TH AVE 100 SE 17TH AVE 2408 N CONWAY 3401 W MILE 5 RD STE 2 1512 E GRIFFIN PKWY STE 1 906 S BRYAN RD STE 101 611 N BRYAN RD 1112 E GRIFFIN PKWY STE B

MINEOLA MINERAL WELLS MINERAL WELLS MISSION MISSION MISSION MISSION MISSION MISSION

TX TX TX TX TX TX TX TX TX

75773-2001 76067-5129 76067-5607 78574 78574 78572-2422 78572-6605 78572-6285 78572-2409

SAENZ MEDICAL PHARMACY LONE STAR TLC PHARMACY & MED EQUIP TLC PHARMACY & MEDICAL EQUIP AMAZING GRACE PHARMACY

(956) 519-6500 (956) 581-5499 (956) 583-2700 (832) 230-0169

2121 E GRIFFIN PKWY STE 18 2120 E GRIFFIN PKWY 1242 EAST HWY BUS 83 # 7 1965 TEXAS PKWY

MISSION MISSION MISSION MISSOURI CITY

TX TX TX TX

78572-3072 78572-3225 78572 77489-3121

ECO PHARMACY OF SIENNA PLANTATION ED'S PHARMACY FORT BEND RX PHARMACY HAECKERVILLE PHARMACY MEDLIN PHARMACY QUAIL VALLEY PHARMACY SIENNA COMPOUNDING PHARMACY STRIDENT PHARMACY WINDIES COMMUNITY RX LLC LOWES MARKETPLACE PHCY MONAHANS PHARMACY LAKESIDE PHARMACY

(832) 440-0085 (281) 499-4555 (281) 969-7611 (281) 915-0793 (281) 437-1818 (281) 499-9300 (281) 915-5055 (346) 304-2203 (281) 208-7937 (432) 943-4445 (432) 943-4365 (936) 448-6337

8721 HIGHWAY 6 SOUTH #200 3740 CARTWRIGHT RD 1100 FM 1092 RD STE D 9402 HIGHWAY 6 S STE 400 2755 TEXAS PKWY STE 101 2244 FM 1092 RD 9029 HIGHWAY 6 STE 190 2817 DULLES AVE 5201 HIGHWAY 6 STE 200 1201 S STOCKTON AVE 801 E 4TH ST 16955 WALDEN RD STE 100

MISSOURI CITY MISSOURI CITY MISSOURI CITY MISSOURI CITY MISSOURI CITY MISSOURI CITY MISSOURI CITY MISSOURI CITY MISSOURI CITY MONAHANS MONAHANS MONTGOMERY

TX TX TX TX TX TX TX TX TX TX TX TX

77459-7151 77459-2431 77459-1585 77459-5108 77489-5105 77459-1802 77459-4874 77459-2950 77459-4398 79756-6032 79756-4018 77356-3227

MEDICAL CENTER FAMILY PHARMACY INC SUPER 1 PHARMACY THURMANS PRO-MED PHARMACY TIGERX PHARMACY MUENSTER PHARMACY K & K PHARMACY UNITED PHARMACY INVERNESS LONE STAR PHARMACY FREST HARVEST PHARMACY M & S PHARMACY MEDICINE SHOPPE STRIPLINGS PHARMACY PRUETTS FOOD-PHARMACY#5

(903) 572-4755 (903) 575-1610 (903) 572-6337 (903) 537-4700 (940) 759-2833 (806) 272-7511 (806) 272-3169 (214) 535-2020 (936) 564-0800 (936) 564-7373 (936) 569-6430 (936) 564-4646 (580) 584-6056

2001 N JEFFERSON AVE STE 132 602 JEFFERSON PARK 402 N MADISON AVE 405 TEXAS HIGHWAY 37 S 511 N MAPLE 1411 W AMERICAN BLVD 104 W 9TH ST 223 E FM 544 STE 806 1420 N UNIVERSITY DR 917 E AUSTIN ST 212 NORTH ST STE B 1205 N MOUND ST 410 W.L. DOC DODSON WEST

MOUNT PLEASANT MOUNT PLEASANT MOUNT PLEASANT MOUNT VERNON MUENSTER MULESHOE MULESHOE MURPHY NACOGDOCHES NACOGDOCHES NACOGDOCHES NACOGDOCHES NAPLES

TX TX TX TX TX TX TX TX TX TX TX TX TX

75455-2387 75455-0000 75455-3949 75457-3103 76252-2425 79347 79347-3221 75094-4029 75961-4221 75965-2845 75961-5260 75961-4028 75568

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 612 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name BETTER LIVING MED EQUIP & SRVC, LTD LIFECHEK 10 MINUTE PHARMACY BEST MED PHARMACY COMAL DRUG GRUENE ROAD PHARMACY LLC HILLTOP PHARMACY INC HUNTER'S CREEK PHARMACY YOUR NEW WAVERLY PHARMACY LLC NEWTON PHARMACY MAIN DRUG COMPANY GIBBS DRUG STORE EVANS PRESCRIPTION PHARMACY GOLDER PROFESSIONAL PHARMACY LOWES MARKETPLACE PHCY SAVON PHARMACY SAV-ON PHARMACY SAV-ON PHARMACY TOWN & COUNTRY DRUG UNIVERSITY HEALTHMART PHARMACY CUB DRUG INC MAURICEVILLE FAMILY PHARMACY LOUIS MORGAN DRUGS OVERTON PHARMACY VILLAGE DRUG PALACIOS PRESCRIPTION SHOPPE BRATTONS HOMETOWN PHARMACY PHARMAVIDA RX WESTSIDE PHARMACY B & B PHARMACY KEYES PHARMACY UNITED PHARMACY PANHANDLE DRUG STORE LLC MEDPRIME PHARMACY PARIS APOTHECARY LLC AMEX PHARMACY NO. 7 ANGELS PHARMACY ASPCARES BAYSHORE HEALTH MART BAYSHORE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (409) 727-8660 (979) 793-5534 (830) 387-4914 (830) 608-1600 (830) 625-2421 (830) 387-4378 (830) 627-0069 (830) 515-1278 (936) 344-2424 (409) 379-9999 (830) 582-1851 (940) 825-3226 (432) 337-2361 (432) 337-7311 (432) 367-3407 (432) 367-4612 (432) 332-7361 (432) 333-1591 (432) 366-2868 (432) 366-8821 (940) 564-5551 (409) 745-3784 (903) 834-3178 (903) 834-0154 (325) 392-2666 (361) 972-3608 (903) 731-4734 (903) 729-3100 (956) 424-6640 (956) 584-3458 (806) 665-5788 (806) 669-1202 (806) 665-7642 (806) 537-3034 (903) 706-5065 (903) 785-4208 (832) 767-5563 (713) 740-7800 (832) 500-3575 (713) 677-0039 (713) 944-8893

Provider Street 1039 N TWIN CITY HWY 13500 HIGHWAY 36 18 GRUENE PARK DR 2115 STEPHENS PL STE 100 544 N UNION AVE 910 GRUENE RD #3 631 LAKEVIEW BLVD 213 HUNTERS VILLAGE STE 100 9320C STATE HIGHWAY 75 S 104 W COURT ST 201 N NIXON AVE 216 CLAY ST 310 DOTSY AVE 319 GOLDER AVE 1107 E 42ND ST 4950 E 42ND ST 1350 E 8TH ST 2751 N COUNTY RD W 2745 N GRANDVIEW AVE 4850 E UNIVERSITY BLVD 116 E MAIN ST 10897 HWY 12 101 N RUSK ST 104 W HENDERSON ST 902 11TH ST 321 MAIN ST 2305 W OAK ST 101 MEDICAL DR 1337 E PALMA VISTA DR 200 N PALMVIEW DR 300 N BALLARD ST 928 N HOBART ST 1420 N HOBART ST 201 MAIN STREET 3310 B LAMAR AVE 707 LAMAR AVE STE A 3316 PLAINVIEW ST STE B 3623 RED BLUFF RD 5150 CRENSHAW RD STE 9 3315 BURKE RD STE 100 4024A BROOKHAVEN AVE

Page 613 of 679

Provider City NEDERLAND NEEDVILLE NEW BRAUNFELS NEW BRAUNFELS NEW BRAUNFELS NEW BRAUNFELS NEW BRAUNFELS NEW BRAUNFELS NEW WAVERLY NEWTON NIXON NOCONA ODESSA ODESSA ODESSA ODESSA ODESSA ODESSA ODESSA ODESSA OLNEY ORANGE OVERTON OVERTON OZONA PALACIOS PALESTINE PALESTINE PALMVIEW PALMVIEW PAMPA PAMPA PAMPA PANHANDLE PARIS PARIS PASADENA PASADENA PASADENA PASADENA PASADENA

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77627-3850 77461-8417 78130-2460 78130 78130-4158 78130-3919 78130-4017 78132 77358-4224 75966-3249 78140-2723 76255-2104 79763-4342 79761-5009 79762-7723 79762-7240 79761-4714 79764-1665 79762-6952 79762-8106 76374-1922 77632-7402 75684-1333 75684-1613 76943-0000 77465-5461 75801-4063 75801-4781 78572-2055 78572-8121 79065-6542 79065-5204 79065-4124 79068 75460 75460-4460 77504-1906 77503-3345 77505-3094 77504-1873 77504-1902

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BURKE FAMILY PHARMACY CRENSHAW PHARMACY DT PHARMACY FAMILY PHARMACY FAMILY PHARMACY CARE PASADENA MEDICAL PLAZA PHARMACY PCF PHARMACY PHARMHOUSE PREMIERCARE PHARMACY RRX PHARMACY

Provider Name

(281) 619-2130 (281) 998-2777 (832) 775-0060 (713) 472-3138 (832) 900-7712 (713) 429-1842 (713) 947-6767 (281) 998-9400 (281) 991-1300 (281) 991-3441

4002 BURKE RD STE 400 5010 CRENSHAW RD STE 160 3911 WOODLAWN AVE 2418 SOUTHMORE AVE 4949 FAIRMONT PKWY STE 202 1430 PASADENA BLVD STE B 2615 STRAWBERRY RD 4500 E SAM HOUSTON PKWY S STE 5108 FAIRMONT PKWY STE A 6243 FAIRMONT PKWY STE 103

PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA PASADENA

TX TX TX TX TX TX TX TX TX TX

77504-3451 77505-3047 77504 77502-1421 77505 77502-2433 77502-5103 77505-3956 77505-3756 77505

STRAWBERRY FAMILY DRUG & PHARMACY WOODLAWN PHARMACY COUNTRY PLACE PHARMACY FAMILY PHARMACY CARE HAZEL'S COMPOUND RX PHARMACY MARATHON INFUSION CARE LLC MASTERY PHARMACY PHARMCARE ROYAL PHARMACY RX CARE PHARMACY SCRIPT SOURCE PHARMACY TODAH PHARMACY LLC PROFESSIONAL PHARMACY PENITAS FAMILY PHARMACY SAENZ MEDICAL PHARMACY PENITAS REDS PHARMACY, LLC UNITED PHARMACY PORTER DRUG GRAND AVENUE PHARMACY THE PFLUGERVILLE PHARMACY J & L PHARMACY LAS MILPAS PHARMACY MARIO'S RX PHARMACY PHARRMACY UNITEDMIX AXTELL PHARMACY PELZELS HOMETOWN PHARMACY PARKER DRUG THE DRUGSTORE HOMETOWN PHARMACY UNITED PHARMACY

(713) 740-9033 (713) 928-3044 (713) 436-3344 (281) 315-3770 (713) 340-0202 (281) 997-6272 (713) 665-9996 (281) 996-7500 (346) 207-8588 (281) 412-0377 (713) 340-3122 (281) 485-4512 (432) 447-2266 (956) 580-3500 (956) 585-2704 (806) 435-3759 (806) 435-2211 (806) 667-2231 (512) 377-1999 (512) 990-5226 (956) 782-1156 (956) 702-2211 (956) 702-5050 (956) 283-0911 (956) 782-8494 (214) 521-9991 (940) 686-0123 (903) 856-3626 (903) 708-7500 (806) 296-9000 (806) 293-3820

1802 STRAWBERRY RD 3801 VISTA RD STE 395 2404 SMITH RANCH RD STE 100 10905 MEMORIAL HERMANN DR #102 1801 COUNTRY PL PKWY STE 115 2421 ROY RD 2950 CULLEN PKWY STE 112 1834 BROADWAY ST STE 106 12002 SHADOW CREEK PKWY # 106 7121 BROADWAY ST 10223 BROADWAY ST STE D2 2011 E BROADWAY ST #125 925 W DAGGETT ST 2308 EXPRESSWAY 83 STE A 3201 EXPRESSWAY 83 3010 GARRETT DR 2802 HIGHWAY 83 S 1522 MAIN ST 1615 GRAND AVENUE PKWY STE 104 15608 SPRING HILL LN STE 114 900 W SAM HOUSTON STE 3 7013 S CAGE BLVD STE D 6201 S CAGE BLVD STE 5A 1002 W SAM HOUSTON BLVD STE 1 710 S CAGE BLVD STE D 1246 S HIGHWAY 377 STE 100 1340 N HIGHWAY 377 STE 100 114 QUITMAN ST 19 COUNTY ROAD 4114 3200 OLTON RD STE B 2403 N COLUMBIA ST

PASADENA PASADENA PEARLAND PEARLAND PEARLAND PEARLAND PEARLAND PEARLAND PEARLAND PEARLAND PEARLAND PEARLAND PECOS PENITAS PENITAS PERRYTON PERRYTON PETERSBURG PFLUGERVILLE PFLUGERVILLE PHARR PHARR PHARR PHARR PHARR PILOT POINT PILOT POINT PITTSBURG PITTSBURG PLAINVIEW PLAINVIEW

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77502-2610 77504-2184 77584-5233 77584-3490 77584-5120 77581-8601 77584 77581-5606 77584-7324 77581-7743 77584-7881 77581 79772-6902 78576-8316 78576-2229 79070-5322 79070-5310 79250-0000 78660-2060 78660-3320 78577 78577-8673 78577-5612 78577-5198 78577-5461 76258-4332 76258-4039 75686-1322 75686-4199 79072-6653 79072-3119

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 614 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

AMERICAN SPECIALTY PHARMACY ASPCARES BAYLOR MED PLAZA PHCY AT PLANO COURAGE PHARMACY GRACE PHARMACY LIFEPATH PHARMACY MEDSCRIPT PHARMACY PARKWAY PHARMACY PLANO CARE PHARMACY REMEDI SENIORCARE OF DALLAS SCEPTER PHARMACY SPRING CREEK PHARMACY TEXAS HEALTH PRESCRIPTION SHOP TEXAS RX PHARMACY TEXAS STAR PHARMACY THE PHARMACOMPOUNDIA CP THE PHARMACY PLACE THRIVE PHARMACY SOLUTIONS UNITED MARKET STREET PHARMACY ATASCOSA HEALTH CENTER, INC. CENTER PHARMACY REXCO PHARMACY GREENBRIAR PHARMACY KINGS PHARMACY KINGS PHARMACY MID COUNTY O AND M PHARMACY INC

Provider Name

(214) 919-2090 (214) 432-4422 (469) 814-5780 (972) 943-0628 (972) 907-1833 (469) 467-8629 (469) 298-0592 (972) 985-2600 (469) 443-4488 (469) 344-2144 (972) 578-8888 (972) 517-7900 (972) 981-8445 (972) 378-4107 (972) 519-8475 (972) 378-6867 (972) 867-6141 (214) 291-5087 (972) 713-5515 (830) 569-2567 (830) 569-2512 (830) 569-4060 (940) 479-0111 (409) 983-3384 (409) 722-3392 (409) 984-9919

2743 W 15TH ST 2707B W 15TH ST 4716 ALLIANCE BLVD STE 280 3200 14TH STREET STE 404 4032 MCDERMOTT RD STE 160 3920 ALMA DR 1101 OHIO DR STE 115 4708 ALLIANCE BLVD STE 110 2001 COIT RD STE 310 2700 RESEARCH DR STE 200 2520 K AVE STE 600 280 LEGACY DR # 102 6130 W PARKER RD STE 100 6020 W PARKER RD STE 270 3033 W PARKER RD STE 100 4704 ROCK CREEK LN 4031 W PLANO PKWY STE 211 5425 W SPRING CREEK PKWY #190 1929 PRESTON RD 310 W OAKLAWN RD 105 N SMITH ST 120 N SMITH ST 250 E FM 2449 1948 9TH AVE 8455 9TH AVE 1630 HOUSTON AVE

PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLANO PLEASANTON PLEASANTON PLEASANTON PONDER PORT ARTHUR PORT ARTHUR PORT ARTHUR

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

75075-7525 75075 75093 75074 75024-7733 75023-6748 75093-5331 75093-5323 75075-3764 75074-8334 75074-5359 75023-2312 75093-8106 75093-0007 75023-8000 75024 75093-5627 75024-4341 75093-5102 78064-4033 78064-4109 78064-4110 76259-7546 77642-2762 77642-8021 77640

MEDICINE MAN PHARMACY-PT. LAVACA MARKET BASKET PHARMACY HOMETOWN PHARMACY FAMILY PHARMACY OF POTTSBORO PRESIDIO PHARMACY PRINCETON PHARMACY PROSPER PHARMACY STARCARE PHARMACY UNITED PHARMACY SAVE MART PHARMACY SCOTT'S QUITMAN PHARMACY RANKIN COUNTY HOSPITAL PHARMACY WATSONS CITY DRUG RED OAK DRUG VILLAGE PHARMACY

(361) 576-6599 (409) 722-0411 (806) 495-2535 (903) 786-2006 (432) 229-2252 (972) 736-3777 (214) 338-4010 (972) 347-6331 (940) 663-2733 (903) 356-2449 (903) 763-9600 (432) 693-1019 (956) 689-2161 (972) 617-2222 (361) 526-4243

1202 N VIRGINIA ST 864 MAGNOLIA AVE 132 W MAIN ST 111 E HWY 120 STE 101 1501 B NORTH ERMA 201 E PRINCETON DR STE 104 1000 N PRESTON RD STE 10 321 N PRESTON RD STE B 1000 W 11TH ST 741 E QUINLAN PKWY 310 E GOODE ST 1611 SPUR 576 192 S 7TH ST 106 E OVILLA RD 112 S ALAMO ST

PORT LAVACA PORT NECHES POST POTTSBORO PRESIDIO PRINCETON PROSPER PROSPER QUANAH QUINLAN QUITMAN RANKIN RAYMONDVILLE RED OAK REFUGIO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77979-2507 77651-3712 79356-3232 75076-7801 79845 75407-9005 75078-8779 75078-8879 79252-5214 75474-8641 75783-2535 79778 78580-2516 75154-2479 78377-2338

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 615 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BEST VALUE RHOME PHARMACY A & E COMMUNITY PHARMACY, INC ALBERTSON'S PHARMACY AMBER PHARMACY DANA DISCOUNT PHARMACY FAMILY DISCOUNT PHARMACY PHARMETRICS SPEC GRP OF DALLAS SENDERRA RX PHARMACY

Provider Name

(817) 638-5561 (972) 234-8500 (972) 680-8477 (214) 828-9848 (972) 231-8885 (972) 235-0444 (972) 677-7891 (888) 777-5547

400 S MAIN 1112 N FLOYD RD STE 9 2165 BUCKINGHAM RD 1301 E ARAPAHO RD STE 103 1701 N COLLINS BLVD STE 328 970 N COIT RD # 2403 1110 E COLLINS BLVD STE 100 1301 E ARAPAHO RD STE 101

RHOME RICHARDSON RICHARDSON RICHARDSON RICHARDSON RICHARDSON RICHARDSON RICHARDSON

TX TX TX TX TX TX TX TX

76078-4425 75080 75081-5477 75081-2444 75080-3602 75080-5416 75081-2340 75081

GLENVIEW PROFESSIONAL PHARMACY INC NRH PHARMACY ALLCARE PHARMACY BELLE PHARMACY LLC FORT BEND FAMILY HEALTH CENTER MARISTE PHARMACY METSCRIPT PHARMACY METSCRIPT PHARMACY RICHMOND PHARMACY LINOS PHARMACY RINGGOLD PHARMACY SPENCE PHARMACY ROANOKE PHARMACY PHARMACY PLUS LAKEPOINTE PHARMACY ROCKWALL DRUG & GENERAL STORE ROCKWALL PHARMACY SUPER DRUG LINOS PHARMACY ROMA PHARMACY STARR PHARMACY ROSEBUD PHARMACY AVENUE H PHARMACY C-MED PHCY & HLTH CARE SRVCS L PIONEER PHARMACY TRIDENT XAVIER PHARMACY II CLINIC PHARMACY ADVANCED RX PHARMACY BAYLOR SCOTT AND WHITE PHCY LSCC A & M PHARMACY TEXAN PHARMACY COMPLETE PHARMACY CARE

(817) 284-1489 (817) 369-8988 (281) 419-8820 (346) 230-4125 (281) 342-4530 (713) 234-7190 (281) 762-6375 (281) 277-2707 (281) 762-7462 (956) 488-1811 (956) 488-1660 (817) 626-3764 (817) 491-9111 (254) 662-4444 (972) 332-3477 (972) 722-3784 (469) 769-1160 (972) 772-0500 (956) 849-1811 (956) 847-1688 (956) 353-6051 (254) 583-2727 (832) 945-5611 (832) 363-3787 (832) 759-5114 (281) 238-8440 (281) 762-0874 (325) 735-2500 (512) 600-3330 (512) 509-3600 (512) 524-9260 (512) 296-2633 (972) 675-3300

7640 GLENVIEW DR # A 7200 GLENVIEW DR STE 1 7120 FM 1464 RD STE D 1100 JACKSON ST STE D 400 AUSTIN ST 8433 FM 1464 STE G 7790 W GRAND PKWY S STE 101 1300 MAIN ST STE 100 1601 MAIN ST, STE 106 201 N FM 3167 STE A B 1623 E US HIGHWAY 83 4821 GREEN OAKS DR 207 E BYRON NELSON BLVD 635 N ROBINSON DR 1005 W RALPH HALL PKWY STE 147 106 S GOLIAD ST 2504 RIDGE RD STE 106 3021 RIDGE RD STE 103 708 GRANT ST 700 E BRAVO BLVD STE B 4857 E HIGHWAY 83 112 NORTH 4TH ST 3926 AVENUE H STE 2 5633 AVENUE I STE C 5101 AVENUE H STE 18 2307 4TH ST STE 102 4114 AVENUE H 774 STATE HIGHWAY 70 N 2000 S MAYS ST STE 200 425 UNIVERSITY BLVD STE 165 3950 N AW GRIMES STE N105 7201 WYOMING SPRINGS DR #300 4206 DALROCK RD

RICHLAND HILLS RICHLAND HILLS RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RIO GRANDE CITY RIO GRANDE CITY RIVER OAKS ROANOKE ROBINSON ROCKWALL ROCKWALL ROCKWALL ROCKWALL ROMA ROMA ROMA ROSEBUD ROSENBERG ROSENBERG ROSENBERG ROSENBERG ROSENBERG ROTAN ROUND ROCK ROUND ROCK ROUND ROCK ROUND ROCK ROWLETT

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

76180-8330 76180 77407 77469 77469-4406 77407-1102 77406 77469-3348 77469 78582-6207 78582-4600 76114-3004 76262-6185 76706-5330 75032-6658 75087 75087-2570 75032-5806 78584-0000 78584-5668 78584-6296 76570 77471-2842 77471-6192 77471-2024 77471-5127 77471-2833 79546-6918 78664-7576 78665-1056 78665 78681-4311 75088-5546

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 616 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TOTAL RX ROYSE CITY PHARMACY CHAPMAN PHARMACY ALBERTSON'S PHARMACY SAGINAW PHARMACY

Provider Name

(492) 250-7487 (972) 636-2451 (903) 683-2422 (817) 232-3877 (817) 405-3333

9101 LAKEVIEW PKWY STE 500 205 E MAIN ST 108 E 5TH ST 1201 N SAGINAW BLVD 200 W J BOAZ RD STE 100

ROWLETT ROYSE CITY RUSK SAGINAW SAGINAW

TX TX TX TX TX

75088 75189 75785-1310 76179-1145 76179

BAYLOR SCOTT & WHITE PHARMACY #232 COMMUNITY PHARMACY LOWE'S PHARMACY LOWE'S PHARMACY MEDI MART PHARMACY MEDICAL ARTS PHARMACY MEDWAY INFUSION SERVICES MYERS DRUG SAV-ON PHARMACY SHANNON PHARMACY 15RX PHARMACY 15RX PHARMACY 15RX PHARMACY ALAMO CITY PHARMACY LLC APOTHECA COMPOUNDING PHARMACY ASPCARES ASTORIA PHARMACY AVITA DRUGS BABCOCK SQR UNITED DRUGS BROADWAY PHARMACY CARVAJAL PHARMACY INGRAM PARK CARVAJAL PHARMACY SOUTH SAN CARVAJAL PHCY CROCKETT PARK CARVAJALS PHARMACY CF MEDICAL SUPPLIES & PHARMACY RX CRAWFORD PHARMACY CYSTIC FIBROSIS SERVICES INC DAVILA PHARMACY INC EMPIRE PHARMACY EXPRESS PHARMACY GALAXY SPECIALTY PHARMACY GENOA-QOL HEALTHCARE GOOD LIFE PHARMACY GROCERY OUTLET PHARMACY HIGH PERFORMANCE PHARMACY LLC HILL COUNTRY PHARMACY

(254) 947-7555 (325) 949-4577 (325) 653-3271 (325) 655-2821 (325) 949-5381 (325) 949-4636 (325) 944-0300 (325) 655-3146 (325) 942-6658 (325) 655-8191 (210) 684-1579 (210) 543-1579 (210) 684-1579 (210) 598-2688 (210) 226-1112 (210) 615-7400 (210) 951-8877 (210) 231-0383 (210) 696-6269 (210) 824-3322 (210) 521-2552 (210) 977-1860 (210) 977-1870 (210) 922-2176 (210) 617-5507 (210) 354-7864 (800) 541-4959 (210) 226-5293 (210) 223-3863 (830) 896-0167 (210) 617-4311 (210) 610-9091 (210) 819-4515 (210) 541-7813 (210) 691-4779 (844) 295-5516

3525 FM 2484 SUITE B 3520 KNICKERBOCKER RD STE A 1926 N BRYANT BLVD 2 S MAIN ST 2102 PECOS ST STE 13 2102 PECOS ST 3123 EXECUTIVE DR 29 S CHADBOURNE ST 3121 SUNSET DR 119 E BEAUREGARD AVE 10415 STATE HWY 151 STE 105 11212 ST HWY 151 PLZ 2 #110 11398 BANDERA RD STE 302 3338 OAKWELL CT STE 106 14603 HUEBNER RD STE 2602 2414 BABCOCK RD STE 111 818 E GRAYSON STREET 7302 LOUIS PASTEUR STE 105 5824 BABCOCK RD 6100 BROADWAY ST 6157 NW LOOP 410 STE 124 7500 BARLITE BLVD # 201 1715 MCCULLOUGH AVE 3410 ROOSEVELT AVE 4203 GARDENDALE ST STE 223C 711 PLEASANTON RD 119 HUIZAR #REAR-A 1423 GUADALUPE ST STE 108 2207 S ZARZAMORA 3930 E SOUTHCROSS BLVD 2829 BABCOCK RD STE 120 8535 TOM SLICK STE 104 26108 OVERLOOK PKWY BLDG 4 1568 AUSTIN HWY 21 SPURS LN STE SL-120 5282 MEDICAL DR STE 165

SALADO SAN ANGELO SAN ANGELO SAN ANGELO SAN ANGELO SAN ANGELO SAN ANGELO SAN ANGELO SAN ANGELO SAN ANGELO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

76571 76904-7601 76903-3744 76903-5927 76901-3061 76901-3061 76904-6801 76903-5805 76904-6501 76903-5918 78251 78251 78250-6843 78218-3087 78230-5469 78229-4870 78208 78229 78240-2134 78209-4545 78238 78224-1361 78212-4046 78214-2606 78229-3177 78214-1305 78214-2707 78207-5568 78207 78222-3520 78229-6009 78229-3367 78260-6046 78218 78240-1669 78229

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 617 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

HILLS DRUG STORE HOAST PHARMACY HOSPITAL PHARMA CONSULTING INVENTIVE INFUSION SOLUTIONS LAUREL HEIGHTS PHARMACY LEGENDS PHARMACY LIFECARE GARZA PHARMACY LIFECARE PHARMACY LIV-WELL PHARMACY MEDICAL CENTER PHARMACY MEDICINE SHOPPE MISSION UNITED DRUG NETCARE PHARMACY NETCARE PHARMACY #2 OAK HLLS MEDICAL BLDG PHCY INC OAKDELL LONGTERM CARE PHARMACY OAKDELL PHARMACY OAKDELL PHARMACY AT THE QUARRY OAKDELL PHARMACY IN STONE OAK ONE SOURCE PHCY MEDICAL SUPPLIES OPTION CARE PARAGON INFUSION CARE PIONEER PHARMACY PREMIER PHARMACY PRIMECARE PHARMACY QUALITY CARE RX LLC RITE AWAY PHARMACY RITE AWAY PHCY & MED SUPPLY RITE AWAY PHCY & MEDICAL SUPPLY RITE-AWAY PHARMACY RIVER MEDICAL PHARMACY, INC SAN ANTONIO SSLC PHARMACY SHAVANO OAKS PHARMACY SHAVANO OAKS PHARMACY @ BROOKS

Provider Name

(210) 225-7283 (210) 595-5691 (844) 870-5146 (210) 494-4272 (210) 736-3161 (210) 735-2323 (210) 225-4561 (210) 881-0474 (210) 960-4613 (210) 534-5457 (210) 224-7676 (210) 923-4389 (210) 256-8629 (210) 923-4404 (210) 614-4100 (210) 614-6200 (210) 614-6200 (210) 822-6330 (210) 496-7070 (210) 504-3949 (210) 615-7211 (210) 591-6700 (210) 492-3005 (210) 298-9000 (210) 530-4269 (210) 595-8077 (210) 923-7717 (210) 490-2733 (210) 927-3742 (210) 433-9991 (210) 877-6180 (210) 531-5111 (210) 448-9080 (210) 441-4484

705 KIRK PL 4411 MEDICAL DR STE 100 4742 DODGE ST 18866 STONE OAK PKWY STE 101A 2602 N MAIN AVE 6601 BLANCO RD STE 125 311 CAMDEN STE 103 315 N SAN SABA STE 110 607 CAMDEN ST STE 102 1342 FAIR AVE 2004 E HOUSTON ST 3267 ROOSEVELT AVE 6428 BANDERA RD 810 SE MILITARY DR 7711 LOUIS PASTEUR DR STE 100 7220 LOUIS PASTEUR DR STE 174 7220 LOUIS PASTEUR DR STE 176 423 TREELINE PARK STE 201 104 GALLERY CIR STE 104 15733 SAN PEDRO AVE 14220 NORTHBROOK DR 719 CARNOUSTIE DR STE 100 4503 DE ZAVALA STE 108 2425 BABCOCK RD STE 108A 14032 NACOGDOCHES RD 607 SOUTH WW WHITE RD 2115 PLEASANTON RD #100 2235 THOUSAND OAKS DR STE 114 2716 SW MILITARY DR STE 102 426 CASTROVILLE RD #5 4752 RESEARCH DR 6711 S NEW BRAUNFELS STE 500 3603 PAESANOS PKWY # 102 3124 SIDNEY BROOKS ST # 570 #

SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78226-1407 78229-3832 78217-3711 78258 78212-2919 78216-6102 78215 78207 78215-2100 78223-1438 78202-2934 78214-2559 78238-1511 78214-2823 78229-3411 78229-4535 78229-4535 78209-1997 78258-3330 78232-3726 78232-5076 78258 78249 78229-4899 78247 78220 78221 78232-3967 78224 78207 78240-5002 78223 78231-1267 78235-5113

SHAVONO OAKS PHCY @ WESTOVER HILLS SMART PHARMACY LLC SONTERRA RX SOUTH SAN MED BLDG PHCY STONE OAK PHARMACY

(210) 441-4501 (210) 858-7299 (210) 490-7711 (210) 922-1816 (210) 494-4272

3903 WISEMAN BLVD STE 313 4390 CALLAGHAN RD 1162 E SONTERRA BLVD STE 100 919 SW MILITARY DR STE 105 18866 STONE OAK PKWY STE 101

SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO

TX TX TX TX TX

78251-4422 78228-3401 78258-4048 78221 78258-4113

THE CENTER PHARMACY AT LEGACY OAKS

(210) 971-5803

5372 FREDERICKSBURG RD STE 110

SAN ANTONIO

TX

78229-3559

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 618 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE START CENTER PHARMACY TRINITY RX UBA PHARMACY UROLOGY SAN ANTONIO PHARMACY WESTOVER HILLS PHARMACY WHITE CROSS PHARMACY ZIKAM NEIGHBORHOOD PHARMACY SAN AUGUSTINE LEGEND DRUG FRY'S PRESCRIPTION PHARMACY MEDICINE SHOPPE SALINAS PHARMACY LA HACIENDA PRSCRPTN PHRMCY INC NUESTRA CLINICA DEL VALLE SAN JUAN DRUG B & J PHARMACY GENOA-QOL HEALTHCARE MEDPARK PHARMACY THORPE LANE PHARMACY

Provider Name

(210) 593-2660 (210) 927-4744 (210) 646-8804 (210) 582-5649 (210) 684-1800 (210) 227-7207 (210) 503-5063 (936) 275-3401 (956) 399-2453 (956) 399-1411 (956) 399-5501 (361) 279-3869 (956) 787-8915 (956) 961-4870 (512) 392-3301 (512) 212-5373 (512) 353-8900 (512) 353-5042

4383 MEDICAL DR STE 113 120 PALO ALTO RD STE 240 5445 WALZEM RD 7909 FREDERICKSBURG RD # 110-A 9793 CULEBRA RD STE 101 1303 MCCULLOUGH AVE STE 128 21920 BULVERDE RD # 102/103 104 E COLUMBIA ST 311 N SAM HOUSTON BLVD 205 W US HIGHWAY 77 500 N SAM HOUSTON BLVD STE 1 213 S DR E E DUNLAP ST 806 W 3RD ST 1205 N RAUL LONGORIA RD STE F 2111 HUNTER RD 1200 N BISHOP ST STE 200 2004 MEDICAL PKWY STE A 1346 THORPE LN STE D

SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN ANTONIO SAN AUGUSTINE SAN BENITO SAN BENITO SAN BENITO SAN DIEGO SAN JUAN SAN JUAN SAN MARCOS SAN MARCOS SAN MARCOS SAN MARCOS

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78229-3307 78211-3772 78218-2126 78229-3425 78251-3750 78212-5603 78259-2181 75972-1902 78586-4656 78586-5143 78586-4669 78384-2801 78589 78589-3721 78666-5102 78666-2706 78666-7585 78666-7117

TX STATE UNIV STUDENT HLTH CTR PHCY EVERETTS PHARMACY S & J PHARMACY LONE STAR PHARMACY MEDICINE MAN PHARMACY SCHERTZ SPECIALTY PHARMACY MEDICINE SHOPPE PHARMACY GIBSON DISCOUNT PHCY SEALY PHARMACY PARKER'S CITY PHCY OSWALT PHARMACY GIBSON PRESCRIPTION PHARMACY SEYMOUR PHARMACY UNITED PHARMACY SHALLOWATER PHARMACY JC'S TRUECARE PHARMACY INC ALBERTSON'S PHARMACY CARERX PHARMACY AT SHERMAN GENOA-QOL HEALTHCARE HERITAGE PARKWAY PHARMACY MEDICINE SHOPPE SHERMAN PHARMACY QUALITY PHARMACY

(512) 245-3590 (325) 372-3033 (940) 458-4448 (409) 925-9995 (409) 927-1979 (210) 651-6337 (832) 864-3785 (972) 287-7070 (979) 256-3045 (830) 379-1450 (432) 758-3656 (903) 432-3494 (940) 888-2222 (940) 889-3622 (806) 832-0300 (936) 628-2099 (903) 868-9414 (903) 893-1700 (903) 357-5655 (903) 893-8222 (903) 892-9291 (903) 328-6655 (361) 594-2262

298 STUDENT CENTER DR 401 W WALLACE ST 303 BOLIVAR ST 4111 FM 1764 RD STE F 13250 HIGHWAY 6 5000 SCHERTZ PKWY STE 401 4614 NASA PKWY 112 HALL RD 707 MEYER ST 1005 E COURT ST 701 HOBBS HWY 205 CEDAR CREEK PKWY 201 STADIUM DR STE 1 101 N WASHINGTON 600 8TH ST 11011 HIGHWAY 150 100 E TAYLOR ST 1733 TEXOMA PKWY STE 200 315 W MCLAIN DR STE 308 1906 W US HWY 82 1624 N TRAVIS ST 1916 N GRAND AVE 724 N AVE E

SAN MARCOS SAN SABA SANGER SANTA FE SANTA FE SCHERTZ SEABROOK SEAGOVILLE SEALY SEGUIN SEMINOLE SEVEN POINTS SEYMOUR SEYMOUR SHALLOWATER SHEPHERD SHERMAN SHERMAN SHERMAN SHERMAN SHERMAN SHERMAN SHINER

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

78666 76877-4433 76266-8960 77517-3852 77510-7682 78154-1457 77586-5414 75159-2916 77474-2715 78155-5843 79360-3401 75143 76380-2343 76380 79363-5726 77371-2839 75092-2830 75090-2613 75092-2605 75092-6893 75092 75090-2610 77984-0000

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 619 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SHINER FAMILY PHARMACY INC. MOORES PHARMACY SLATON PHARMACY SMITHVILLE PHARMACY MCWILLIAMS PHARMACY UNITED PHARMACY B & B PHARMACY EVERETTS PHARMACY SONORA PHARMACY PLUS HANSFORD HOSPITAL PHARMACY MEDIC PHARMACY AND GIFTS SPLENDORA PHARMACY ASTRO RX BETTER BALANCE PHARMACY BUDGET PHARMACY CRYSONCARE PHARMACY DCE PHARMACY EXPRESS SPECIALTY PHARMACY LLC KATY PHARMACY & DRUGSTORE LLC LIFECHEK DRUG

Provider Name

(361) 594-2394 (361) 364-1416 (806) 828-4444 (512) 237-5216 (325) 573-7582 (325) 574-1683 (979) 596-3081 (325) 387-2541 (817) 410-1000 (806) 659-2226 (806) 659-2141 (281) 689-7700 (832) 209-4999 (281) 205-7091 (713) 694-3785 (832) 813-5085 (281) 528-0288 (281) 453-7085 (832) 953-2611 (281) 367-2700

408 N AVE B 200 S RACHAL ST 165 S 9TH ST STE A 1404A NE LOOP 230 3706 COLLEGE AVE 3500 COLLEGE AVE 16800 SH 36 SOUTH 417 HIGHWAY 277 N 731 E SOUTHLAKE BLVD STE 110 707 ROLAND ST 314 MAIN ST 13841 HIGHWAY 59 STE C 20423 KUYKENDAHL RD STE 250 5834 LOUETTA RD STE D 19786 I-45 NORTH 22325 GOSLING RD 2540 FM 2920 STE G 5039 FM 2920 # C 25115 GOSLING RD 440 RAYFORD RD STE 155

SHINER SINTON SLATON SMITHVILLE SNYDER SNYDER SOMERVILLE SONORA SOUTHLAKE SPEARMAN SPEARMAN SPLENDORA SPRING SPRING SPRING SPRING SPRING SPRING SPRING SPRING

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77984 78387-2524 79364-4121 78957-2036 79549-4625 79549-4635 77879 76950-2204 76092-6378 79081-3441 79081-2068 77372-4697 77379-3322 77379-7884 77373 77389 77388-3672 77388 77389-3226 77386-1918

MASWOSWES ALT PHARM SVCS (MAPSRX)

(956) 316-2224

6402 LOUETTA RD. SUITE 145

SPRING

TX

77379

MASWOSWES ALTERNATIVE PHCY SERV RAYFORD PHARMACY STERLING RIDGE ORTHO & SPORTS THE WOODLANDS APOTHECARY NORTH SHORE PHARMACY DOUGHERTYS PHCY SPRINGTOWN DANA'S PHARMACY CROSSROAD PHARMACY DR PHARMACY PHARMACY 4 LESS PR PHARMACY LLC STAFFORD PHARMACY & DME COUNTRY DRUG STORE RIVER NORTH PHARMACY TANGLEWOOD PHARMACY INC ELK PHARMACY 1 STOP PHARMACY ADMIX COMPOUNDING PHARMACY AMERICAN SPECIALTY PHARMACY

(832) 761-7817 (832) 953-2926 (281) 210-2409 (346) 224-2125 (830) 214-2920 (817) 220-7927 (806) 271-3394 (972) 442-4277 (832) 539-6386 (281) 969-5077 (832) 230-8027 (281) 969-5901 (915) 773-2441 (254) 968-6006 (254) 968-7657 (806) 366-5505 (832) 328-5996 (832) 532-3113 (832) 500-3565

16736 CHAMPION FOREST DR 7623 LOUETTA RD STE 104 20639 KUYKENDAHL RD STE 300 9303 PINCROFT DR STE 300 113 STAR GRASS STE 100 117 E 1ST ST 315 BURLINGTON AVE 3945 PARKER RD 103 AVENUE F 432 MURPHY RD 720 FM 1092 2448 S MAIN ST 1517 COLUMBIA ST 150 RIVER NORTH BLVD STE A 2445 NORTHWEST LOOP STE A 317 N MAIN 17310 W GRAND PKWY S STE Z 1403 HIGHWAY 6 STE 300B 13515 SOUTHWEST FWY STE 113

SPRING SPRING SPRING SPRING SPRING BRANCH SPRINGTOWN SPUR ST PAUL STAFFORD STAFFORD STAFFORD STAFFORD STAMFORD STEPHENVILLE STEPHENVILLE STRATFORD SUGAR LAND SUGAR LAND SUGAR LAND

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77379 77379-7237 77379-3318 77380 78070 76082-2402 79370-2812 75098-7825 77477-5548 77477-5448 77477 77477-5522 79553-6832 76401-1803 76401-1705 79084 77479-2586 77478 77478-3562

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 620 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name DELIVERIT PHARMACY INC DELIVERIT PHCY INFUSION CENTER LLC ECLEATS PHARMACY, INC EVOLUTION RX PHARMACY HEALTHQUEST INFUSION SERVICES HEALTHQUEST PHARMACY METSCRIPT PHARMACY NAHS PHARMACY II PHARMTRUST PHARMACY PRO PHARMACY HEALTH, INC. RITE CARE PHARMACY SUGAR LAND COMPOUNDING PHCY TEX CARE PHARMACY TEXAN CARE PHARMACY THE RITE PHARMACY INC VITA CARE PHARMACY II VITAMED PHARMACY HEALTH CHECK PHARMACY CODY DRUG LIFECHEK DRUG MALONEY PRESCRIPTION PHARMACY MEDICINE PLACE TAFT PHARMACY INC B & B PHARMACY SCHWENKER PHARMACY PHARMACY PLUS BAYLOR SCOTT AND WHITE PHCY BAYLOR SCOTT AND WHITE PHCY BAYLOR SCOTT AND WHITE PHCY KINGS DAUGHTERS PHARMACY LLC WESTSIDE DRUG BASS RUTLEDGE DRUG ALBERTSON'S PHARMACY PLEASANT GROVE PHARMACY RELIANT HEALTHCARE SUPER 1 PHARMACY AFFORDABLE PHARMACY INC TEXAS CITY PHARMACY NORTH TEXAS PHARMACY CONCEPTION PHARMACY GHPMA2 MILLENNIUM PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (281) 277-1071 (713) 562-6775 (281) 903-7491 (832) 532-7961 (832) 612-3500 (832) 222-0100 (281) 277-2700 (832) 939-8950 (281) 201-2627 (281) 491-0767 (713) 955-5700 (281) 302-6080 (832) 532-0135 (281) 329-4498 (832) 532-0806 (281) 277-2800 (281) 313-0234 (281) 277-3334 (903) 885-2639 (979) 548-0212 (325) 236-6394 (325) 236-6809 (361) 528-2012 (903) 947-2174 (512) 352-3659 (254) 739-2585 (254) 215-9100 (254) 774-1050 (254) 774-1600 (254) 778-1731 (254) 778-2773 (972) 563-3311 (903) 832-3524 (903) 832-4545 (877) 354-2688 (903) 832-2258 (409) 229-4636 (409) 655-3033 (214) 494-6101 (844) 602-1990 (936) 447-9432 (281) 298-1129

Provider Street 13303 W AIRPORT BLVD 13303 W AIRPORT BLVD STE B 4427 HIGHWAY 6, STE F 931 ELDRIDGE RD 2600 CORDES DR STE E 2600 CORDES DR STE F 4888 HIGHWAY 90A STE 100 11677 STATE HIGHWAY 6 1111 HIGHWAY 6 STE 110 14021 SOUTHWEST FWY # 409B 15271 SOUTHWEST FREEWAY 14823 SOUTHWEST FRWY STE B 4660 SWEETWATER BLVD STE 180 14311 SANDY RIPPLE CT 2225 WILLIAMS TRACE BLVD #109 1429 HIGHWAY 6 16126 SOUTHWEST FWY STE # 180 3533 TOWN CTR BLVD S STE 100 1505 S BROADWAY ST 200 N MAIN ST 1405 HAILEY ST 1410 LAMAR ST 213 MEYERS 420 N HILL 2407 N MAIN ST 600 MAIN ST 1605 S 31ST ST 514 W ADAMS AVE 937 CANYON CREEK DR 1905 SW H K DODGEN LOOP 1516 S 31ST STREET 601 W MOORE AVE 2315 RICHMOND RD 3302 RICHMOND RD 4315 TEXAS BLVD 2610 RICHMOND RD 8030 FM 1765 SUITE A104 2506 25TH AVE NORTH STE 4 5200 PAIGE RD STE 102 25301 INTERSTATE 45 N STE B 17521 ST LUKES WAY STE 120 9319 PINECROFT DR #110

Page 621 of 679

Provider City SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGAR LAND SUGARLAND SULPHUR SPRINGS SWEENY SWEETWATER SWEETWATER TAFT TATUM TAYLOR TEAGUE TEMPLE TEMPLE TEMPLE TEMPLE TEMPLE TERRELL TEXARKANA TEXARKANA TEXARKANA TEXARKANA TEXAS CITY TEXAS CITY THE COLONY THE WOODLANDS THE WOODLANDS THE WOODLANDS

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77478-5800 77478-5800 77478-4515 77478-2809 77479-1352 77479-1352 77498-2194 77498-1302 77478-4960 77478-3550 77478 77478-5016 77479-3164 77498-7496 77478 77478-4908 77479-2638 77479 75482-4921 77480 79556-2507 79556-7124 78390 75691 76574-1833 75860-1628 76504 76501-4215 76502-3293 76502-1814 76504 75160-3123 75503-2485 75503-0703 75503-3024 75503-2327 77591 77590 75056-2121 77380 77384-8035 77380

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name OUR PHARMACY PINECROFT PHARMACY CAMPBELL DRUG STORE BENZER PHARMACY FIRST CARE PHARMACY GLOYERS LEGEND PHARMACY MS PHARMACY PHARMCARE USA OF HOUSTON TOMBALL ATRIUM UNTD DRUGS TOMBALL HEALTH MART PHARMACY LIFECHEK ASPCARES BRICK STREET PHARMACY CRAIG PHARMACY DRUG EMPORIUM FAMILY FIRST PHCY FREDS PHARMACY GENOA-QOL HEALTHCARE GOOD'S MEDICINE CHEST KINSEY'S PHARMACY MAJORS PHARMACY PHARMSCRIPT OF TEXAS NORTH SUPER 1 FOODS PHARMACY SUPER 1 PHARMACY SUPER 1 PHARMACY SUPER 1 PHARMACY THO PHARMACY TYLER RX PHARMACY UTHCT PHARMACY WOODY WEAVER PHARMACY LIFECARE PHARMACY OUR HEALTH PHARMACY CITY DRUG COMPANY FAMILY PHARMACY FAMILY PHARMACY HILLCREST PHARMACY UNITED PHARMACY CASTLE HILLS PHARMACY LLC HARDING & PARKER PHARMACY ROGERS PHARMACY ROGERS PHARMACY ROGERS PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (832) 299-6802 (281) 466-3650 (361) 786-3757 (832) 843-7105 (832) 698-1532 (281) 351-5454 (832) 698-1565 (888) 738-5283 (281) 351-8239 (832) 559-6413 (936) 594-3593 (903) 354-0231 (903) 533-8155 (903) 595-3737 (903) 534-9105 (903) 561-2822 (903) 533-1345 (903) 595-3100 (903) 939-8500 (903) 561-5656 (903) 595-1132 (908) 389-1818 (903) 525-6923 (214) 595-4863 (903) 535-9467 (903) 581-9666 (903) 592-6152 (903) 593-1400 (903) 877-7088 (903) 593-2533 (830) 591-1000 (830) 278-5604 (903) 482-5279 (940) 552-2999 (940) 552-2999 (940) 553-4361 (940) 552-2600 (361) 575-6328 (361) 573-2476 (361) 578-3521 (361) 572-0297 (361) 572-0226

Provider Street 25329 INTERSTATE 45 STE 126 9305 PINECROFT DR STE 102 623 THORNTON ST 28455 TOMBALL PKWY 24922 TOMBALL PKWY STE 120 1010 W MAIN ST 27721 TOMBALL PARKWAY STE 400 420 CHESTNUT BUS PARK DR STE C 425 HOLDERRIETH BLVD STE 111 506 GRAHAM DR STE 140 104 WEST MAIN 1109 E 5TH ST 314 W RUSK ST 1863 TROUP HWY 5614 S BROADWAY AVE 16623 FM 2493 STE A 1803 E GENTRY PKWY 2323 W FRONT ST 2130 GRANDE BLVD 4290 KINSEY DR 108 SHELLEY DR 1041 NNE LOOP 323 172 CENTENNIAL PKWY 3000 WNW LOOP 323 1105 E GENTRY PKWY 3828 TROUP HWY 721A CLINIC DR 2415 E 5TH ST 11937 US HIGHWAY 271 2722 W GENTRY PKWY 1001 E MAIN ST 200 EVANS ST 232 E JEFFERSON 1720 HILLCREST DR 1720 HILLCREST DR 1015 HILLCREST DR STE B 3000 WILBARGER ST 3412 SAM HOUSTON DR 2806 N NAVARRO ST STE A 4402 N LAURENT ST 2700 CITIZENS PLZ 512 E RIO GRANDE ST

Page 622 of 679

Provider City THE WOODLANDS THE WOODLANDS THREE RIVERS TOMBALL TOMBALL TOMBALL TOMBALL TOMBALL TOMBALL TOMBALL TRINITY TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER TYLER UVALDE UVALDE VAN ALSTYNE VERNON VERNON VERNON VERNON VICTORIA VICTORIA VICTORIA VICTORIA VICTORIA

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77380 77380 78071 77375-3307 77375-7872 77375-5526 77375 77375 77375-4551 77375-3366 75862 75701-3318 75701-1513 75701-5871 75703-4356 75703-7983 75702 75702-7704 75703-0563 75703-1024 75701-8723 75708-2014 75703 75702 75702-4715 75703-1726 75701 75701-3523 75708-3154 75702-1635 78801-4831 78801-5142 75495-9998 76384-4099 76384-4099 76384-3165 76384-4574 77904-2238 77901-3976 77901-2742 77901-5754 77901-6033

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name ROGERS PHARMACY ROGERS PHARMACY BUDGET CHOPPER PHCY T & T UNITED DRUGS VIDOR FAMILY PHARMACY BAYLOR SCOTT & WHITE PHARMACY BAYLOR SCOTT AND WHITE PHCY BAYLOR UNIVERSITY HLTH CTR PHY CIRCLE DRUG DRUG EMPORIUM FAMILY HEALTH CENTER PHARMACY FHC MEDICAID PHARMACY LYNNS LA VEGA PHARMACY PHARMACY PLUS PHARMACY PLUS PHARMACY PLUS #10 ALBERTSON'S PHARMACY CSI PHARMACY KILLION RX BAYLOR SCOTT & WHITE PHARMACY GENOA-QOL HEALTHCARE THE PRESCRIPTION SHOP ALBERTSON'S PHARMACY BEST VALUE HOMETOWN DAVIS CITY PHARMACY TACKETT'S SUPER SAVE PHARMACY TOWN CREEK PHARMACY BLOSSOM PHARMACY CLEAR LAKE PROF BLDG PHCY MEDICAL PLAZA PHCY AT CLEAR LAKES MEDICX PHARMACY PYRAMIDS PHARMACY WEBSTER WEBSTER PHARMACY THE PHARMACY SHOP COLLINGSWORTH PHARMACY DADS PHARMACY DE LA ROSA PHARMACY INC LIFECHEK DRUG #47 PRO-SCRIPT PHARMACY SERVICES SANDER PHARMACY OF WESLACO WESLACO PHARMACY OLD CORNER PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (361) 572-3106 (361) 894-6430 (409) 769-2439 (409) 769-2438 (409) 769-2406 (254) 202-3730 (254) 761-5200 (254) 710-4991 (254) 662-0774 (254) 772-0011 (254) 313-4521 (254) 313-4521 (254) 799-4949 (254) 867-6700 (254) 756-5383 (254) 836-5255 (903) 831-5882 (870) 774-9319 (903) 687-2525 (469) 843-7120 (972) 937-8309 (972) 938-2642 (817) 594-9816 (817) 594-3435 (817) 594-3851 (817) 341-7046 (817) 458-5292 (281) 724-0280 (281) 332-2496 (281) 332-2213 (832) 632-1661 (281) 724-0531 (281) 886-7164 (979) 725-6713 (806) 447-1184 (956) 447-1800 (956) 968-8995 (956) 975-2513 (956) 969-3784 (956) 968-4528 (956) 969-0636 (254) 826-5122

Provider Street 6502 NURSERY DR STE 102 8621 N NAVARRO 1380 N MAIN ST 315 N MAIN ST 1130 N MAIN ST 1001 HEWITT DR STE B 1412 N VALLEY MILLS STE 116 209 SPEIGHT AVE # 214 3211 ROBINSON DR 5900 BOSQUE BLVD 1600 PROVIDENCE DR STE 101 1600 PROVIDENCE SUITE 201 2401 E WACO DR 829A N LOOP 340 3308 HILLCREST DR 10412 CHINA SPRING RD STE A 4415 W 7TH ST 811 N KINGS HWY 396 W TEXAS AVE 2460 N I-35 STE 155 1305 W JEFFERSON ST STE 231 120 S GRAND AVE STE 1 225 E SPRING ST 1702 SANTA FE DR 111 TRINITY ST 138 COLLEGE PARK DR STE 130 907 E EUREKA STE B1 250 BLOSSOM ST STE 105 251 MEDICAL CENTER BLVD #100 250 BLOSSOM ST STE 110 504 WEST NASA PKWY 500 N KOBAYASHI STE E 15610 HIGHWAY 3 406 YOUENS DR 1016 16TH ST 415 S AIRPORT DR STE G 1500 E 6TH ST 512 S WESTGATE DR STE G 911 S AIRPORT DR 916 E 6TH ST 1102 S AIRPORT DR 200 N MAIN ST

Page 623 of 679

Provider City VICTORIA VICTORIA VIDOR VIDOR VIDOR WACO WACO WACO WACO WACO WACO WACO WACO WACO WACO WACO WAKE VILLAGE WAKE VILLAGE WASKOM WAXAHACHIE WAXAHACHIE WAXAHACHIE WEATHERFORD WEATHERFORD WEATHERFORD WEATHERFORD WEATHERFORD WEBSTER WEBSTER WEBSTER WEBSTER WEBSTER WEBSTER WEIMAR WELLINGTON WESLACO WESLACO WESLACO WESLACO WESLACO WESLACO WEST

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX

77904-1181 77904-2603 77662-3727 77662-4935 77662-3739 76712-8486 76710-4445 76706-1507 76706-4409 76710-8007 76707-2261 76707 76705-3259 76705-2592 76708-3118 76708-5685 75501-6351 75501-5700 75692-9113 75165-5240 75165-2269 75165-2222 76086-3380 76086-6420 76086-3358 76086 76086 77598-4204 77598-4223 77598-4204 77598 77598-4820 77598-2132 78962 79095-3738 78596-5396 78596-6606 78596-6296 78596-6651 78596-6414 78596-6652 76691-1207

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WEST DRUG HYLANDS PHARMACY FREDS PHARMACY AXTELL RITE-VALUE PHARMACY HOMETOWN PHARMACY WHITEWRIGHT PHARMACY EUBANK DRUG PRESCRIPTION PHARMACY CASHSAVER COST PLUS PHCY DOWNTOWN PHARMACY ENGLISH PHARMACY FRANKLIN PHARMACY GUFFEYS DRUG STORE HARVEST DRUG & GIFT INTEGRATED PHARMACY PARK PLAZA PHARMACY TROTTS CALL FIELD DRUG UNITED PHARMACY UNITED PHARMACY UNITED PHARMACY BRUCE & HUMAN DRUG WIMBERLEY PHARMACY WILCOX PHARMACY SCOTT'S PHARMACY LAWRENCE BROTHERS PHARMACY DOGWOOD PHARMACY AND GIFT WOODVILLE DRUG ALBERTSON'S PHARMACY QUALITY CARE PHARMACY & COMP 2 VENUS CARE SPECIALTY PHARMACY WYLIE PHARMACY CITY DRUG STORE YOAKUM DISCOUNT PHARMACY YOAKUM DISCOUNT PHARMACY THE KRAEGE DRUG STORE FRESH MARKET PHARMACY IHC AMERICAN FORK PHARMACY TAYLOR DRUG BEAVER DRUG & GIFT WAYNE COMM HEALTH CENTRE PHCY BLUE MOUNTAIN PHARMACY SAN JUAN PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (254) 826-5292 (806) 826-5561 (903) 839-5149 (903) 564-3216 (903) 564-1234 (903) 364-5537 (254) 694-3314 (254) 694-2249 (940) 691-0801 (940) 767-4345 (940) 723-6060 (940) 723-7145 (940) 322-8626 (940) 692-7081 (940) 312-1111 (940) 322-5492 (940) 692-1234 (940) 767-3368 (940) 322-1114 (940) 692-3443 (903) 873-2538 (512) 847-2288 (409) 296-2497 (903) 342-3669 (325) 754-5681 (409) 283-7509 (409) 283-3073 (972) 429-4951 (972) 442-5333 (737) 808-0055 (972) 429-9594 (361) 293-2181 (361) 741-7455 (361) 293-6881 (361) 564-2216 (801) 756-2411 (801) 855-2935 (801) 756-4021 (435) 438-2588 (435) 425-3744 (435) 678-4640 (435) 678-2781

Provider Street 206 N MAIN ST 108 W OKLAHOMA AVE 1123 STATE HIGHWAY 110 N 304 1/2 CHARLIE ST 310 CHARLIE ST 419 S STATE HWY 69 1510 N. BRAZOS 203 E JEFFERSON AVE 2720 SOUTHWEST PKWY 1100 SCOTT AVE 2600 TENTH STREET 1013 BROOK AVE 1610A 9TH ST 4426 KELL BLVD 516 DENVER ST STE 200 1900 9TH ST 4122 CALL FIELD RD 4516 JACKSBORO HWY 2522 OLD IOWA PARK RD 4590 KELL BLVD 145 N 4TH ST 120 JOE WIMBERLEY BLVD 415 STATE HWY 124 211 E COKE RD 900 N MAIN ST 205 S MAGNOLIA ST 1010 W BLUFF ST 921 S WESTGATE WAY 2300 FM 544 STE 130 615 S STATE HWY 78 STE 200 430 S HIGHWAY 78 STE 160 223 W GRAND AVE 210 NELSON ST STE E 1200 CARL RAMERT DR STE A 113 E MAIN ST 135 E MAIN ST 1159 E 200 N STE 125 76 N 1100 E 98 N MAIN ST 128 S 300 W 802 SOUTH 200 WEST 65 S MAIN ST

Page 624 of 679

Provider City WEST WHEELER WHITEHOUSE WHITESBORO WHITESBORO WHITEWRIGHT WHITNEY WHITNEY WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WICHITA FALLS WILLS POINT WIMBERLEY WINNIE WINNSBORO WINTERS WOODVILLE WOODVILLE WYLIE WYLIE WYLIE WYLIE YOAKUM YOAKUM YOAKUM YORKTOWN AMERICAN FORK AMERICAN FORK AMERICAN FORK BEAVER BICKNELL BLANDING BLANDING

State

ZIP code

TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX TX UT UT UT UT UT UT UT

76691-1207 79096 75791 76273-1103 76273-1103 75491 76692 76692 76308-3704 76301-4650 76309-2296 76301 76301-4305 76309-4719 76301-2110 76301-4130 76308-2517 76302-2920 76306-6104 76309-4744 75169-2040 78676-5975 77665-0000 75494-3259 79567-3203 75979-5234 75979-4736 75098-4947 75098 75098 75098-3974 77995-2613 77995-2718 77995-4868 78164-2030 84003-2407 84003 84003-2952 84713 84715-0000 84511 84511-3742

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BOUNTIFUL DRUG DICKS FAMILY PHARMACY IHC HEALTH CTR PHCY BOUNTIFUL MOUNTAIN VIEW PHARMACY MOUNTAINWEST APOTHECARY SMITH'S PHARMACY WINEGARS SUPERMARKETS BRIGHAM COMMUNITY PHARMACY KENT'S PHARMACY SMITH'S PHARMACY BOYDS FAMILY PHARMACY BULLOCH UNITED DRUGS CEDAR DRUG AND GIFT, INC LIN'S SUPERMARKETS INC SMITH'S PHARMACY TOWNSHIP PROFESSIONAL PHARMACY DICKS PHARMACY KENT'S PHARMACY CLEARFIELD WINEGARS PHARMACY MACEYS PHARMACY WESTSIDE HEALTH MART SERVICE DRUG FRESH MARKET PHARMACY INNOVATIVE RX LLC LONE PEAK RX LLC PIONEER PHARMACY SERVICES SMITH'S PHARMACY A&W PHARMACY

Provider Name

(801) 295-3463 (801) 296-2222 (801) 294-1004 (801) 295-3439 (801) 295-6979 (801) 397-7833 (801) 292-5558 (435) 723-5211 (435) 723-8841 (435) 734-2027 (435) 381-5464 (435) 586-9651 (435) 590-6099 (435) 865-6665 (435) 586-1043 (435) 867-0800 (801) 677-0171 (801) 773-8700 (801) 773-7330 (801) 776-8161 (801) 698-2497 (435) 864-2545 (801) 571-1406 (801) 355-5189 (801) 307-8603 (801) 890-0346 (801) 571-2115 (435) 738-3784

47 E 500 S 2280 ORCHARD DR 390 N MAIN ST 425 MEDICAL DR 1551 S RENAISSANCE TWN DR #104 555 S 200 W 3371 S ORCHARD DR 1017 MEDICAL DR 260 N MAIN ST 156 S MAIN ST 25 WEST MAIN STREET 91 N MAIN ST 755 S MAIN ST STE 7 150 N MAIN ST 633 S MAIN ST 108 W 1325 N 350 E PAGES LN 580 S STATE ST 1080 W 300 N 2062 W 1800 N 1407 N 2000 W STE E 215 W MAIN ST 1212 DRAPER PKWY 12176 S 1000 E STE 2 11724 S STATE ST STE 102 11585 S STATE ST STE 103 212 E 12300 S 171 E MAIN ST

BOUNTIFUL BOUNTIFUL BOUNTIFUL BOUNTIFUL BOUNTIFUL BOUNTIFUL BOUNTIFUL BRIGHAM CITY BRIGHAM CITY BRIGHAM CITY CASTLE DALE CEDAR CITY CEDAR CITY CEDAR CITY CEDAR CITY CEDAR CITY CENTERVILLE CLEARFIELD CLEARFIELD CLINTON CLINTON DELTA DRAPER DRAPER DRAPER DRAPER DRAPER DUCHESNE

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84010 84010-5614 84010-6046 84010-4945 84010-7667 84010-7249 84010-8005 84302-3049 84302-2120 84302-2529 84513-0000 84720-2648 84720-3653 84720-2637 84720-3548 84721-7791 84014-2544 84015-1733 84015-8732 84015 84015-8219 84624-9257 84020-9097 84020 84020-9457 84020-7403 84020-8184 84021

DUCHESNE VALLEY MED CLINIC PHARMACY RIDLEY'S PHARMACY VALLEY PHARMACY STAPLEY PHARMACY ENTERPRISE ANDERSON DRUG EPHRAIM MARKET FRESH PHARMACY KAZAN PHARMACY SMITH'S PHARMACY U OF U FARMINGTON PHARMACY SERVICE DRUG BEAR LAKE COMM HLTH CTR PHCY BIRCH FAMILY PHARMACY GUNNISON FAMILY PHCY & FLORAL

(435) 738-5403 (801) 789-4997 (801) 745-1800 (435) 878-2300 (435) 283-4444 (435) 283-6462 (435) 826-4374 (801) 451-2900 (801) 213-6310 (435) 743-6540 (435) 946-2770 (435) 884-9990 (435) 528-3455

50 E 200 S 4045 E PONY EXPRESS PKWY 2555 N WOLF CREEK DR 167 E. MAIN STREET 1 N MAIN ST 475 S MAIN 570 E MOQUI LN 1316 N HIGHWAY 89 165 N UNIVERSITY AVE RM 102 40 N MAIN ST 325 W LOGAN HWY 213 E MAIN ST 77 S MAIN ST

DUCHESNE EAGLE MOUNTAIN EDEN ENTERPRISE EPHRAIM EPHRAIM ESCALANTE FARMINGTON FARMINGTON FILLMORE GARDEN CITY GRANTSVILLE GUNNISON

UT UT UT UT UT UT UT UT UT UT UT UT UT

84021 84005-5512 84310-0000 84725 84627-1129 84627 84726-0276 84025-3841 84025 84631-4506 84028 84029-9595 84634-0807

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 625 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

GUNNISON PHARMACY LEES MRKTPL HEBER CITY PHCY SMITH'S PHARMACY CARBON MEDICAL HELPER PHARMACY SMITH'S PHARMACY RIDLEY'S PHARMACY #1167 AMPHEX PHARMACY LLC HURRICANE FAMILY PHARMACY LIN'S SUPERMARKETS INC REEDS PHARMACY KAMAS FOODTOWN PHARMACY KANAB UNITED DRUG ZION PHARMACY KANAB BOWMAN'S PHARMACY FRESH MARKET PHARMACY SMITH'S PHARMACY APOTHECARY WEST DAVIS FOOD AND DRUG DAVIS DRUG FRESH MARKET PHARMACY

Provider Name

(435) 528-7555 (435) 654-0414 (435) 654-1267 (435) 299-9165 (801) 254-8336 (801) 756-8353 (801) 341-1300 (435) 635-8200 (435) 635-3840 (435) 245-6422 (435) 783-4316 (435) 644-2418 (435) 644-2693 (801) 544-1462 (801) 593-9471 (385) 888-5320 (801) 969-1986 (435) 635-6944 (801) 525-5277 (801) 544-8512

520 S MAIN 890 S MAIN ST 550 NO MAIN ST 125 S MAIN ST 5560 W 13400 S 5353 W 11000 NORTH 898 E 3300 S 25 N 2000 W 1120 W STATE ST 790 E MAIN ST 145 W 200 S 176 W CENTER ST 14 E CENTER ST 326 N MAIN ST 170 W 200 N 1370 W 200 N 4188 W 5415 S 495 N MAIN ST 1580 W ANTELOPE DR STE 130A 910 N FAIRFIELD RD

GUNNISON HEBER CITY HEBER CITY HELPER HERRIMAN HIGHLAND HOLLADAY HURRICANE HURRICANE HYRUM KAMAS KANAB KANAB KAYSVILLE KAYSVILLE KAYSVILLE KEARNS LA VERKIN LAYTON LAYTON

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84634 84032-2463 84032 84526-1535 84096 84003 84106 84737-4111 84737-3433 84319-1408 84036-9099 84741-3416 84741-3542 84037-1106 84037-1943 84037 84118-4310 84745-5139 84041-1173 84041-2723

IHC HEALTH CENTER PHARMACY LAYTON NORTH VIEW PHARMACY THE OAKSTEAD INFUSION VITAL CARE PROFESSIONAL PLAZA PHCY, INC. SKY VIEW PHARMACY SMITH'S PHARMACY TIBBITTS FAMILY HEALTH MART PH WEST GORDON PHARMACY CECILS PHARMACY DRY CREEK PHARMACY LLC MACEYS PHARMACY SMITHS PHARMACY

(801) 779-6210 (801) 773-5666 (801) 825-3879 (801) 773-3863 (385) 405-2252 (801) 546-3497 (801) 771-0363 (801) 544-7979 (801) 768-4244 (801) 331-6630 (801) 766-0355 (801) 341-6515

2075 N 1200 W 2121 ROBINS DR 1492 W ANTELOPE DR SUITE 208 2065 N 1700 W 1750 E 3100 N 1170 E GENTILE ST 2940 N CHURCH ST STE 201 3225 W GORDON AVE STE 2 300 E MAIN ST 3300 RUNNING CREEK WAY # G100 760 E MAIN ST 1550 EAST 3500 NORTH

LAYTON LAYTON LAYTON LAYTON LAYTON LAYTON LAYTON LAYTON LEHI LEHI LEHI LEHI

UT UT UT UT UT UT UT UT UT UT UT UT

84041-1616 84041-8803 84041-1158 84041-1133 84040 84040-4062 84040-6503 84041-5728 84043-2242 84043-5728 84043-2284 84043

CACHE VALLEY COMM HEALTH CTR PHCY

(435) 755-8424

1515 N 400 E STE 104

LOGAN

UT

84341-7595

IHC HEALTH CENTER PHARMACY LOGAN LEE'S MARKETPLACE PHARMACY LOGAN CLINIC PHARMACY MACEYS PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY

(435) 792-1521 (435) 774-4150 (435) 713-2770 (435) 752-6850 (435) 753-1643 (435) 753-6570

1350 N 500 E 555 E 1400 N 412 N 200 E 49 E 400 N 750 N MAIN ST 175 E 442 N

LOGAN LOGAN LOGAN LOGAN LOGAN LOGAN

UT UT UT UT UT UT

84341-2400 84341-2453 84321 84321-4020 84321-3227 84321-4064

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 626 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SPENCES NORTH PHARMACY OQUIRRH MOUNTAIN PHARMACY SMITH'S PHARMACY MANTI PHARMACY MAPLE MOUNTAIN PHARMACY INTERMOUNTAIN SPECIALTY PHCY SELECT PHARMACY SMITH'S PHARMACY RIDLEY'S PHARMACY CITY MARKET PHARMACY WALKER DRUG ASPEN RIDGE PHARMACY MONTEZUMA CREEK CHS PHARMACY SAN JUAN PHARMACY MORGAN DRUG & GIFT LLC RIDLEY'S PHARMACY SKYLINE PHARMACY TERRELS PHARMACY GIBSON'S PHARMACY SMITH'S PHARMACY

Provider Name

(435) 753-8500 (801) 252-1000 (801) 250-6900 (435) 835-4225 (801) 515-6048 (801) 442-4600 (801) 849-1595 (801) 256-0532 (435) 654-1926 (435) 259-8971 (435) 259-5959 (435) 527-1300 (435) 651-3707 (435) 587-2302 (801) 829-3262 (801) 829-6271 (435) 462-2434 (435) 462-6300 (801) 262-5526 (801) 269-0066

550 E 1400 N 3665 S 8400 W 8055 W 3500 S 159 N MAIN ST 724 S 1600 W 7268 S BINGHAM JUNCTION BL #B1 628 W 7250 S 980 FORT UNION BLVD 42 W MAIN ST 425 S MAIN ST 290 S MAIN ST 515 N MAIN ST E HIGHWAY 262 140 S MAIN 109 N COMMERCIAL ST 275 E 300 NORTH 1 W MAIN ST 1050 S STATE ST 240 E WINCHESTER 665 W 5300 S

LOGAN MAGNA MAGNA MANTI MAPLETON MIDVALE MIDVALE MIDVALE MIDWAY MOAB MOAB MONROE MONTEZUMA CREEK MONTICELLO MORGAN MORGAN MOUNT PLEASANT MOUNT PLEASANT MURRAY MURRAY

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84341-2406 84044-2214 84044-2218 84642-1257 84664-5029 84047 84047-1060 84047-1714 84049 84532-2921 84532-2509 84754-3115 84534-0130 84535-0000 84050-9570 84050 84647-1327 84647-2206 84107 84123-5671

CENTRAL VALLEY COMMUNITY PHARMACY MT NEBO PHARMACY CACHE VALLEY PHARMACY LEES MARKETPLACE-FOXBORO PHCY 12TH STREET PHARMACY CANYON VIEW HEALTH MART FRESH MARKET PHARMACY FRESH MARKET PHARMACY IHC HEALTH CNTR PHCY SO OGDEN IHC HEALTH CTR PHCY N OGDEN INTERMOUNTAIN PHARMACY #136 LEE'S MARKETPLACE PHARMACY LTDEE PHARMACY MACEYS PHARMACY MIDTOWN COMM HEALTH CNTR PHCY OGDEN CLINIC HEALTH MART RIDLEY'S PHARMACY WEST #1134 SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY THE MEDICINE SHOPPE

(435) 623-3700 (435) 623-2183 (435) 787-1212 (385) 322-7900 (801) 621-2154 (801) 475-3795 (801) 393-5270 (801) 479-0827 (801) 387-6300 (801) 786-7600 (801) 387-8550 (801) 782-6116 (801) 387-7500 (801) 399-5866 (801) 395-8200 (801) 479-4030 (801) 621-2532 (801) 479-0700 (801) 621-0211 (801) 782-3303 (801) 399-1151

152 WEST 1500 NORTH 965 N MAIN ST 2380 N 400 E STE E 725 N REDWOOD RD 698 12TH ST 1159 12TH ST 2044 HARRISON BLVD 5691 HARRISON BLVD 975 CHAMBERS ST 2400 N 400 E 3895 HARRISON BLVD 2645 N 400 E 4401 HARRISON BLVD 325 36TH ST 2240 ADAMS AVE 4650 HARRISON BLVD 145 HARRISVILLE RD 4275 HARRISON BLVD 1485 HARRISON BLVD 2560 N 400 E 2562 MONROE BLVD

NEPHI NEPHI NORTH LOGAN NORTH SALT LAKE OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN OGDEN

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84648 84648-1003 84341-1767 84054 84404-5877 84404-5144 84401-0739 84403-4322 84403-4591 84414-7233 84403 84414-2240 84403-3195 84405-1673 84401-1511 84403-4303 84404-3927 84403-3101 84404-6093 84414-7243 84401-2514

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 627 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WASATCH PHARMACY CARE WEBER HUMAN SERVICES PHARMACY IHC HEALTH CTR PHCY OREM MACEY'S PHARMACY OREM FAMILY PHARMACY PRECISION MEDICAL PHARMACY PREMIER CARE PHARMACY RIDLEY'S PHARMACY RIDLEY'S PHARMACY SALMONS PHARMACY SMITH'S PHARMACY UTAH VALLEY PHARMACY PANGUITCH DRUG FRESH MARKET PHARMACY FRESH MARKET PHARMACY PARK CITY CLINIC PHARMACY SMITH'S PHARMACY THE MARKET PHARMACY THE PHARMACIE PAROWAN DRUG AND GIFT INC MTN VIEW FAMILY PHARMACY PAYSON MARKET PHARMACY PAYSON RX EXPRESS SMITH'S PHARMACY MACEYS PHARMACY SMITH REXALL DRUG SMITH'S PHARMACY MOUNTAIN VIEW HEALTH MART LIN'S SUPERMARKETS INC SMITH'S PHARMACY MACEY'S PHARMACY ALLENS SUPER SAVE B & H PHARMACY

Provider Name

(801) 479-0331 (801) 625-3662 (801) 714-3511 (801) 225-4621 (801) 434-7670 (801) 221-9355 (801) 607-2138 (208) 324-4633 (801) 224-3684 (801) 225-2150 (801) 224-3332 (801) 224-3932 (435) 676-2212 (435) 649-6264 (435) 645-7945 (435) 776-7525 (435) 649-7606 (435) 645-7916 (866) 777-7000 (435) 477-3000 (801) 465-4322 (801) 465-2347 (801) 609-2300 (801) 465-2591 (801) 796-6580 (801) 785-3221 (801) 785-9445 (801) 475-3695 (435) 637-7112 (435) 637-0840 (435) 752-1111 (801) 375-5005 (801) 373-7288

4387 HARRISON BLVD STE D7 237 26TH ST 505 W 400 N 880 N STATE ST 406 N STATE ST 726 S 400 E 452 WEST 800 NORTH 1585 N STATE ST 25 W CENTER ST 450 W 800 N 45 SOUTH STATE ST 214 E UNIVERSITY PKWY 95 E CENTER ST 1760 PARK AVE 3151 KILBY RD 750 ROUND VALLEY DR STE 203 1725 UINTA WAY 1500 SNOW CREEK DR 1890 BONANZA DRIVE 20 NORTH MAIN ST 1172 E 100 N STE 1 586 N MAIN ST 869 TURF FARM RD 632 S 100 W 931 W STATE RD 10 S MAIN ST 210 E 700 S 1100 W 2700 N 760 W PRICE RIVER DR 1075 E MAIN ST 50 N HIGHWAY 165 655 E 300 S 286 W CENTER ST

OGDEN OGDEN OREM OREM OREM OREM OREM OREM OREM OREM OREM OREM PANGUITCH PARK CITY PARK CITY PARK CITY PARK CITY PARK CITY PARK CITY PAROWAN PAYSON PAYSON PAYSON PAYSON PLEASANT GROVE PLEASANT GROVE PLEASANT GROVE PLEASANT VIEW PRICE PRICE PROVIDENCE PROVO PROVO

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84403-3267 84401-3105 84057-1950 84057-3149 84057-3802 84097 84057 84057-2578 84057-4605 84057-3728 84058 84058-7601 84759 84060-5125 84098-8309 84060 84098-7534 84060-7506 84060 84761-0000 84651-1668 84651-3428 84651-5709 84651-2864 84062-2102 84062-2630 84062-3510 84404 84501-2841 84501-2712 84332-6700 84606-4962 84601-4488

BYU STUDENT HEALTH CENTER PHARMACY CENTRAL UTAH PHARMACY EDGEMONT HEALTHMART PHARMACY FRESH MARKET PHARMACY MACEY'S PHARMACY

(801) 422-5171 (801) 418-0800 (801) 226-7994 (801) 374-1704 (801) 377-0307

1750 N WYMOUNT TERRACE DR 1055 N 500 W 3661 N CANYON RD 560 W CENTER ST 1400 N STATE ST

PROVO PROVO PROVO PROVO PROVO

UT UT UT UT UT

84602 84604-3305 84604-4536 84601-4276 84604-2415

MOUNTAINLANDS FAM PHCY WASATCH MOUNTAINLANDS FAMILY PHARMACY

(801) 429-2035 (801) 429-2020

750 N 200 W 589 S STATE ST

PROVO PROVO

UT UT

84601-1677 84606-5056

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 628 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ROCK CANYON PHARMACY SMITH'S PHARMACY TIMPVIEW PHARMACY INTERMOUNTAIN SEVIER VALLEY PHCY LENNYS RICHFIELD FAMILY PHCY LIN'S SUPERMARKETS INC ECO PHARMACY OF SALT LAKE CITY INTERMOUNTAIN SOUTHRIDGE PHCY PETERSON'S FRESH MARKET SOUTH VALLEY COMPOUNDING PHCY DAVIS FOOD AND DRUG NUMBER 2 STEWARTS BASIN FAMILY PHARMACY UINTAH BASIN MEDICAL CTR PHCY

Provider Name

(801) 377-2002 (801) 377-9250 (801) 357-7333 (435) 893-0690 (435) 896-6000 (435) 896-5759 (801) 254-6111 (801) 285-4500 (801) 254-0809 (801) 676-7880 (435) 722-2255 (435) 722-2454 (435) 722-6123

3179 N CANYON RD 350 N FREEDOM BLVD 1055 N 300 W 1000 N MAIN ST 508 N MAIN ST 250 S MAIN ST 12523 S CREEK MEADOW RD #109 3723 W 12600 S STE 170 1784 W 12600 S 3796 W 12600 S 750 E 200 N 245 W HIGHWAY 40 250 W 300 N # 75-2

PROVO PROVO PROVO RICHFIELD RICHFIELD RICHFIELD RIVERTON RIVERTON RIVERTON RIVERTON ROOSEVELT ROOSEVELT ROOSEVELT

UT UT UT UT UT UT UT UT UT UT UT UT UT

84604-3916 84601-2810 84604-3344 84701-1857 84701-1864 84701-2559 84065 84065-7215 84065-7025 84065-7215 84066-3005 84066 84066-2336

HEREFORDSHIRE HEALTH CENTER PHCY KENT'S MARKET PHARMACY RIDGE VIEW PHARMACY ROY PHARMACY WINEGARS PHARMACY ALBERTSON'S PHARMACY BRENT'S PHCY & DIABETES CARE CRIMSON VALLEY PHARMACY LLC IHC HEALTH CTR PHCY ST GEORGE IHC WATSON DIXIE PHARMACY LIN'S SUPERMARKETS INC PROFESSIONAL PARK PHARMACY SIENAS PHARMACY LLC SMITH'S PHARMACY STAPLEY PHARMACY STAPLEY PHCY AT DINO CROSSING SALEM HILLS PHARMACY

(801) 387-8215 (801) 985-3942 (801) 825-6400 (801) 732-0202 (801) 217-3673 (435) 688-7196 (435) 674-5667 (435) 218-7744 (435) 688-6500 (435) 251-2560 (435) 673-9781 (435) 652-1548 (435) 673-6777 (435) 673-8898 (435) 673-3575 (435) 627-2910 (801) 723-0570

1915 W 5950 S 3536 W 5600 S 3443 W 5600 S 3460 W 4800 S 3444 W 4800 S STE C 745 N DIXIE DR 1091 N BLUFF ST STE 1005 2351 S RIVER RD STE 3 577 S RIVER RD 1380 E MEDICAL CENTER DR STE 1 1930 W SUNSET BLVD 736 S 900 E STE 102 1664 S DIXIE DR. STE L-106 20 N BLUFF ST 102 E CITY CENTER ST 446 S MALL DR STE B8 795 STATE ROAD 198

ROY ROY ROY ROY ROY SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SAINT GEORGE SALEM

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84067-1454 84067-9116 84067-9103 84067-9430 84067 84770-5737 84770 84790-8280 84790-2097 84790-2125 84770-6587 84790-7001 84770 84770-3334 84770-3460 84790-4947 84653-4604

INTERMOUNTAIN NORTH SEVIER PHARMACY BYRAM HEALTHCARE CENTERS INC COMMUNITY PHARMACY COTTONWOOD APOTHECARY DANS DRUGS DAN'S DRUGS DAN'S DRUGS DAN'S DRUGS FRESH MARKET PHARMACY FRESH MARKET PHARMACY

(435) 529-5988 (800) 775-4372 (801) 270-0600 (801) 314-2325 (801) 487-7585 (801) 581-1700 (801) 943-0951 (801) 272-9494 (801) 964-2626 (801) 484-8742

530 N 250 W 3793 S STATE ST 1220 E 3900 S STE 1H 5770 S 250 E 2330 E 3300 S 1360 FOOTHILL DR 2029 FORT UNION BLVD 3981 WASATCH BLVD 1825 W 4700 S 1638 S 900 E

SALINA SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY

UT UT UT UT UT UT UT UT UT UT

84654 84115-4828 84124-1327 84107-8100 84109-2724 84108-2321 84121-3143 84124-2247 84129 84105-2366

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 629 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FRESH MARKET PHARMACY FRESH MARKET PHARMACY FRESH MARKET PHARMACY FRESH MARKET PHARMACY FRESH MARKET PHARMACY GENOA-QOL HEALTHCARE GLOBAL MEDICAL THERAPEUTICS,IN GRANGER PHARMACY, LLC HOLLADAY HRX PHARMACY

Provider Name

(801) 487-1018 (801) 272-5298 (801) 278-5388 (801) 963-6874 (801) 262-1025 (385) 212-2934 (801) 935-4305 (801) 965-3639 (801) 278-0411 (801) 553-3426

2040 S 2300 E 3865 S 2300 E 4530 S HIGHLAND DR 3555 W 3500 S 5632 S 900 E 1020 S MAIN ST STE 100 1890 S 3850 W STE 121-A 3725 W 4100 S 4690 HOLLADAY BLVD 4227 S HIGHLAND DRIVE STE 6

SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY

UT UT UT UT UT UT UT UT UT UT

84108-3220 84109-3422 84117-4202 84119-2539 84121-1034 84101-3194 84104-4909 84120-5530 84117-5243 84124-2672

IHC HEALTH CENTER PHARMACY MEMORIAL IHC HEALTH CTR PHCY SALT LAKE IMC COMMUNITY PHARMACY JOLLEY'S COMPOUNDING PHARMACY JOLLEYS CORNER PHARMACY LDS HOSPITAL OUTPATIENT PHARMACY MEDICAL CENTER PHARMACY MEDICAL MALL PHARMACY MEDICAL PLAZA PHARMACY MEDICINE MARKET MEDS IN MOTION MEDS IN MOTION MEDS IN MOTION MEIER'S PHARMACY PRIMARY CHILDRENS MED CTR PHCY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SOUTHEAST PHARMACY THE APOTHECARY SHOPPE UNIVERSITY PHARMACY UTAH CANCER SPECIALISTS VRX PHARMACY @ CITY CREEK FRESH MARKET PHARMACY

(801) 464-7800 (385) 282-2350 (801) 507-3030 (801) 484-4393 (801) 582-1999 (801) 408-1019 (801) 350-8140 (801) 840-4350 (801) 539-0231 (801) 559-7719 (801) 316-0799 (801) 506-6999 (801) 316-0790 (801) 679-3278 (801) 662-1682 (801) 328-6033 (801) 355-5257 (801) 355-4617 (801) 364-2564 (801) 486-4331 (801) 261-8787 (801) 486-8477 (801) 363-1047 (801) 943-0177 (801) 972-4945 (801) 466-2181 (801) 521-6353 (801) 582-7624 (801) 270-2253 (801) 236-8879 (801) 501-9151

2000 S 900 E 389 S 900 E 5121 COTTONWOOD ST 1702 S 1100 E 1676 E 1300 S 8TH AVE AND C ST 1050 E SOUTH TEMPLE 3845 W 4700 S 1060 E. 100 S. SUITE L-2 6225 S HIGHLAND DR 4624 S HOLLADAY BLVD STE 003 3798 S 700 E STE 7 4624 S HOLLADAY BLVD STE 101 4698 HOLLADAY BLVD 100 MARIO CAPECCHI DR 455 S 500 E 876 E 800 S 402 6TH AVE 828 S 900 W 922 E 2100 S 845 E 4500 S 3215 VALLEY ST 1174 W 600 N 3470 E 7800 S 4065 S REDWOOD RD 2670 S 2000 E 82 S 1100 E STE 104 1320 E 200 S 3838 S 700 E STE 100 50 E SOUTH TEMPLE STE 145 1860 E 9400 S

SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SALT LAKE CITY SANDY

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84105-3208 84102-2310 84107-5701 84105-3424 84105-1704 84103 84102-1507 84129-3454 84102-1040 84121 84117 84106-1150 84117-7054 84117-5243 84113-1103 84102-2753 84102-3634 84103-3377 84104-1455 84106-2364 84107-3049 84109-4217 84116-2676 84121-5803 84123-1131 84109-1736 84102-1687 84102-2604 84106-1494 84111-1010 84093-3000

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 630 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

IHC HEALTH CENTER PHARMACY SANDY JOLLEY'S SANDY PHARMACY MACEY'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY FUSION SPECIALTY PHARMACY SANTAQUIN PHCY AND DIABETES CTR SMITH'S PHARMACY LARRY'S SMITHFIELD PHARMACY LEE'S MARKET PLACE PHARMACY

(801) 501-2530 (801) 571-0201 (801) 567-1423 (801) 942-2227 (801) 572-1398 (435) 703-9680 (801) 754-1141 (801) 768-2240 (435) 563-6262 (435) 563-6201

9500 S 1300 E 9829 S 1300 E STE 100 7850 S 1300 E 2039 E 9400 S 10305 S 1300 E 1100 CANYON VIEW DR STE C 27 W MAIN ST 1320 REDWOOD RD 502 S MAIN ST STE B 850 S MAIN ST

SANDY SANDY SANDY SANDY SANDY SANTA CLARA SANTAQUIN SARATOGA SPRINGS SMITHFIELD SMITHFIELD

UT UT UT UT UT UT UT UT UT UT

84094-3763 84094-4063 84094-0746 84093-3100 84094-4681 84765-5672 84655-7083 84045 84335-2314 84335-2302

INTERMOUNTAIN HOMECARE PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY FRESH MARKET PHARMACY MACEYS PHARMACY STONE DRUG COMPANY ALLENS SUPER SAVE ART CITY PHARMACY REAMS SPRINGVILLE PHARMACY SMITH'S PHARMACY SOS DRUG COMPANY LIN'S SUPERMARKETS INC #6 RED ROCK PHARMACY SMITHS PHARMACY C3 PHARMACY SMITH'S PHARMACY ISLAND VIEW PHARMACY SMITH'S PHARMACY ALBERTSON'S PHARMACY BIRCH FAMILY PHARMACY BIRCH FAMILY PHARMACY HOLT'S PHARMACY MACEY'S PHARMACY KENT'S THRIFTWAY TREMONTON COMMUNITY PHCY DAVIS FOOD AND DRUG SMITH'S PHARMACY ALBERTSON'S PHARMACY STUCKI FAMILY PHARMACY FAMILY PLAZA PHARMACY INC

(385) 887-6000 (801) 501-7180 (801) 254-4660 (801) 798-9788 (801) 798-8832 (801) 798-8611 (801) 489-7327 (801) 489-5618 (801) 489-3784 (385) 685-7005 (801) 489-6041 (435) 773-6801 (435) 703-2900 (435) 705-7420 (435) 703-2273 (801) 825-2262 (801) 773-7899 (801) 773-5373 (435) 882-8990 (435) 882-8880 (435) 882-7775 (435) 249-0767 (435) 843-8821 (435) 257-0445 (435) 257-5249 (435) 789-7010 (435) 789-7235 (435) 628-7430 (435) 627-8848 (801) 569-0175

11520 S REDWOOD RD 5448 W DAYBREAK PKWY 1634 W SOUTH JORDAN PKWY 652 N 800 E 187 E 1000 N 159 N MAIN ST 340 S MAIN ST 405 S MAIN ST 759 E 400 S 1117 W 400 S 214 S MAIN ST 2928 E MALL DR 1240 E 100 S SUITE 220 565 S MALL DR. 126 E CITY CENTER 2353 N MAIN ST 2038 W 1900 S 951 W 1700 S 740 N MAIN ST 6727 N HWY 36 493 N MAIN ST 134 W 1180 N STE 12 972 N MAIN ST 300 E MAIN ST 44 E MAIN ST 575 W MAIN ST 1080 W HIGHWAY 40 915 W REDCLIFF DR 568 W TELEGRAPH ST #3 3570 W 9000 S STE 150

SOUTH JORDAN SOUTH JORDAN SOUTH JORDAN SPANISH FORK SPANISH FORK SPANISH FORK SPRINGVILLE SPRINGVILLE SPRINGVILLE SPRINGVILLE SPRINGVILLE ST GEORGE ST GEORGE ST GEORGE ST. GEORGE SUNSET SYRACUSE SYRACUSE TOOELE TOOELE TOOELE TOOELE TOOELE TREMONTON TREMONTON VERNAL VERNAL WASHINGTON WASHINGTON WEST JORDAN

UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT UT

84095 84009 84095-4562 84660-1651 84660-1269 84660-1724 84663-1853 84663-2252 84663-2014 84663-3061 84663-1851 84790 84790-3001 84790 84770 84015-2454 84075-9320 84075-9127 84074-1612 84074 84074-1654 84074-1483 84074-1616 84337-2319 84337-1624 84078-2405 84078-2333 84780 84780-1596 84088

NR_0009_10823 10/2017

Page 631 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JOLLEYS PHARMACY REDWOOD MACEY'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY DAVIS JUBILEE OLIVE PHARMACY PIONEER VALLEY PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY SMITH'S PHARMACY FALCON PHARMACY FOOD CITY PHARMACY HEALTHPLUS & PHARMACY AT JMH HIGHLANDS COMMUNITY PHARMACY MICHAEL'S PHARMACY NORTHGATE PHARMACY NORTHGATE PHARMACY II AGAPE PHARMACY ALEXANDRIA COMPOUNDING PHCY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY LANDMARK PROFESSIONAL PHCY LLC MEDPLUS PHARMACY

Provider Name

(801) 747-7500 (801) 255-7557 (801) 545-3480 (801) 566-6645 (801) 562-4993 (801) 280-5545 (385) 383-3040 (801) 969-1493 (801) 972-5155 (801) 964-3935 (801) 968-1896 (801) 966-6546 (801) 298-2124 (276) 258-5251 (276) 628-2580 (276) 258-1990 (276) 566-4234 (276) 676-2900 (276) 628-2001 (276) 525-4633 (703) 642-2900 (703) 549-4350 (703) 253-7697 (703) 704-6798 (571) 777-2387 (703) 370-0122 (703) 765-6696 (703) 461-6199 (703) 922-6620 (703) 313-8092 (703) 212-0200 (703) 751-1111

8806 REDWOOD RD STE 102 7859 S 3200 W 5710 WEST 7800 SOUTH 7061 REDWOOD RD 1820 W 9000 S 4080 W 9000 S 217 N 2000 W 3765 CONSTITUTION BLVD 2290 S REDWOOD RD 4052 PIONEER PKWY #111 4643 S 4000 W 5620 W 4100 S 2399 S MAIN ST 795 CUMMINGS ST 396 TOWNE CENTER DR 16000 JOHNSTON MEMORIAL DR 16400 JEB STUART HIGHWAY 101 CHARWOOD DR 611 CAMPUS DR STE 500 26100 LEE HWY 6349 LINCOLNIA RD 500 MONTGOMERY ST #120 8119 HOLLAND RD 8350 RICHMOND HWY STE 301 621 EAST GLEBE RD 5730 EDSALL RD 6800 RICHMOND HWY 3131 DUKE ST 7558 TELEGRAPH RD 5870 KINGSTOWNE CTR 5249 DUKE ST #LL 5130 DUKE ST STE 2

WEST JORDAN WEST JORDAN WEST JORDAN WEST JORDAN WEST JORDAN WEST JORDAN WEST POINT WEST VALLEY CITY WEST VALLEY CITY WEST VALLEY CITY WEST VALLEY CITY WEST VALLEY CITY WOODS CROSS ABINGDON ABINGDON ABINGDON ABINGDON ABINGDON ABINGDON ABINGDON ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA

UT UT UT UT UT UT UT UT UT UT UT UT UT VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

84088-9335 84088-5230 84081 84084-3420 84088-6503 84088-8928 84015 84119-3721 84119 84120-2063 84120-6233 84128-4322 84010-7707 24211-3631 24210-3248 24211-7659 24211 24210-2576 24210-9701 24211 22312-1533 22314 22306-3135 22309-2344 22305 22304-4712 22306-1704 22314-4518 22315-3829 22315-5704 22304-2926 22304

NEIGHBORHOOD PHARMACY OF DEL RAY SHOPPERS PHARMACY SHOPPERS PHARMACY SHOPPERS PHARMACY THE MEDICINE SHOPPE AMELIA PHARMACY ANNANDALE PHARMACY GIANT PHARMACY GIANT PHARMACY

(703) 836-1700 (703) 518-5016 (703) 647-4841 (703) 256-6085 (434) 369-5257 (804) 561-6885 (703) 992-8806 (703) 256-2773 (703) 333-6361

2204 MOUNT VERNON AVE 3801 JEFFERSON DAVIS HWY 7660 RICHMOND HWY 6200 LITTLE RIVER TPKE 1230 MAIN ST 15412 PATRICK HENRY HWY 7004-B LITTLE RIVER TNPK 7137 COLUMBIA PIKE 6980 BRADDOCK RD

ALEXANDRIA ALEXANDRIA ALEXANDRIA ALEXANDRIA ALTAVISTA AMELIA COURT HOUSE ANNANDALE ANNANDALE ANNANDALE

VA VA VA VA VA VA VA VA VA

22301-1362 22305-3118 22306-2843 22312-1700 24517-1458 23002-4725 22003 22003-3146 22003-6036

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 632 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

NEW WORLD PHARMACY PROCARE PHARMACY HEALTH CENTER CORNERSTONE PHARMACY APPOMATTOX DRUG STORE INC HOMETOWN PHARMACY ARLINGTON PHARMACY CARLIN SPRINGS PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY JOULE WELLNESS PHARMACY NOVA PHARMACY VIRGINIA HOSP CTR OUTPATIENT PHCY BLUE RIDGE MEDICAL CENTER PHCY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY MARTINS PHARMACY RX CONNEX 10762 KING WILLIAM PHARMACY FAMILY DISCOUNT PHARMACY INC BLAND COUNTY PHARMACY BEAVERDAM PHARMACY BATTLETOWN PHARMACY REED'S PHARMACY FAMILY DRUG INC FOOD CITY PHARMACY UNION DRUG BLACKSBURG PHARMACY GENOA-QOL HEALTHCARE MAIN STREET PHARMACY SPENCERS DRUGSTORE FOOD CITY PHARMACY NEW GRAHAM PHARMACY BOWLING GREEN PHARMACY PATHS BOYDTON PHARMACY BRIDGEWATER HEALTHCARE PHCY BRIDGEWATER PHARMACY

Provider Name

(703) 237-8178 (571) 830-6583 (276) 565-3434 (434) 352-7161 (434) 352-3784 (703) 525-0500 (703) 379-4000 (703) 271-8330 (703) 351-9220 (703) 739-3714 (571) 699-3593 (703) 538-5555 (703) 717-7750 (434) 263-4810 (571) 223-1796 (703) 723-2161 (703) 729-3878 (804) 798-8543 (804) 412-2533 (804) 769-3885 (276) 627-0536 (276) 688-4204 (804) 449-6333 (540) 955-0500 (540) 955-2020 (276) 523-1713 (276) 523-6052 (276) 523-2100 (540) 552-3000 (540) 232-9022 (540) 605-7721 (434) 292-3132 (276) 322-3835 (276) 326-1166 (804) 633-4674 (434) 210-4488 (540) 828-2787 (540) 828-6000

7031 LITTLE RIVER TPKE STE 9B 7202 POPLAR ST STE E 205 KILBOURNE AVENUE 2046 CONFEDERATE BLVD 199 OLD COURTHOUSE RD 5513 WILSON BLVD 611 S CARLIN SPRINGS ROAD #105 2501 9TH ROAD SOUTH 3450 WASHINGTON BLVD 2901 S GLEBE RD 1028 S WALTER REED DR 6023 WILSON BLVD 1701 N GEORGE MASON DR 4038 THOMAS NELSON HWY 43670 GREENWAY CORP DRIVE 43330 JUNCTION PLZ 44110 ASHBURN SHOPPING PLZ 253 N WASHINGTON HWY 9555 KINGS CHARTER DR STE D 7890B RCHMND TAPPAHANNOCK HWY 335 RIVERSIDE DR 12315 GRAPEFIELD RD 16151-B TRAINHAM RD 33 W MAIN ST STE A 15 CROW ST STE A 14 E 27TH ST N STE 1 603 WOOD AVE E 322 CLOVERLEAF SQ 1403 N MAIN ST 700 UNIVERSITY CITY BLVD # 142 301 S MAIN ST STE 107 100 N MAIN ST 1000 LEATHERWOOD LN 566 VIRGINIA AVE 121 TRAVIS ST 380 WASHINGTON ST 302 N 2ND ST 509 N MAIN ST

ANNANDALE ANNANDALE APPALACHIA APPOMATTOX APPOMATTOX ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARLINGTON ARRINGTON ASHBURN ASHBURN ASHBURN ASHLAND ASHLAND AYLETT BASSETT BASTIAN BEAVERDAM BERRYVILLE BERRYVILLE BIG STONE GAP BIG STONE GAP BIG STONE GAP BLACKSBURG BLACKSBURG BLACKSBURG BLACKSTONE BLUEFIELD BLUEFIELD BOWLING GREEN BOYDTON BRIDGEWATER BRIDGEWATER

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

22003-5958 22003 24216 24522-4097 24522 22205-1119 22204 22204 22201-4508 22206-2710 22204-0815 22205-1503 22205 22922-2302 20147 20147-3406 20147-3999 23005-1623 23005-7994 23009 24055-4245 24314-4547 23015-1301 22611-1340 22611-1327 24219-3624 24219-3021 24219-2752 24060-2563 24060-2706 24060-4978 23824-1424 24605-2032 24605-1729 22427-9318 23917-3415 22812-1712 22812-1626

BUNTINGS AND NORTHSIDE DRUG CENTER FOOD CITY PHARMACY FOOD CITY PHARMACY

(276) 466-3600 (276) 645-0044 (276) 669-2388

1883 EUCLID AVE 1320 EUCLID AVE 100 BONHAM RD

BRISTOL BRISTOL BRISTOL

VA VA VA

24201-3605 24201-3818 24202-5946

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 633 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SOUTHWEST VIRGINIA COMM PHCY BROADWAY DRUG CENTER BROOKNEAL DRUG RANSONES DRUGS BUENA VISTA FAMILY PHARMACY GIANT PHARMACY HANA PHARMACY BURKE RAYFIELD'S PHARMACY DAVIS DRUG BLUE DEVIL DRUG INC. FOOD CITY PHARMACY THE CLINIC PHARMACY INC VITAL CARE OF SW VIRGINIA GIANT PHARMACY GIANT PHARMACY HANARO PHARMACY AKINA PHARMACY GIANT PHARMACY LOTTELEAH PHARMACY OPTION CARE GIANT PHARMACY HARRRIS TEETER PHARMACY

Provider Name

(276) 644-3338 (540) 896-3251 (434) 376-2220 (540) 254-2904 (540) 261-2896 (703) 425-0362 (703) 425-1500 (757) 331-1212 (757) 745-7440 (276) 762-5959 (276) 964-5748 (276) 963-6600 (276) 964-0555 (703) 803-8556 (703) 631-7720 (703) 825-1860 (571) 267-5050 (703) 542-2990 (703) 378-7777 (703) 378-6736 (434) 244-4301 (434) 872-0013

2195 EUCLID AVE SUITE 7 169 E SPRINGBROOK RD 120 RUSH ST 19771 MAIN ST 2263 MAGNOLIA AVE 6011 BURKE CENTRE PKWY 9550 BURKE RD 2 FIG ST 13478 CARROLLTON BLVD 19408 US HWY 58 ALT. #E 1135 CLAYPOOL HILL MALL RD 398 CLINIC RD 305 OLD KENTUCKY TPKE 5615 STONE RD 14125 SAINT GERMAIN DR 13818-B BRADDOCK RD 4080 LAFAYETTE CTR DR STE 270 25050 RIDING PLZ STE 100 13955 METROTECH DRIVE 4170 LAFAYETTE CENTER DR STE 3 1900 ABBEY RD 159 COMMUNITY DR

BRISTOL BROADWAY BROOKNEAL BUCHANAN BUENA VISTA BURKE BURKE CAPE CHARLES CARROLLTON CASTLEWOOD CEDAR BLUFF CEDAR BLUFF CEDAR BLUFF CENTREVILLE CENTREVILLE CENTREVILLE CHANTILLY CHANTILLY CHANTILLY CHANTILLY CHARLOTTESVILLE CHARLOTTESVILLE

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

24201 22815-9526 24528 24066 24416-3121 22015-3717 22015-3132 23310-3322 23314-3208 24224 24609-7013 24609-9413 24609-9401 20120-1618 20121-2310 20121 20151-1250 20152-5925 20151 20151-1254 22911-3543 22911

MARTHA JEFFERSON OUTPATIENT PHCY MEADOWBROOK PHARMACY TIMBERLAKES DRUG STORE TOP NOTCH FAMILY PHARMACY UVA BOOKSTORE PHARMACY UVA CONTINUUM HOME HLTH PHCY UVA ECCCC PHARMACY UVA HOPE PANTOPS PHARMACY UVA OUTPATIENT PHARMACY UVA ST HEALTH PHARMACY CHATHAM FAMILY PHARMACY COMMONWEALTH PHARMACY CANCER SPECIALISTS OF TIDEWATER COMMONWEALTH COMMUNITY PHARMACY, RX GENX PHARMACY IRWINS PHARMACY LAWRENCE PHARMACY NEWMAN FAMILY PHARMACY

(434) 654-7359 (434) 296-4135 (434) 295-9155 (434) 995-5595 (434) 982-5694 (434) 984-2273 (434) 243-3881 (434) 982-6900 (434) 924-2390 (434) 924-1544 (434) 432-0780 (434) 432-2094 (757) 436-2995

500 MARTHA JEFFERSON DR 2037 BARRACKS RD 322 E MAIN ST 943 PRESTON AVE 400 EMMET ST S 2205 FONTAINE AVE STE 204 1240 LEE ST 590 PETER JEFFERSON PKWY #175 1215 LEE ST 400 BRANDON AVE 13701 US HIGHWAY 29 STE H1 21 S MAIN ST 110 WIMBLEDON SQ STE E

CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHARLOTTESVILLE CHATHAM CHATHAM CHESAPEAKE

VA VA VA VA VA VA VA VA VA VA VA VA VA

22911 22903-1206 22902-5234 22903-4421 22903-2481 22903-2974 22908 22911-4655 22908-0816 22903 24531-3611 24531 23320-4946

(757) 216-9678 (757) 387-1201 (757) 420-8418 (757) 487-3458 (757) 482-0960

480 KEMPSVILLE RD, SUITE 108 1101 EXECUTIVE BLVD SUITE D 4300 E INDIAN RIVER RD 1156 N GEORGE WASHIN HWY, N 800 BATTLEFIELD BLV S #105-107

CHESAPEAKE CHESAPEAKE CHESAPEAKE CHESAPEAKE CHESAPEAKE

VA VA VA VA VA

23320 23320 23325-3116 23323 23322-6670

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 634 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name WESTWOOD BEHAVIORAL HEALTH PHCY FOOD LION PHARMACY RX SOUTH LLC CHILHOWIE DRUG FOOD CITY PHARMACY GREEVERS DRUG STORE INC H & H PHARMACY COMMUNITY PHCY & MEDICAL SUPPLY DAVIDSON'S PHARMACY PC CLARKSVILLE COMMUNITY PHARMACY FOOD LION PHARMACY GIANT PHARMACY FOOD CITY PHARMACY GREEN WAVE PHARMACY HANCOCK-LAMBERT PHARMACY WEST END PHARMACY FAMILY DRUG CENTER PHARMACY PLUS INC CRITTENDEN'S DRUG INC PARKWAY PHARMACY GENOA-QOL HEALTHCARE MARTINS PHARMACY THE PHARMACY OF CULPEPER CUMBERLAND PHARMACY FOOD CITY PHARMACY LAUREL FAMILY DRUG BROSVILLE FAMILY PHARMACY GENOA-QOL HEALTHCARE KARE PHARMACY MEDICAL CENTER PHARMACY MODERN PHARMACY PATHS COMMUNITY PHARMACY PIEDMONT INFUSION SERVICES, INC PIEDMONT PHARMACY ROMAN EAGLE MEMORIAL HOME PHCY DILLWYN PHARMACY DINWIDDIE DRUG STORE INC VILLAGE PHARMACY SHOPPERS PHARMACY CLINCH RIVER PHARMACY ELKTON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (757) 547-2247 (804) 706-6892 (804) 717-5000 (276) 521-0491 (276) 646-2941 (276) 646-3512 (757) 336-3115 (540) 639-1647 (540) 381-9345 (434) 374-2623 (434) 374-5620 (703) 818-0589 (276) 926-6002 (276) 926-4733 (276) 926-6707 (276) 926-6890 (276) 395-2257 (804) 520-2400 (434) 645-9545 (804) 823-6337 (540) 317-1596 (540) 825-1837 (540) 825-0003 (804) 492-4325 (276) 475-3653 (276) 475-5022 (434) 685-1509 (434) 483-2503 (434) 792-8281 (434) 799-2131 (434) 793-5711 (434) 791-4880 (434) 792-6387 (434) 791-3784 (434) 836-9510 (434) 983-2013 (804) 469-3261 (276) 431-2299 (703) 580-5499 (276) 467-2469 (540) 298-9090

Provider Street 224 GREAT BRIDGE BLVD STE 161B 12140 BERMUDA CROSSROAD LN 12230 IRON BRIDGE RD STE C 1449 E LEE HWY 145 W LEE HWY 106 W LEE HWY 6300 MADDOX BLVD 2900 TYLER RD STE 1890 1500 N FRANKLIN ST 11226 HWY 15 S 1013 VIRGINIA AVE 5740 UNION MILL RD 410 CHASE ST 165 MCCLURE AVE 342 CLINTWOOD MAIN STREET 340 COLLEY SHOPPING CTR 517 WEST FRONT ST 2029 BOULEVARD 121 W CAROLINA AVE 5771 THE SQ 650 LAUREL STREET STE A 15371 MONTANUS DR 261 SOUTHGATE SHOPPING CTR 1756 ANDERSON HWY 736 N BEAVER DAM AVE 204 S SHADY AVE 10372 MARTINSVILLE HWY STE A 245 HAIRSTON ST 411 PARK AVE 142 S MAIN ST 155 S MAIN ST 705 MAIN ST 111 MALL DR 305 MT CROSS RD 2526 N MAIN ST 1054 MAIN ST 13723 BOYDTON PLANK RD 443 DUFF PATT HWY STE 104 4174 FORTUNA CENTER PLAZA 17633 VETERANS MEMORIAL HWY 111 S STUART AVE

Page 635 of 679

Provider City CHESAPEAKE CHESTER CHESTER CHILHOWIE CHILHOWIE CHILHOWIE CHINCOTEAGUE ISLAND CHRISTIANSBURG CHRISTIANSBURG CLARKSVILLE CLARKSVILLE CLIFTON CLINTWOOD CLINTWOOD CLINTWOOD CLINTWOOD COEBURN COLONIAL HEIGHTS CREWE CROZET CULPEPER CULPEPER CULPEPER CUMBERLAND DAMASCUS DAMASCUS DANVILLE DANVILLE DANVILLE DANVILLE DANVILLE DANVILLE DANVILLE DANVILLE DANVILLE DILLWYN DINWIDDIE DUFFIELD DUMFRIES DUNGANNON ELKTON

State

ZIP code

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

23320 23831-2345 23831-1530 24319-5458 24319-4602 24319-4617 23336-2617 24073-6374 24073-1412 23927-0000 23927-9040 20124-1088 24228 24228-6845 24228 24228-5756 24230-0000 23834-2309 23930-1803 22932-3163 22701 22701-2523 22701 23040-2524 24236-2125 24236-3203 24541 24540-4137 24541-4629 24541-2922 24541-2921 24541-1803 24540-4069 24540-4045 24540-2333 23936-3027 23841-2438 24244-5191 22025 24245-3929 22827-1525

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

A & B PHARMACY SHORE PHARMACY ACARIAHEALTH PHARMACY INC DYNQUEST PHARMACY

Provider Name

(434) 336-5000 (757) 442-7982 (703) 846-9912 (703) 206-0002

6 DOCTORS DR SUITE A 3271-B MAIN ST 8505 ARLINGTON BLVD STE 110 8326 PROFESSIONAL HILL DR

EMPORIA EXMORE FAIRFAX FAIRFAX

VA VA VA VA

23847-1240 23350-4708 22031-4636 22031-4611

FAIRFAX FAMILY PRACTICE APOTHECARY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY HANA PHARMACY, INC INOVA PHCY PLUS AT FAIROAKS PROSPERITY RX FAIRFAX, INC. REMEDIUM PHARMACY REVOLUTION MEDS PHARMACY INC ROYAL CARE PHARMACY SHOPPERS PHARMACY STONE SPRINGS PHARMACY VIRGINIA CANCER SPECIALISTS, PC ACARIAHEALTH PHARMACY INC BAILEYS PHARMACY BROAD STREET PHARMACY FALLS CHURCH PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY INOVA PHCY PLS @ INOVA FAIRFAX INOVA PHCY PLUS @ FAIRFAX IHVI MILLENNIUM PHARMACY SEVEN CORNERS PHARMACY SHOPPERS PHARMACY CLARK'S PHARMACY INC FARMVILLE PHARMACY WELLNESS CONCEPTS #2

(703) 391-2020 (703) 531-3759 (703) 852-0041 (703) 277-2864 (703) 591-0020 (703) 968-9293 (703) 273-9010 (703) 391-3640 (703) 544-2020 (703) 743-7604 (703) 272-7040 (703) 573-4111 (703) 667-2421 (703) 592-8300 (703) 280-5390 (866) 920-1880 (703) 260-6770 (703) 533-9013 (703) 237-2182 (703) 931-1333 (703) 280-3350 (703) 536-0954 (703) 776-6550 (703) 776-8250 (703) 992-8686 (703) 532-8989 (703) 533-2278 (434) 392-1560 (434) 392-1985 (434) 395-7003

3650 JOSEPH SIEWICK DR STE 101 8221 WILLOW OAKS CORP DR #450 8221 WILLOW OAKS CORPORATE DR 11200 FAIRFAX BLVD 10653 BRADDOCK RD 13043 LEE JACKSON MEMORIAL HWY 10780 FAIRFAX BLVD 3600 JOSEPH SIEWICK DR 2740 PROSPERITY AVE STE 200 3957 PENDER DR STE #104 11230 WAPLES MILL RD STE 115 3023 HAMAKER CT STE LL110 9622 MAIN ST 10721 MAIN ST STE 107 8503 ARLINGTON BLVD STE 400 2924 TELESTAR CT 5623 COLUMBIA PIKE 450 W BROAD ST 6795 WILSON BLVD STE 1-A 3480 S JEFFERSON ST 7235 ARLINGTON BLVD 1230 W BROAD ST 3300 GALLOWS RD 3300 GALLOWS RD 6305 CASTLE PL #1E 2946 SLEEPY HOLLOW RD 6360 SEVEN CORNERS CTR 119 N MAIN ST STE A 308A S MAIN ST 2003 COBB STREET

FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FAIRFAX FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FALLS CHURCH FARMVILLE FARMVILLE FARMVILLE

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

22033-1700 22031 22031-4512 22030-5050 22032-2202 22033-2001 22030-4323 22033-1709 22031-4354 22030-6027 22030-5026 22031-2630 22031-3733 22030-6902 22031-4629 22042 22041 22046-3340 22044 22041-3104 22042-3219 22046-2116 22042-3307 22042-3307 22044 22044-2003 22044-2409 23901-1305 23901-1744 23901

TRI-AREA COMMUNITY PHCY AT FERRUM AMC PRESCRIPTION SVCS UVA HOPE PHCY AUGUSTA FORK UNION PHARMACY SHOPPERS PHARMACY

(540) 365-9992 (540) 332-5946 (540) 213-8655 (434) 842-3208 (703) 971-5744

40 WILEY DR 12 PARKWAY LN 57 BEAM LN STE 300 4316B JAMES MADISON HWY 7005 MANCHESTER LAKES BLVD

FERRUM FISHERSVILLE FISHERSVILLE FORK UNION FRANCONIA

VA VA VA VA VA

24088 22939-2345 22939-2350 23055-2025 22310

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 636 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

SOUTHAMPTON MEMORIAL HOSP PHCY COWAN PHARMACY GENOA-QOL HEALTHCARE GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY HNR FAMILY PHARMACY HOA OF FREDERICKSBURG MEDICAL ARTS PHARMACY FAMILY PHARMACY SERVICES LESTER AND MOWERY'S PHARMACY MARTINS PHARMACY GAINESVILLE PHARMACY GIANT PHARMACY FOOD CITY PHARMACY GALAX PHARMACY BOARDWATER DRUG POWERED BY WALGREEN GLADE PHARMACY GLOUCESTER PHARMACY DAWSONS PHARMACY GOOCHLAND PHARMACY GORDONSVILLE MEDICAL PHARMACY GRETNA DRUG COMPANY GROTTOES PHARMACY WELLNESS CONCEPTS

(757) 569-6339 (540) 479-6900 (540) 322-5180 (540) 371-7790 (540) 899-1061 (540) 286-1722 (540) 785-1025 (540) 358-8188 (540) 371-0079 (540) 741-1425 (540) 636-2222 (540) 622-2307 (540) 635-3175 (703) 743-5603 (703) 754-2357 (276) 238-0684 (276) 236-1120

100 FAIRVIEW DR 2571 COWAN BLVD 600 JACKSON ST STE Q 1245 JEFFERSON DAVIS HWY 35 TOWN AND COUNTRY DR 550 CELEBRATE VIRGINIA PKWY 5701 PLANK RD 3449 FALL HILL AVE 4501 EMPIRE COURT 1101 SAM PERRY BLVD STE 120 303 W 10TH ST 20 SOUTH ST 409 SOUTH ST 7963 HERITAGE VILLAGE PLZ 7575 LINTON HALL RD 955A E STUART DR 967C E STUART DR

FRANKLIN FREDERICKSBURG FREDERICKSBURG FREDERICKSBURG FREDERICKSBURG FREDERICKSBURG FREDERICKSBURG FREDERICKSBURG FREDERICKSBURG FREDERICKSBURG FRONT ROYAL FRONT ROYAL FRONT ROYAL GAINESVILLE GAINESVILLE GALAX GALAX

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

23851-1238 22401-8440 22401-5719 22401-4415 22405-8705 22406-7292 22407-6227 22401-4929 22408 22401-4465 22630-2803 22630-2220 22630-2115 20155-3077 20155-2972 24333-2407 24333-2407

(276) 386-3821 (276) 429-2004 (804) 694-5815 (804) 556-3311 (804) 556-3607 (540) 832-2214 (434) 656-1251 (540) 249-5881 (540) 249-0431

119 E JACKSON ST STE 101 33472 LEE HWY 7453 HARGETT BLVD 2728 FAIRGROUND RD 1956 SANDY HOOK RD 103 E GORDON AVE 108 VADEN DR 402 AUGUSTA AVE 1003 DOGWOOD AVE

GATE CITY GLADE SPRING GLOUCESTER GOOCHLAND GOOCHLAND GORDONSVILLE GRETNA GROTTOES GROTTOES

VA VA VA VA VA VA VA VA VA

24251-3418 24340-5100 23061 23063-3103 23063-3107 22942-9609 24557-4160 24441-2404 24441-2405

BUCHANAN PHARMACY ASSOCIATES INC FOOD CITY PHARMACY MEDICAL PARK PHARMACY PLAZA PHARMACY WESTWOOD PHARMACY GENOA-QOL HEALTHCARE HAMPTON HEALTH MART PHARMACY SENTARA CAREPLEX HOSP O/P PHCY VIRGINIA ONCOLOGY ASSOCIATES MARTINS PHARMACY MEDICAP MEDICAP PHARMACY PARKVIEW PHARMACY

(276) 935-2323 (276) 935-7455 (276) 935-6455 (276) 935-7332 (276) 935-4040 (757) 750-1877 (757) 864-0380 (757) 736-1200 (757) 459-9250 (540) 442-7380 (540) 433-6337 (540) 434-7455 (540) 433-8678

1520 SLATE CREEK RD 18765 RIVERSIDE DR 1503 SLATE CREEK RD 1123 PLAZA DR 24505 RIVERSIDE DR 200 MEDICAL DR STE 289 3321 W MERCURY BLVD STE D 3000 COLISEUM DR 3000 COLISEUM DR STE 104 2035 E MARKET ST STE 115 2091 PRO POINTE LN 1851 VIRGINIA AVE 627 CHICAGO AVENUE

GRUNDY GRUNDY GRUNDY GRUNDY GRUNDY HAMPTON HAMPTON HAMPTON HAMPTON HARRISONBURG HARRISONBURG HARRISONBURG HARRISONBURG

VA VA VA VA VA VA VA VA VA VA VA VA VA

24614-6975 24614-6748 24614-6974 24614-6780 24614 23666-1763 23666-3806 23666-5963 23666-5963 22801-8881 22801-8021 22802-8374 22802

NR_0009_10823 10/2017

Page 637 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SENTARA RMH OUTPATIENT PHCY SUNNYSIDE PHARMACY WILLIAMSON HUGHES PHARMACY THE MEDICINE SHOPPE GIANT PHARMACY HAYSI DRUG CENTER JONES & COUNTS PHARMACY NORTHUMBERLAND PHARMACY BREMO PHCY @ HENRICO DOCTORS SPRINGER PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY MY DOCTOR'S PHARMACY SHOPPERS PHARMACY NUCKOLLS DRUG COMPANY CROUCHS PHARMACY NEW GARDEN PHARMACY TIGERX PHARMACY HOMETOWN DRUG HOT SPRINGS PHARMACY HURLEY COMMUNITY PHARMACY WALTERS DRUG INC WOODY'S PHARMACY JONESVILLE DRUG COMPANY SMITHS PHARMACY MAIN STREET PHARMACY

Provider Name

(540) 689-2400 (540) 568-8249 (540) 434-2372 (804) 776-9990 (571) 248-4551 (276) 865-5135 (276) 865-5560 (804) 580-4940 (804) 285-7730 (804) 737-6049 (703) 689-2570 (703) 620-9664 (703) 689-3450 (703) 657-0303 (703) 667-4283 (276) 728-2731 (540) 366-3179 (276) 873-6132 (276) 873-4700 (804) 458-3784 (540) 839-7350 (276) 566-4488 (276) 773-2501 (276) 773-2211 (276) 346-2180 (434) 676-2266 (804) 435-8818

2010 HEALTH CAMPUS DR 3935 SUNNYSIDE DR STE A 1380 LITTLE SORRELL DR STE 110 9893 GENERAL PULLER HWY 5581 MERCHANTS VIEW SQ 23906 DICKENSON HWY 251 MAIN STREET 6954 NORTHUMBERLAND HWY 1602 SKIPWITH RD # 201 1 W NINE MILE RD 1228 ELDEN ST 2551 JOHN MILTON DR 13330 FRANKLIN FARM RD 412 ELDEN ST 2425 CENTREVILLE RD 100 CARROLL ST 7535 WILLIAMSON RD 5300 REDBUD HWY 5638 RED BUD HWY 2508 GRAY ST 2833 MAIN ST 10249 HURLEY RD 533 E MAIN ST 576 E MAIN ST 154 CHAPPELL DRIVE 111 BROAD ST 308 N MAIN ST

HARRISONBURG HARRISONBURG HARRISONBURG HARTFIELD HAYMARKET HAYSI HAYSI HEATHSVILLE HENRICO HENRICO HERNDON HERNDON HERNDON HERNDON HERNDON HILLSVILLE HOLLINS HONAKER HONAKER HOPEWELL HOT SPRINGS HURLEY INDEPENDENCE INDEPENDENCE JONESVILLE KENBRIDGE KILMARNOCK

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

22801 22801-2341 22801-7372 23071-3122 20169 24256 24256 22473-3335 23229-5205 23075-1345 20170-5504 20171-2527 20171-4036 20170-4511 20171-3013 24343-1427 24019-4301 24260-7001 24260 23860-5026 24445-2918 24620-0000 24348-3899 24348-3879 24263 23944-0000 22482-3834

TRI-AREA COMM PHCY AT LAUREL FORK FAMILY DRUG CENTER FOOD CITY PHARMACY MCFARLANE HILLMAN PHARMACY GIANT PHARMACY GIANT PHARMACY LANSDOWNE PHARMACY LEESBURG PHARMACY INC LEX CARE PHARMACY LEXINGTON PRESCRIPTION CTR ROCKBRIDGE PHARMACY WILDERNESS CENTER PHARMACY INC GIANT PHARMACY KC PHARMACY

(276) 398-2620 (276) 889-1919 (276) 889-3800 (276) 889-5721 (571) 258-1901 (703) 771-9518 (703) 726-9800 (703) 777-5333 (540) 463-6284 (540) 463-9166 (540) 463-4001 (540) 972-7994 (703) 690-5001 (703) 339-9599

14558 DANVILLE PIKE 110 W MAIN ST STE 1 159 PITTSTON RD 116 SOUTH FLANNAGAN AVE 635 POTOMAC STATION DR NE 61 CATOCTIN CIR NE 19465 DEERFIELD AVE STE 107 36 CATOCTIN CIR SE STE C 146 S MAIN ST STE B 800 S MAIN ST 146 S MAIN ST 5479 GERMANNA HWY 8941 OX RD 8988 LORTON STATION BLVD #102

LAUREL FORK LEBANON LEBANON LEBANON LEESBURG LEESBURG LEESBURG LEESBURG LEXINGTON LEXINGTON LEXINGTON LOCUST GROVE LORTON LORTON

VA VA VA VA VA VA VA VA VA VA VA VA VA VA

24352-3982 24266-4214 24266 24266 20176-1818 20176-3100 20176-1702 20175 24450-2356 24450-2237 24450-2356 22508-2018 22079-3216 22079

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 638 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SHOPPERS PHARMACY BAILEYS DRUG STORE GENOA-QOL HEALTHCARE HILL CITY PHARMACY HILL CITY PHARMACY

Provider Name

(703) 372-2891 (540) 967-0223 (434) 338-7764 (434) 237-2221 (434) 237-2221

9409 LORTON MARKET ST 117 W MAIN ST 2235 LANDOVER PL STE A 1215 GREENVIEW DRIVE 1215 GREENVIEW DR

LORTON LOUISA LYNCHBURG LYNCHBURG LYNCHBURG

VA VA VA VA VA

22079 23093-9449 24501-2115 24502 24502-2705

LYNCHBURG HEMATOLOGY ONCOLOGY CLINI TIMBERLAKE FAMILY PHARMACY MADISON DRUG COMPANY HOMETOWN PHARMACY ADKOA PHARMACY LLC BULL RUN PROFESSIONAL PHARMACY CARE 4 U PHARMACY GIANT PHARMACY GIANT PHARMACY MANASSAS PHARMACY PROSPERITY PHARMACY MANASSAS SHOPPERS PHARMACY SUDLEY PHARMACY FOOD CITY PHARMACY MARION FAMILY PHARMACY MAYSONS PHARMACY CAVALIER PHARMACARE FIRST PHARMACY OF MARTINSVILLE STARLING PHARMACY INC HUDGINS PHARMACY INC MATHEWS PHARMACY FT CHISWELL PHARMACY INC ACCESS COMPOUNDING PHARMACY GIANT PHARMACY MCLEAN PHARMACY MEDICINE CHEST PHARMACY CARE CONNECT PHARMACY BELL CREEK PHARMACY CAREPAC PHARMACY

(434) 200-5925 (434) 237-6337 (540) 948-4400 (434) 929-1000 (703) 479-7642 (571) 357-4818 (571) 229-9631 (703) 361-9210 (703) 331-2320 (703) 361-1332 (703) 334-5180 (703) 393-8990 (703) 366-3666 (276) 783-5761 (276) 783-7284 (540) 364-8291 (276) 666-6644 (276) 226-2464 (276) 632-6222 (804) 725-2222 (804) 725-2556 (540) 637-3178 (571) 488-6620 (703) 893-8593 (571) 488-6030 (703) 827-0990 (703) 790-6156 (804) 277-8938 (804) 746-4049

1701 THOMSON DR STE 200 20276 TIMBERLAKE RD STE A 114 N MAIN ST 196 AMELON SQ 8261 SHOPPERS SQUARE 10762 SUDLEY MANOR DR 10458 DUMFRIES RD 8025 SUDLEY RD 10100 DUMFRIES RD 8573 SUDLEY RD STE B 8644 SUDLEY ROAD STE 120 10864 SUDLEY MANOR DR 8609 SUDLEY RD STE 103 910 N MAIN ST STE 100 1581 N MAIN ST 4199 WINCHESTER RD 806 MEMORIAL BLVD S 1105 SPRUCE ST 1312 MEMORIAL BLVD S 256 MAIN ST 10858 BUCKLEY HALL RD 791 FORT CHISWELL RD 1450 EMERSON AVE APT 110 1454 CHAIN BRIDGE RD 1392 CHAIN BRIDGE RD 6823 OLD DOMINION DR 6845 ELM ST STE 105 8324 BELL CREEK RD STE 800 8209 WHIPPOORWILL RD

LYNCHBURG LYNCHBURG MADISON MADISON HEIGHTS MANASSAS MANASSAS MANASSAS MANASSAS MANASSAS MANASSAS MANASSAS MANASSAS MANASSAS MARION MARION MARSHALL MARTINSVILLE MARTINSVILLE MARTINSVILLE MATHEWS MATHEWS MAX MEADOWS MC LEAN MC LEAN MC LEAN MC LEAN MCLEAN MECHANICSVILLE MECHANICSVILLE

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

24501-1101 24502-7214 22727-3041 24572-5990 20111 20109 20110-7958 20109-8001 20110-7951 20110-3809 20110 20109-2834 20110 24354-4140 24354-4317 20115-3269 24112-6417 24112-4508 24112-4809 23109 23109 24360-3562 22101-5748 22101-3706 22101-3904 22101-3711 22101-3863 23116-3849 23116

GOOD HEALTH PHARMACY AT HANOVER LEE DAVIS PHARMACY MECHANICSVILLE DRUG STORE THE COLONIAL PHARMACY FOOD LION PHARMACY MARTINS PHARMACY

(804) 442-3754 (804) 730-9200 (804) 746-5168 (804) 746-7997 (804) 744-7926 (804) 794-1526

8200 MEADOWBRIDGE RD STE 301 7023 LEE PARK RD STE A 8077 MECHANICSVILLE PIKE 7510 MECHANICSVILLE TPKE 13530 WATERFORD PL 200 CHARTER COLONY PKWY

MECHANICSVILLE MECHANICSVILLE MECHANICSVILLE MECHANICSVILLE MIDLOTHIAN MIDLOTHIAN

VA VA VA VA VA VA

23116-2331 23111-3608 23111-1222 23111-2144 23112-3928 23114

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 639 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MIDLOTHIAN APOTHECARY INC.

Provider Name

(804) 794-5592

13502 MIDLOTHIAN TPKE

MIDLOTHIAN

VA

23113-4214

MIDLOTHIAN APOTHECARY WATKINS CTR FOOD LION PHARMACY BENZER PHARMACY FOOD LION PHARMACY HMC PHARMACY MONTPELIER PHARMACY MT JACKSON DRUG STORE RAYFIELDS PHARMACY STONEY CREEK PHARMACY MARKET STREET PHARMACY DENBIGH PHARMACY DOMINION PHARMACY SERVICES GLENDALE PHARMACY GOOD HEALTH PHCY AT MIH HIDENWOOD PHARMACY INC MEDICAP PHARMACY PAVILION PHARMACY VIRGINIA ONCOLOGY ASSOCIATES NICKELSVILLE PHARMACY ATRIUM PHARMACY AT DEPAUL BAYVIEW COMMUNITY PHARMACY BAYVIEW SRC PHARMACY COLLEY DISCOUNT PHARMACY GRAYS PHARMACY HAGUE PHARMACY MACARTHUR PHARMACY PEOPLES PHARMACY LLC SENTARA LEIGH OUTPATIENT

(804) 378-1893 (540) 894-0650 (540) 297-8640 (540) 297-0927 (540) 468-6421 (804) 883-6363 (540) 477-3101 (757) 442-6159 (434) 361-0370 (540) 864-8800 (757) 877-0253 (757) 599-5007 (757) 595-3355 (757) 947-3740 (757) 595-1151 (757) 599-9643 (757) 223-7709 (757) 459-9250 (276) 479-2600 (757) 278-2150 (757) 383-6636 (757) 819-4636 (757) 622-2757 (757) 489-4848 (757) 622-0222 (757) 533-6566 (757) 227-4677 (757) 261-8055

611 WATKINS CENTRE PKWY #120 11010 KENTUCKY SPRINGS ROAD 4860 RUCKER RD STE 1 14807 MONETA ROAD 120 JACKSON RIVER RD 17128 MOUNTAIN RD 5350 MAIN STREET 9502 HOSPITAL AVE 2831 ROCKFISH VALLEY HWY 317 MARKET STREET 13349 WARWICK BLVD 10516 JEFFERSON AVE 12444 WARWICK BLVD 12720 MCMANUS BLVD STE 100 35 HIDENWOOD SHOPPING CTR 956 J CLYDE MORRIS BLVD 500 J CLYDE MORRIS BLVD RM 1-5 1051 LOFTIS BLVD STE 100 11708 NICKELSVILLE HIGHWAY 155 KINGSLEY LN STE 125 1846 E LITTLE CREEK RD 710 E LITTLE CREEK RD 1415 COLLEY AVE 4712 HAMPTON BLVD 400 GRESHAM DR, SUITE 104 261 GRANBY ST 1446 CHURCH STREET SUITE C 830 KEMPSVILLE ROAD

MIDLOTHIAN MINERAL MONETA MONETA MONTEREY MONTPELIER MT JACKSON NASSAWADOX NELLYSFORD NEW CASTLE NEWPORT NEWS NEWPORT NEWS NEWPORT NEWS NEWPORT NEWS NEWPORT NEWS NEWPORT NEWS NEWPORT NEWS NEWPORT NEWS NICKELSVILLE NORFOLK NORFOLK NORFOLK NORFOLK NORFOLK NORFOLK NORFOLK NORFOLK NORFOLK

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

23114 23117 24121-5281 24121 24465-2416 23192-2550 22842 23413-1820 22958 24127-0000 23602-5601 23601 23606-3042 23602 23606-2200 23601-1043 23601-1929 23606-3069 24271 23505-4600 23518-4204 23518-3710 23517-1705 23508-1822 23507-1903 23510-1813 23504 23502

SENTARA NORFOLK GEN HOSP O/P PHCY VIRGINIA ONCOLOGY ASSOCIATES VIRGINIA ONCOLOGY ASSOCIATES 4-WAY PHARMACY HAYES DRUG COMMUNITY HOSPITAL PHARMACY LONESOME PINE ECONOMY DRUG H & H PHARMACY OAK HALL PRESTON'S PHARMACY GIANT PHARMACY ORANGE PHARMACY

(757) 388-2012 (757) 459-9250 (757) 213-5714 (540) 988-6000 (276) 988-4414 (276) 679-4452 (276) 566-4488 (757) 824-4477 (703) 522-3412 (703) 255-3484 (540) 661-5006

600 GRESHAM DR 5900 LAKE WRIGHT DR 5900 LAKE WRIGHT DR STE 200 627 E RIVERSIDE DR 704 E RIVERSIDE DR 96 15TH ST NW STE 101 517 PARK AVE SW 7001 LANKFORD HWY 12839 ROSE GROVE DR 2932 CHAIN BRIDGE RD 130 W MAIN ST

NORFOLK NORFOLK NORFOLK NORTH TAZEWELL NORTH TAZEWELL NORTON NORTON OAK HALL OAK HILL OAKTON ORANGE

VA VA VA VA VA VA VA VA VA VA VA

23507-1904 23502-1871 23502-1871 24630-9577 24630-9579 24273-1626 24273-2018 23416-2223 20171 22124-3001 22960-1534

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 640 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name JEFFERSON PHARMACY RUNNINGER'S PHARMACY INC FOOD CITY PHARMACY JOHN C MARION-PHARMACIST PC PENNINGTON PHARMACY CYRUS KIRKPATRICK PHARMACY WALNUT HILL PHARMACY POQUOSON DISCT PHARMACY DRUG CENTER PHARMACY DRUG CENTER PHARMACY POUND DISCOUNT PHARMACY WILDCAT PHARMACY CLAYPOOL HILL PHARMACY FOOD CITY PHARMACY MARTIN'S PHARMACY INC GIANT PHARMACY PURCELLVILLE PHARMACY BLOOM PHARMACY RADFORD DRUG INC THE MEDICINE SHOPPE AT WHITE'S REMINGTON DRUG CO GENOA-QOL HEALTHCARE GIANT PHARMACY SUPER AID PHARMACY LLC CEDAR BLUFF PHARMACY RANDYS GATEWAY DRUG INC RICHLANDS PHARMACY SCOTTIE PHARMACY INC BON SECOURS BON SECOURS GOOD HLTH PHCY AT BREMO PHARMACY BREMO-LTC PHARMACY BUFORD ROAD PHARMACY C3 HEALTHCARE RX CEDARFIELD PHARMACY GROVE AVENUE PHARMACY LAFAYETTE PHARMACY MARTINS PHARMACY MARTINS PHARMACY MCGUIRE PARK PHARMACY PLAZA LTC PHARMACY PLAZA PROFESSIONAL PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (434) 589-7902 (757) 665-5200 (276) 546-6820 (276) 546-5841 (276) 546-1551 (804) 733-5888 (804) 733-7711 (757) 868-7114 (757) 393-4039 (757) 399-6361 (276) 796-5500 (276) 796-2200 (276) 963-3502 (540) 980-9368 (540) 980-4060 (703) 443-6361 (540) 751-9750 (804) 932-8835 (540) 639-3996 (540) 851-1760 (540) 439-3247 (703) 787-3217 (703) 437-0037 (540) 726-2993 (276) 964-4068 (276) 964-2494 (276) 963-2115 (276) 963-0284 (804) 893-8630 (804) 325-8795 (804) 288-8361 (804) 285-7823 (804) 272-1423 (804) 321-7500 (804) 968-5530 (804) 355-3405 (804) 353-7726 (804) 272-2114 (804) 264-1597 (804) 344-4444 (804) 864-0276 (804) 264-1319

Provider Street 194B TURKEYSAG TRL 18465 DUNNE AVE 205 RIVER BEND DR STE 102 156 COMBS RD 209 W MORGAN AVE 518 S SYCAMORE ST 1950 S SYCAMORE ST 498 WYTHE CREEK RD 600 HIGH ST 912 AIRLINE BLVD 11133 INDIAN CREEK RD 8461 MAIN ST 12252 GOV GC PERRY HWY 1400 BOB WHITE BLVD 400 N WASHINGTON AVE 1000 E MAIN ST 609 E MAIN ST STE Q 7300 MARKET PLACE DR 243 W MAIN ST 2440 RAPHINE RD 207 E MAIN ST 11484 WASHINGTON PLZ W STE 300 1450 NORTHPOINT VILLAGE CTR 247 OLD VIRGINIA AVE 3141 CEDAR VALLEY DR 3118 CEDAR VALLEY DR 2625 FRONT ST 1951 2ND ST 6900 FOREST AVE STE 100 1510 N 28TH ST STE 100 2024 STAPLES MILL RD 2002 STAPLES MILL RD 2608 BUFORD RD 2026 DABNEY RD STE A 2300 CEDARFIELD PKWY 4911 GROVE AVE 1011 LAFAYETTE ST 7045 FOREST HILL AVE 5700 BROOK RD 2106 E MAIN ST 1717 BELLEVUE AVE 1717 BELLEVUE AVE

Page 641 of 679

Provider City PALMYRA PARKSLEY PENNINGTON GAP PENNINGTON GAP PENNINGTON GAP PETERSBURG PETERSBURG POQUOSON PORTSMOUTH PORTSMOUTH POUND POUND POUNDING MILL PULASKI PULASKI PURCELLVILLE PURCELLVILLE QUINTON RADFORD RAPHINE REMINGTON RESTON RESTON RICH CREEK RICHLANDS RICHLANDS RICHLANDS RICHLANDS RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND

State

ZIP code

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

22963-2658 23421-0000 24277-2917 24277-2855 24277-2315 23803-5038 23805-2729 23662-1936 23704-3424 23707-3309 24279-5013 24279-5411 24637 24301-4404 24301-4630 20132-3134 20132-3182 23141-1639 24141-1584 24472-2541 22734-9693 20190-4342 20194-1190 24147-9646 24641-3076 24641-3075 24641-2225 24641-2303 23230 23223-5311 23230-3109 23230-3109 23235-3422 23230-3347 23233-1938 23226-1603 23221-1156 23225-1607 23227-2257 23223-7051 23227-3961 23227-3961

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PROGRESSIVE PHARMACY CARE RX3 PHARMACY ST MARYS PHARMACY COMMUNITY WESTBURY APOTHECARY WESTWOOD PHARMACY

Provider Name

(804) 322-1590 (804) 717-5000 (804) 281-8425 (804) 527-1927 (804) 288-1933

6605 W BROAD ST SUITE A 11934 W BROAD ST STE 100 5801 BREMO RD 7702 E PARHAM RD STE 108 5823 PATTERSON AVE

RICHMOND RICHMOND RICHMOND RICHMOND RICHMOND

VA VA VA VA VA

23230 23233-1007 23226-1907 23294-4372 23226-2536

CARILION CLINIC PHARMACY RIVERSIDE CARILION CLNC PHCY ROANOKE DOWN HOME PHARMACY

(540) 266-6191 (540) 266-6480 (540) 966-4858

3 RIVERSIDE CIR 1906 BELLEVIEW AVE SE 40 SUMMERS WAY STE 101

ROANOKE ROANOKE ROANOKE

VA VA VA

24016-4955 24014-1838 24019-8286

FRIENDSHIP INSTITUTIONAL PHARMACY FRIENDSHIP PHARMACY GENOA-QOL HEALTHCARE MEDICAL CENTER PHARMACY

(540) 265-2153 (540) 265-2152 (540) 491-0409 (540) 266-6191

327 HERSHBERGER RD STE 1 327 HERSHBERGER RD 611 MCDOWELL AVE NW 2001 CRYSTAL SPRING AVE SW

ROANOKE ROANOKE ROANOKE ROANOKE

VA VA VA VA

24012-1983 24012-1983 24016-1225 24014-2462

NEW HORIZONS HEALTHCARE PHARMACY WELLNESS CONCEPTS OF ROANOKE WEST PHARMACY WILLIAMSON ROAD PHARMACY ROCKY MOUNT FAMILY PHARMACY ROSE HILL PHARMACY, INC DICKENSON DRUG COMPANY RUSTBURG FAMILY PHARMACY ERNIE'S DRUG INC BROOKS-BYRD PHARMACY CARILION CLINIC PHARMACY SALEM FORT LEWIS PHARMACY TRINITY PHARMACY VALLEY APOTHECARY CARTERS PHARMACY LLC CLARK'S PHARMACY SCOTTSVILLE PHARMACY FOOD LION PHARMACY HALIFAX PHARMACY APPOMATTOX DRUGS THE MEDICINE SHOPPE FOOD LION PHARMACY GIANT PHARMACY A&D PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY

(540) 283-2552 (540) 689-0935 (540) 774-5500 (540) 366-4481 (540) 489-5400 (276) 445-5026 (276) 686-5073 (434) 332-1730 (276) 762-5800 (540) 389-8111 (540) 444-7320 (540) 380-4681 (540) 444-7383 (540) 772-3788 (276) 496-4530 (276) 496-7211 (434) 286-6009 (434) 575-0078 (434) 575-0511 (804) 520-4282 (434) 447-2601 (703) 327-9666 (540) 710-9314 (703) 644-0060 (703) 569-5401 (703) 569-6866 (703) 866-2336

3716 MELROSE AVE NW STE 130 6701 PETERS CREEK RD SUITE 109 2012 ELECTRIC RD 3416 WILLIAMSON ROAD 1165 FRANKLIN ST 5462 DR THOMAS WALKER RD 580 N MAIN ST 925 VILLAGE HWY STE 2 16408 WISE ST 2 E MAIN ST 1955 W MAIN ST 3737 W MAIN ST STE 106 396 E BURWELL ST 1802 BRAEBURN DR 222 PANTHER LN 402 PALMER AVE SUITE B 295B E MAIN ST 1020 BILL TUCK HWY 4121 HALIFAX RD 21414 CHESTERFIELD AVE 605 E ATLANTIC ST 43090 PEACOCK MARKET PLZ 10346 COURTHOUSE RD 6134 BRANDON AVE 6426 SPRINGFIELD PLZ 8320 OLD KEENE MILL RD 7501 HUNTSMAN BLVD

ROANOKE ROANOKE ROANOKE ROANOKE ROCKY MOUNT ROSE HILL RURAL RETREAT RUSTBURG SAINT PAUL SALEM SALEM SALEM SALEM SALEM SALTVILLE SALTVILLE SCOTTSVILLE SOUTH BOSTON SOUTH BOSTON SOUTH CHESTERFIELD SOUTH HILL SOUTH RIDING SPOTSYLVANIA SPRINGFIELD SPRINGFIELD SPRINGFIELD SPRINGFIELD

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

24017-2716 24019 24018-1938 24012 24151-1248 24281 24368-2564 24588-4591 24283 24153-3807 24153-3109 24153-2073 24153 24153-7357 24370 24370 24590 24592-7136 24592-4833 23803-2408 23970-2709 20152-4458 22553-1710 22150-2610 22150-3428 22152-1640 22153-1649

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 642 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name GIANT PHARMACY NEIGHBORCARE GREENSPRING DANS WELLNESS PHARMACY GIANT PHARMACY SHOPPERS PHARMACY STAFFORD PHARMACY GREENE PHARMACY STANLEY PHARMACY INC FISHERSVILLE FAMILY PHARMACY GENOA-QOL HEALTHCARE MARTINS PHARMACY RAYS PHARMACY LANTZS PHARMACY MARTINS PHARMACY GIANT PHARMACY GIANT PHARMACY GOLDEN HEALTH PHARMACY LOUDOUN PHARMACY STONY CREEK PHARMACY LLC FAMILY PHARMACY SPRING DRUG INC STUARTS DRAFT FAMILY PHARMACY BENNETTS CREEK PHARMACY GOOD HLTH PHCY @ HARBOUR VIEW HARBOUR VIEW PHARMACY SENTARA OBICI HOSPITAL OUTPT P SUPER DRUG SUTHERLAND PHARMACY TAPPAHANNOCK PHARMACY CLINCH VALLEY PHARMACY OLDE VIRGINIA PHARMACY MARSHALL'S DRUG STORE FAMILY DRUG TYSONS PHARMACY VIENNA DRUG CENTER CUNDIFF DRUG STORE INC WONDER DRUG BARR'S PHARMACY BEACH PHARMACY PHARMACY INNOVATIONS SENTARA PRINCESS ANNE PHCY SENTARA RX

NR_0009_10823 10/2017

Provider Phone Number (703) 569-5322 (703) 923-4645 (540) 657-0006 (540) 657-5007 (540) 288-3259 (540) 628-0290 (343) 985-3424 (540) 778-2219 (540) 324-8042 (540) 569-4158 (540) 885-7491 (540) 887-2228 (540) 869-5354 (540) 868-0663 (703) 430-1818 (703) 430-0400 (703) 430-8883 (703) 665-2223 (434) 246-5191 (276) 694-4586 (276) 694-3100 (540) 337-3776 (757) 483-6966 (757) 541-1100 (757) 394-1870 (757) 934-4840 (757) 539-6400 (804) 265-5214 (804) 443-3461 (276) 988-4871 (276) 988-7977 (804) 758-5344 (276) 597-2520 (703) 992-7083 (703) 938-7111 (540) 342-8928 (540) 890-3027 (757) 428-1211 (757) 965-3036 (757) 934-0533 (757) 507-1115 (757) 252-0975

Provider Street 8074 ROLLING RD 7440 SPRING VILLAGE DR 418 GARRISONVILLE RD STE 100 317 WORTH AVE 1505 STAFFORD MARKET PL 2769 JEFFERSON DAVIS HWY #101 331 MAIN ST 308 E MAIN ST 16 GOSNELL XING STE 101 85 SANGERS LN 1015 RICHMOND AVE 1011 N AUGUSTA ST STE C 5015 MAIN ST 240 ELIZABETH DR 21800 TOWNCENTER PLZ 21000 SOUTHBANK ST STE 150 46950 COMMUNITY PLZ STE 112 23590 OVERLAND DRIVE SUITE 130 12451 MAIN ST 301B S MAIN ST 22042 JEB STUART HWY 2929 STUARTS DRAFT HWY STE 1 3219 BRIDGE RD 5818 HARBOUR VIEW BLVD #100D 5839 HARBOUR VIEW BLVD STE 102 2800 GODWIN BLVD 108 N MAIN ST 5607 CLAIBORNE RD 517 CHURCH LN 100 BEN BOLT AVE 836 E FINCASTLE ST 50 CROSS ST 1755 LOVERS GAP HIGHWAY 110 PLEASANT ST NW 150 MAPLE AVE W 119 E CLEVELAND AVE 15818 STEWARTSVILLE RD 201 VIRGINIA BEACH BLVD 501 LASKIN RD 4661 HAYGOOD RD STE 101 2025 GLENN MITCHELL DRIVE 800 INDEPENDENCE BLVD

Page 643 of 679

Provider City SPRINGFIELD SPRINGFIELD STAFFORD STAFFORD STAFFORD STAFFORD STANARDSVILLE STANLEY STAUNTON STAUNTON STAUNTON STAUNTON STEPHENS CITY STEPHENS CITY STERLING STERLING STERLING STERLING STONY CREEK STUART STUART STUARTS DRAFT SUFFOLK SUFFOLK SUFFOLK SUFFOLK SUFFOLK SUTHERLAND TAPPAHANNOCK TAZEWELL TAZEWELL URBANNA VANSANT VIENNA VIENNA VINTON VINTON VIRGINIA BEACH VIRGINIA BEACH VIRGINIA BEACH VIRGINIA BEACH VIRGINIA BEACH

State

ZIP code

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

22153-2928 22150-4446 22554-1592 22556-1538 22556-4528 22554-8325 22973-2965 22851-4043 24401-6344 24401-6712 24401-4905 24401-3298 22655-3003 22655-2764 20164-1897 20165-7242 20164-1814 20166 23882-0000 24171-3853 24171-2788 24477-2753 23435-1719 23435-3315 23435 23434-8038 23434-4508 23885-9303 22560 24651-9703 24651-1419 23175-0000 24656 22180-4447 22180-5727 24179-2538 24179-5902 23451-3429 23451-3901 23455-5435 23456 23455-6005

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SENTARA VIRGINIA BEACH UROLOGY OF VIRGINIA, PLLC WAKEFIELD PHARMACY GIANT PHARMACY WAVERLY PHARMACY LLC FISHBURNE & SON PHARMACY MARTINS PHARMACY VALLEY VITAL CARE FOOD CITY PHARMACY WEBER CITY DRUG CENTER WEST POINT PHARMACY WHITE STONE PHARMACY FAMILY CARE WILLIAMSBURG OLDE TOWNE PHARMACY INC PROFESSIONAL PHARMACY

Provider Name

(757) 395-8844 (757) 452-3491 (757) 899-2551 (540) 347-1078 (804) 220-1489 (540) 949-8211 (540) 942-7220 (540) 569-3463 (276) 386-2118 (276) 386-3482 (804) 843-4450 (804) 435-1051 (757) 220-1621 (757) 220-8764 (757) 229-3560

1060 FIRST COLONIAL RD 225 CLEARFIELD AVE 105 RAILROAD AVE 41 W LEE HWY STE 27 328 WEST MAIN STREET 436 S LINDEN AVE 437 TIFFANY DR 250 N POPLAR AVE STE C 3004 US HIGHWAY 23 N 1482 US HIGHWAY 23 N 1302 LEE STREET 416 CHESAPEAKE DR 3900 WINDSOR HALL DR 4854 LONGHILL RD STE 5 1302 S MOUNT VERNON AVE

VIRGINIA BEACH VIRGINIA BEACH WAKEFIELD WARRENTON WAVERLY WAYNESBORO WAYNESBORO WAYNESBORO WEBER CITY WEBER CITY WEST POINT WHITE STONE WILLIAMSBURG WILLIAMSBURG WILLIAMSBURG

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA

23454-3002 23462-1815 23888-2702 20186-2200 23890 22980-3506 22980-3283 22980-4360 24290-7087 24290-7039 23181-0000 22578 23188-2875 23188-1500 23185-2817

SENTARA WILLIAMSBURG REG MED CTR WILLIAMSBURG DRUG COMPANY MARTINS PHARMACY MARTINS PHARMACY MARTINS PHARMACY ROTZ PHARMACY SHENANDOAH ONCOLOGY PC VALLEY PHARMACY CAVALIER PHARMACY INC FOOD CITY PHARMACY EXPRESS PHARMACY FOOD LION PHARMACY GIANT PHARMACY GIANT PHARMACY GIANT PHARMACY GOODCARE PHARMACY ONE HANSON PHARMACY POTOMAC CENTER PHARMACY REGAL PHARMACY WELLCHECK PHARMACY WALTON & SMOOT DRUG STORE COUNTS DRUG COMPANY INC FOREST PHARMACY UVA ZION CROSSROADS PHCY NEIGHBORHOOD PHARMACY THE MEDICINE SHOPPE PHARMACY

(757) 984-8100 (757) 229-1041 (540) 535-0923 (540) 665-1817 (540) 545-8301 (540) 662-8312 (540) 662-1108 (540) 536-8899 (276) 328-9141 (276) 679-7850 (703) 494-8000 (703) 580-8211 (703) 491-7694 (703) 670-6179 (703) 590-1700 (571) 408-4112 (571) 285-1784 (703) 523-0670 (703) 490-1600 (571) 931-6697 (540) 459-2136 (276) 228-2178 (276) 227-0781 (434) 243-9466 (340) 718-6784 (340) 719-6100

100 SENTARA CIR 240 MCLAWS CIR 400 GATEWAY DRIVE 1950 S PLEASANT VALLEY RD 200 RIVENDELL CT 1338 AMHERST ST 1870 AMHERST ST STE F 190 CAMPUS BLVD STE 110 301 CHURCH ST 207 WOODLAND DR SW # 898 1690 OLD BRIDGE RD 12420 DILLINGHAM SQ 12445 HEDGES RUN DR 4309 DALE BLVD 5469 MAPLEDALE PLZ 14904 JEFFERSON DAVIS HWY #101 12493 DILLINGHAM SQ 2296 OPITZ BLVD STE 100 2068 DANIEL STUART SQ 16593 RIVER RIDGE BLVD 109 S MAIN ST 289 W MAIN ST 1787 W LEE HWY 1015 SPRING CREEK PKWY 140B ESTATE ST GEORGE 4200 SUNNY ISLE

WILLIAMSBURG WILLIAMSBURG WINCHESTER WINCHESTER WINCHESTER WINCHESTER WINCHESTER WINCHESTER WISE WISE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODBRIDGE WOODSTOCK WYTHEVILLE WYTHEVILLE ZION CROSSROADS FREDERIKSTED ST CROIX

VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VA VI VI

23188-5713 23185-5678 22603 22601-4400 22603-8629 22601-3008 22601-2841 22601-2872 24293-0000 24293-4605 22192-8006 22192-5258 22192-1715 22193-2401 22193-4526 22191-3908 22192-5257 22191-3344 22191-3315 22191-4623 22664-1422 24382-2331 24382-1437 22942-7019 840 820

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 644 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

THE MEDICINE SHOPPE KINNEY DRUGS MEDICINE SHOPPE KINNEY DRUGS INC GREATER FALLS PHARMACY INC PRICE CHOPPER PHARMACY THE PHARMACY INC SHAWS PHARMACY KINNEY DRUGS INC KINNEY DRUGS INC BRANDON COMMUNITY PHARMACY BRATTLEBORO PHARMACY THE HOTEL PHARMACY, INC MARBLE WORKS PHARMACY FLETCHER ALLEN OUTPATIENT PHY FLETCHER ALLEN OUTPT PHARMACY KINNEY DRUGS LAKESIDE PHARMACY INC PRICE CHOPPER PHARMACY SHAWS PHARMACY

Provider Name

(340) 776-1235 (802) 476-6659 (802) 479-3381 (802) 525-4098 (802) 460-2634 (802) 447-9951 (802) 442-5602 (802) 223-8599 (802) 468-5777 (802) 222-9292 (802) 465-0011 (802) 254-7777 (802) 254-2303 (802) 453-2999 (802) 847-3784 (802) 847-2821 (802) 864-8154 (802) 862-1491 (802) 651-9835 (802) 860-3311

6F EST THOMAS NEW QTR B BLD IV 800 US ROUTE 302 20 S MAIN ST STE 1 16 CHURCH ST 78 ATKINSON ST 214 NORTHSIDE DR 205 NORTH ST PAINE TURNPIKE NORTH 34 ROUTE 30 N 901 LOWER PLN 420 GROVE ST 413 CANAL ST 20 ELLIOT ST STE 1 61 PINE ST STE 401 1 S PROSPECT ST 111 COLCHESTER AVE 308 SHELBOURNE RD 242 PEARL ST 595 SHELBURNE RD 570 SHELBURNE RD

ST THOMAS BARRE BARRE BARTON BELLOWS FALLS BENNINGTON BENNINGTON BERLIN BOMOSEEN BRADFORD BRANDON BRATTLEBORO BRATTLEBORO BRISTOL BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON

VI VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT

802 05641-2310 05641-4826 5822 05101-1321 05201-1754 05201-1829 5602 05732-9805 05033-8924 05733-9062 05301-6619 05301-3208 05443-1043 05401-3456 05401-1473 05401-4919 05401-8532 05401-5050 05401-5049

THE UNIV OF VERMONT MED CTR HOME VERMONT FAMILY PHARMACY INC KINNEY DRUGS INC COMMUNITY HEALTH PHARMACY FLETCHER ALLEN OP PHARMACY SHAWS PHARMACY BROWNS DRUG STORE ENOSBURG PHARMACY KINNEY DRUGS PRICE CHOPPERS PHARMACY KINNEY DRUGS INC KINNEY DRUGS INC GREEN MOUNTAIN PHARMACY LUDLOW PHARMACY KINNEY DRUGS INC THE PHARMACY-NORTHSHIRE LLC KINNEY DRUGS MARBLE WORKS PHARMACY KINNEY DRUGS MONTPELIER PHARMACY KINNEY DRUGS

(802) 847-5519 (802) 658-9664 (802) 644-8811 (802) 893-1120 (802) 847-7461 (802) 655-2536 (802) 873-3122 (802) 933-9200 (802) 878-5351 (802) 879-4155 (802) 482-4886 (802) 723-1031 (802) 842-3344 (802) 228-2500 (802) 626-3779 (802) 362-0390 (802) 388-0973 (802) 388-3784 (802) 893-7459 (802) 223-4633 (802) 888-5244

1 SO PROSPECT ST SUITE 1413 1219 NORTH AVE 155 S MAIN ST 158 BRENTWOOD DRIVE STE 7 792 COLLEGE PKWY 66 MOUNTAIN VIEW DR 40 MAIN ST 366 MAIN ST 82 PEARL ST 90 CENTER RD 10212 ROUTE 116 12 RAILROAD ST 5700 VT ROUTE 100 UNIT C-10 57 POND ST 407 BROAD ST 34 WAYS LN 40 COURT ST 99 MAPLE ST STE 19 3 CENTRE DR 69 MAIN ST 97 MORRISVILLE PLAZA

BURLINGTON BURLINGTON CAMBRIDGE COLCHESTER COLCHESTER COLCHESTER DERBY LINE ENOSBURG FALLS ESSEX JUNCTION ESSEX JUNCTION HINESBURG ISLAND POND LONDONDERRY LUDLOW LYNDONVILLE MANCHESTER CENTER MIDDLEBURY MIDDLEBURY MILTON MONTPELIER MORRISVILLE

VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT

5401 05408-2747 05444-9665 5446 05446-3052 05446-5967 05830-9203 05450-0300 05452-3642 05452-2658 5461 05846-9716 05148-9400 05149-1083 05851-5600 05255-9231 05753-4449 05753-1595 05468-3779 05602-2931 5661

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 645 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Street

Provider City

State

ZIP code

KINNEY DRUGS NORTHFIELD PHARMACY INC PUTNEY PHARMACY KINNEY DRUGS INC BEAUCHAMP & O'ROURKE INC PRICE CHOPPER PHARMACY RRMC PHARMACY RUTLAND PHARMACY WILCOX PHARMACY KINNEY DRUGS PRICE CHOPPER PHARMACY KINNEY DRUGS INC KINNEY DRUGS INC KINNEY DRUGS SOUTH HERO PHARMACY RIVER STREET PHARMACY SPRINGFIELD PHARMACY INC SWANTON REXALL DRUGS MESSENGER VALLEY PHARMACY KINNEY DRUGS MARBLE WORKS PHARMACY KINNEY DRUGS INC KINNEY DRUGS INC SHAWS OSCO PHARMACY WATERBURY PHARMACY WELLS RIVER PHARMACY CORNER DRUG CO.,INC SHAWS PHARMACY WOODSTOCK PHARMACY ABERDEEN HEALTH MART PHARMACY CITY CENTER DRUG SWANSONS OWL PHARMACY YOKES PHARMACY FAMILY PHARMACY ARLINGTON CHC PHARMACY ARLINGTON PHARMACY INC AUBURN COMM HLTH CNTR PHCY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE HAGGEN PHARMACY

Provider Name

(802) 334-1600 (802) 485-4771 (802) 387-4692 (802) 728-6284 (802) 775-4321 (802) 747-7887 (802) 747-1777 (802) 775-2545 (802) 775-3351 (802) 524-6543 (802) 524-2918 (802) 748-2778 (802) 985-0008 (315) 287-1500 (802) 372-5377 (802) 885-6800 (802) 885-6400 (802) 868-3338 (802) 365-4117 (802) 877-3148 (802) 877-1190 (802) 496-2345 (802) 244-8458 (802) 241-4115 (802) 244-7701 (802) 757-2244 (802) 295-2501 (802) 878-9056 (802) 457-1306 (360) 533-1525 (360) 532-5182 (360) 533-3294 (509) 244-5822 (360) 293-2124 (360) 572-5454 (360) 435-5771 (253) 804-3591 (253) 373-9944 (253) 288-2111 (253) 876-1761

55 SHATTUCK HILL RD 14 DEPOT SQ 4 KIMBALL HILL RD 151 VT ROUTE 12 S 62 WOODSTOCK AVE 38 RUTLAND SHOPPING PLZ 160 ALLEN ST 75 ALLEN ST 252 STRATTON ROAD 164 SWANTON RD 170 SWANTON RD 957 MEMORIAL DR 47 EXECUTIVE DR 1653 WILLISTON RD 334 US RT 2 100 RIVER ST UNIT 203 264 RIVER ST 44 MERCHANTS ROW 170 GRAFTON RD 115B MONKTON RD 187 MAIN ST 5091 MAIN ST #7 80 S MAIN ST 820 WATERBURY STOWE RD 149 S MAIN ST 41 MAIN ST N 213 MAPLE ST 71 BOXWOOD ST 19 CENTRAL ST 1812 SUMNER AVE STE H 108 E WISHKAH ST 117 N BOONE ST 12825 W SUNSET HWY 1213 24TH ST STE 400 326 S STILLAGUAMISH AVE 540 N WEST AVE 126 AUBURN AVE STE 104 4508 AUBURN WAY N STE A104 2704 I ST NE 1406 LAKE TAPPS PKWY EAST

NEWPORT NORTHFIELD PUTNEY RANDOLPH RUTLAND RUTLAND RUTLAND RUTLAND RUTLAND SAINT ALBANS SAINT ALBANS SAINT JOHNSBURY SHELBURNE SOUTH BURLINGTON SOUTH HERO SPRINGFIELD SPRINGFIELD SWANTON TOWNSHEND VERGENNES VERGENNES WAITSFIELD WATERBURY WATERBURY WATERBURY WELLS RIVER WHITE RIVER JUNCTION WILLISTON WOODSTOCK ABERDEEN ABERDEEN ABERDEEN AIRWAY HEIGHTS ANACORTES ARLINGTON ARLINGTON AUBURN AUBURN AUBURN AUBURN

VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT VT WA WA WA WA WA WA WA WA WA WA WA

05855-9831 05663-6958 05346-9036 05060-9237 05701-3534 05701-5201 05701-4560 05701-4501 05701-4623 05478-2601 05478-2601 05819-9238 5482 05403-6426 05486-0264 05156-2930 05156-2306 05488-1420 5353 05491-9778 05491-1117 05673-7111 05676-1553 05676-9730 05676-1516 05081-9692 05001-7028 05495-8211 05091-1005 98520-4602 98520-6508 98520-7603 99001-9405 98221-2595 98223 98223-1251 98002-5082 98002-1381 98002-2411 98092-8154

HEALTHPOINT AUBURN NORTH PHARMACY

(253) 351-3952

923 AUBURN WAY N

AUBURN

WA

98002

NR_0009_10823 10/2017

Provider Phone Number

Page 646 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MUCKLESHOOT HWC PHARMACY

Provider Name

(253) 333-3618

17500 SE 392ND ST

AUBURN

WA

98092

MULTICARE AMC OUTPATIENT PHARMACY ALBERTSON'S PHARMACY QFC PHARMACY LAKEMONT PHARMACY PHARMACY PLUS INC QFC PHARMACY QFC PHARMACY QFC PHARMACY SEA MAR COMMUNITY HEALTH CTR SEATTLE CHILDREN'S HOSPITAL CUSTOM RX SHOPPE HAGGEN PHARMACY HAGGEN PHARMACY HAGGEN PHARMACY HOAGLAND PHARMACY HOAGLAND PHARMACY LTC INFUSION SOLUTIONS INTERFAITH PHARMACY OPTION CARE RX MART PHARMACY LOGAR PHARMACY MULTICARE BONNEY LAKE PHCY RXPRESS PHARMACY ALBERTSON'S PHARMACY HEALTHPOINT BOTHELL QFC PHARMACY APOTHECARY UNITED DRUGS GENOA-QOL HEALTHCARE PENINSULA COMM HLTH SVC PHCY

(253) 545-2445 (360) 687-4092 (360) 275-9671 (425) 644-6080 (425) 644-8887 (425) 454-3358 (425) 378-0202 (425) 653-2431 (425) 998-5990 (206) 884-9120 (360) 685-4242 (360) 671-3305 (360) 733-9277 (360) 715-5321 (360) 734-5413 (360) 734-5413 (360) 933-4892 (360) 752-7406 (360) 733-7799 (360) 933-1401 (509) 588-8600 (253) 403-1000 (253) 862-5000 (425) 338-3956 (425) 486-0658 (425) 487-3031 (360) 479-4900 (360) 415-6700 (360) 616-3131

202 NORTH DIVISION ST MS: 2022108 W MAIN ST 201 NE STATE ROUTE 300 4935 LAKEMONT BLVD SE STE B4 1299 156TH AVE NE STE 140 2636 BELLEVUE WAY NE 3550 FACTORIA BLVD SE 1510 145TH PL SE 3801 150TH AVE SE 1500 116TH AVE NE 1313 E MAPLE ST STE 101 2814 MERIDIAN 1401 12TH ST 2900 WOBURN ST 2330 YEW ST 1414 MEADOR AVE STE H102 134 PRINCE AVE STE B 218 UNITY ST 777 W HORTON 300 E SUNSET DR 515 9TH ST STE A 10004 204TH AVE E 21509 STATE ROUTE 410 E STE 4 3322 132ND ST SE 10414 BEARDSLEE BLVD 18921 BOTHELL WAY NE 2500 CHERRY AVE 5455 ALMIRA DR NE STE 329 2508 WHEATON WAY

AUBURN BATTLE GROUND BELFAIR BELLEVUE BELLEVUE BELLEVUE BELLEVUE BELLEVUE BELLEVUE BELLEVUE BELLINGHAM BELLINGHAM BELLINGHAM BELLINGHAM BELLINGHAM BELLINGHAM BELLINGHAM BELLINGHAM BELLINGHAM BELLINGHAM BENTON CITY BONNEY LAKE BONNEY LAKE BOTHELL BOTHELL BOTHELL BREMERTON BREMERTON BREMERTON

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98001 98604-9144 98528-9617 98006-7800 98007-7561 98004-2209 98006-6126 98007-5593 98006-1668 98004 98225-5708 98225 98225-7417 98226-3865 98229-3942 98229-5833 98226-6703 98225-4420 98226 98225-1922 99320-9702 98391 98391 98012-5654 98011-3205 98011-1934 98310-4202 98311-8330 98310-3303

PENNINSULA COMMUNITY HEALTH SVCS BREWSTER DRUG INC FAMILY HEALTH CENTERS

(360) 475-3731 (509) 689-2421 (509) 422-7637

616 6TH ST 811 US HIGHWAY 97 525 W JAY

BREMERTON BREWSTER BREWSTER

WA WA WA

98337-1420 98812 98812-0000

OKANOGAN DOUGLAS DISTRICT HOSP PHCY CHUCK'S UNITED DRUGS GENOA-QOL HEALTHCARE HAGGEN PHARMACY MARKS CAMANO PHARMACY PC DOANE'S SENIOR CARE PHARMACY

(509) 689-2517 (360) 829-0451 (206) 242-4446 (360) 814-1561 (360) 387-5757 (509) 888-6650

507 HOSPITAL WAY 787 MAIN ST 1010 S 146TH ST STE 1 757 HAGGEN DR 370 NE CAMANO DR STE 6 108 ELBERTA AVE

BREWSTER BUCKLEY BURIEN BURLINGTON CAMANO ISLAND CASHMERE

WA WA WA WA WA WA

98812-0000 98321-8509 98168-3669 98233-3328 98282-7279 98815-1090

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 647 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

DOANES VALLEY PHARMACY CASTLE ROCK PHARMACY CATHLAMET PHARMACY CENTRALIA PHARMACY GENOA-QOL HEALTHCARE PROVIDENCE CENTRALIA HOSP RETA VALLEY VIEW HEALTH CENTER PHCY LAKE CHELAN UNITED DRUGS BI-MART PHARMACY CHENEY OWL PHARMACY AKERS UNITED DRUGS VALLEY DRUG COMPANY ALBERTSON'S PHARMACY BI-MART PHARMACY OWL TRI-STATE PHARMACY WASEM'S DRUG CLE ELUM DRUG ISLAND DRUG TICK KLOCK DRUG LLC SUPER 1 PHARMACY UPTOWN DRUG SEA MAR COMMUNITY HEALTH CTR DARRINGTON PHARMACY DAVENPORT PHARMACY LINCOLN COUNTY PHARMACY ELK DRUG INC BI-MART PHARMACY MEDICINE SHOPPE YOKES PHARMACY HEALTHPOINT - MIDWAY PHARMACY

Provider Name

(509) 782-2717 (360) 274-8211 (360) 795-3691 (360) 736-5000 (360) 559-1591 (360) 330-5822 (360) 669-0600 (509) 682-2751 (509) 235-4705 (509) 235-8441 (509) 935-8441 (509) 935-8611 (509) 758-7475 (509) 758-8230 (509) 758-5533 (509) 758-2565 (509) 674-2155 (360) 341-3885 (509) 397-2111 (509) 684-3151 (509) 684-1440 (360) 853-8109 (360) 436-1200 (509) 725-1151 (509) 725-3310 (509) 382-2536 (509) 276-9016 (509) 276-5081 (509) 276-2939 (206) 870-3595

119 COTTAGE AVE 117 FIRST S W 74 MAIN ST 417 S TOWER AVE 2428 W REYNOLDS AVE STE 146 914 S SCHEUBER RD 2690 NE KRESKY AVE 223 E JOHNSON AVE 2221 1ST ST 120 F ST 406 N PARK ST 102 E MAIN AVE 400 BRIDGE ST 511 3RD ST 1275 HIGHLAND AVE 800 6TH ST 219 E 1ST ST 11042 STATE ROUTE 525 109 S MAIN ST 1250 N HIGHWAY 358 N MAIN ST 7438 S D AVE SUITE C 1200 SEEMAN ST 525 MORGAN 621 MORGAN ST 176 E MAIN ST 412 S MAIN ST 11 E H ST STE A 810 S MAIN AVE 26401 PACIFIC HWY S STE 102

CASHMERE CASTLE ROCK CATHLAMET CENTRALIA CENTRALIA CENTRALIA CHEHALIS CHELAN CHENEY CHENEY CHEWELAH CHEWELAH CLARKSTON CLARKSTON CLARKSTON CLARKSTON CLE ELUM CLINTON COLFAX COLVILLE COLVILLE CONCRETE DARRINGTON DAVENPORT DAVENPORT DAYTON DEER PARK DEER PARK DEER PARK DES MOINES

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98815-1001 98611 98612 98531-3917 98531-4554 98531-9027 98532-2412 98816-9160 99004-2049 99004 99109-8972 99109-8960 99403-1931 99403-1969 99403-2846 99403-2013 98922-1103 98236-8618 99111-1803 99114-2005 99114-2310 98237 98241 99122 99122-0000 99328-1393 99006 99006-7178 99006 98198-9247

SEA MAR COMMUNITY HEALTH CENTERS DUPONT PHARMACY, INC DUVALL FAMILY DRUGS BI-MART PHARMACY RAYS PHARMACY KIRK'S PHCY UNITED DRUG CHC-SNOHOMISH CTY EDMONDS PHCY EDMONDS PHARMACY EDMONDS PHCY @ STEVENS HLTH CTR FAMILY PHARMACY HIGHLAND PHARMACY

(206) 212-4530 (253) 964-3400 (425) 788-2644 (509) 884-4022 (360) 376-2230 (360) 832-3121 (425) 640-5530 (425) 977-4880 (425) 563-6381 (425) 778-7778 (425) 673-8533

2781 S 242ND ST 1545 WILMINGTON DR STE 160 15602 MAIN ST NE 780 GRANT RD 68 N BEACH RD 104 MASHELL AVE N 23320 HIGHWAY 99 7631 212TH ST SW STE D100 21701 76TH AVE W STE 104A 7315 212TH ST SW STE 100 22618 HIGHWAY 99

DES MOINES DUPONT DUVALL EAST WENATCHEE EASTSOUND EATONVILLE EDMONDS EDMONDS EDMONDS EDMONDS EDMONDS

WA WA WA WA WA WA WA WA WA WA WA

98198-5166 98327 98019-8434 98802-5429 98245-8200 98328-0000 98026 98026-7565 98026-7536 98026-7610 98026-8395

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 648 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PAKTIA PHARMACY QFC PHARMACY BI-MART PHARMACY COMMUNITY HEALTH OF CENT WA

Provider Name

(425) 967-5375 (425) 778-2144 (509) 925-6996 (509) 962-1470

315 5TH AVE S UNIT C 22828 100TH AVE W 608 E MOUNTAIN VIEW AVE 521 E MOUNTAIN VIEW AVE

EDMONDS EDMONDS ELLENSBURG ELLENSBURG

WA WA WA WA

98020-3600 98020-5920 98926-3819 98926-3865

DOWNTOWN HEALTH MART PHARMACY KITTITAS VALLEY HEALTHCARE SUPER 1 PHARMACY ELMA PHARMACY QFC PHARMACY ALBERTSON'S PHARMACY CHC OF SNOHOMISH CTY EVERETT N CHC OF SNOHOMISH CTY EVERETTE GENOA-QOL HEALTHCARE MEDICAL CENTER PHARMACY OPTION CARE QFC PHARMACY QFC PHARMACY SAV-ON PHARMACY SEA MAR COMM HLTH CNTR PHCY SEVAN PHARMACY SHIRAZ SPECIALTY PHARMACY NOOKSACK VALLEY DRUG STORE FAIRFIELD OWL PHARMACY ANGEL PHARMACY FRANCISCAN PHARMACY 1ST AVE FRANCISCAN PHARMACY FEDERAL WAY HEALTHPOINT FEDERAL WAY PHCY HIGHLAND PHARMACY ONURI PHARMACY VIRGINIA MASON SOUTH PHCY HAGGEN PHARMACY FIRCREST PHARMACY CHINOOK PHARMACY & VARIETY FRIDAY HARBOR DRUG ALBERTSON'S PHARMACY COSTLESS SENIOR SERVICES FRANCISCAN PHARMACY ST ANTHONY MULTICARE GIG HARBOR

(509) 925-1514 (509) 962-7420 (509) 962-7777 (360) 482-2442 (360) 825-9360 (425) 353-7539 (425) 789-2050 (425) 551-6521 (425) 789-3050 (425) 261-3555 (425) 348-3600 (425) 259-6262 (425) 259-3444 (425) 347-1007 (425) 312-0190 (425) 348-5353 (425) 356-3276 (360) 966-3481 (509) 283-4299 (253) 642-7850 (253) 529-8888 (253) 944-4040 (253) 815-8045 (253) 839-1399 (253) 719-8554 (253) 874-1650 (360) 380-7210 (253) 830-5242 (360) 374-2294 (360) 378-4421 (253) 853-4755 (253) 857-7677 (253) 530-2066 (253) 530-8030

414 N PEARL ST 603 SOUTH CHESTNUT STREET 200 E MTN VIEW AVE 221 W MAIN ST 1009 MONROE AVE 6623 EVERGREEN WAY 1424 BROADWAY 1019 112TH ST SW 3322 BROADWAY STE 230 1330 ROCKEFELLER AVE STE 150 8223 BROADWAY STE C 2615 BROADWAY 4919 EVERGREEN WAY 520 128TH ST SW 1920 100TH ST SE STE B 620 SE EVERETT MALL WAY STE 21 205 E CASINO RD STE B16 208 E MAIN ST 208 E MAIN ST 31217 PACIFIC HWY S 30809 1ST AVE S 34503 9TH AVE S STE 110 33431 13TH PL S 31260 PACIFIC HWY S STE 10 1014 S 320TH ST STE G 33501 1ST WAY S 1815 MAIN ST 1107 REGENTS BLVD 11 S FORKS AVE 210 SPRING ST W 11330 51ST AVE NW 14218 92ND AVE NW STE 2 11511 CANTERWOOD BLVD NW #220 4545 POINT FOSDICK DR NW # 125

ELLENSBURG ELLENSBURG ELLENSBURG ELMA ENUMCLAW EVERETT EVERETT EVERETT EVERETT EVERETT EVERETT EVERETT EVERETT EVERETT EVERETT EVERETT EVERETT EVERSON FAIRFIELD FEDERAL WAY FEDERAL WAY FEDERAL WAY FEDERAL WAY FEDERAL WAY FEDERAL WAY FEDERAL WAY FERNDALE FIRCREST FORKS FRIDAY HARBOR GIG HARBOR GIG HARBOR GIG HARBOR GIG HARBOR

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98926-3112 98926 98926-3771 98541-9353 98022-2993 98203-4552 98201-1720 98204-4875 98201-4425 98201-1676 98203-6853 98201-3044 98203-2828 98204-9362 98208-3832 98208-3249 98208-2608 98247 99012 98003 98003-4074 98003-8726 98003-6357 98003 98003-5344 98003-6208 98248-9454 98466-6031 98331-9006 98250-0000 98332-7890 98329-8710 98332-5818 98335-1700

OLYMPIC PHARMACY AND HEALTH CARE PURDY COST LESS PHARMACY

(253) 858-9941 (253) 857-7797

4700 PT FOSDICK DR NW STE 120 14218 92ND AVE NW

GIG HARBOR GIG HARBOR

WA WA

98335-1706 98329-8710

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 649 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name YAKIMA VALLEY FARM WORKERS CLINIC PHARM-A-SAVE CROWN DRUG OF HOQUIAM INC HARBOR DRUG COMPANY ILWACO PHARMACY SELKIRK CHC IONE MEDICAL CENTER PHARMACY QFC PHARMACY QFC PHARMACY GODFREY'S PHARMACY L J 'S FURNESS DRUG INC OSTROMS DRUG & GIFT ALBERTSON'S PHARMACY MEDICAL MALL PHARMACY OPTION CARE RELIANCE PHARMACY RELIANT RX LLC YOKES PHARMACY COVINGTON MULTI CARE CLINIC GLOBAL PHARMACY KENT CHC PHARMACY SENIOR CARE GLOBAL UNITED CARE PHARMACY-RETAIL KETTLE FALLS PHARMACY ALBERTSON'S PHARMACY ASSURED PHARMACY EVERGREEN PROF CENTER PHCY QFC PHARMACY QFC PHARMACY LA CONNER DRUG HAWKS PRAIRIE HEALTH MART PHCY METMEDS QFC PHARMACY HAGGEN PHARMACY COMMUNITY HEALTY CARE PHARMACY GENOA-QOL HEALTHCARE GOOD PHARMACY INTERNATIONAL PHARMACY INTERNATIONAL PHARMACY LTC LAKEWOOD PHARMACY SAV-ON PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (866) 983-9279 (360) 691-7778 (360) 533-0961 (360) 532-3061 (360) 642-3133 (509) 442-3514 (425) 392-8650 (425) 392-7500 (425) 392-8551 (360) 673-2600 (360) 425-3280 (425) 486-7711 (509) 582-9545 (509) 585-5250 (509) 783-2273 (509) 579-0032 (509) 343-3400 (509) 585-0846 (253) 372-7220 (253) 236-8136 (253) 372-3662 (253) 236-4073 (425) 656-2900 (509) 738-2223 (360) 297-1811 (972) 668-7394 (425) 899-2790 (503) 797-5755 (425) 820-0440 (360) 466-3124 (360) 438-3072 (360) 459-5401 (360) 438-6314 (425) 377-7110 (253) 284-4377 (253) 620-5132 (253) 584-9164 (253) 302-4553 (253) 302-4559 (253) 581-3426 (253) 582-0648

Provider Street 1000 WALLACE WAY 207 E STANLEY ST # A 2544 SIMPSON AVE 316 8TH ST 101 1ST AVE S 208 CEDAR CREEK TER 450 NW GILMAN BLVD STE 107 1540 NW GILMAN BLVD 4560 KLAHANIE DR SE 270 NE 1ST ST 114 S PACIFIC AVE 6414 NE BOTHELL WAY 5204 W CLEARWATER AVE 521 N YOUNG ST 7325 W DESCHUTES AVE 133 N ELY ST STE C1 4123 W 24TH AVE 1410 W 27TH AVE 17700 SE 272ND ST 25680 104TH AVE SE 403 E MEEKER ST STE 300 25680 104TH AVE SE ROOM 1 18230 E VALLEY HWY STE 188 W 280 THIRD AVE 8196 NE STATE HIGHWAY 104 12071 124TH AVE NE 12303 NE 130TH LN STE 210 325 PARKPLACE CTR 11224 NE 124TH ST 708 E MORRIS ST 2539 MARVIN RD NE STE E 5707 LACEY BLVD SE STE 103 4775 WHITMAN LN SE 8915 MARKET PLACE NE 10510 GRAVELLY LAKE DR SW 9330 59TH AVE SW STE 179 8741 S TACOMA WAY 11228 BRIDGEPORT WAY SW 11228 BRIDGEPORT WAY SW # B 8720 S TACOMA WAY STE 103 8611 STEILACOOM BLVD SW

Page 650 of 679

Provider City GRANDVIEW GRANITE FALLS HOQUIAM HOQUIAM ILWACO IONE ISSAQUAH ISSAQUAH ISSAQUAH KALAMA KELSO KENMORE KENNEWICK KENNEWICK KENNEWICK KENNEWICK KENNEWICK KENNEWICK KENT KENT KENT KENT KENT KETTLE FALLS KINGSTON KIRKLAND KIRKLAND KIRKLAND KIRKLAND LA CONNER LACEY LACEY LACEY LAKE STEVENS LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD LAKEWOOD

State

ZIP code

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98930-8805 98252-9800 98550-3937 98550-3606 98624-9100 99139-5011 98027-2483 98027-5309 98029-5812 98625 98626-1616 98028-4819 99336-1906 99336-7806 99336-6705 99336-2941 99037-2071 99337-3701 98042-4951 98030-7610 98030-5904 98030-7610 98032-1231 99141 98346-8493 98034-8204 98034-3060 98033-6229 98034-4301 98257-0000 98516-3138 98503-2496 98513-2245 98258-4916 98499-5036 98499-2858 98499-4544 98499-3003 98499 98499-4545 98498-4716

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

VILLAGE PHARMACY ALBERTSON'S PHARMACY WELL LIFE LIBERTY LAKE YOKES PHARMACY LONG BEACH PHARMACY GENOA-QOL HEALTHCARE PEACEHEALTH ST JOHN MED CTR LOPEZ ISLAND PHARMACY FAIRWAY DRUG ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY BETHEL PHARMACY

Provider Name

(509) 548-7622 (509) 891-6967 (509) 755-3333 (509) 922-0705 (360) 642-3200 (360) 703-9057 (360) 414-7451 (360) 468-2616 (360) 354-1226 (425) 347-3145 (425) 670-9723 (425) 741-0075

815 FRONT ST 1304 N LIBERTY LAKE RD 23801 E APPLEWAY AVE 1233 N LIBERTY LAKE RD 101 BOLSTAD 921 14TH AVE STE 201A 1615 DELAWARE ST 352 LOPEZ RD 1758 FRONT ST 12811 BEVERLY PARK RD 19500 HIGHWAY 99 17414 HIGHWAY 99 STE 100

LEAVENWORTH LIBERTY LAKE LIBERTY LAKE LIBERTY LAKE LONG BEACH LONGVIEW LONGVIEW LOPEZ ISLAND LYNDEN LYNNWOOD LYNNWOOD LYNNWOOD

WA WA WA WA WA WA WA WA WA WA WA WA

98826-1376 99019-8523 99019-9687 99019-7518 98631 98632-2316 98632-2367 98261-8300 98264-1246 98087 98036-5241 98037-9243

LYNWOOD COMMUNITY HLTH CTR PHCY PHARMACY CARE SERK APOTHECARY ALBERTSON'S PHARMACY HAGGEN PHARMACY HILTON PHARMACY LLC

(425) 835-5202 (425) 743-2211 (425) 835-0281 (360) 659-8952 (360) 530-7761 (360) 659-3222

4111 194TH ST SW STE 204 4629 168TH ST SW #A 19410 36TH AVE WEST #3 301 MARYSVILLE MALL # 60 3711 88TH ST NE 220 STATE AVE

LYNNWOOD LYNNWOOD LYNNWOOD MARYSVILLE MARYSVILLE MARYSVILLE

WA WA WA WA WA WA

98036-4604 98037 98036-5747 98270-5502 98270-7214 98270-5108

WAHLUKE FAMILY HEALTH CENTER PHARMA MCCLEARY HEALTHMART PHARMACY YOKES PHARMACY MEDICAL LAKE OWL PHARMACY QFC PHARMACY SAV-ON PHARMACY PHARM A SAVE MONROE PROVIDENCE PHARMACY MONROE VALU DRUG COLTON PHARMACY LAKETOWN PHARMACY MOSES LAKE COM HEALTH CTR PHCY SOUTHGATE PHARMACY HAGGEN PHARMACY HILLTOP PHARMACY MOUNT BAKER PP MOUNT VERNON SEA MAR PHARMACY SKAGIT REG CLINICS MT VERNON SKAGIT REG CLINICS RIVERBEND PHCY ALBERTSON'S PHARMACY AXIS PHARMACY NW MERCURY PHARMACY SVCS INC

(509) 932-3535 (360) 495-0700 (509) 242-0201 (509) 299-5113 (425) 743-4806 (253) 344-4830 (360) 794-7351 (360) 794-5555 (360) 249-4444 (360) 496-5902 (509) 765-8891 (509) 765-0674 (509) 765-9332 (360) 848-6930 (360) 428-1710 (360) 848-1744 (360) 542-8800 (360) 428-6465 (360) 814-6840 (425) 775-5011 (425) 356-3276 (425) 673-5200

601 GOVERNMENT WAY 115 W SIMPSON AVE 14202 N MARKET ST 123 E LAKE ST 926 164TH ST SE 2800 MILTON WAY STE 10 17788 147TH ST SE 19200 N KELSEY ST 201 E PIONEER AVE 377 S SECOND ST 1550 S PIONEER WAY STE 105 605 S COOLIDGE ST 2709 W BROADWAY AVE 2601 E DIVISION ST 1223 E DIVISION ST 1805 E DIVISION ST 1400 N LAVENTURE 1410 E KINCAID ST 2320 FREEWAY DR 4301 212TH ST SW 6007 244TH ST SW STE A1 21718 66TH AVE W STE 202

MATTAWA MCCLEARY MEAD MEDICAL LAKE MILL CREEK MILTON MONROE MONROE MONTESANO MORTON MOSES LAKE MOSES LAKE MOSES LAKE MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNT VERNON MOUNTLAKE TERRACE MOUNTLAKE TERRACE MOUNTLAKE TERRACE

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

99349 98557 99021-9524 99022 98012-6305 98354-9344 98272-1030 98272-1431 98563-4514 98356-0000 98837 98837-1893 98837-2904 98274-4748 98274-4101 98274-4632 98273-2766 98274-4127 98273 98043-3585 98043-5427 98043-2138

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 651 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

SEEBER'S PHARMACY LAKE SPOKANE PHARMACY ACCESS PHARMACY QFC PHARMACY ISLAND DRUG SAARS MARKETPLACE FOOD & DRUG CHEHALIS TRIBAL WELLNESS CTR OCEAN PARK PHARMACY OCEAN SHORES PHARMACY OKANOGAN VALLEY PHARMACY HAGGEN PHARMACY NISQUALLY PHARMACY NORTHWEST SPECIALTY PHARMACY

Provider Name

(509) 447-2484 (509) 443-4178 (206) 246-0040 (425) 888-2357 (360) 675-6688 (360) 675-4511 (360) 273-5504 (360) 665-5181 (360) 289-4647 (509) 422-9958 (360) 754-1504 (360) 491-9770 (360) 596-0108

336 S WASHINGTON AVE 5919F HIGHWAY 291 STE 5 17833 1ST AVE S STE C 439 E SECOND ST 32170 STATE ROUTE 20 32199 STATE ROUTE 20 21 NIEDERMAN RD 1501 BAY AVE 172 W CHANCE A LA MER NW 236 N SECOND AVE 1313 COOPER POINT RD SW 4816 SHE NAH NUM DR SE 1908 4TH AVE E STE B

NEWPORT NINE MILE FALLS NORMANDY PARK NORTH BEND OAK HARBOR OAK HARBOR OAKVILLE OCEAN PARK OCEAN SHORES OKANOGAN OLYMPIA OLYMPIA OLYMPIA

WA WA WA WA WA WA WA WA WA WA WA WA WA

99156-9671 99026-9525 98148-1728 98045-0000 98277-3774 98277-3774 98568 98640-4203 98569-9660 98840 98502-5729 98513 98506-4632

PROVIDENCE MOTHER JOSEPH CARE CTR RALPH'S THRIFTWAY PHARMACY SAMY'S DRUG STORE SAV-ON PHARMACY SEA MAR COMMUNITY HEALTH CENTER VISTA ONCOLOGY INC VISTA ONCOLOGY INC, PS WASHINGTON VETERANS HOME WEST OLYMPIA PHARMACY FAMILY HEALTH CENTERS OMAK PHARMACY INC BI-MART PHARMACY COPES UNITED DRUGS OTHELLO FAMILY CLINIC PHARMACY FIESTA PHARMACY LOURDES WEST PASCO PHCY TCCH PHARMACY THE MEDICINE SHOPPE YOKES PHARMACY POMEROY PHARMACY JIM'S PHARMACY AND HOME QFC PHARMACY TRI-AREA PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY PENINSULA COMM HLTH PT ORCHARD SOUTH PARK REXALL PHARMACY DON'S PHARMACY, INC.

(360) 493-4572 (360) 352-4426 (360) 878-8174 (360) 491-9754 (360) 704-7575 (360) 352-2900 (360) 413-8880 (360) 895-4687 (360) 742-3340 (509) 422-1913 (509) 422-1500 (360) 944-8368 (360) 893-2117 (509) 488-5256 (509) 545-0596 (509) 546-8388 (509) 543-1922 (509) 547-7537 (509) 545-4884 (509) 843-1821 (360) 452-4200 (360) 385-1900 (360) 379-9800 (360) 895-0613 (360) 876-2085 (360) 874-5583 (360) 871-1020 (360) 385-0969

3333 ENSIGN RD NE 1908 4TH AVE E 3525 ENSIGN RD NE STE H 3520 PACIFIC AVE SE 3030 LIMITED LN NW 420 MCPHEE RD SW 141 LILLY RD NE 1102 QUINCE STREET SE 400 YAUGER WAY SW STE B 1003 KOALA AVE 903 ENGH RD, SUITE #A 11912 NE FOURTH PLAIN BLVD 134 WASHINGTON AVE S 140 E MAIN ST 115 S 10TH AVE 7425 WRIGLEY DR STE 104 515 W COURT ST 1121 W COURT ST 4905 N ROAD 68 764 MAIN 424 E 2ND ST 1890 IRONDALE RD 93 OAK BAY RD 1434 OLNEY ST SE 370 SW SEDGWICK RD 320 S KITSAP BLVD 1743 VILLAGE LN SE 1151 WATER ST

OLYMPIA OLYMPIA OLYMPIA OLYMPIA OLYMPIA OLYMPIA OLYMPIA OLYMPIA OLYMPIA OMAK OMAK ORCHARDS ORTING OTHELLO PASCO PASCO PASCO PASCO PASCO POMEROY PORT ANGELES PORT HADLOCK PORT HADLOCK PORT ORCHARD PORT ORCHARD PORT ORCHARD PORT ORCHARD PORT TOWNSEND

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98506-5012 98506-4632 98506 98501-2121 98502-2704 98502-5014 98506-5028 98501 98502-8140 98841-9247 98841 98682-5593 98360 99344-1040 99301 99301-5292 99301-3737 99301-4158 99301-8934 99347 98362-3119 98339-9582 98339-9783 98366-4041 98367-7527 98366-3778 98366-2643 98368-6707

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 652 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

JEFFERSON FAMILY PHARMACY CASCADE SPECIALTY PHCY KITSAP PHARMACY PENINSULA HLTH PHCY - POULSBO ELFERS LYON PHARMACY SID'S PHARMACY

Provider Name

(360) 385-3005 (360) 779-2737 (360) 779-5335 (360) 697-7636 (509) 786-3200 (509) 332-4608

2005 E SIMS WAY 325 NE HOSTMARK ST 20148 10TH AVE NE 19917 7TH AVE NE STE 205 820 MEMORIAL ST STE 2 825 SE BISHOP BLVD STE 301

PORT TOWNSEND POULSBO POULSBO POULSBO PROSSER PULLMAN

WA WA WA WA WA WA

98368 98370 98370-7372 98370-6555 99350-2504 99163-5491

WSU STUDENT HLTH & WELLNESS SERV GOOD SAMARITAN BEHAVIORAL HLTH KIRKS PHARMACY AT HARTLAND KIRKS PHARMACY AT SUNRISE MULTICARE GOOD SAM PARTNER ONCOLOGY SAV-ON PHARMACY SAGENS PHARMACY HEALTHPOINT REDMOND PHCY LIVING WELL HEALTH CENTER PHARMACA INTEGRATIVE PHARMACY QFC PHARMACY QFC PHARMACY SAV-ON PHARMACY HEALTHPOINT CENTRAL FILL PHCY HIMERX PHARMACY JOLLYS PHARMACY PRESCRIPTION PAD PHCY NORTH PRESCRIPTION PAD PHCY SOUTH

(509) 335-5742 (253) 697-8333 (253) 848-2011 (253) 770-3408 (253) 697-3494 (253) 770-1700 (253) 537-3808 (360) 942-2634 (425) 882-6008 (425) 497-1225 (425) 885-2323 (425) 636-0440 (425) 869-7474 (425) 836-9173 (425) 203-0455 (425) 738-1262 (425) 251-6335 (425) 656-4050 (425) 917-6226

1125 NE WASHINGTON ST 325 E PIONEER AVE 3909 10TH ST SE STE 2 11212 SUNRISE BLVD STE 204 1450 5TH ST SE SUITE 1200 1519 3RD ST SE STE 260 11012 CANYON RD E 515 COMMERCIAL ST 16315 NE 87TH ST STE B6 3925 159TH AVE NE 15840 REDMOND WAY REDMOND 23475 NE NOVELTY HILL RD 8867 161ST AVE NE 3925 236TH AVENUE NE 947 POWELL AVE SW 3901 NE 4TH ST STE 102A 1412 SW 43RD ST STE 120B 3915 TALBOT RD S STE 201 400 S 43RD ST

PULLMAN PUYALLUP PUYALLUP PUYALLUP PUYALLUP PUYALLUP PUYALLUP RAYMOND REDMOND REDMOND REDMOND REDMOND REDMOND REDMOND RENTON RENTON RENTON RENTON RENTON

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

99163 98372 98374-2189 98374 98372-4001 98372-3716 98373-4200 98577-2509 98052-3537 98052-6309 98052-3829 98053 98052-3585 98053-8455 98057-2975 98056-4100 98057-4803 98055-5738 98055

PROVIDENCE INFUSION AND PHCY SERVS READY MEDS PHARMACY SAV-ON PHARMACY REPUBLIC DRUG STORE ALBERTSON'S PHARMACY MALLEY'S COMPOUNDING PHARMACY RX PHARMACY YOKES PHARMACY RITZVILLE DRUG COMPANY ST JOHN PHARMACY HEALTHPOINT SEATAC PHARMACY 45TH STREET CLINIC PHARMACY AHF PHARMACY AHF PHARMACY BALLARD PLAZA PHARMACY

(425) 687-4400 (425) 251-6335 (425) 873-3600 (509) 775-3351 (509) 627-5133 (509) 943-9173 (509) 713-7444 (509) 491-3339 (509) 659-0250 (509) 648-3430 (206) 277-7216 (206) 548-2964 (206) 624-1391 (206) 568-2486 (206) 782-7200

2201 LIND AVE SW STE 130 1412 SW 43RD ST STE 120 14215 SE PETROVITSKY RD N 6 CLARK ST 140 GAGE BLVD 1906 GEORGE WASHINGTON WAY 800 SWIFT BLVD STE 140 454 KEENE RD 209 W MAIN AVE 18 E FRONT ST 4040 188TH ST STE 201 1629 N 45TH ST 901 BOREN AVE STE 802 1016 E PIKE ST STE 100 1801 NW MARKET ST

RENTON RENTON RENTON REPUBLIC RICHLAND RICHLAND RICHLAND RICHLAND RITZVILLE SAINT JOHN SEATAC SEATTLE SEATTLE SEATTLE SEATTLE

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98057-3369 98057 98058-8983 99166-0000 99352-8900 99354-2308 99352-3559 99352 99169-1409 99171-8775 98188-5070 98103-6701 98104-3534 98122-3847 98107-3987

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 653 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BOB JOHNSONS UNITED DRUGS BUCK PAVILION PHARMACY CABRINI PHARMACY SERVICES CHESTERFIELD PHARMACY COLUMBIA UNITED DRUGS COUNTRY DOC COMM HEALTH CL PHCY EASTERNS PHARMACY GENEVA WOODS PHARMACY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE KATTERMANS SANDPT UNTDDRG KELLEY-ROSS PHARMACY KING PLAZA PHARMACY LINDEMAN PHARMACY LOWRY'S PRESCRIPTIONS LUKES PHARMACY

Provider Name

(206) 782-5822 (206) 223-6877 (206) 682-1011 (206) 838-6070 (206) 723-5233 (206) 299-1600 (206) 622-6094 (206) 767-0411 (206) 695-1976 (425) 835-7110 (206) 524-2211 (206) 324-6990 (206) 721-5009 (206) 625-7202 (206) 368-6060 (206) 621-8883

1407 NW 85TH ST 1100 9TH AVE 901 BOREN AVE STE 100 720 7TH AVE STE 100 4741 RAINIER AVE S 500 19TH AVE E 515 MINOR AVE 1605 S 93RD ST STE EB 3639 MARTIN LUTHER KING JR. WA 1600 E OLIVE ST BLDG D 5400 SAND POINT WAY NE 904 7TH AVE #103 7101 MLK JR WAY S STE 101B 1201 TERRY AVE # X2-PN 10330 MERIDIAN AVE N STE 180 611 MAYNARD AVE S

SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98117-4237 98101-2756 98104-3508 98104-1957 98118-1657 98112-4007 98104-2120 98108-5112 98144 98122-2735 98105-2941 98104-1132 98118 98101-2735 98133-9496 98104-2920

MERIDIAN CENTER FOR HEALTH PHARMACY NAVOS NGUYEN'S PHARMACY & GIFTS NGUYEN'S UNITED DRUGS

(206) 548-5900 (206) 933-7219 (206) 323-6003 (206) 323-9525

10521 MERIDIAN AVE N. 2600 SW HOLDEN ST 1221 S MAIN ST STE 103 2120 RAINIER AVE S

SEATTLE SEATTLE SEATTLE SEATTLE

WA WA WA WA

98133 98126-3505 98144-2089 98144-4623

NORTHWEST KIDNEY CENTER PHARMACY NORTHWEST PRESCRIPTIONS PARKS PHARMACY PHARMACA INTEGRATIVE PHARMACY PHARMACA INTEGRATIVE PHARMACY PHARMACA INTERGRATIVE PHARMACY PIKE MARKET MEDICAL CLINIC

(206) 343-4870 (206) 365-2255 (206) 527-3010 (206) 547-1208 (206) 932-4225 (206) 324-1188 (206) 548-3012

700 BROADWAY 1536 N 115TH ST STE 100 401 NE RAVENNA BLVD 1815 N 45TH ST STE 110 4707 CALIFORNIA AVE SW 4130 E MADISON ST 1930 POST ALLEY

SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE

WA WA WA WA WA WA WA

98122-4302 98133-8401 98115-8443 98103-6856 98116-4412 98112-3231 98101-1015

PREMIERE LONG TERM CARE PHARMACY QFC PHARMACY QFC PHARMACY QFC PHARMACY QFC PHARMACY QFC PHARMACY QFC PHARMACY QFC PHARMACY RAINIER BEACH PHARMACY RAINIER PARK CLINIC PHARMACY SEA-MAR CLINIC PHARMACY SEATTLEMEDS

(206) 323-0868 (206) 323-6586 (360) 729-3080 (260) 352-4030 (206) 923-6391 (206) 782-4100 (206) 361-0188 (206) 366-4672 (206) 548-3640 (206) 461-6935 (206) 762-3397 (206) 382-2087

1618 S LANE ST STE 204 417 BROADWAY E 2746 NE 45TH ST 500 MERCER ST 4550 42ND AVE SW 9999 HOLMAN RD NW 11100 ROOSEVELT WAY NE 1531 NE 145TH ST 9245 RAINIER AVE S 4400 37TH AVE S 8800 14TH AVE S 1305 MADISON ST

SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE SEATTLE

WA WA WA WA WA WA WA WA WA WA WA WA

98144-2829 98102-5009 98105-5099 98109-4616 98116-4225 98117-2041 98125-6234 98155-7205 98118 98118-1609 98108-4864 98104

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 654 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name SWEDISH ARNOLD PAVILION PHCY UNION CENTER PHARMACY HOMETOWN PHARMACY SKAGIT REG CLNCS SEDRO-WOOLLEY HOWARD'S DRUG SELAH SAVE-ON PHARMACY QFC PHARMACY MEDICINE SHOPPE NEIL'S UNITED DRUGS SHELTON PHARMACY ICHS SHORELINE PHARMACY QFC PHARMACY RIDGETOP PHARMACY HAGGEN PHARMACY SAV-ON PHARMACY RIDGE PHARMACY THE FALLS COMPOUNDING PHARMACY SOUTH BEND PHARMACY SPANAWAY PHARMACY 1ST AVENUE PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY CHAS PHARMACY HART& DILATUSH PHARMACY LIDGERWOOD OWL PHARMACY MEDICAL ONCOLOGY ASSOCIATES MEDICINE SHOPPE OPTION CARE PROVIDENCE SACRED HRT MD CNTR RELIANT RX LLC RIVERPOINT PHARMACY ROSAUERS PHARMACY ROSAUERS PHARMACY ROSAUERS PHARMACY ROSAUERS PHARMACY ROSAUERS PHARMACY SIXTH AVE MEDICAL PHARMACY SPOKANE FALLS FAMILY CLINIC PHCY THE NATIVE PROJECT WELL LIFE LATAH PHARMACY YOKES PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (206) 386-6020 (206) 441-9174 (360) 503-1676 (360) 854-2760 (509) 697-6125 (509) 697-6188 (360) 683-1157 (360) 426-4272 (360) 426-3327 (360) 545-4333 (206) 533-2727 (206) 542-5469 (360) 633-7066 (360) 568-5154 (360) 668-2742 (425) 363-2960 (425) 888-6858 (360) 875-5757 (253) 847-2781 (509) 624-3017 (509) 489-5287 (509) 465-8590 (509) 443-6502 (509) 343-1116 (509) 624-2111 (509) 483-3566 (509) 462-2273 (509) 327-1504 (800) 426-6101 (509) 474-3088 (509) 343-3400 (509) 343-6252 (509) 624-0126 (509) 624-2371 (509) 325-3431 (509) 467-6806 (509) 535-3623 (509) 455-9345 (509) 865-6175 (509) 483-4797 (509) 838-0896 (509) 462-5691

Provider Street 1221 MADISON ST 2324 EASTLAKE AVE E STE 405 640 STATE ROUTE 20 UNIT A 1900 HOSPITAL DR STE 101 119 E 3RD AVE 800 N PARK CTR 990 E WASHINGTON ST 207 PROFESSIONAL WAY 512 W FRANKLIN ST 110 W K ST 16549 AURORA AVE N 600 NW RICHMOND BEACH RD 9414 RIDGETOP BLVD NW, STE 104 1301 AVENUE D 17520 STATE ROUTE 9 SE 7730 CENTER BLVD SE 8112 RAILROAD AVE SE 101 WILLAPA AVE 17701 PACIFIC AVE S STE D2 6 E 1ST AVE 6520 N NEVADA ST 9001 N INDIAN TRAIL RD 3010 E 57TH AVE 3919 N MAPLE ST 601 W RIVERSIDE AVE STE 140 5901 N LIDGERWOOD ST 6001 N MAYFAIR ST 1327 W NORTHWEST BLVD 1328 N ASH ST 101 W 8TH AVE 2820 N ASTOR ST 528 E SPOKANE FALLS BLVD 1808 W 3RD AVE 907 W 14TH AVE 1724 W FRANCIS AVE 9414 N DIVISION ST 2610 E 29TH AVE 508 W 6TH AVE 120 W MISSION AVE 1803 WEST MAXWELL AVE. 5608 S REGAL ST STE 102 4235 S CHENEY SPOKANE RD

Page 655 of 679

Provider City SEATTLE SEATTLE SEDRO WOOLLEY SEDRO WOOLLEY SELAH SELAH SEQUIM SHELTON SHELTON SHELTON SHORELINE SHORELINE SILVERDALE SNOHOMISH SNOHOMISH SNOQUALMIE SNOQUALMIE SOUTH BEND SPANAWAY SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE SPOKANE

State

ZIP code

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98104-3588 98102-6536 98284 98284-9315 98942-1430 98942-1173 98382-3517 98584-4404 98584-3517 98584-2939 98133-5308 98177-3122 98383-8526 98290-1711 98296-8320 98065-8743 98065 98586-9068 98387-4609 99202-1503 99208-5100 99208-9116 99223-7011 99205-1349 99201-0622 99207 99208-1129 99205-4315 99201-2804 99204-2307 99207-2112 99202-5081 99201-7410 99204-3821 99205-6833 99218-1229 99223-4806 99204-2770 99201-2315 99201-2831 99223-7957 99224

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

YOKES PHARMACY YOKES PHARMACY ALBERTSON'S PHARMACY ALBERTSON'S PHARMACY COMM HEALTH ASSOC OF SPOKANE GENEVA WOODS PHARMACY ROSAUERS PHARMACY THE MEDICINE SHOPPE VALLEY MISSION HMCARE PHCY YOKES PHARMACY YOKES PHARMACY HAGGEN PHARMACY QFC PHARMACY WIND RIVER PHARMACY SULTAN PHARMACY & NATURAL CARE SUMAS DRUG NICHOLSON'S PHARMACY BI-MART PHARMACY YAKIMA NEIGHBORHOOD HLTH SVCS ALBERTSON'S PHARMACY ALLENMORE MULTICARE PHARMACY CHUNG PHARMACY COMMUNITY HEALTH CARE PHARMACY COMMUNITY HEALTHCARE PHARMACY COMMUNITY HEALTHCARE PHARMACY COSTLESS PRESCRIPTIONS FRANCISCAN PHARMACY FRANCISCAN PHARMACY TACOMA LINCOLN PHARMACY LINCOLN PHARMACY LTC MAI LINH UNITED DRUGS MARKET PLACE PHARMACY MARY BRIDGE CLINICS PHARMACY MEGA PHARMACY MULTICARE CLINIC PHARMACY

Provider Name

(509) 325-6933 (509) 325-8720 (509) 924-9052 (509) 892-3659 (509) 343-1116 (509) 744-9891 (509) 924-5560 (509) 924-1222 (509) 928-6400 (509) 343-3379 (509) 926-2200 (360) 629-5520 (360) 629-0662 (509) 427-5480 (360) 793-8813 (360) 988-2681 (253) 863-8141 (509) 839-0766 (509) 837-8989 (253) 538-2611 (253) 403-5055 (253) 584-2484 (253) 284-2324 (253) 284-2226 (253) 536-6257 (253) 474-9493 (253) 985-6290 (253) 274-7650 (253) 473-1155 (253) 473-1155 (253) 383-2576 (253) 531-3711 (253) 403-1411 (253) 507-7492 (253) 403-4920

210 E NORTH FOOTHILLS DR 3321 W INDIAN TRAIL RD 8851 E TRENT AVE 13606 E 32ND AVE 924 S PINES 3808 N SULLIVAN RD 10618 E SPRAGUE AVE 12414 E SPRAGUE AVE 12509 E MISSION AVE STE 103 9329 E MONTGOMERY AVE 13014 E SPRAGUE AVE 26603 72ND AVE NW 27008 92ND AVE NW 280 SW 2ND ST 505 W STEVENS AVE 1143 CHERRY ST 910 ALDER AVE 110 WEST SOUTH HILL RD 617 SCOON RD 104 MILITARY RD S 1901 S UNION AVE 9122 S TACOMA WAY STE 104 1102 S I ST 1728 E 44TH ST 11225 PACIFIC AVE S 5431 PACIFIC AVE 2111 S 90TH ST 1608 S J ST 821 S 38TH ST 821B S 38TH ST 1211 S 11TH ST 13322 PACIFIC AVE S 311 S L ST 1902 96TH ST S STE A 521 MARTIN LUTHER KING JR WAY

SPOKANE SPOKANE SPOKANE VALLEY SPOKANE VALLEY SPOKANE VALLEY SPOKANE VALLEY SPOKANE VALLEY SPOKANE VALLEY SPOKANE VALLEY SPOKANE VALLEY SPOKANE VALLEY STANWOOD STANWOOD STEVENSON SULTAN SUMAS SUMNER SUNNYSIDE SUNNYSIDE TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

99207-2155 99208-4762 99212-2332 99216-0113 99206 99216-1608 99206-3634 99216-0722 99216-1061 99206-4295 99216-1858 98292-6273 98292-5343 98648 98294-9453 98295 98390-1406 98944 98944-1031 98444-6927 98405-1702 98499-4406 98405-4559 98404-4611 98444-5525 98408 98444-1824 98405-4930 98418 98418-5028 98405-4020 98444-4864 98405-3720 98444-2808 98405-4238

MULTICARE MEDICAL CENTR ED PHARMACY MULTICARE WESTGATE PHARMACY NORTHWEST MEDICAL SPECIALTIES PUGET SOUND PHARMACY LLC RANKOS STADIUM PHARMACY SEA MAR COMMUNITY HEALTH CTR

(253) 403-2403 (253) 459-7144 (253) 428-8740 (253) 572-0180 (253) 383-2411 (253) 246-6830

315 MARTIN LUTHER KING JR WAY 2209 N PEARL ST STE 100 1624 S I ST STE 407 710 S 38TH ST 101 N TACOMA AVE 1112 S. CUSHMAN AVE.

TACOMA TACOMA TACOMA TACOMA TACOMA TACOMA

WA WA WA WA WA WA

98405-4234 98406-2529 98405-5094 98418-6718 98403-2631 98405

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 656 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

TACOMA MEDICAL CENTER PHCY TEKOA PHARMACY HEDDEN'S PHARMACY INC ROYS PHARMACY INC GIBBONS PHARMACY YAKIMA VLY FARM WORKERS CLINIC HEALTHPOINT TUKWILA PHARMACY OPTION CARE PARAMOUNT PHARMACY TULALIP PHARMACY ALBERTSON'S PHARMACY MARTIN'S SOUTHGATE DRUG YAUGER PARK FAMILY PHARMACY ULRICHS VALLEY PHARMACY FRANCISCAN HOSPICE LTC PHARMACY ALBERTSON'S PHARMACY BI-MART PHARMACY COMPASS ONCOLOGY PHARMACY GENEVA WOODS PHARMACY GENOA-QOL HEALTHCARE HI-SCHOOL PHARMACY MILL PLAIN MEDICAL AND PHARMACY PACIFIC NW SPECIALTY PHCY PAYLESS DRUG QFC PHARMACY SALMON CREEK APOTHECARY SW WASHINGTON MED CTR O/P PHCY THE VANCOUVER CLINIC PHARMACY

Provider Name

(253) 383-5359 (509) 284-3025 (360) 264-2575 (509) 486-2149 (509) 865-2722 (509) 865-3355 (206) 839-3565 (206) 246-0635 (425) 251-1660 (360) 716-2660 (360) 705-3679 (360) 943-4043 (360) 357-3371 (509) 997-2191 (253) 534-7033 (360) 576-4066 (360) 695-7578 (360) 597-1070 (360) 694-7377 (360) 450-4881 (360) 787-4000 (360) 253-8993 (360) 448-7890 (800) 330-3665 (360) 253-3043 (360) 487-3700 (360) 514-2294 (360) 397-3602

1206 S 11TH ST STE 1 124 N CROSBY 196 SUSSEX AVE W 318 S WHITCOMB AVE 117 S TOPPENISH AVE 510 W 1ST AVE 13030 MILITARY RD S STE 206 13035 GATEWAY DR STE 131 7200 S 180TH ST STE 104 8825 34TH AVE NE STE A 705 TROSPER RD SW 5201 CAPITOL BLVD SW 1625 MOTTMAN RD SW 423 E METHOW HWY. 2901 BRIDGEPORT WAY W STE 128 14300 NE 20TH AVE 2601 FALK RD 1498 TECH CENTER PL #240 6600 NE 112TH CT STE 103 1601 E FOURTH PLAIN BLVD 3200 NE 52ND ST 8614 E MILL PLAIN BLVD 3801 MAIN ST STE A 18110 SE 34TH ST BLDG 2 3505 SE 192ND AVE 2121 NE 139TH ST STE 310 420 NE MOTHER JOSEPH PL 501 SE 172ND AVE

TACOMA TEKOA TENINO TONASKET TOPPENISH TOPPENISH TUKWILA TUKWILA TUKWILA TULALIP TUMWATER TUMWATER TUMWATER TWISP UNIVERSITY PLACE VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER VANCOUVER

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98405-4092 99033-9726 98589-9327 98855-8824 98948-1557 98948-1564 98168-3080 98168-3395 98188-5548 98271-8085 98512-6933 98501-4418 98512 98856 98466-4614 98686-6420 98661-5721 98683 98662-5494 98661-3753 98663 98664-2059 98663-2258 98683-9497 98683-1436 98686-2316 98664-3200 98684-9542

VANCOUVER CLINIC PHCY SALMON CREEK VASHON PHARMACY ADVENTIST HLTH COMMUNITY PHCY BI-MART PHARMACY FAMILY MEDICAL CENTER PHARMACY SAV-ON PHARMACY TALLMANS PHARMACY HORIZON PHARMACY BI-MART PHARMACY CENTRAL WA HOSP PROFESS PHCY

(360) 397-3880 (206) 463-9118 (509) 527-8333 (509) 529-9350 (866) 983-9279 (509) 529-2008 (509) 525-1010 (509) 584-0300 (360) 835-0681 (509) 667-3333

2525 NE 139TH ST STE 160 17617 VASHON HWY SW 1111 S 2ND AVE 1649 PLAZA WAY 1120 W ROSE ST 450 N WILBUR AVE 4 W MAIN ST 633 W 1ST ST 3003 ADDY ST 933 RED APPLE RD STE A

VANCOUVER VASHON WALLA WALLA WALLA WALLA WALLA WALLA WALLA WALLA WALLA WALLA WAPATO WASHOUGAL WENATCHEE

WA WA WA WA WA WA WA WA WA WA

98686-2719 98070-5204 99362-4118 99362-4324 99362-1662 99362-2254 99362-2816 98951-1107 98671-2672 98801-3370

COLUMBIA VALLEY COMMUNITY HLTH PHCY SAV-ON PHARMACY

(509) 664-3508 (509) 662-5152

600 ORONDO AVE 1128 N MILLER ST

WENATCHEE WENATCHEE

WA WA

98801-2800 98801-1541

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 657 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

WENATCHEE CLINIC PHARMACY YOKES PHARMACY TWIN HARBOR UNITED DRUGS HI SCHOOL PHARMACY CEDAR VILLAGE PHARMACY BELLEGROVE PHARMACY HAGGEN PHARMACY WOODINVILLE PHARMACY INC HI SCHOOL PHARMACY ALBERTSON'S PHARMACY BARTON'S CENTER PHARMACY BI-MART PHARMACY BI-MART PHARMACY CENTRAL WA FAMILY MED PHARMACY GENOA-QOL HEALTHCARE MEMORIAL PHCY AT CORNERSTONE NORTH STAR LODGE PHARMACY ROSAUERS PHARMACY TERRACE VILLAGE PHARMACY TIETON VILLAGE DRUGS WRAY'S CHALET PHARMACY WRAY'S MEADOWBROOK PHARMACY

Provider Name

(509) 662-5801 (509) 967-8008 (360) 268-0505 (509) 493-4842 (360) 785-4711 (425) 455-2123 (425) 398-6710 (425) 485-2900 (360) 225-9475 (509) 248-4274 (509) 248-6232 (509) 452-6648 (509) 457-1628 (509) 494-6719 (509) 248-5153 (509) 573-3808 (509) 574-3400 (509) 972-0284 (509) 248-3311 (509) 966-6850 (509) 966-0530 (509) 966-0202

820 N CHELAN AVE 1401 BOMBING RANGE RD 733 N MONTESANO ST 250 E JEWETT BLVD 206 E WALNUT ST 18800 142ND AVE NE #4B 17641 GARDEN WAY NE 17000 140TH AVE NE UNIT E101 1365 LEWIS RIVER RD 1610 W LINCOLN AVE 1011 W SPRUCE ST 309 S 5TH AVE 1207 N 40TH AVE 1806 W LINCOLN AVE 402 S 4TH AVE 4003 CREEKSIDE LOOP 808 N 39TH AVE 410 S 72ND AVE 4040 TERRACE HEIGHTS DR # 120 3708 TIETON DR 5605 SUMMITVIEW AVE 7200 W NOB HILL BLVD

WENATCHEE WEST RICHLAND WESTPORT WHITE SALMON WINLOCK WOODINVILLE WOODINVILLE WOODINVILLE WOODLAND YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA YAKIMA

WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA WA

98801-2028 99353 98595-9730 98672 98596-9419 98072 98072-3535 98072-6903 98674-9692 98902-2408 98902-3332 98902-3548 98908-9456 98902-2473 98902-3546 98908-3962 98902-6388 98908-1673 98901-1464 98902-3664 98908-3039 98908-1928

YAKIMA NEIGHBORHOOD HEALTH SERVICES

(509) 853-2354

12 S 8TH ST

YAKIMA

WA

98901-3020

YAKIMA VLY FARM WORKERS CLINIC PHCY TIM'S PHARMACY & GIFT SHOP AURORA PHARMACY CHET JOHNSON & SONS JOHNSON DRUG AT ARMC LAKESIDE PHARMACY CONSUMER PRESCRIPTION CENTER COPPS FOOD CENTER PHARMACY COPPS FOOD CENTER PHARMACY COPPS FOOD CENTER PHARMACY FOX VALLEY FAMILY PHARMACY HEALTH DIRECT IPS HUHN DRUG THE MEDICINE SHOPPE WALLY SHONG HEALTH MART PHCY VILLAGE PHARMACY VILLAGE PHARMACY AT WWH

(866) 983-9279 (360) 458-8467 (920) 487-2887 (715) 268-8121 (715) 268-0678 (715) 623-2631 (920) 739-9232 (920) 996-0121 (920) 831-0400 (920) 734-3882 (920) 702-4802 (920) 739-5900 (715) 682-3123 (715) 682-2701 (715) 286-2515 (715) 684-2674 (715) 688-2674

602 E NOB HILL BLVD 106 1ST ST S 801 JEFFERSON ST 204 KELLER AVE N 265 GRIFFIN ST E 536 5TH AVE 2310 W COLLEGE AVE 2700 N BALLARD RD 2400 W WISCONSIN AVE 511 W CALUMET ST 3925 N GATEWAY DR 3701 E EVERGREEN DR STE 1000 522 W MAIN ST 510 ELLIS AVE 120 W LINCOLN ST 840 MAIN STREET 1100 BERGSLIEN ST

YAKIMA YELM ALGOMA AMERY AMERY ANTIGO APPLETON APPLETON APPLETON APPLETON APPLETON APPLETON ASHLAND ASHLAND AUGUSTA BALDWIN BALDWIN

WA WA WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

98901-3534 98597-7700 54201-1733 54001-1036 54001-1439 54409-2221 54914-4644 54911-8657 54914-3109 54915-1462 54913-7863 54913 54806-1512 54806-1632 54722-9152 54002 54002

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 658 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

BALSAM LAKE PHARMACY UNITY PHARMACY CORNER DRUG CLINIC PHARMACY CORNER DRUG STORE ECONOFOODS PHARMACY JAMES PHARMACY BDCH PHARMACY BEAVER DAM HOMETOWN PHCY BELLEVILLE HOMETOWN PHARMACY HOMECARE PHARMACY FIELD PHARMACY LLC BLACK RIVER FALLS CLINIC PHCY BLAIR PHARMACY ED'S HEALTH MART PHARMACY BOSCOBEL PHARMACY INC PINNOW HOMETOWN PHARMACY AURORA PHARMACY AURORA PHARMACY AURORA PRESCRIPTION DISP CTR HEALTHDIRECT IPS #124 METRO MARKET PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY WHEATON FRANCISCAN PHARMACY PICK N SAVE PHARMACY AGNESIAN PHARMACY BROWNSVILLE AURORA PHARMACY AURORA PHARMACY AURORA PHARMACY PICK N SAVE PHARMACY THE PHARMACY STATION MILLER DRUG VILLAGE PHARMACY & GIFTS VILLAGE APOTHECARY AURORA PRESCRIPTION DISP CTR

Provider Name

(715) 485-3374 (715) 825-4498 (608) 356-6966 (608) 356-8701 (715) 537-5345 (715) 537-5005 (920) 356-0040 (920) 356-1500 (608) 424-3364 (608) 362-1234 (920) 361-1565 (715) 284-4089 (608) 989-2919 (715) 568-2190 (608) 375-4466 (608) 897-2595 (262) 782-8125 (262) 786-8080 (262) 641-7665 (262) 395-4658 (262) 784-2490 (262) 783-7302 (262) 782-2787 (262) 373-1080 (262) 780-4430 (414) 354-7213 (920) 583-1310 (262) 767-6004 (262) 763-7177 (262) 971-9550 (262) 767-1446 (262) 763-8877 (715) 289-3243 (608) 423-3231 (920) 533-4012 (920) 668-6286

315 MAIN ST 1504 190TH AVE 1700 TUTTLE ST 522 OAK ST 622 LA SALLE AVE 337 E LA SALLE AVE 705 S UNIVERSITY AVE 709 N SPRING ST 1019 RIVER ST STE 1 1006 WOODWARD AVE 135 W HURON ST 610 W ADAMS ST 125 W BROADWAY ST 1511 MAIN ST 1028 WISCONSIN AVE 1028 1ST CENTER AVE 16985 W BLUEMOUND RD STE 100 17280 W NORTH AVE STE 103 16985 W BLUEMOUND RD STE 100 150 N PATRICK BLVD STE 250 17630 W BLUEMOUND RD 12735 W CAPITOL DR 15170 W GREENFIELD AVE 17295 W CAPITOL DR 19333 W NORTH AVE STE 390 9200 N GREENBAY ROAD 900 MAIN STREET 250 MCHENRY ST 210 S PINE ST 709 SPRING VALLEY RD STE 1200 1008 MILWAUKEE AVE 300 S PINE ST 318 N MAIN 109 W MAIN ST 110 W MAIN ST 313 S MAIN ST

BALSAM LAKE BALSAM LAKE BARABOO BARABOO BARRON BARRON BEAVER DAM BEAVER DAM BELLEVILLE BELOIT BERLIN BLACK RIVER FALLS BLAIR BLOOMER BOSCOBEL BRODHEAD BROOKFIELD BROOKFIELD BROOKFIELD BROOKFIELD BROOKFIELD BROOKFIELD BROOKFIELD BROOKFIELD BROOKFIELD BROWN DEER BROWNSVILLE BURLINGTON BURLINGTON BURLINGTON BURLINGTON BURLINGTON CADOTT CAMBRIDGE CAMPBELLSPORT CEDAR GROVE

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54810-7262 54810-7102 53913-3319 53913-2478 54812-1649 54812-1502 53916 53916-2041 53508-9181 53511-5427 54923-1545 54615 54616-9367 54724-1640 53805-1532 53520-1420 53005-5909 53045-4366 53005-5946 53045 53045-2908 53005-2442 53005-7018 53045-2004 53045-4132 53209 53006 53105-1828 53105-1914 53105-7614 53105-1362 53105-2235 54727-9658 53523-9141 53010 53013-1611

YE OLDE PHARMACY AND WELLNESS CNTR OHDE HEALTH MART PHARMACY CHIPPEWA CLINIC PHARMACY KONSELLA HEALTH MART PHARMACY THE MEDICINE SHOPPE

(262) 375-0010 (715) 924-3592 (715) 723-2824 (715) 723-9177 (715) 723-9192

N54W6135 MILL ST 628 2ND ST 2509 COUNTY HIGHWAY I 212 BAY ST 603 N BRIDGE ST

CEDARBURG CHETEK CHIPPEWA FALLS CHIPPEWA FALLS CHIPPEWA FALLS

WI WI WI WI WI

53012-2021 54728-9007 54729-1422 54729-2491 54729-2424

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 659 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CLINTON PHARMACY ERICKSON PHARMACY VILLAGE PHARMACY INC COLFAX HEALTHMART PHARMACY CORNELL PHARMACY COTTAGE GROVE HOMETOWN PHCY CRANDON PHARMACY CRIVITZ PHARMACY CROSS PLAINS PHARMACY CUBA CITY HOMETOWN PHARMACY AURORA ST. LUKE'S SOUTH SHORE PICK N SAVE PHARMACY SCHNEIDER DRUG THE APOTHECARY HARTIG DRUG CO. DEFOREST HOMETOWN PHARMACY AURORA PHARMACY DEERFIELD HOMETOWN PHARMACY

Provider Name

(608) 676-2700 (715) 823-2222 (920) 897-5333 (715) 962-3784 (715) 239-6453 (608) 839-3335 (715) 478-3313 (715) 854-7425 (608) 798-3031 (608) 744-2440 (414) 489-4600 (414) 744-6058 (715) 822-2434 (715) 822-2424 (608) 776-4481 (608) 846-4736 (920) 403-8050 (608) 764-1500

238 ALLEN ST 8 S MAIN ST STE B 633 N HWY 141 525 MAIN ST 300 MAIN ST 536 SOUTHING GRANGE UNIT G 101 N LAKE AVE 710 MAIN AVE 1910 MAIN ST 122 N MAIN ST 5900 S LAKE DR 5851 S PACKARD AVE 1296 2ND AVE 1470 WEBB ST 327 MAIN ST 645 S MAIN ST 1881 CHICAGO ST 10 LIBERTY ST STE 106

CLINTON CLINTONVILLE COLEMAN COLFAX CORNELL COTTAGE GROVE CRANDON CRIVITZ CROSS PLAINS CUBA CITY CUDAHY CUDAHY CUMBERLAND CUMBERLAND DARLINGTON DE FOREST DE PERE DEERFIELD

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

53525-9496 54929-1565 54112 54730-9083 54732-8384 53527-9337 54520-1386 54114 53528-9594 53807 53110-3171 53110-2615 54829-7210 54829-9187 53530-1425 53532-1421 54115-3770 53531-9458

CORNER DRUG HOMETOWN PHARMACY ECONOFOODS PHARMACY HEIKE PHARMACY INC TRIGS PHARMACY WALL STREET HEALTH CARE PHARMACY EAST TROY HOMETOWN PHARMACY HEALTH DIRECT IPS

(608) 935-3661 (715) 672-5900 (715) 672-5202 (715) 479-6413 (715) 479-3306 (262) 642-3510 (715) 832-3780

206 N IOWA ST 520 W MAIN ST 213 W MAIN ST 925 E WALL ST 123 E WALL ST 3284 MAIN ST 3184 LONDON RD

DODGEVILLE DURAND DURAND EAGLE RIVER EAGLE RIVER EAST TROY EAU CLAIRE

WI WI WI WI WI WI WI

53533-1548 54736 54736-1146 54521-8720 54521-0000 53120-1152 54701

VALUE CENTER HEALTH MART PHARMACY EDGERTON PHARMACY AURORA PRESCRIPTION DISP CTR AURORA PRESCRIPTION DISP CTR PLAZA PHARMACY THE PHARMACY STATION EVANSVILLE HOMETOWN PHARMACY HARTIG DRUG CO. FITCHBURG HOMETOWN PHARMACY FLORENCE PRESCRIPTION SERVICES AGNESIAN PHARMACY AGNESIAN PHARMACY - WEST AGNESIAN PRESC CNTR HLTH PLAZA AURORA PHARMACY PHARMACY PLUS

(715) 833-6760 (608) 884-3308 (262) 741-2311 (262) 741-1955 (262) 723-8444 (262) 723-6466 (608) 882-4550 (608) 822-3601 (608) 274-3784 (715) 254-1010 (920) 921-4660 (920) 929-7480 (920) 926-5455 (920) 907-7260 (920) 926-8585

2421 E CLAIREMONT AVE 711 N MAIN ST W3985 COUNTY ROAD NN 201 E MORRISSEY DR STE 100 603 E GENEVA ST 3 E GENEVA ST # THE 21 W MAIN ST 1120 LINCOLN AVE 3000 CAHILL MAIN STE J114 1010 OLIVE AVE 145 N MAIN ST 912 S HICKORY ST 421 CAMELOT DR 210 WISCONSIN AMERICAN DR 420 E DIVISION ST

EAU CLAIRE EDGERTON ELKHORN ELKHORN ELKHORN ELKHORN EVANSVILLE FENNIMORE FITCHBURG FLORENCE FOND DU LAC FOND DU LAC FOND DU LAC FOND DU LAC FOND DU LAC

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54701-6724 53534-1530 53121-4337 53121-4395 53121-2301 53121-1718 53536-1143 53809-1746 53711-7132 54121 54935-3423 54935-5530 54935-8335 54937 54935-4560

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 660 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PICK N SAVE PHARMACY PICK 'N SAVE PHARMACY TUTTLES PHARMACY AURORA PHARMACY PICK N SAVE PHARMACY WHEATON FRANCISCAN PHARMACY FREDERIC PHARMACY PHILLIPS ROCHE-A-CRI PHCY GALESVILLE PHARMACY PICK N SAVE PHARMACY PROVIDENCE FAMILY PHARMACY LLC VILLAGE PHARMACY GLENWOOD AURORA PHARMACY PICK N SAVE PHARMACY WOOD RIVER PHARMACY AURORA PHARMACY AURORA PRESCRIPTION DISP CTR

Provider Name

(920) 929-7422 (920) 923-7780 (920) 563-2458 (414) 529-9275 (414) 427-8692 (414) 325-4740 (715) 327-4208 (608) 339-9080 (608) 582-2446 (262) 253-0052 (414) 885-0550 (715) 565-3465 (262) 329-1600 (262) 375-1628 (715) 463-2525 (920) 288-3140 (920) 327-7220

760 W JOHNSON ST 55 W PIONEER RD 102 S MAIN ST 9200 W LOOMIS RD 7201 S 76TH ST 10101 S 27TH ST RM 1005 201 OAK ST WEST 402 W LAKE ST 16812 S MAIN ST N112W16200 MEQUON RD 2500 W SILVER SPRING DR 224 W. OAK ST. 975 PORT WASHINGTON RD STE 100 301 FALLS RD 122 W MADISON AVE 2845 GREENBRIER RD 2253 W MASON ST

FOND DU LAC FOND DU LAC FORT ATKINSON FRANKLIN FRANKLIN FRANKLIN FREDERIC FRIENDSHIP GALESVILLE GERMANTOWN GLENDALE GLENWOOD CITY GRAFTON GRAFTON GRANTSBURG GREEN BAY GREEN BAY

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54935-2016 54935-6151 53538-2014 53132-8887 53132-9041 53132-9533 54837 53934-9699 54630 53022-3334 53209-4218 54013 53024-9201 53024-2620 54840-7022 54311-6519 54303-4706

AURORA VISITING NURSE ASSOCIATION COPPS FOOD CENTER PHARMACY COPPS FOOD CENTER PHARMACY CUSTOM HEALTH PHARMACY, INC KRIDER PHARMACY LINEVILLE HEALTHMART PHARMACY STREU'S PHARMACY INC HAYAT PHARMACY #6 PICK N SAVE PHARMACY PICK N SAVE PHARMACY AURORA PHARMACY AURORA PHARMACY AURORA PRESCRIPTION DISP CTR CO-OP PHARMACY

(920) 288-5141 (920) 469-3436 (920) 498-9783 (920) 884-7345 (920) 499-6225 (920) 434-1444 (920) 437-0206 (414) 817-6666 (414) 541-3836 (414) 525-0763 (262) 670-4210 (262) 367-3141 (262) 369-7080 (715) 634-8238

931 DISCOVERY RD 1819 MAIN ST 1291 LOMBARDI ACCESS RD 844 WILLARD DR STE 7 1119 W MASON ST 2673 LINEVILLE RD 635 MAIN ST 4931 S 27TH ST STE 400 4279 S 76TH ST 5800 S 108TH ST 1640 E SUMNER ST 109 E CAPITOL DR 600 WALNUT RIDGE DR 15870 W 1ST ST

GREEN BAY GREEN BAY GREEN BAY GREEN BAY GREEN BAY GREEN BAY GREEN BAY GREENFIELD GREENFIELD HALES CORNERS HARTFORD HARTLAND HARTLAND HAYWARD

WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54311-8002 54302-3918 54304-4046 54304-5265 54303-1860 54313 54301-4918 53221-2653 53220-2804 53130-1912 53027 53029-2103 53029-9385 54843-7106

ESSENTIA HEALTH HAYWARD PHARMACY MARKETPLACE PHARMACY PETERSON PHARMACY DEGEN BERGLUND INC MARSHLAND PHARMACIES AURORA PHARMACY AURORA PHARMACY COUNTY MARKET PHARMACY FAMILY FRESH MARKET PHARMACY

(715) 634-6774 (715) 634-1817 (608) 489-3141 (608) 775-8875 (920) 485-3400 (920) 565-5425 (262) 628-3550 (715) 381-5923 (715) 381-9661

11134 N COUNTY RD S APT 77 10514 MAIN ST 727 WATER AVE 600 N HOLMEN DR STE 1 700 WASHINGTON ST 620 S WISCONSIN DR 1303 STATE ROAD 175 2310 CREST VIEW DR 2351 COULEE RD

HAYWARD HAYWARD HILLSBORO HOLMEN HORICON HOWARDS GROVE HUBERTUS HUDSON HUDSON

WI WI WI WI WI WI WI WI WI

54843-3431 54843-6720 54634-6229 54636 53032 53083-1263 53033-9304 54016-9315 54016-9177

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 661 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

HUDSON HOSPITAL & CLINICS PHARMACY MICKLESEN DRUG INC WHITE CROSS PHARMACY

(715) 531-6450 (715) 386-3344 (715) 561-5666

405 STAGELINE RD 530 2ND ST 314 SILVER ST

HUDSON HUDSON HURLEY

WI WI WI

54016-7848 54016-1512 54534-1254

SWEET MEDICINE PRESCRIPTIONS PLUS NORTHLAKES CLINIC PHARMACY GENOA-QOL HEALTHCARE JANESVILLE HOMETOWN PHARMACY MERCY EAST PHARMACY MERCY MALL PHARMACY MERCY WEST PHARMACY SSM HEALTH PHARMACY

(715) 445-3117 (715) 372-5011 (262) 677-1401 (608) 752-7869 (608) 754-5194 (608) 754-0286 (608) 741-6980 (608) 371-8100

155 N MAIN ST 7665 US HIGHWAY 2 W209N17321 INDUSTRIAL DR 21 S JACKSON ST 3524 E MILWAUKEE ST 1010 N WASHINGTON ST # 105 1000 MINERAL POINT AVE 3200 EAST RACINE ST

IOLA IRON RIVER JACKSON JANESVILLE JANESVILLE JANESVILLE JANESVILLE JANESVILLE

WI WI WI WI WI WI WI WI

54945-9120 54847 53037-9389 53548 53546-1626 53548-1561 53548-2940 53546-2343

THE DRUG STORE MUELLER DRUGS INC AURORA PRESCRIPTION DISP CTR AURORA PHARMACY AURORA PRESCRIPTION DISP CTR AURORA PRESCRIPTION DISP CTR GOOD VALUE PHARMACY GOOD VALUE PHARMACY

(920) 674-5733 (920) 759-3050 (262) 948-7040 (262) 551-2790 (262) 605-3674 (262) 697-5744 (262) 925-0201

132 S MAIN ST 2700 CROOKS AVE 10400 75TH ST 2707 15TH PL STE 101 7540 22ND AVE 3207 80TH ST STE 100 9916 75TH ST STE 203

JEFFERSON KAUKAUNA KENOSHA KENOSHA KENOSHA KENOSHA KENOSHA

WI WI WI WI WI WI WI

53549-1632 54130-3900 53142-7884 53140-4497 53143-5702 53142-4908 53142-7583

GOOD VALUE PHARMACY MEDCARE WEST GOOD VALUE PHCY LARSEN-MAYER MODERN APOTHECARY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY FHHP KEWASKUM AURORA PHARMACY ASSOCIATES PHARMACY CASS ST PHARMACY GHS DEGEN BERGLUND PHARMACY GENOA-QOL HEALTHCARE RUSK COUNTY PHARMACY

(262) 925-0201 (262) 658-8124 (262) 997-9573 (262) 551-0367 (262) 697-5424 (262) 653-1202 (262) 477-1700 (920) 894-4370 (920) 459-8768 (608) 784-9922 (608) 775-8585 (608) 433-2287 (715) 532-3339

9916 75TH ST STE 103 3535 30TH AVE STE 103 4924 7TH AVE 2811 18TH ST 5710 75TH ST 1901 63RD ST 901 FOND DU LAC AVE 1001 SERVICE RD STE 101 795 WOODLAKE RD STE C 528 CASS ST 2511 GREEN BAY ST 1707 MAIN ST STE 102 400 W 9TH ST N

KENOSHA KENOSHA KENOSHA KENOSHA KENOSHA KENOSHA KEWASKUM KIEL KOHLER LA CROSSE LA CROSSE LA CROSSE LADYSMITH

WI WI WI WI WI WI WI WI WI WI WI WI WI

53142-7583 53144-1632 53140-3349 53140-4665 53142-3635 53143-4467 53040 53042-1297 53044 54601 54601 54601-4200 54848-1249

VERNON MEMORIAL PHARMACY LAFARGE AURORA PHARMACY MERCY WALWORTH PHARMACY NICOLET PHARMACY INC HARTIG DRUG CO

(608) 625-2552 (262) 249-7119 (262) 245-2319 (715) 276-3646 (608) 723-4737

206 N. MILL ST. 146 E GENEVA SQ N2950 STATE ROAD 67 15481 COMMERCIAL RD STE A 139 W MAPLE ST

LAFARGE LAKE GENEVA LAKE GENEVA LAKEWOOD LANCASTER

WI WI WI WI WI

54639 53147-9694 53147-2655 54138-9677 53813-1640

NR_0009_10823 10/2017

Page 662 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name

Provider Phone Number

Provider Street

Provider City

State

ZIP code

LAND O LAKES HEALTH CARE PHARMACY LAONA PHARMACY SMITH PHARMACY LODI HOMETOWN PHARMACY AURORA PHARMACY LUCK PHARMACY LUXEMBURG PHARMACY, LLC AMC PHARMACY COMMUNITY PHARMACY COPPS FOOD CENTER PHARMACY DEAN PHARMACY GENOA-QOL HEALTHCARE HOEY APOTHECARY MALLATT PHARMACY METRO MARKET PHARMACY NEUHAUSER PHARMACIES, INC. SSM HEALTH CLINIC SSM HEALTH PHARMACY SSM HEALTH PHARMACY ST MARYS CARE CENTER PHARMACY AURORA PHARMACY COPPS FOOD CENTER PHARMACY HFM PHARMACY

(715) 547-3788 (715) 674-2635 (920) 788-8888 (920) 992-6800 (920) 269-2080 (715) 472-2122 (920) 845-5832 (800) 486-6276 (608) 251-4454 (608) 243-7788 (608) 252-8044 (608) 251-1838 (608) 221-4639 (608) 310-9922 (608) 223-0951 (608) 256-8712 (608) 824-4500 (608) 256-6465 (608) 260-6500 (608) 845-0447 (920) 686-5237 (920) 682-3051 (920) 320-4400

4348A COUNTY ROAD B 4876 MILL ST 1800 FREEDOM RD UNIT D 801 N MAIN ST STE I 375 EAST AVE STE 1 132 S MAIN ST 125 SCHOOL CREEK TRL 600 WILLIAMSON ST STE H 341 STATE ST 2502 SHOPKO DR 1313 FISH HATCHERY RD 625 W WASHINGTON AVE 217 COTTAGE GROVE RD 3250 KINGSLEY WAY 6010 COTTAGE GROVE RD 1875 MONROE ST 752 N HIGH POINT RD 700 S PARK ST 1821 S STOUGHTON RD 3401 MAPLE GROVE DR 601 REED AVE 3300 CALUMET AVE 3310 CALUMET AVE

LAND O LAKES LAONA LITTLE CHUTE LODI LOMIRA LUCK LUXEMBURG MADISON MADISON MADISON MADISON MADISON MADISON MADISON MADISON MADISON MADISON MADISON MADISON MADISON MANITOWOC MANITOWOC MANITOWOC

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54540-9635 54541-0000 54140 53555 53048-9202 54853 54217-1095 53703-3588 53703-2057 53704-4119 53715-1911 53703-2637 53716-1105 53713-4628 53718-6582 53711-2024 53717-2236 53715-1830 53716-2257 53719-5013 54220-2026 54220-5426 54220-5426

HOLY FAMILY MEMORIAL MED CTR PHCY MANITOWOC PHARMACIES INC AURORA PHARMACY VALUCARE CENTER MARKESAN PHARMACY PHILLIPS PHARMACY AGNESIAN PHARMACY MAYVILLE MCFARLAND HOMETOWN PHARMACY THE MEDICINE SHOPPE MEDFORD PHARMACY MEDICAL CENTER PHARMACY AURORA PHARMACY AURORA SPECIALTY PHARMACY

(920) 320-2273 (920) 684-6789 (715) 732-8040 (715) 732-0717 (920) 398-3261 (608) 847-5949 (920) 387-7570 (608) 838-7455 (608) 838-5700 (715) 748-4477 (715) 748-5800 (262) 251-8500 (262) 253-3000

2300 WESTERN AVE 919 S 8TH ST 4061 OLD PESHTIGO RD 1378 MAIN ST 49 S BRIDGE ST 123 E STATE ST 360 S MOUNTIN DR 4880 LARSON BEACH RD 5700 U S HIGHWAY 51 210 S MAIN ST 139 S GIBSON ST N84W16889 MENOMONEE AVE # 1408 N93W14575 WHITTAKER WAY

MANITOWOC MANITOWOC MARINETTE MARINETTE MARKESAN MAUSTON MAYVILLE MC FARLAND MCFARLAND MEDFORD MEDFORD MENOMONEE FALLS MENOMONEE FALLS

WI WI WI WI WI WI WI WI WI WI WI WI WI

54220-3712 54220-4504 54143-3887 54143-2425 53946-8043 53948-0136 53050-1498 53558-8724 53558 54451-1843 54451-1622 53051-2810 53051-1652

COMMUNITY MEMORIAL HOSP PHARMACY FALLS LTC PHARMACY FROEDTERT HLTH MF CLINIC PHCY

(262) 257-3073 (262) 437-0031 (262) 532-3050

W180N8085 TOWN HALL RD N85W15882 APPLETON AVE W180N8000 TOWN HALL RD

MENOMONEE FALLS MENOMONEE FALLS MENOMONEE FALLS

WI WI WI

53051-3518 53051-3082 53051

NR_0009_10823 10/2017

Page 663 of 679

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PICK N SAVE PHARMACY PICK N SAVE PHARMACY THE MEDICINE SHOPPE COLUMBIA ST MARYS PHARMACY MEQUON PHARMACY METRO MARKET PHARMACY SKYWALK MEQUON JOHNSON PHARMACY YOUNG'S DRUG STORE MILTON PHARMACY AMC PHARMACY ASLMC PHARMACY ASLMC PHARMACY AURORA OHC PHARMACY AURORA PHARMACY AURORA PHARMACY AURORA PHARMACY AURORA PHARMACY AURORA PHARMACY AURORA PHARMACY AURORA PRESCRIPTION DISP CNTR AURORA PRESCRIPTION DISP CTR AURORA SINAI MEDICAL CTR INC

Provider Name

(262) 253-4705 (262) 255-8673 (715) 309-4329 (262) 243-6700 (262) 241-5320 (262) 241-7983 (262) 236-7722 (715) 539-2772 (715) 536-2909 (608) 868-6777 (414) 225-1542 (414) 649-6738 (414) 649-6930 (414) 219-7963 (414) 540-9236 (414) 224-1555 (414) 385-0244 (414) 385-7868 (414) 541-2400 (414) 325-5236 (414) 586-5665 (414) 744-4302 (414) 219-3100

N95 W18351 COUNTY LINE RD N77W14435 APPLETON AVE 1302 STOUT RD 13133 N PORT WASHINGTON RD 10932 N PORT WASHINGTON RD STE 11558 N PORT WASHINGTON RD 1655 W MEQUON RD 1021 EAST MAIN STREET 301 E 2ND ST 725 S JANESVILLE ST 820 N PLANKINTON AVE 2801 W KK RIVER PKWY STE 125 2900 W OKLAHOMA AVE STE 1001 1020 N 12TH ST 3003 W GOOD HOPE RD STE 1129 1575 N RIVERCENTER DR 3355 W FOREST HOME AVE 2906 S 20TH ST 2700 S 60TH ST 6901 W EDGERTON AVE 7878 N 76TH ST STE 101 180 W GRANGE AVE 945 N 12TH ST

MENOMONEE FALLS MENOMONEE FALLS MENOMONIE MEQUON MEQUON MEQUON MEQUON MERRILL MERRILL MILTON MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

53051 53051-4306 54751-2979 53097-2419 53092-5031 53092-3416 53092 54452 54452-2317 53563-1775 53203-1802 53215-3678 53215-4330 53233-1308 53209-2042 53212-3978 53215-2843 53215-3732 53219-3151 53220-4420 53223-3914 53207-6030 53233-1305

AURORA VISITING NURSE ASSOCIATION CENTER FOR ADVANCED CARE PHCY DAN FITZGERALD PHARMACY INC DRUGS R US INC FROEDTERT CLINIC PHARMACY FROEDTERT EYE INSTITUTE PHCY FROEDTERT HOSP CAN CNTR FROEDTERT HOSP O/P PHCY GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE HAYAT HAYAT PHARMACY HAYAT PHARMACY HAYAT PHARMACY HAYAT PHARMACY 7 HAYEK SHOREWOOD PHARMACY MEDICATE PHARMACY INC MEDPACK PHARMACY

(414) 328-4503 (414) 805-1295 (414) 332-8380 (414) 332-9300 (414) 805-6501 (414) 955-3360 (414) 805-0977 (414) 805-5113 (414) 244-9844 (414) 244-9844 (414) 374-0000 (414) 817-1111 (414) 454-0000 (414) 509-2222 (414) 858-1111 (414) 332-8870 (414) 539-3912 (414) 436-7311

11333 W NATIONAL AVE 9200 W WISCONSIN AVE 424 E SILVER SPRING DR 3512 N OAKLAND AVE 9200 W WISCONSIN AVE 925 N 87TH ST 9200 W WISCONSIN AVE STE 200C 9200 W WISCONSIN AVE 229 E WISCONSIN AVE STE 601 10424 W BLUEMOUND RD STE B 1919 W NORTH AVE 5434 W CAPITOL DR 5928 W VLIET ST 8434 W SILVER SPRING DR 5312 W VILLARD AVE 4001 N DOWNER AVE 2741 W LAYTON AVE STE 102 7324 W CAPITOL DR

MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

53227-3111 53226-3522 53217-5224 53211-2701 53226-3522 53226 53226-3522 53226-3522 53202-4230 53226-4331 53205-1153 53216 53208-2165 53225-2824 53218 53211-2127 53221-2600 53216-2062

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 664 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name METRO MARKET PHARMACY MIDTOWN PHARMACY MIDTOWN PHARMACY OPTION CARE PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PROCARE PHARMACY SETON PHARMACY THOMPSON'S SERV-U PHARMACY UNION SERV-U PHARMACY WCS CLINIC PHCY WHEATON FRANCISCAN PHARMACY WHEATON FRANCISCAN PHARMACY WHEATON FRANCISCAN PHARMACY WHEATON FRANCISCAN PHARMACY WISCONSIN HEALTH FUND ZAIBAK PRN LLC IVEY'S PHARMACY, INC. TRIG'S FOOD & DRUG MONDOVI HEALTH MART PHARMACY THE MEDICINE SHOPPE SCHULTZ PHARMACY THE CLINIC PHARMACY BENTLEY PHARMACY MT HOREB PHARMACY INC PICK N SAVE PHARMACY MILLER PHARMACY, INC. PICK N SAVE PHARMACY AURORA PRESCRIPTION DISP CTR NEENAH HOMETOWN PHARMACY PICK N SAVE PHARMACY SNITEMAN PHARMACY AURORA PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (414) 347-9219 (414) 269-0341 (414) 299-3828 (414) 908-2525 (414) 769-8990 (414) 247-8581 (414) 447-8117 (414) 374-8769 (414) 475-1932 (414) 476-5111 (414) 281-3622 (414) 760-3273 (414) 461-1428 (414) 778-1884 (414) 328-4051 (414) 931-0000 (414) 291-1303 (414) 962-9665 (414) 481-8170 (414) 343-3543 (414) 447-2585 (414) 647-5300 (414) 281-7500 (414) 259-7440 (414) 771-5606 (414) 463-1111 (608) 987-2336 (715) 356-9449 (715) 926-4938 (608) 221-8151 (608) 325-2151 (608) 325-3111 (608) 297-2474 (608) 437-3001 (262) 554-1116 (262) 363-4001 (262) 363-1680 (414) 422-4257 (920) 992-6800 (920) 722-1348 (715) 743-3500 (262) 827-9062

Provider Street 1123 N VAN BUREN ST 7235 W APPELTON AVE STE 101 7733 W BURLEIGH ST 1435 N 113TH ST 250 W HOLT AVE 1735 W SILVER SPRING DR 2355 N 35TH ST 1100 E GARFIELD AVE 6950 W STATE ST 6760 W NATIONAL AVE 3701 S 27TH ST 7401 W GOOD HOPE RD 10202 W SILVER SPRING DR 1717 N MAYFAIR RD 2625 S 108TH ST 3727 W WISCONSIN 2323 N LAKE DR 1421 E CAPITOL DR 709 W OKLAHOMA AVE 3734 W WISCONSIN AVE 5000 W CHAMBERS ST RM 1801 3237 S 16TH ST RM 121 2500 W LAYTON AVE 201 N MAYFAIR RD 6118 W BLUEMOUND RD 8500 W CAPITOL DR 128 HIGH ST 9750 STATE HIGHWAY 70 122 S EAU CLAIRE ST 4205 MONONA DR 1008 17TH AVE 515 22ND AVE 25 W MONTELLO ST 203 W MAIN ST 2820 S GREEN BAY RD 801 N ROCHESTER ST 1010 N ROCHESTER ST S68W15500 JANESVILLE RD 1415 S COMMERCIAL ST 828 FOX POINT PLZ 528 HEWETT ST 14555 W NATIONAL AVE

Page 665 of 679

Provider City MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MILWAUKEE MINERAL POINT MINOCQUA MONDOVI MONONA MONROE MONROE MONTELLO MOUNT HOREB MOUNT PLEASANT MUKWONAGO MUKWONAGO MUSKEGO NEENAH NEENAH NEILLSVILLE NEW BERLIN

State

ZIP code

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

53202-3269 53216 53222-5003 53226-3213 53207-3200 53209-4400 53210-3033 53212-3473 53213-2842 53214-4965 53221-1304 53223-4618 53225-3265 53226-3019 53227-1931 53208-3182 53211-4508 53211-1956 53215-4719 53208-3153 53210-1650 53215-4526 53221-5420 53226-4216 53213-4143 53222-1869 53565-1208 54548-9753 54755-1504 53716-1663 53566-2005 53566-1569 53949-9701 53572-1914 53406-4950 53149-1142 53149-8738 53150-2613 54956-4637 54956-3781 54456-1926 53151-4494

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FROEDTERT & MCW MOORLAND PHCY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PRN RX SKYWALK PHARMACY NEW BERLIN NEW GLARUS HOMETOWN PHARMACY RAABE'S PHARMACY JERNEGAN'S HEALTH MART PHARMACY FAMILY FRESH MARKET PHARMACY WESTFIELDS COMMUNITY PHARMACY

Provider Name

(262) 798-7386 (262) 827-0201 (262) 938-0133 (262) 784-9600 (262) 432-7613 (608) 527-2517 (608) 562-3302 (920) 982-7670 (715) 246-2186 (715) 243-2970

4805 S MOORLAND RD RM G0502A 13995 W NATIONAL AVE 15445 W NATIONAL AVE 5478 S WESTRIDGE DR STE B 4855 S MOORLAND RD 1101 STATE ROAD 69 STE 7 112 S ADAMS ST 1301 MILL ST 110 W 4TH ST 535 HOSPITAL RD

NEW BERLIN NEW BERLIN NEW BERLIN NEW BERLIN NEW BERLIN NEW GLARUS NEW LISBON NEW LONDON NEW RICHMOND NEW RICHMOND

WI WI WI WI WI WI WI WI WI WI

53151 53151-4524 53151-5156 53151 53151-7494 53574-9311 53950-1206 54961 54017-1722 54017-1449

AGNESIAN PHARMACY NORTH FOND DU LAC PICK N SAVE PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY AURORA PHARMACY PICK N SAVE PHARMACY PICK N SAVE PHARMACY PRESCRIPTION CENTER PHARMACIES PROHEALTH CARE PHARMACY TOBIN DRUGS OCONTO PHARMACY

(920) 926-8660 (414) 761-1550 (414) 761-1692 (414) 762-6770 (262) 569-8204 (262) 200-7000 (262) 567-7938 (262) 567-7267 (262) 569-0284 (262) 567-6651 (920) 834-4455

723 PARK RIDGE LN 6462 S 27TH ST 2320 W RYAN RD 8770 S HOWELL AVE 1284 SUMMIT AVE 1300 PABST FARMS CIRCLE 36903 E WISCONSIN AVE 888 THACKERAY TRL STE 101 791 SUMMIT AVE 1260 BROWN ST # A 1008 MAIN ST

NORTH FOND DU LAC OAK CREEK OAK CREEK OAK CREEK OCONOMOWOC OCONOMOWOC OCONOMOWOC OCONOMOWOC OCONOMOWOC OCONOMOWOC OCONTO

WI WI WI WI WI WI WI WI WI WI WI

54937-1385 53154-1036 53154-4325 53154-7524 53066-3921 53066 53066-3144 53066-4342 53066-3844 53066-2491 54153

COMMUNITY MEMORIAL HOSPITAL PHARM OCONTO FALLS PHARMACY OMRO HEALTHMART PHARMACY DEGEN BERGLUND PHARMACY OREGON HOMETOWN PHARMACY SSM HEALTH PHARMACY AURORA PHARMACY AURORA PHARMACY LHO PHARMACY MURDOCH HOMETOWN PHARMACY PICK N SAVE PHARMACY SAWYER STREET HOMETOWN PHCY SCHULTZ PHARMACY SMARTSCRIPT PHARMACY PARDEEVILLE HOMETOWN PHARMACY PARK PHARMACY PESHTIGO HOMETOWN PHARMACY PESHTIGO PHARMACY PICK N SAVE PHARMACY

(920) 846-3444 (920) 848-3721 (920) 685-5041 (608) 775-8595 (608) 835-3191 (608) 835-7175 (920) 303-5006 (920) 303-8830 (920) 966-1345 (920) 231-3300 (920) 236-9494 (920) 426-0763 (920) 233-2151 (844) 476-2781 (608) 429-2325 (715) 762-3283 (715) 582-0898 (715) 582-4237 (262) 547-6343

855 S MAIN ST 323 E HIGHLAND DR 328 E MAIN ST 111 SAND LAKE RD 815 MAIN ST 753 N MAIN ST STE 300 414 DOCTORS CT STE 100 855 N WESTHAVEN DR 225 N EAGLE ST 1828 N JACKSON ST 1940 S KOELLER ST 321 N SAWYER ST 220 N MAIN ST 4041 STATE ROAD 91 STE B 135 N MAIN ST 138 2ND AVE N 960 FRONTAGE RD 220 FRENCH ST 2160 SILVERNAIL RD

OCONTO FALLS OCONTO FALLS OMRO ONALASKA OREGON OREGON OSHKOSH OSHKOSH OSHKOSH OSHKOSH OSHKOSH OSHKOSH OSHKOSH OSHKOSH PARDEEVILLE PARK FALLS PESHTIGO PESHTIGO PEWAUKEE

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54154-1241 54154-1006 54963-1415 54650-0000 53575 53575-1003 54901-2065 54904-7668 54902-4125 54901-2204 54902-6200 54902-4252 54901-4815 54904-9218 53954-8005 54552-1214 54157-1702 54157 53072-5526

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 666 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

COPPS FOOD CENTER PHARMACY LAKEVIEW PHARMACY INC HARTIG DRUG CO

Provider Name

(715) 339-3116 (715) 339-2424 (608) 348-9771

256 S LAKE AVE 114 N LAKE AVE 180 W PINE ST

PHILLIPS PHILLIPS PLATTEVILLE

WI WI WI

54555-1320 54555-1221 53818

THE PHARMACY AT SOUTHWEST HEALTH COPPS FOOD CENTER PHARMACY COPPS PHARMACY AURORA PHARMACY WILZ DRUG INC POYNETTE HOMETOWN PHARMACY HARTIG DRUG CO PRAIRIE PHCY GUNDERSEN HEALTH BALLWEG FAMILY PHARMACY EANNELLI PHARMACY MOST PHARMACY INC BENTLEY PHARMACY PULASKI PHARMACY INC AURORA PHARMACY AURORA PHARMACY GENOA-QOL HEALTHCARE LAKEVIEW LTC PHARMACY LAKEVIEW PHCY OF RACINE INC

(608) 342-6200 (715) 344-0066 (715) 345-0585 (920) 893-1442 (608) 742-3545 (608) 635-9456 (608) 326-2581 (608) 326-8911 (608) 643-6500 (608) 643-3396 (715) 262-3294 (920) 295-6271 (920) 822-3011 (262) 639-1611 (262) 884-4030 (262) 672-6183 (262) 632-8215 (262) 632-0520

1450 E SIDE ROAD #130 1850 PLOVER RD 1542 PLOVER RD 2635 EASTERN AVE 140 E COOK ST 317 N HWY 51 101 S MARQUETTE RD 610 TAYLOR ST 1200 PRAIRIE ST 405 WATER ST 201 BROAD ST N 528 W WATER ST 121 N SAINT AUGUSTINE ST 3900 ERIE ST 8348 WASHINGTON AVE 1717 TAYLOR AVE STE P1 517 WISCONSIN AVE 516 MONUMENT SQ

PLATTEVILLE PLOVER PLOVER PLYMOUTH PORTAGE POYNETTE PRAIRIE DU CHIEN PRAIRIE DU CHIEN PRAIRIE DU SAC PRAIRIE DU SAC PRESCOTT PRINCETON PULASKI RACINE RACINE RACINE RACINE RACINE

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

53818 54467-3921 54467-3902 53073-4270 53901-2205 53955 53821-1639 53821 53578-2041 53578-1126 54021-1703 54968-9141 54162-8800 53402-3500 53406-3733 53403-2405 53403-1050 53403-1033

NUTRITIONAL DESIGNS & PHARMACY LLC WHEATON FRANCISCAN PHARMACY WHEATON FRANCISCAN PHARMACY WHEATON FRANCISCAN PHARMACY RANDOLPH HOMETOWN PHARMACY REEDSBURG AREA MED CENTER PHCY

(262) 632-6500 (262) 687-2150 (262) 687-1600 (262) 687-8430 (920) 326-5242 (608) 768-6261

5220 WASHINGTON AVE STE 101 1244 WISCONSIN AVE 3811 SPRING ST 3807 SPRING ST 107 N HIGH ST 2000 N DEWEY AVE

RACINE RACINE RACINE RACINE RANDOLPH REEDSBURG

WI WI WI WI WI WI

53406-4228 53403-1987 53405-1667 53405-1667 53956-1267 53959-1049

REEDSBURG AREA MED CTR COMM PHCY BACKE'S APOTHECARY PHARMACY STOXEN PROFESSIONAL PHCY TRIG'S PHARMACY MEDICATIONS PLUS PHARMACY OSTERBAUER DRUGS LTD RIO HOMETOWN PHARMACY RIPON DRUG ECONOFOODS PHARMACY FREEMAN DRUG FREEMAN DRUG PICK N SAVE PHARMACY

(608) 768-6205 (715) 365-5020 (715) 361-4770 (715) 369-4849 (715) 234-9021 (715) 234-3969 (920) 992-3369 (920) 748-5174 (715) 425-1325 (715) 425-2255 (715) 425-2255 (715) 241-0245

2000N DEWEY AVE 114 N BROWN ST 2251 N SHORE DR 232 S COURTNEY ST 8 E KOEPP ST 312 W KNAPP ST 208 LINCOLN AVE 328 WATSON ST 303 S MAIN ST 104 S MAIN ST 104 S MAIN ST 10101 MARKET ST

REEDSBURG RHINELANDER RHINELANDER RHINELANDER RICE LAKE RICE LAKE RIO RIPON RIVER FALLS RIVER FALLS RIVER FALLS ROTHSCHILD

WI WI WI WI WI WI WI WI WI WI WI WI

53959 54501-3162 54501-8360 54501-3319 54868-2221 54868 53960-8015 54971-1517 54022-2468 54022-2423 54022-2423 54474-7938

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 667 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

ST CROIX FALLS PHARMACY TANGEN DRUG INC AURORA PHARMACY PICK N SAVE PHARMACY ST GERMAINE HEALTH CARE PHCY SAUK CITY PHARMACY 29 SUPER PHARMACY DREIER PHARMACY & GIFT AURORA PHARMACY AURORA PHARMACY GLANDER PRESCRIPTIONS PLUS PICK N SAVE PHARMACY PICK N SAVE PHARMACY SHEBOYGAN HEALTH MART PHARMACY SHELL LAKE PHARMACY LTD METRO MARKET PHARMACY SIREN PHARMACY AURORA PHARMACY SOLAR TOWN PHARMACY SOMERSET DRUG AURORA PHARMACY SPARTA PHARMACY LLC RED CROSS PHARMACY SCHMITZS ECONOMART SPRING GREEN PHARMACY INC COPPS FOOD CENTER PHARMACY TRIGS PHARMACY MCGLYNN PHARMACY STRUM PHARMACY INC AURORA PHARMACY BAY HOMETOWN PHARMACY AURORA PHARMACY COPPS FOOD CENTER PHARMACY COPPS FOOD CENTER PHARMACY O'CONNELL PHARMACY INC SSM HEALTH PRESCRIPTION CENTER SUN PRAIRIE HOMETOWN PHARMACY

Provider Name

(715) 483-0260 (715) 483-3271 (414) 483-3800 (414) 769-0660 (715) 479-7608 (608) 643-6858 (715) 359-3194 (715) 526-2011 (920) 459-2637 (920) 459-2630 (920) 459-2755 (920) 457-5839 (920) 452-2739 (920) 459-7467 (715) 468-7800 (414) 962-3744 (715) 349-2221 (262) 644-5246 (608) 624-3344 (715) 247-3535 (414) 762-2610 (608) 269-2949 (715) 635-2117 (715) 635-8785 (608) 588-2541 (715) 345-7175 (715) 341-6102 (608) 873-3244 (715) 695-3417 (920) 746-7340 (920) 746-4110 (262) 434-7700 (608) 837-2867 (608) 837-3821 (608) 837-5949 (608) 825-3690 (608) 825-7530

216 S ADAMS ST 124 N WASHINGTON ST 2000 E LAYTON AVE 4698 S WHITNALL AVE 252 HWY 70 830 WATER ST 2806 SCHOFIELD AVE 117 S MAIN ST 509 SUPERIOR AVE 2414 KOHLER MEMORIAL DR 3529 SUPERIOR AVE 1317 N 25TH ST 2625 S BUSINESS DR 577 S TAYLOR DR 108 4TH AVE 4075 N OAKLAND AVE 24106 STATE RD 35 1061 E COMMERCE BLVD STE 100 104 SUNSET AVE 107 PARENT ST 2414 10TH AVE 201 S WATER ST 146 WALNUT ST 700 S RIVER ST 208 E JEFFERSON ST 1500 PINECREST AVE 1600 ACADEMY AVE 100 E MAIN ST 111 5TH AVE N 1910 ALABAMA ST 231 N 7TH AVE 36500 AURORA DR STE 100 2538 IRONWOOD DR 640 E MAIN ST 302 SOUTH GRAND AVENUE 10 TOWER DR STE 300 13 N BIRD ST

SAINT CROIX FALLS SAINT CROIX FALLS SAINT FRANCIS SAINT FRANCIS SAINT GERMAIN SAUK CITY SCHOFIELD SHAWANO SHEBOYGAN SHEBOYGAN SHEBOYGAN SHEBOYGAN SHEBOYGAN SHEBOYGAN SHELL LAKE SHOREWOOD SIREN SLINGER SOLDIERS GROVE SOMERSET SOUTH MILWAUKEE SPARTA SPOONER SPOONER SPRING GREEN STEVENS POINT STEVENS POINT STOUGHTON STRUM STURGEON BAY STURGEON BAY SUMMIT SUN PRAIRIE SUN PRAIRIE SUN PRAIRIE SUN PRAIRIE SUN PRAIRIE

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54024-9449 54024-9243 53235-6053 53235-6052 54558-0000 53583-1532 54476-2431 54166-2357 53081-2855 53081-3129 53081-1865 53081-3168 53081-6101 53081-4234 54871 53211 54872 53086-9326 54655 54025 53172-2507 54656-1724 54801-1319 54801-9692 53588-8002 54481 54481-1147 53589-1721 54770-9252 54235-3532 54235 53066-4899 53590-8820 53590-9696 53590 53590-1239 53590

ESSENTIA HEALTH SPECIALTY PHARMACY

(715) 817-7145

3500 TOWER AVE STE B

SUPERIOR

WI

54880-4685

ESSENTIA HEALTH SUPERIOR PHARMACY ESSENTIA HLTH SUPERIOR EAST PHCY

(715) 817-7880 (715) 817-7999

3500 TOWER AVE STE A 2202 E 2ND ST STE 477

SUPERIOR SUPERIOR

WI WI

54880-5335 54880-5395

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 668 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name PEOPLES DRUG STORE PICK N SAVE PHARMACY THREE LAKES PHARMACY MEDICINE SHOPPE PHILLIPS TOMAH PHARMACY TOMAHAWK PHARMACY JAMES PHARMACY AURORA PRESCRIPTION DISP CNTR AURORA PHARMACY AURORA PRESCRIPTION DISP CTR THE MEDICINE SHOPPE AURORA PHARMACY VERONA HOMETOWN PHARMACY VERNON MEMORIAL PHARMACY PICK N SAVE PHARMACY AURORA PRESCRIPTION DISP CTR MC CULLOUGHS LANGFORD PHARMACY AURORA PRESCRIPTION DISP CTR THE PHARMACY STATION ZIMBRIC PHARMACY PICK N SAVE PHARMACY WATERTOWN HOMETOWN PHARMACY AURORA PRESCRIPTION DISP CTR GENOA-QOL HEALTHCARE GENOA-QOL HEALTHCARE MEDICAL CENTER PHARMACY MORELAND PLAZA PHARMACY INC PICK N SAVE PHARMACY PICK N SAVE PHARMACY PROHEALTH PHARMACY-PEWAUKEE VALUCARE PRESC CENTER WAUKESHA PHARMACY WAUNAKEE HOMETOWN PHARMACY STRATTON DRUG INC WAUPACA HOMETOWN PHARMACY AGNESIAN PHARMACY ASPIRUS CLINIC PHARMACY COUNTY MARKET PHARMACY TRIGS PHARMACY YOUNG'S DRUG STORE YOUNG'S DRUG STORE

NR_0009_10823 10/2017

Provider Phone Number (715) 394-7765 (414) 384-2474 (715) 546-3266 (608) 372-2101 (608) 372-4115 (715) 453-6600 (715) 986-2225 (262) 877-8777 (920) 793-7380 (920) 794-8029 (920) 794-1225 (262) 878-1171 (608) 848-8020 (608) 637-4716 (262) 968-9570 (262) 275-0936 (262) 275-2137 (715) 373-5588 (262) 514-8050 (262) 534-9222 (920) 478-2685 (920) 261-7140 (920) 261-1900 (262) 896-6040 (262) 347-4201 (262) 955-8811 (262) 544-5303 (262) 542-4488 (262) 574-0405 (262) 446-6924 (262) 696-0919 (262) 544-6622 (262) 928-2279 (608) 850-9314 (715) 258-7057 (715) 256-0400 (920) 324-3010 (715) 847-2547 (715) 845-8846 (715) 848-9066 (715) 845-5203 (715) 845-3713

Provider Street 1124 BELKNAP ST N65 W24838 MAIN ST 1790 SUPERIOR ST 300 SUPERIOR AVE 1004 SUPERIOR AVE 1208 N 4TH ST 215 MAPLE ST N 700 N LAKE AVE STE 101 5300 MEMORIAL DR STE 120 2219 GARFIELD ST STE 100 1500 WASHINGTON ST 4310 67TH DR 202 S MAIN ST 407 S MAIN ST STE 104 405 N WALES RD 525 KENOSHA ST STE C 547 KENOSHA ST 114 W BAYFIELD ST 818 FORREST LN STE 101 601 N MILWAUKEE ST 104 E MADISON ST 624 S CHURCH ST 204 E MAIN ST W231N1440 CORPORATE CT 1501 AIRPORT RD STE 1072 514 RIVERVIEW AVE RM 328 1111 DELAFIELD ST STE 109 827 W MORELAND BLVD 220 E SUNSET DR 1220 W SUNSET DR N16W24131 RIVERWOOD DR 501 S GRAND AVE 725 AMERICAN AVE 235 S CENTURY AVE 107 N MAIN ST 115 N WESTERN AVE UNIT 8 910 W MAIN ST 2720 PLAZA DR STE 1125 220 18TH AVE S 110 S 17TH AVE 310 E BRIDGE ST 2106 GRAND AVE

Page 669 of 679

Provider City SUPERIOR SUSSEX THREE LAKES TOMAH TOMAH TOMAHAWK TURTLE LAKE TWIN LAKES TWO RIVERS TWO RIVERS TWO RIVERS UNION GROVE VERONA VIROQUA WALES WALWORTH WALWORTH WASHBURN WATERFORD WATERFORD WATERLOO WATERTOWN WATERTOWN WAUKESHA WAUKESHA WAUKESHA WAUKESHA WAUKESHA WAUKESHA WAUKESHA WAUKESHA WAUKESHA WAUKESHA WAUNAKEE WAUPACA WAUPACA WAUPUN WAUSAU WAUSAU WAUSAU WAUSAU WAUSAU

State

ZIP code

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

54880-2856 53089 54562 54660-1636 54660-2002 54487 54889-9064 53181-9436 54241 54241-2416 54241-3045 53182-9338 53593-1422 54665-4004 53183-9728 53184 53184-9512 54891-1131 53185 53185-4405 53594-1273 53094-6229 53094-3748 53186-1303 53188 53188-3631 53188-3402 53188-2963 53189-7602 53189-8423 53188 53186-6121 53188-5031 53597 54981-1542 54981 53963-1201 54401-4158 54401-4252 54401-4227 54403-3574 54403-6912

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

AURORA PHARMACY AURORA PHARMACY AURORA PHARMACY FROEDTERT HEALTH PLANK ROAD PHCY SKYWALK PHARMACY SWAN SERV U PHARMACY YELLOW RIVER PHARMACY INC AURORA PHARMACY AURORA PHARMACY EVERGREEN PHARMACY SKYWALK PHARMACY WEST ALLIS AURORA PHARMACY FROEDTERT HEALTH HOMETOWN PHARMACY FROEDTERT HLTH ST JOSEPHS PHCY GENOA-QOL HEALTHCARE PICK N SAVE PHARMACY PICK N SAVE PHARMACY ALTSCRIPTS SPECIALTY PHARMACY PICK N SAVE PHARMACY WEST SALEM PHARMACY VERNON MEMORIAL PHARMACY BENTLEY PHARMACY COLBY HEALTH MART PHARMACY MC CULLOUGH'S PHARMACY TRAVELMART PHARMACY COPPS FOOD CENTER PHARMACY DALY DRUG

Provider Name

(920) 787-6940 (414) 454-6796 (414) 479-2500 (414) 955-3990 (414) 266-1893 (414) 258-9550 (715) 866-8644 (414) 771-1350 (414) 546-9722 (414) 533-6600 (414) 337-3333 (262) 338-2311

900 E DIVISION ST 1220 DEWEY AVE 1055 N MAYFAIR RD STE 100 1155 N MAYFAIR RD 9000 W WISCONSIN AVE # 211 9130 W NORTH AVE 7438 MAIN ST W 7220 W NATIONAL AVE 2424 S 90TH ST 10101 W GREENFIELD AVE 6737 W WASHINGTON ST STE 1100 205 VALLEY AVE

WAUTOMA WAUWATOSA WAUWATOSA WAUWATOSA WAUWATOSA WAUWATOSA WEBSTER WEST ALLIS WEST ALLIS WEST ALLIS WEST ALLIS WEST BEND

WI WI WI WI WI WI WI WI WI WI WI WI

54982 53213-2504 53226-3436 53226 53226-3518 53226-2623 54893-8206 53214 53227-2455 53214-3953 53214-5653 53095-5312

(262) 338-6444 (262) 836-5411 (262) 346-1144 (262) 334-4033 (262) 335-2292 (414) 385-9500 (414) 384-2474 (608) 786-0210 (608) 634-2222 (608) 296-2877 (715) 538-4947 (262) 473-5065 (608) 253-4231 (715) 423-2585 (715) 423-3400

1709 S 18TH AVE 3200 PLEASANT VALLEY RD STE 1A 333 E WASHINGTON ST STE 2100 2518 W WASHINGTON ST 1629 S MAIN ST 1636 MILLER PARK WAY 2201 MILLER PARKWAY 880 MILL ST N 115 W STATE ST 206 S MAIN ST 36363 MAIN ST 1173 W MAIN ST 802 BROADWAY 900 E RIVERVIEW EXPY 3215 8TH ST S

WEST BEND WEST BEND WEST BEND WEST BEND WEST BEND WEST MILWAUKEE WEST MILWAUKEE WEST SALEM WESTBY WESTFIELD WHITEHALL WHITEWATER WISCONSIN DELLS WISCONSIN RAPIDS WISCONSIN RAPIDS

WI WI WI WI WI WI WI WI WI WI WI WI WI WI WI

53095-7808 53095-9274 53095-2503 53095-2106 53095-4935 53214 53214 54669-2213 54667-1254 53964-7506 54773-9186 53190-1672 53965-1602 54494-5482 54494

DALY DRUG LONG TERM CARE PHARMACY OWEN-WITHEE PHARMACY GWIDT PHARMACY INC FRITZ'S PHARMACY IV MEDS 2 GO EXPRESS E A HAWSE PHARMACY DRUG EMPORIUM FRUTH PHARMACY AT FOODFAIR APEX PHARMACY BECKLEY ARH PHARMACY BECKLEY PHARMACY BYPASS PHARMACY BYPASS PHARMACY

(715) 423-3401 (715) 229-2074 (715) 253-2164 (304) 445-2956 (304) 756-1260 (304) 897-8220 (304) 736-2451 (304) 948-6651 (681) 207-7334 (304) 255-3598 (681) 207-7008 (304) 256-2006 (304) 256-2006

3215 8TH ST S STE 101 514 DIVISION ST 203 E WESTGOR AVE 105 RAILROAD AVE 762 LITTLE COAL RIVER RD 17978 SR 55 3 MALL RD 6350 US ROUTE 60 E 165 RAGLAND RD 250 STANAFORD RD 105 ANWAR FATIMA LANE 1802 HARPER RD 104 S EISENHOWER DR

WISCONSIN RAPIDS WITHEE WITTENBERG ALDERSON ALUM CREEK BAKER BARBOURSVILLE BARBOURSVILLE BECKLEY BECKLEY BECKLEY BECKLEY BECKLEY

WI WI WI WV WV WV WV WV WV WV WV WV WV

54494-6564 54498 54499-9174 24910 25003-9262 26801 25504-1822 25504-1232 25801-9763 25801-3140 25801 25801-3331 25801-4930

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 670 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

CARRIAGE DRIVE PHARMACY INC COLONY DRUG COMMUNITY HLTH SYSTEMS BECKLEY COMMUNITY HLTH SYSTEMS MABSCOT COMMUNITY HLTH SYSTEMS PEDIAT EPPYS DRUG RHONDAS PHARMACY THE BECKLEY PHARMACY MACE'S PHARMACY INC. REED'S PHARMACY CLAY BATTELLE PHARMACY BLUEWELLS FAMILY PHARMACY INC GOODYKOONTZ DRUG STORE INC BRADSHAW ECONOMY DRUG INC. BRIDGEPORT FAMILY PHARMACY BRIDGEPORT PHARMACY COMMUNITY PHCY OF BRIDGEPORT MOUNTAINEER MEDICAL PHARMACY UNITED PHARMACY BRUCETON PHARMACY COMMUNITY CARE PHARMACY OF BUCKHANN THOMPSONS PHARMACY BUFFALO DRUG BURNSVILLE DRUG STORE LIFETREE PHARMACY THE PHARMACY

Provider Name

(304) 252-5349 (304) 252-5305 (304) 255-6800 (304) 461-1200 (304) 461-0420 (304) 252-6331 (304) 255-6337 (304) 252-1200 (304) 823-1001 (304) 258-3800 (304) 432-8268 (304) 589-7788 (304) 325-7121 (304) 967-9333 (304) 848-9500 (304) 933-3880 (304) 842-3223 (304) 423-5200 (681) 342-1580 (304) 379-6929

350 CARRIAGE DR 2810 ROBERT C BYRD DR 252 RURAL ACRES DR 200 RALEIGH AVE 131 MELLON ST 2987 ROBERT C BYRD DR 3413 ROBERT C BYRD DR STE B 269A STANAFORD RD 204 CRIM AVE 261 BERKMORE PL STE 1C 5851 MASON DIXON HWY 3675 COAL HERITAGE RD 1526 BLAND ST 10029 MARSHALL HIGHWAY 139 CONFERENCE CTR WAY #101 527 MEDICAL PARK DR STE 105 1212 JOHNSON AVE. 120 MEDICAL PARK DR STE 102 327 MEDICAL PARK DR 198 MORGANTOWN ST

BECKLEY BECKLEY BECKLEY BECKLEY BECKLEY BECKLEY BECKLEY BECKLEY BELINGTON BERKELEY SPRINGS BLACKSVILLE BLUEFIELD BLUEFIELD BRADSHAW BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRIDGEPORT BRUCETON MILLS

WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV

25801-2812 25801 25801-3503 25801-5944 25801-3535 25801-4400 25801-3756 25801-3139 26250-9468 25411-6247 26521 24701-9511 24701-3747 24817 26330 26330-9009 26330 26330 26330 26525

(304) 472-1712 (304) 472-1120 (304) 937-3000 (304) 853-2500 (304) 595-4900 (304) 595-9500

37 W. MAIN ST 4 E MAIN ST 20442 BUFFALO RD 110 MUNICIPAL ST 15063 MACCORKLE AVE SE 15041 MACCORKLE AVE

BUCKHANNON BUCKHANNON BUFFALO BURNSVILLE CABIN CREEK CABIN CREEK

WV WV WV WV WV WV

26201 26201-2753 25033 26335 25035-8047 25035

CAMDEN-ON-GAULEY MEDICAL PHARMACY CAMERON DRUG STORE INC REEDS PHARMACY ARACOMA DRUG COMPANY CHAPMANVILLE PHARMACY DIGNITY RX MARTINS PHARMACY BEE WELL PHARMACY CAMC PHARMACY CAMC PHARMACY DRUG EMPORIUM DRUG EMPORIUM FRUTH PHARMACY FRUTH PHARMACY

(304) 226-5725 (304) 686-2101 (304) 856-2901 (304) 855-4541 (304) 855-9502 (304) 855-4764 (304) 728-8705 (304) 766-8484 (304) 388-9547 (304) 388-9700 (304) 345-3784 (304) 925-7099 (304) 341-0257 (304) 720-8341

10003 WEBSTER RD 1 BRIDGE ST 2830 N WESTERN PIKE 772 MAIN STREET 289 CRAWLEY CREEK RD 557 MAIN STREET 190 FLOWING SPRINGS RD 4501 MACCORKLE AVE SW STE 102 3200 MACCORKLE AVE SE 3415 MACCORKLE AVE SE 1603 KANAWHA BLVD W 5101 MACCORKLE AVE SE 511 MORRIS ST 701 LEE ST EAST

CAMDEN ON GAULEY CAMERON CAPON BRIDGE CHAPMANVILLE CHAPMANVILLE CHAPMANVILLE CHARLES TOWN CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON

WV WV WV WV WV WV WV WV WV WV WV WV WV WV

26208-7713 26033-1130 26711-8800 25508-4533 25508 25508 25414-3911 25309-1444 25304 25304 25387 25304-2148 25301-1326 25301-1706

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 671 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

FRUTH PHARMACY GOOD LIFE APOTHECARY KANAWHA CITY HLTH CENTER PHCY KINES FAMILY PHARMACY MED CENTER SPECIALTY PHARMACY TRIVILLIAN'S PHARMACY VALLEY WELLNESS PHARMACY CITIZENS DRUG STORE

Provider Name

(304) 343-2807 (304) 345-8600 (304) 205-7534 (304) 984-1001 (304) 344-8021 (304) 343-8621 (304) 932-0032 (304) 387-2731

864 OAKWOOD RD 3212 PENNSYLVANIA AVE # 8 4602 MACCORKLE AVE SE 6097 SISSONVILLE DR 3100 MACCORKLE AVE SE STE 100 215 35TH ST SE 3715 MACCORKLE AVE SE 501 CAROLINA AVE

CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHARLESTON CHESTER

WV WV WV WV WV WV WV WV

25314-2010 25302 25304-1848 25312-9443 25304-1215 25304-1318 25304-1525 26034-1319

DAVIS BROTHERS PHARMACY - CHESTER BYARD-MERCER PHARMACY NEWPOINTE PHARMACY LLC CLAY FAMILY PHARMACY PRIMARY CARE PHARMACY CLENDENIN PHARMACY INC RIVERVIEW PHARMACY FAMILY LIFE PHARMACY COWEN PHARMACY CRAB ORCHARD PHARMACY CRAIGSVILLE HOMETOWN PHARMACY GAULEY RIVER PHARMACY CAMC PHARMACY CROSS LANES FAMILY PHARMACY COMMUNITY HLTH SYSTEMS DANIELS JARRELL'S PHARMACY MEDICAP PHARMACY

(304) 387-1741 (304) 624-5679 (304) 423-5000 (304) 587-2123 (304) 587-4555 (304) 965-5451 (304) 548-2155 (304) 837-3777 (304) 226-3600 (304) 253-7474 (304) 742-6040 (304) 742-5001 (304) 388-7050 (304) 204-2588 (304) 461-0300 (304) 763-2442 (304) 369-3981

559 CAROLINA AVE STE B 440 W MAIN ST 463 EMILY DR 2000 MAIN ST 122 CENTER ST 10 MAIN ST 107 KOONTZ AVE 21189 COAL RIVER RD 6815 WEBSTER ROAD 1299 ROBERT C BYRD DRIVE 18077 WEBSTER RD 433 CRAIGSVILLE RD SUITE 2 314 GOFF MOUNTAIN RD # STE.5 107 GOFF MT RD 2157 RITTER DR 2122 RITTER DR 2008 SMOOT AVE

CHESTER CLARKSBURG CLARKSBURG CLAY CLAY CLENDENIN CLENDENIN COMFORT COWEN CRAB ORCHARD CRAIGSVILLE CRAIGSVILLE CROSS LANES CROSS LANES DANIELS DANIELS DANVILLE

WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV

26034 26301-2817 26301-5512 25043 25043-7046 25045-0000 25045-9578 25049-9613 26206 25827 26205 26205 25313 25313 25832-9371 25832-9372 25053

CABIN CREEK HEALTH CENTER PHARMACY BRIOVARX FRUTH PHARMACY CARDINAL PHARMACY MED SHOPPE HEALTH CENTER PHARMACY GOOD FAMILY PHARMACY, INC AMERICAN PHARMACY FAIRMONT CLINIC PHARMACY MANCHIN FAMILY PHARMACY PLEASANT VALLEY PHARMACY LLC RIDER PHCY MEDICINE SHOPPE FOOD LION PHARMACY

(304) 595-5065 (304) 720-6970 (304) 586-0886 (304) 275-4687 (304) 636-6767 (304) 935-4812 (304) 368-9123 (304) 367-8750 (304) 367-9122 (304) 366-3145 (304) 366-2710 (304) 271-8836

5722 CABIN CREEK RD 206 ROXALANA BUSINESS PARK 501 ROOSEVELT BLVD 78 MAZE PLZ 909 GORMAN AVE 242 SOUTH PINCH ROAD 2500 FAIRMONT AVE 1322 LOCUST AVE 181 MIDDLETOWN CIR 49 VIP WAY 303 MERCHANT ST 78 WORCHESTER DR

DAWES DUNBAR ELEANOR ELIZABETH ELKINS ELKVIEW FAIRMONT FAIRMONT FAIRMONT FAIRMONT FAIRMONT FALLING WATERS

WV WV WV WV WV WV WV WV WV WV WV WV

25054 25064 25070 26143-5101 26241-4109 25071 26554-3451 26554-1436 26554-2015 26554 26554-5213 25419-4998

NEW RIVER HEALTH FAYETTEVILLE PHARM

(304) 574-3991

217 W MAPLE AVE

FAYETTEVILLE

WV

25840

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 672 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name FOLLANSBEE PHMCY, MEDICINE SHOPPE HOODS PHARMACY THE MEDICINE SHOPPE OF FT ASHB PILL BOX PHARMACY CARL WALKERS DRUG STORE ADKINS PHARMACY GILBERT PHARMACY INC RIVERSIDE PHARMACY COMMUNITY HLTH SYSTEMS GLEN COUNTRY ROADS PHARMACY BYPASS PHARMACY GIL-CO FAITH PHARMACY INC J & B DRUG STORE INC GREENBANK PHARMACY DENNIS' PHARMACY LINCOLN PRIMARY CARE CENTER ROSS DRUG PHARMACY HARMAN PILL BOX PHARMACY HOMETOWN PHARMACY HARTS PHARMACY INC REED'S PHARMACY BIG FOUR DRUG STORE COMPRECARE FRUTH PHARMACY FRUTH PHARMACY FRUTH PHARMACY FRUTH PHARMACY MARSHALL PHARMACY MARSHALL PHARMACY AT BCC MEDICAL ARTS PHARMACY MEDICAP PHARMACY ROSS DRUG OF CEREDO THE MEDICINE SHOPPE THE PHARMACY @ HIMG VALLEY HEALTH PHARMACY VALLEY HEALTH PHARMACY FRUTH PHARMACY IAEGER PHARMACY SOUTH BERKELEY PHARMACY GRIFFITH & FEIL DRUG MEDICINE CABINET PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (304) 527-1004 (304) 527-0150 (304) 298-4557 (304) 358-2887 (304) 364-5193 (304) 664-8883 (304) 664-6337 (304) 664-3343 (304) 934-7146 (304) 934-5327 (304) 252-3000 (304) 462-8300 (304) 354-7737 (304) 456-3333 (304) 824-2667 (304) 824-5806 (304) 824-5000 (304) 227-3661 (304) 643-4001 (304) 855-5616 (304) 754-5800 (304) 466-2323 (304) 525-1222 (304) 522-6090 (304) 429-5544 (304) 525-0507 (304) 697-2151 (304) 691-6879 (304) 696-5000 (304) 529-7141 (304) 523-5003 (304) 908-5586 (304) 429-6716 (205) 795-8800 (304) 399-3355 (304) 525-4112 (304) 562-2677 (304) 938-2819 (304) 229-2400 (304) 453-4192 (304) 393-3386

Provider Street 1415 MAIN ST 971 MAIN ST 10010 FRANKFORT HIGHWAY 203 N MAIN ST 620 ELK ST 37 US ROUTE 80 761 LARRY JOE HARLESS DRIVE 22 LARRY JOE HARLESS DR 7127 HARPER ROAD 109 BOLT ROAD 725 RITTER DR FL 1 356 WV HIGHWAY 5 E 352 MAIN ST 4498 POTOMAC HIGHLAND TRL. 6 FIRST STREET 7400 LYNN AVE 8119 COURT AVE 1 MOTT STREET 1607 E MAIN ST 1073 MCCLELLAN HIGHWAY 71 COWARDLY LION DR STE A 300 TEMPLE ST 1308 4TH AVE 4541 5TH STREET RD 425 CAMDEN RD 1419 US RT 60 EAST 125 7TH AVE 1600 MEDICAL CENTER DR 1249 15TH ST 949 6TH AVE 4352 5TH STREET RD 420 4TH ST 2402 ADAMS AVE 5170 U. S. RTE 60 E STE 150 1301 HAL GREER BLVD 3377 US ROUTE 60 3109 TEAYS VALLEY RD RR 52 5054 GERRARDSTOWN ROAD 1405 CHESTNUT ST 50 LINCOLN ST

Page 673 of 679

Provider City FOLLANSBEE FOLLANSBEE FORT ASHBY FRANKLIN GASSAWAY GILBERT GILBERT GILBERT GLEN DANIEL GLEN DANIEL GLEN MORGAN GLENVILLE GRANTSVILLE GREENBANK HAMLIN HAMLIN HAMLIN HARMAN HARRISVILLE HARTS HEDGESVILLE HINTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HUNTINGTON HURRICANE IAEGER INWOOD KENOVA KERMIT

State

ZIP code

WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV

26037-1217 26037 26719 26807 26624-1136 25621-1537 25621 25621 25844 25844 25813-7709 26351-7602 26147-9714 24944 25523 25523-1138 25523-1402 26270 26362-9200 25524 25427-6779 25951-2311 25701-2401 25701 25704 25705 25701-1923 25701-0195 25701-3662 25701-2305 25701-9558 25701-1315 25704-1322 25705 25701-3803 25705-2837 25526 24844-9802 25428 25530-1235 25674

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

KEYSER MEDISAVE PHARMACY INC REED'S DRUG STORE KINGWOOD PHARMACY LLC PRESTON FAMILY PHARMACY ENCORE PHARMACY ENCORE PHARMACY FRITZ'S PHARMACY II

Provider Name

(304) 788-6010 (304) 788-1643 (304) 329-3600 (304) 329-6979 (304) 647-9776 (304) 793-6315 (304) 645-7447

1405 BONNIEVIEW TERRACE 43 N MAIN ST 220 W MAIN ST 17548 VETERANS MEM HWY STE P 400 N JEFFERSON ST 3558 JEFFERSON ST N STE 4 1318 N JEFFERSON ST STE B

KEYSER KEYSER KINGWOOD KINGWOOD LEWISBURG LEWISBURG LEWISBURG

WV WV WV WV WV WV WV

26726-2938 26726-3220 26537 26537 24901-1177 24901-5730 24901

GREENBRIER MEDICAL ARTS PHARM NORTH COMMUNITY HLTH SYSTEMS FAYETTE

(304) 647-1377 (304) 461-0068

3272 JEFFERSON ST N STE 1 1 PHYSICIANS DR

LEWISBURG LOCHGELLY

WV WV

24901-9616 25866

FAMILY DISCOUNT PHARMACY(STOLLINGS) VILLAGE PHARMACY LUMBERPORT PHARMACY INC MADISON FAMILY PHARMACY MEDICINE STOP MAN PHARMACY R-EXCELLENCE PROGRAM - MAN TOWN PHARMACY CARE RED DOT PHARMACY POCAHONTAS PHARMACY MARTINS PHARMACY MEDICAP PHARMACY MOORES PHARMACY PATTERSONS DRUG STORE REEDS PHARMACY SHENANDOAH PHARMACY THE PHARMACY AT BERKELEY MED CTR WEIS PHARMACY BELLDINA'S PHARMACY VALLEY HEALTH CARE PHARMACY FRUTH PHARMACY FRUTH PHARMACY SOUTH FORK PHARMACY ALLIED HEALTH SOLUTIONS AMERICAN RX PHARMACY MEDICAL CENTER PHARMACY MOUNTAINEER PHARMACY PIERPONT LANDING PHARMACY SUNCREST PHARMACY WATERFRONT FAMILY PHARMACY MOUNDSVILLE PHARMACY

(304) 752-0082 (304) 745-3301 (304) 584-4210 (304) 369-0209 (304) 369-4330 (304) 583-9910 (304) 583-0535 (304) 583-2863 (304) 986-3486 (304) 799-4944 (304) 267-6414 (304) 260-9040 (304) 264-0300 (304) 267-8903 (304) 274-6699 (304) 263-4999 (304) 350-3261 (304) 260-9185 (304) 864-4000 (304) 335-6005 (304) 743-4880 (304) 489-2710 (304) 530-1044 (304) 285-7216 (304) 292-2787 (304) 598-4848 (304) 285-7348 (304) 594-9955 (304) 599-2159 (304) 225-7979 (304) 845-0390

153 STOLLINGS AVE 102 RAILROAD STREET 308 MAIN STREET 313 MADISON AVE 2789 POND FORK RD 124 MAIN ST 650 E MCDONALD AVE 300 MAIN ST 131 MARKET ST 105 DUNCAN RD STE C 901 FOXCROFT AVE 85 TAVERN RD 1311 OLD COURTHOUSE SQ 134 S QUEEN ST 5078 WILLIAMSPORT PIKE STE A 99 TAVERN RD 2500 HOSPITAL DR 1102 N QUEEN ST 107 S MAIN STREET 1 POLING STREET 16 PERRY MORRIS SQ 1506 ELIZABETH PIKE 414 S MAIN ST 3040 UNIVERSITY AVE STE 1400 889 VENTURE DR STE 2 1 MEDICAL CENTER DRIVE 390 BIRCH STREET 7000 MID ATLANTIC RD 3121 UNIVERSITY AVE 215 DON KNOTTS BLVD 118 N LAFAYETTE AVE

LOGAN LOST CREEK LUMBERPORT MADISON MADISON MAN MAN MAN MANNINGTON MARLINTON MARTINSBURG MARTINSBURG MARTINSBURG MARTINSBURG MARTINSBURG MARTINSBURG MARTINSBURG MARTINSBURG MASONTOWN MILL CREEK MILTON MINERAL WELLS MOORFIELD MORGANTOWN MORGANTOWN MORGANTOWN MORGANTOWN MORGANTOWN MORGANTOWN MORGANTOWN MOUNDSVILLE

WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV

25601-4010 26385 26386 25130-1510 25130-9237 25635-1212 25635-1012 25635-1342 26582-1130 24954 25401-1840 25401-2890 25404 25401 25404-6434 25401 25401 25404 26542 26280 25541-1397 26150-8413 26836 26505-3380 26508 26506-8100 26505 26508 26505-3238 26501-6737 26041-1029

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 674 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

Provider Name FAMILY DISCOUNT PHARMACY INC. MOUNT HOPE PHARMACY CHARLIES PHARMACY OF MULLENS DAVIS BROTHERS PHARMACY NEW CUMBERLAND RX CENTER HEALTH-AID PHARMACY WITSCHEYS PHCY MEDICINE SHOPPE FRUTH PHARMACY BLACK DIAMOND PHARMACY LLC MAIN ST PHARMACY OAK HILL HOMETOWN PHARMACY DOUG'S DRUGS OCEANA PHARMACY WESTSIDE PHARMACY COX FAMILY PHARMACY COX FAMILY PHARMACY COX FAMILY PHARMACY INC GENOA-QOL HEALTHCARE PARKERSBURG FAMILY CARE PHCY THE EYE MDS DISPENSARY COMMUNITY CARE PHARMACY PENNSBORO FAMILY PHARMACY JUDY'S DRUG STORE PETERSTOWN PHARMACY MACE'S PHARMACY PINE GROVE PHARMACY CHARLIES PHARMACY RHONDA'S POCA VALUE RITE PHCY FRUTH PHARMACY FOUR SEASONS PHARMACY INC GENOA-QOL HEALTHCARE HICKMANS PHARMACY HICKMAN'S PHARMACY FRITZS PHARMACY III RAINELLE MEDICAL CTR PHCY JEFFERSON PHARMACY INC WEIS PHARMACY RAVENSWOOD DRUG VALLEY PHARMACY FRUTH PHARMACY RIPLEY FAMILY MEDICINE PHARMACY

NR_0009_10823 10/2017

Provider Phone Number (304) 752-1445 (304) 877-7921 (304) 294-5447 (304) 564-7249 (304) 564-3272 (304) 882-2005 (304) 455-2171 (304) 755-0128 (304) 862-2105 (304) 465-7200 (304) 465-0222 (304) 682-6900 (304) 682-8289 (304) 682-0444 (304) 893-9100 (304) 485-4501 (304) 865-7600 (304) 485-0800 (304) 917-3739 (304) 428-3500 (304) 478-2319 (304) 659-4234 (304) 257-1044 (304) 753-5074 (304) 457-4233 (304) 889-3131 (304) 732-6969 (304) 732-9011 (304) 755-1500 (304) 675-2303 (304) 487-0015 (304) 487-6337 (304) 425-1077 (304) 425-2188 (304) 438-8500 (304) 438-6186 (304) 725-6533 (304) 728-9041 (304) 440-4410 (304) 864-6935 (304) 372-1605 (304) 514-5511

Provider Street OLD 119 301 MAIN STREET 224 HOWARD AVE 615 N CHESTER ST 900 RIDGE AVE 307 5TH ST 155 NORTH ST 106 21ST ST MAIN ST 435 MAIN ST 819 EAST MAIN ST 1125 COOK PARKWAY 928 COOK PKWY RT 10 COOK PKWY/ LOGAN ST 2012 GARFIELD AVE STE C 110 GIHON VLG 1212 GARFIELD AVE STE 102 2121 7TH ST 2610 CAMDEN AVE 418 GRAND PARK DR STE 315 149 IVY LN 401A W MYLES AVE 24 N MAIN ST 105 MARKET ST 303 S MAIN ST 300 STATE RT 20 125 MAIN AVENUE 35 MAIN AVE 119C MAIN ST 2501 JACKSON AVE 300 MORRISON DR 200 12TH ST EXTENTION 306 ROGERS ST 199 12TH STREET EXT 499 KANAWHA AVE 645 KANAWHA AVE 201 S PRESTON ST 217 OAK LEE DR STE 15 408 WASHINGTON ST 13150 VETERANS MEMORIAL HWY 509 CHURCH ST S 512-A CHURCH ST S

Page 675 of 679

Provider City MOUNT GAY MOUNT HOPE MULLENS NEW CUMBERLAND NEW CUMBERLAND NEW HAVEN NEW MARTINSVILLE NITRO NORTHFORK OAK HILL OAK HILL OCEANA OCEANA OCEANA PARKERSBURG PARKERSBURG PARKERSBURG PARKERSBURG PARKERSBURG PARKERSBURG PARSONS PENNSBORO PETERSBURG PETERSTOWN PHILIPPI PINE GROVE PINEVILLE PINEVILLE POCA POINT PLEASANT PRINCETON PRINCETON PRINCETON PRINCETON RAINELLE RAINELLE RANSON RANSON RAVENSWOOD REEDSVILLE RIPLEY RIPLEY

State

ZIP code

WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV

25637-0000 25880 25882-1421 26047 26047-9581 25265 26155-1330 25143-1740 24868 25901-0000 25901 24870 24870 24870 26101-2527 26101-7109 26101-3207 26101-3803 26101-5652 26105-4000 26287-1337 26415-1330 26847-1518 24963 26416-1240 26149 24874 24874 25159-9602 25550-2035 24740-2765 24740 24740-3600 24740-2352 25962 25962-1013 25438-1628 25438 26164 26547 25271-1615 25271-1616

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

RIVESVILLE COMMUNITY PHARMACY TRI COUNTY PHARMACY LAMBERT DRUG STORE FRITZ'S PHCY AND WELLNESS CTR WESTERN GREENBRIER PHCY HPC SPECIALTY RX WEST VIRGINIA INC LOOP PLAZA DISCOUNT PHARMACY PHILLIPS PHARMACY SALEM COLONIAL PHARMACY FRUTH PHARMACY SHEPHERDSTOWN PHARMACY PROCARE PHARMACY, INC PHILLIPS DRUG SISTERSVILLE PHARMACY GULF FAMILY PRACTICE PHCY

Provider Name

(304) 278-7884 (304) 924-6784 (304) 822-1000 (304) 645-1890 (304) 392-6348 (800) 757-9192 (304) 727-2233 (304) 684-3784 (304) 782-2171 (304) 201-1630 (304) 876-9966 (304) 592-2680 (304) 652-6131 (304) 652-3711 (304) 683-3809

426 MAIN ST 78 QUEENS ALLEY RD 22630 NORTHWESTERN PIKE 370 SENECA TRL 356 NICHOLAS ST 66 SIXTH AVE 72 6TH AVE 329 2ND ST 120 E MAIN ST 4012 TEAYS VALLEY RD 7670 MARTINSBURG PIKE STE 2 720 PIKE ST 615 WELLS ST 312 DIAMOND ST 302 W MAIN ST

RIVESVILLE ROCK CAVE ROMNEY RONCEVERTE RUPERT SAINT ALBANS SAINT ALBANS SAINT MARYS SALEM SCOTT DEPOT SHEPHERDSTOWN SHINNSTON SISTERSVILLE SISTERSVILLE SOPHIA

WV WV WV WV WV WV WV WV WV WV WV WV WV WV WV

26588-0307 26234 26757 24970-1340 25984 25177-2769 25177-2769 26170-1005 26426-1303 25560-9760 25443 26431-1435 26175-1323 26175 25921

ALUM CREEK PHARMACY AT SAND PLANT BYPASS PHARMACY # 4 THOMAS FAMILY PHARMACY FRUTH PHARMACY STAATS PHCY & HEALTH CARE INC WILLOW DRUG TOWN & COUNTRY DRUG CAMDEN FAMILY PHARMACY MOUNTAIN LAKE PHARMACY NICHOLAS PHARMACY SMH PHARMACY GLEN DANIEL PHARMACY

(304) 756-2181 (304) 766-0900 (304) 414-4820 (304) 927-0011 (304) 927-2980 (304) 927-3784 (304) 624-5433 (304) 872-1663 (304) 872-9000 (304) 872-2777 (304) 872-8481 (304) 934-6337

1563 SAND PLANT RD 5151 MACCORKLE AVE SW 4605 MACCORKLE AVE SW 211 BOWMAN ST 100 E MAIN ST 41 WILLIAMS DR 100 COST AVE 55 FRIENDS R FUN DR 1129 BROAD ST STE 100 421 MAIN ST 400 FAIRVIEW HEIGHTS RD 6435C HARPER ROAD

SOUTH CHARLESTON SOUTH CHARLESTON SOUTH CHARLESTON SPENCER SPENCER SPENCER STONEWOOD SUMMERSVILLE SUMMERSVILLE SUMMERSVILLE SUMMERSVILLE SURVEYOR

WV WV WV WV WV WV WV WV WV WV WV WV

25309 25309 25309 25276-1307 25276-1503 25276-1825 26301-4804 26651-9514 26651-1838 26651-1343 26651-9308 25932

GREGGS PHARMACY, MEDICINE SHOPPE PRESTON TAYLOR PHARMACY UNION PHARMACY VAN PROFESSIONAL PHARMACY INC BONDS DRUG DUTTON PHARMACY WARDENSVILLE PHARMACY BONDS DRUG STORE VALLEY HEALTH WAYNE PHARMACY WAYNE PHARMACY HIGHLANDER PHARMACY ANILE PHARMACY MEDICINE SHOPPE MARLAND HEIGHTS PHARMACY

(304) 789-2200 (304) 463-4200 (304) 772-5701 (304) 245-8255 (304) 295-7356 (304) 295-9594 (304) 874-3687 (304) 863-3051 (304) 399-3341 (304) 272-5122 (304) 847-5151 (304) 723-1818 (304) 748-8464

101 GREGG MEMORIAL DRIVE 30 CORTLAND ACRES LN 100 MAIN ST 19024 POND FORK RD 800 GRAND CENTRAL MALL STE 5 3201 GRAND CENTRAL AVE 333 E MAIN ST 1649 HARRIS HWY 42 MCGINNIS DRIVE 701 HENDRICKS ST 117 BACK FORK ST 2413 PENNSYLVANIA AVE 3901 BRIGHTWAY ST

TERRA ALTA THOMAS UNION VAN VIENNA VIENNA WARDENSVILLE WASHINGTON WAYNE WAYNE WEBSTER SPRINGS WEIRTON WEIRTON

WV WV WV WV WV WV WV WV WV WV WV WV WV

26764 26292 24983-0000 25206 26105-4100 26105-1539 26851 26181-3599 25570-9553 25570-0000 26288-1032 26062-3632 26062-4332

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 676 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

PENN WAY PHARMACY TED'S PLAZA PHARMACY THREE SPRINGS VILLAGE PHARMACY

Provider Name

(304) 748-0505 (304) 723-2656 (304) 723-2528

3159 MAIN ST 265 PENCO RD 204 THREE SPRINGS DR STE A

WEIRTON WEIRTON WEIRTON

WV WV WV

26062-4711 26062-3816 26062-3815

TRI-STATE PHARMACY, MEDICINE SHOPPE VILLAGE LONG TERM PHARMACY CITIZENS DRUG STORE FLAT IRON DRUG STORE TRAUBERTS PHARMACY ROSS DRUG WEST MILFORD PHARMACY MICHELS PHARMACY FAST & FRIENDLY PHARMACY ELM GROVE PHARMACY MEDICAP MEDICAL PARK PHARMACY THE MEDICINE SHOPPE THE PRESCRIPTION CTR AT OVMC WHITE HALL PHARMACY

(304) 723-6331 (304) 723-2528 (304) 436-4932 (304) 436-3380 (304) 737-0383 (304) 824-4000 (304) 745-3000 (304) 873-1010 (304) 517-2211 (304) 242-1500 (304) 243-3388 (304) 232-4984 (304) 219-2822 (304) 368-9355

651 COLLIERS WAY 204 THREE SPRING DR STE B 70 WYOMING ST 69 MCDOWELL ST 800 CHARLES ST 23 LINCOLN PLAZA 924 W LIBERTY ST 103 E MAIN ST 4 GARTON PLAZA 102 E BETHLEHEM BLVD 1 MEDICAL PARK 620 NATIONAL RD STE 400 2000 EOFF ST 177 MIDDLETOWN RD STE 2

WEIRTON WEIRTON WELCH WELCH WELLSBURG WEST HAMLIN WEST MILFORD WEST UNION WESTON WHEELING WHEELING WHEELING WHEELING WHITE HALL

WV WV WV WV WV WV WV WV WV WV WV WV WV WV

26062-5055 26062 24801-2431 24801-2440 26070-1618 25571 26451 26456-1221 26452-2129 26003 26003-6379 26003-6543 26003 26554-8254

GREENBRIER MEDICAL ARTS PHARMACY MOUNTAINEER DRUG HURLEY DRUG COMPANY INC TUG VALLEY PHARMACY WILLIAMSTOWN PHARMACY FRUTH PHARMACY BROULIMS PHARMACY OUR VALLEY PHARMACY

(304) 536-2454 (304) 854-7990 (304) 235-3535 (304) 235-8080 (304) 375-6547 (304) 586-3088 (307) 885-5055 (307) 654-6337

128 COMMUNITY LN 76 LEWIS STREET 210 LOGAN ST 54 W 2ND AVE 426 HIGHLAND AVE 12803 WINFIELD RD 141 N WASHINGTON ST 168 US HWY 89 SUITE D

WHITE SILVER SPRINGS WHITESVILLE WILLIAMSON WILLIAMSON WILLIAMSTOWN WINFIELD AFTON ALPINE

WV WV WV WV WV WV WY WY

24986 25209 25661-3608 25661-3506 26187-1249 25213-7452 83110 83128

WIND RIVER FAMILY & COMMUNITY PHCY BASIN PHARMACY COMM HLTH CTR OF CENTRAL WY FAMILY PHARMACY GENOA-QOL HEALTHCARE OSCO PHARMACY OSCO PHARMACY RIDLEY'S PHARMACY RIDLEY'S PHARMACY SMITH'S PHARMACY GENOA-QOL HEALTHCARE HEALTHWORKS PHARMACY HOY'S DRUG KING SOOPERS PHARMACY

(307) 855-2975 (307) 568-3636 (307) 233-6050 (307) 265-4446 (307) 439-5199 (307) 266-0156 (307) 234-7159 (307) 234-7949 (307) 577-7062 (307) 266-6250 (307) 778-3818 (307) 637-7000 (307) 634-1818 (307) 638-0192

14 GREAT PLAINS RD 405 W. C STREET 5000 BLACKMORE RD 1522 E A STREET 1430 WILKINS CIR STE 154 1076 CY AVE 2625 E 2ND ST 1375 CY AVENUE 300 SE WYOMING BOULEVARD 2405 CY AVE 2526 SEYMOUR AVE 2508 E FOX FARM RD STE 1B 1115 E PERSHING BLVD 3702 DELL RANGE BLVD

ARAPAHO BASIN CASPER CASPER CASPER CASPER CASPER CASPER CASPER CASPER CHEYENNE CHEYENNE CHEYENNE CHEYENNE

WY WY WY WY WY WY WY WY WY WY WY WY WY WY

82510 82410 82609-3345 82601-2217 82601-1336 82604-3561 82609-2045 82604 82609 82604-3444 82001-3159 82007-2559 82001-3228 82009-5453

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 677 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

MEDICAP PHARMACY

Provider Name

(307) 635-3712

1947 BLUEGRASS CIR

CHEYENNE

WY

82009-7355

NORTH STAR PHARMACY AND INFUSION NORTH STAR PHCY AND INFUSION OSCO PHARMACY OSCO PHARMACY TOWN AND COUNTRY PHARMACY COE PHARMACY MEDICAL CTR UNITED DRUGS OSCO PHARMACY SHATTO'S FRONTIER DRUG CITY DRUG SMITH'S PHARMACY COALITION FAMILY PHARMACY MEDICAL HILL PHARMACY MEDICAP PHARMACY OSCO PHARMACY SMITH'S PHARMACY CLINIC PHARMACY SMITH'S PHARMACY REGISTER CLIFF PHARMACY ALBERTSON'S PHARMACY STONE DRUG SMITH'S PHARMACY KEMMERER PHARMACY RIDLEY'S PHARMACY PALACE PHARMACY RIDLEY'S PHARMACY LOVELL DRUG COMPANY RAWHIDE DRUG COMPANY WESTON COUNTY HEALTH SERV WESTON COUNTY PHARMACY ALTITUDE DRUG RIDLEYS PHARMACY POWELL DRUG

(307) 637-4300 (307) 637-7920 (307) 635-1155 (307) 637-8361 (307) 634-6662 (307) 578-2900 (307) 527-6221 (307) 527-7426 (307) 358-5077 (307) 789-4000 (307) 789-0535 (615) 665-3175 (307) 685-2899 (307) 685-6985 (307) 687-2996 (307) 682-1217 (307) 436-7116 (307) 875-7841 (307) 836-9270 (307) 733-9223 (307) 733-6222 (307) 733-8746 (307) 800-8880 (307) 877-4209 (307) 332-2270 (307) 745-7246 (307) 548-7231 (307) 334-3132 (307) 746-4491 (307) 746-2425 (307) 367-2278 (307) 367-4451 (307) 754-2031

7124 COMMONS DRIVE SUITE B 2301 HOUSE AVE STE 101 3355 E PERSHING BLVD 5800 YELLOWSTONE RD 514 S GREELEY HWY 424 YELLOWSTONE AVE STE 130 698 YELLOWSTONE AVE 1825 17TH ST 1202 E RICHARDS ST 131 10TH ST 70 YELLOW CREEK RD 430 S MEDICAL ARTS CT 407 S MEDICAL ARTS CT STE A 501 E LAKEWAY RD UNIT A 2610 S DOUGLAS HWY 906 CAMEL DR 925 WEST BIRCH 905 BRIDGER DR 437 W WHALEN ST 105 BUFFALO WAY 830 W BROADWAY 1425 SOUTH HIGHWAY 89 613 MOOSE ST 620 PINE AVE 634 MAIN ST 3112 E GRAND 164 E MAIN ST 232 S MAIN 1124 WASHINGTON BLVD 727A WASHINGTON BLVD 709 W PINE STREET 341 E PINE ST 140 N BENT ST

CHEYENNE CHEYENNE CHEYENNE CHEYENNE CHEYENNE CODY CODY CODY DOUGLAS EVANSTON EVANSTON GILLETTE GILLETTE GILLETTE GILLETTE GILLETTE GLENROCK GREEN RIVER GUERNSEY JACKSON JACKSON JACKSON HOLE KEMMERER KEMMERER LANDER LARAMIE LOVELL LUSK NEWCASTLE NEWCASTLE PINEDALE PINEDALE POWELL

WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY WY

82009 82001 82001-5764 82009-4131 82007-2852 82414-9318 82414-9322 82414-4701 82633-2934 82930-3421 82930-5227 82716-3364 82716-3372 82718-6416 82718-6468 82716-4902 82637 82935-5879 82214-0000 83001 83001 83001 83101-3519 83101-3002 82520-3034 82070 82431-2004 82225 82701-2972 82701-2930 82941 82941 82435-2712

POWELL VALLEY HEALTHCARE PHARMACY CITY MARKET PHARMACY SMITH'S PHARMACY ALBERTSON'S PHARMACY ROCK SPRINGS IV CTR SMITH'S PHARMACY

(307) 754-1179 (307) 324-3084 (307) 856-4934 (307) 362-9734 (307) 382-3544 (307) 362-1841

777 AVENUE H 602 N HIGLEY BLVD 1200 W MAIN ST 1323 DEWAR DR 400 2ND ST STE A1 2531 FOOTHILL BLVD

POWELL RAWLINS RIVERTON ROCK SPRINGS ROCK SPRINGS ROCK SPRINGS

WY WY WY WY WY WY

82435-2260 82301-5968 82501-3227 82901-5810 82901-6260 82901-4744

NR_0009_10823 10/2017

Provider Phone Number

Provider Street

Page 678 of 679

Provider City

The following In-network flu and pneumonia vaccine providers are additional to the chains listed on our website. If you have any questions, please call the number listed on your ID Card.

State

ZIP code

VALLEY PHARMACY

Provider Name

Provider Phone Number (307) 326-5129

101 CONSTITUTION AVE

Provider Street

SARATOGA

Provider City

WY

82331

HOSPITAL PHARMACY INC UNITED DRUGS HOSPITAL PHARMACY WEST OSCO PHARMACY RIDLEY'S PHARMACY VILAS PHARMACY OUR VALLEY PHARMACY VICKLUND PHARMACY COMMUNITY DRUG INC VANDEL DRUG COMPANY SOUTH STREET PHARMACY RICKER PHARMACY

(307) 672-2426 (307) 673-3188 (307) 672-8908 (307) 672-1788 (307) 283-3883 (307) 883-6337 (307) 864-2369 (307) 532-3060 (307) 532-2530 (307) 322-2486 (307) 347-2281

1 S MAIN ST 1333 W 5TH ST STE 107 1865 COFFEEN AVE 169 COFFEEN STREET 224 MAIN STREET 118 PETERSEN PKWY 610 S 6TH ST 900 W VALLEY RD 2041 MAIN ST 1456 SOUTH ST 1801 BIG HORN AVE

SHERIDAN SHERIDAN SHERIDAN SHERIDAN SUNDANCE THAYNE THERMOPOLIS TORRINGTON TORRINGTON WHEATLAND WORLAND

WY WY WY WY WY WY WY WY WY WY WY

82801-4221 82801-2752 82801-5711 82801 82729 83127-9753 82443 82240-3232 82240-2708 82201 82401-2912

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. The provider network may change at any time. You will receive notice when necessary. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. ©Aetna Inc.

NR_0009_10823 10/2017

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