For more information, please contact Network Health Medicare Advantage (PPO) Plans customer service at 800-316-3107, 24 hours a day/seven days a week (TTY users should call 800-899-2114). Or, visit NetworkHealthMedicare.com. This Pharmacy Directory was updated on 08/12/2013.
4 201 Pharmacy Directory
Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) NetworkCares (PPO SNP)
H5215_RXPD_14_Vs1
Network PlatinumSelect (PPO) For more information, please contact Network Health Medicare Advantage (PPO) Plans customer service at 800-316-3107, 24 hours a day/ seven days a week (TTY users should call 800-899-2114). Or, visit NetworkHealthMedicare. com. This Pharmacy Directory was updated on 08/12/2013.
2014 Part D Pharmacy Directory
Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) NetworkCares (SNP PPO) Network PlatinumSelect (PPO)
Pharmacy Directory For more information, please contact Network Health Medicare Advantage (PPO) Plans customer service at 800-316-3107, 24 hours a day/seven days a week (TTY users should call 800-899-2114). Or, visit NetworkHealthMedicare.com. This Pharmacy Directory was updated on 08/12/2013.
The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1 of each year. Limitations, copayments and restrictions may apply. Network Health Medicare Advantage Plans are PPO plans with a Medicare contract. NetworkCares is a Coordinated Care Plan with a Medicare contract and a contract with the Forward Health Wisconsin Medicaid Program. Enrollment in Network Health Medicare Advantage plans depends on contract renewal. H5215_RXPD/14_Populated_V1 Accepted 08152013 1
2014 Part D Pharmacy Directory
TABLE OF CONTENTS
Introduction .......................................................................................................................................
Retail Pharmacies ..............................................................................................................................
Mail Order Pharmacy ..................................................................................................................... 1
Home Infusion Pharmacies ............................................................................................................. 1
Long-Term Care Pharmacies ......................................................................................................... 1
Indian Health Service/Tribal/Urban Indian Health Program (I/T/U)
Pharmacies ....................................................................................................................................... 1
NETWORK HEALTH
1570 Midway Place
PO Box 120
Menasha, WI 54952
Customer Service
800-316-3107
TTY 800-899-2114
24 hours a day/seven days a week
Network Health Medicare Advantage Plans Pharmacy Directory
2
2014 Part D Pharmacy Directory
Introduction This booklet provides a list of Network Health Medicare Advantage Plan’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Network PlatinumPlus Pharmacy, Network PlatinumPremier Pharmacy, NetworkCares and Network PlatinumSelect’s formulary. When this Pharmacy Directory refers to “we,” “us,” or “our,” it means Network Health Medicare Advantage Plans. When it refers to “plan” or “our plan,” it means Network PlatinumPlus Pharmacy, Network PlatinumPremier Pharmacy, NetworkCares and Network PlatinumSelect. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to plan members. In most cases, your prescriptions are covered under Network Health Medicare Advantage Plans only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription, but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of August 12, 2013. For the most current list, please contact us. Our contact information appears on the front and back cover pages. You can go to all the pharmacies on this list, but your costs may be less at certain pharmacies in this list, which we have marked with *. We call these pharmacies preferred pharmacies, and they may offer lower cost-sharing than non-preferred pharmacies. If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact us. This directory contains the different types of pharmacies in our network. These pharmacies are listed alphabetically by community. To locate a participating pharmacy, find the community nearest you and check the listing of participating pharmacies. Or, you can visit our website at NetworkHealthMedicare.com or call customer service at 800-316-3107, 24 hours a day/seven days a week. TTY users should call 800-899-2114.
Legend *
Preferred Pharmacy
#
Extended Supply Pharmacy. This pharmacy can provide an extended day supply of medications.
3
2014 Part D Pharmacy Directory
Retail Pharmacies
Retail Pharmacies
Algoma Aurora Pharmacy 801 Jefferson St Algoma WI 54201 (920) 487-2887
Appleton Consumer Prescription 2310 W College Ave
Appleton WI 54914 (920) 739-9232 Copps Food Center Pharmacy 2400 W Wisconsin Ave Appleton WI 54914 (920) 831-0400 Copps Food Center Pharmacy 2700 N Ballard Rd Appleton WI 54911 (920) 996-0121 Copps Food Center Pharmacy 511 W Calumet St Appleton WI 54915 (920) 734-3882 CVS 1485 Oneida St Appleton WI 54915 (920) 733-1194
CVS 700 W Wisconsin Ave Appleton WI 54914 (920) 991-1190
Wal-Mart 3701 E Calumet St Appleton WI 54915 (920) 996-0746
Sam's Club 4895 Integrity Way
Appleton WI 54915 (920) 733-7410
Wal-Mart 955 N Mutual Way
Appleton WI 54913 (920) 954-6400
Shopko Express Pharmacy 2101 E Evergreen Dr
Appleton WI 54913 (920) 733-2305
Walgreens 1901 S Oneida St Appleton WI 54915 (920) 739-7321
Shopko Express Pharmacy W3208 Van Roy Rd
Appleton WI 54915 (920) 733-3846 Shopko Pharmacy 1000 W Northland Ave Appleton WI 54914 (920) 739-6871 Target Pharmacy 1800 South Kensington Dr
Appleton WI 54915 (920) 749-9775 Target Pharmacy 4301 W Wisconsin Ave
STE 42 Appleton WI 54913 (920) 243-7877
Walgreens 2803 N Meade St Appleton WI 54911 (920) 830-6985 Walgreens 3330 E Calumet St Appleton WI 54915 (920) 733-3016 Walgreens 700 W College Ave
Appleton WI 54914 (920) 733-6599 Walgreens 729 W Northland Ave Appleton WI 54914 (920) 954-8100
Network Health Medicare Advantage Plans Pharmacy Directory 4
2014 Part D Pharmacy Directory
Retail Pharmacies
Ashwaubenon Walgreens 2301 S Oneida St Ashwaubenon WI 54304 (920) 490-0424
Marshland Pharmacy 705 S University Ave
Beaver Dam WI 53916 (920) 356-0040 Shopko Pharmacy 822 Park Ave Beaver Dam WI 53916 (920) 887-7461 Thrifty White Drug 609 N Spring St
Beaver Dam WI 53916 (920) 885-3277 Wal-Mart 120 Francis Ln Beaver Dam WI 53916 (920) 885-5808 Walgreens 607 Park Ave Beaver Dam WI 53916 (920) 356-0148
Bellevue Walgreens 1979 Lime Kiln Rd Bellevue WI 54311 (920) 288-0638
Chilton
Field Pharmacy 135 W Huron St Berlin WI 54923 (920) 361-1565
Wal-Mart 810 S Irish Rd Chilton WI 53014 (920) 849-7330
Wal-Mart 822 Broadway St
Berlin WI 54923 (920) 361-3433
Walgreens 245 W Calumet St Chilton WI 53014 (920) 849-2818
Brillion Shopko Pharmacy 1010 W Ryan St
Brillion WI 54110 (920) 756-2640
Brownsville Agnesian Pharmacy 900 Main St Brownsville WI 53006 (920) 583-1310
Campbellsport The Village Apothecary 110 W Main St Campbellsport WI 53010 (920) 533-4012
Cedar Grove Aurora Pharmacy 313 S Main St Cedar Grove WI 53013 (920) 668-6286
Clintonville Erickson Pharmacy 8 S Main St STE B Clintonville WI 54929 (715) 823-2222 Shopko Pharmacy 291 S Main St Clintonville WI 54929 (715) 823-2350 Walgreens 201 S Main St Clintonville WI 54929 (715) 823-4238
De Pere Aurora Pharmacy 1881 Chicago St
De Pere WI 54115 (920) 403-8050 CVS 800 Main Ave De Pere WI 54115 (920) 336-6373
Network Health Medicare Advantage Plans Pharmacy Directory 5
Retail Pharmacies
Beaver Dam
Berlin
2014 Part D Pharmacy Directory
Retail Pharmacies
De Pere (continued)
Retail Pharmacies
Shopko Express 3705 Monroe Rd De Pere WI 54115 (920) 336-6096 Shopko Pharmacy 230 N Wisconsin St De Pere WI 54115 (920) 336-2323 Stowe Drug Store 375 Main Ave De Pere WI 54115 (920) 336-6128 Wal-Mart 1415 Lawrence Dr De Pere WI 54115 (920) 336-7168 Walgreens 901 Main Ave De Pere WI 54115 (920) 983-6153
Denmark Bellin Health Pharmacy
595 County Road R
Denmark WI 54208 (920) 863-5800
Fond du Lac Agnesian Pharmacy 145 N Main St Fond du Lac WI 54935 (920) 926-4660
Agnesian Pharmacy 912 S Hickory Rd
Fond du Lac WI 54935 (920) 929-7480
Wal-Mart 377 N Rolling Meadows Dr
Fond du Lac WI 54935 (920) 921-9591
Agnesian Pharmacy Plus 420 E Division St Fond du Lac WI 54935 (920) 926-8585
Walgreens 192 N Main St Fond du Lac WI 54935 (920) 921-5264
Aurora Pharmacy 210 Wisconsin American
Dr Fond du Lac WI 54935 (920) 907-7260 Kremer Pharmacy 9 N Main St Fond du Lac WI 54935 (920) 921-2550 Pick N Save Pharmacy 55 W Pioneer Rd Fond du Lac WI 54935 (920) 923-7780 Pick N Save Pharmacy 760 W Johnson St Fond du Lac WI 54935 (920) 929-7422 Shopko Pharmacy 616 W Johnson St Fond du Lac WI 54935 (920) 921-5490 Target Pharmacy 485 N Rolling Meadows Dr
Fond du Lac WI 54937 (920) 924-0420
Walgreens 20 W Pioneer Rd Fond du Lac WI 54935 (920) 907-0556
Gillett CMH Pharmacy 117 N Mckenzie St Gillett WI 54124 (920) 848-6323
Grand Chute Walgreens 1305 N Casaloma Dr Grand Chute WI 54913 (920) 730-8218
Green Bay Aurora Pharmacy 2253 W Mason St Green Bay WI 54303 (920) 327-7220 Aurora Pharmacy 2845 Green Brier Rd Green Bay WI 54311 (920) 288-3140
Network Health Medicare Advantage Plans Pharmacy Directory 6
2014 Part D Pharmacy Directory
Retail Pharmacies
Shopko Pharmacy 2430 E Mason St Green Bay WI 54302 (920) 468-6044
CVS 2400 Velp Ave
Green Bay WI 54303 (920) 434-3954
Shopko Pharmacy 301 Bay Park Sq
Green Bay WI 54304 (920) 499-5889
CVS 930 Main St Green Bay WI 54301 (920) 436-9382
Streus Pharmacy 635 Main St Green Bay WI 54301 (920) 437-0206
Bellin Health Pharmacy 744 S Webster Ave Green Bay WI 54301 (920) 431-5696
Kmart Pharmacy 1109 Lombardi Ave Green Bay WI 54304 (920) 499-6004
Target Pharmacy 1001 Cormier Rd Green Bay WI 54304 (920) 499-2608
Bellin Health Remote Disp 3263 Eaton Rd Green Bay WI 54311 (920) 433-6790
Krider Pharmacy and Gifts 1119 W Mason St Green Bay WI 54303 (920) 499-6225
Target Pharmacy 2050 Lime Kiln Rd Green Bay WI 54311 (920) 406-9049
Copps Food Center Pharmacy 1291 Lombardi Access Rd Green Bay WI 54304 (920) 498-9783
Sam's Club 2470 W Mason St Green Bay WI 54303 (920) 494-0536
Aurora Visiting Nurse Assoc 931 Discovery Ave
Green Bay WI 54311 (920) 288-5141 Bellin Health Pharmacy 1630 Commanche Ave
STE 102 Green Bay WI 54313 (920) 430-4555
Copps Food Center Pharmacy 1819 Main St Green Bay WI 54302 (920) 469-3436 CVS 1561 W Mason St Green Bay WI 54303 (920) 497-5959
Shopko Express 2585 Lineville Rd Green Bay WI 54313 (920) 662-9450 Shopko Pharmacy 216 S Military Ave
Green Bay WI 54303 (920) 499-0895 Shopko Pharmacy 2320 Lineville Rd Green Bay WI 54313 (920) 434-5846
Wal-Mart 2292 Main St Green Bay WI 54311 (920) 465-7737 Wal-Mart 2440 W Mason St Green Bay WI 54303 (920) 499-2330 Walgreens 116 N Military Ave
Green Bay WI 54303 (920) 498-3247 Walgreens 1165 W Mason St Green Bay WI 54303 (920) 498-3794
Network Health Medicare Advantage Plans Pharmacy Directory 7
Retail Pharmacies
CVS 2222 S Webster Ave Green Bay WI 54301 (920) 430-8089
Green Bay (continued)
2014 Part D Pharmacy Directory
Retail Pharmacies
Green Bay (continued)
Retail Pharmacies
Walgreens 1401 E Mason St Green Bay WI 54301 (920) 435-7679 Walgreens 1995 Main St Green Bay WI 54302 (920) 465-6210 Walgreens 2204 University Ave
Green Bay WI 54302 (920) 469-5516 Walgreens 464 Cardinal Ln Green Bay WI 54313 (920) 661-9355
Horicon Marshland Pharmacy 700 Washington St
Horicon WI 53032 (920) 485-3400
Howards Grove Aurora Pharmacy 620 S Wisconsin Dr Howards Grove WI 53083 (920) 565-5425
Iola Sweet Med Prescriptions Plus 155 N Main St Iola WI 54945 (715) 445-3117
Kaukauna Aurora Pharmacy 2700 Crooks Ave Kaukauna WI 54130 (920) 759-3050 Walgreens 2412 Crooks Ave Kaukauna WI 54130 (920) 759-9165
Kewaunee Shopko Pharmacy 802 N Main St Kewaunee WI 54216 (920) 388-2915
Kiel Aurora Pharmacy 1001 Service Rd Kiel WI 53042 (920) 894-4370 Shopko Pharmacy 1120 State Road 67 Kiel WI 53042 (920) 894-3604
Kimberly Shopko Pharmacy 800 E Maes Ave Kimberly WI 54136 (920) 788-9154
Kohler Walgreens 795C Woodlake Rd Kohler WI 53044 (920) 459-8768
Lakewood Nicolet Pharmacy 15481 Commercial Rd Lakewood WI 54138 (715) 276-3646
Little Chute Walgreens 219 W Main St Little Chute WI 54140 (920) 687-6193
Lomira Aurora Pres Dispensing Cntr 375 East Ave STE 1 Lomira WI 53048 (920) 269-2080
Network Health Medicare Advantage Plans Pharmacy Directory 8
2014 Part D Pharmacy Directory
Retail Pharmacies
Luxemburg Luxemburg Pharmacy 125 School Creek Trl Luxemburg WI 54217 (920) 845-5832
Aurora Pharmacy 601 Reed Ave Manitowoc WI 54220 (920) 686-5237 Copps Food Center Pharmacy 3300 Calumet Ave Manitowoc WI 54220 (920) 682-3051 Custom Health Pharmacy 1011 S 10th St Manitowoc WI 54220 (920) 482-3145 CVS 701 E Reed Ave Manitowoc WI 54220 (920) 682-3726 Health Mart Manitowoc Phcys 919 S 8th St Manitowoc WI 54220 (920) 684-6789 HFM Pharmacy 3310 Calumet Ave Manitowoc WI 54220 (920) 320-4400
Wal-Mart 4115 Calumet Ave Manitowoc WI 54220 (920) 684-5016 Walgreens 2702 Calumet Ave Manitowoc WI 54220 (920) 683-8887
Markesan Agnesian Pharmacy 49 S Bridge St
Markesan WI 53946 (920) 398-3261
Mayville Agnesian Pharmacy 360 S Mountain Dr Mayville WI 53050 (920) 387-7570 Marshland Pharmacy 1028 Horicon St Mayville WI 53050 (920) 387-7800
Menasha Shopko Pharmacy 1578 Appleton Rd
Menasha WI 54952 (920) 722-1895
Walgreens 305 Racine St Menasha WI 54952 (920) 722-4759
Montello Bentley Drug Store 25 W Montello St Montello WI 53949 (608) 297-2474
Neenah CVS 901 S Green Bay Rd
Neenah WI 54956 (920) 729-1448 Neenah Hometown Pharmacy 1415 S Commercial St Neenah WI 54956 (920) 729-4910 Pick N Save Pharmacy 828 Fox Point Plz Neenah WI 54956 (920) 722-1348 Shopko Pharmacy 699 Green Bay Rd
Neenah WI 54956 (920) 751-0270 Wal-Mart 1155 Winneconne Ave Neenah WI 54956 (920) 722-1185
Network Health Medicare Advantage Plans Pharmacy Directory 9
Retail Pharmacies
Manitowoc
Shopko Pharmacy 3415 Calumet Ave Manitowoc WI 54220 (920) 684-0251
2014 Part D Pharmacy Directory
Retail Pharmacies
Retail Pharmacies
Neenah (continued)
Oconto
Walgreens 1191 W Towne Dr Neenah WI 54956 (920) 725-3152
Oconto Pharmacy 1008 Main St Oconto WI 54153 (920) 834-4455
Walgreens 500 S Commercial St Neenah WI 54956 (920) 729-1311
Shopko Pharmacy 126 Charles St Oconto WI 54153 (920) 834-9800
New London
Oconto Falls
Jernegan's Health Mart 1301 Mill St New London WI 54961 (920) 982-7670
CMH Pharmacy 855 S Main St Oconto Falls WI 54154 (920) 846-8059
Wal-Mart 1717 N Shawano St New London WI 54961 (920) 982-7906
Oconto Falls Pharmacy HM 323 E Highland Dr
Oconto Falls WI 54154 (920) 848-3721
Walgreens 981 N Shawano St New London WI 54961 (920) 982-5189
North Fond du Lac Agnesian Pharmacy 723 Park Ridge Ln
North Fond du Lac WI
54937 (920) 926-8660
Omro Omro Pharmacy 109 E Main St Omro WI 54963 (920) 685-5041
Oshkosh Aurora Pharmacy 2101 Bowen St Oshkosh WI 54901 (920) 303-5006
Aurora Pharmacy 855 N Westhaven Dr Oshkosh WI 54904 (920) 303-8830 Murdoch Hometown Phcy 1828 Jackson St Oshkosh WI 54901 (920) 231-3000 Pick N Save Pharmacy 1940 S Koeller St Oshkosh WI 54902 (920) 236-9494 Sawyer Street Hometown Phcy 321 N Sawyer St
Oshkosh WI 54902 (920) 429-0763 Schultz Pharmacy 220 N Main St Oshkosh WI 54901 (920) 233-2151 Shopko Pharmacy 1300 Koeller Rd Oshkosh WI 54901 (920) 426-5770 Target Pharmacy 1900 S Koeller St Oshkosh WI 54902 (920) 233-4287 Wal-Mart 351 S Washburn St Oshkosh WI 54904 (920) 231-2219
Network Health Medicare Advantage Plans Pharmacy Directory 10
2014 Part D Pharmacy Directory
Retail Pharmacies
Oshkosh (continued) Walgreens 1100 Emmers Ln Oshkosh WI 54904 (920) 237-4753
Walgreens 950 S Koeller St Oshkosh WI 54902 (920) 303-1712
Plover Copps Food Center Pharmacy 1850 Plover Rd Plover WI 54467 (715) 344-0066 Shopko Pharmacy 1800 Plover Rd Plover WI 54467 (715) 342-9368 Wal-Mart 250 Crossroads Dr Plover WI 54467 (715) 345-7870
Plymouth Aurora Pharmacy 2635 Eastern Ave Plymouth WI 53073 (920) 893-1442
Wal-Mart 428 Walton Dr Plymouth WI 53073 (920) 892-2656 Walgreens 2455 Eastern Ave Plymouth WI 53073 (920) 893-5895
Princeton Bentley Drug 528 W Water St Princeton WI 54968 (920) 295-6271
Pulaski Pulaski Health Mart Pharmacy 121 N Saint Augustine St
Pulaski WI 54162 (920) 822-3011
Reeseville Village Healthmart Pharmacy 202 S Main St Reeseville WI 53579 (920) 927-3305
Ripon Kmart Pharmacy 1200 W Fond du Lac St Ripon WI 54971 (920) 748-1203 Ripon Drug 328 Watson St Ripon WI 54971 (920) 748-5174 Walgreens 1203 W Fond du Lac St Ripon WI 54971 (920) 748-6005
Seymour Shopko Pharmacy 1010 S Mainline Dr Seymour WI 54165 (920) 833-0430
Shawano Dreier Health Mart Pharmacy 117 S Main St Shawano WI 54166 (715) 526-2011 Kmart Pharmacy 1211 E Green Bay St
Shawano WI 54166 (715) 526-6551 Thedacare Pharmacy 100 County Road B
Shawano WI 54166 (715) 526-3456
Network Health Medicare Advantage Plans Pharmacy Directory 11
Retail Pharmacies
Walgreens 315 W Murdock Ave Oshkosh WI 54901 (920) 231-8664
Kmart Pharmacy 2615 Eastern Ave Plymouth WI 53073 (920) 892-4182
2014 Part D Pharmacy Directory
Retail Pharmacies
Shawano (continued)
Retail Pharmacies
Wal-Mart 1244 E Green Bay St
Shawano WI 54166 (715) 524-5983 Walgreens 401 E Green Bay St
Shawano WI 54166 (715) 524-5600
Sheboygan Aurora Pharmacy 2414 Kohler Memorial Dr Sheboygan WI 53081 (920) 459-2630 Aurora Pharmacy 509 Superior Ave
Sheboygan WI 53081 (920) 459-2637 Glander Prescription Plus 3529 Superior Ave
Sheboygan WI 53081 (920) 459-2755 Pick N Save Pharmacy 1317 N 25th St Sheboygan WI 53081 (920) 457-5839 Pick N Save Pharmacy 2625 S Business Dr Sheboygan WI 53081 (920) 452-2739
Sheboygan Health Mart Pharmacy 577 S Taylor Dr
Sheboygan WI 53081 (920) 459-7467 Shopko Pharmacy 518 S Taylor Dr
Sheboygan WI 53081 (920) 458-0040 Wal-Mart 3711 S Taylor Dr
Sheboygan WI 53081 (920) 459-8601 Wal-Mart 4433 Vanguard Dr
Sheboygan WI 53081 (920) 459-9470 Walgreens 1029 N 14th St Sheboygan WI 53081 (920) 458-7707 Walgreens 2702 Calumet Dr Sheboygan WI 53083 (920) 457-5656 Walgreens 3320 S Business Dr Sheboygan WI 53081 (920) 452-5858
Sheboygan Falls Target Pharmacy 4085 State Highway 28
Sheboygan Falls WI 53085 (920) 451-8448
Stevens Point Copps Food Center Pharmacy 1500 Pinecrest Ave Stevens Point WI 54481 (715) 345-7175 Kmart Pharmacy 111 Division St N Stevens Point WI 54481 (715) 341-5613 Shopko Pharmacy 1200 Main St Stevens Point WI 54481 (715) 344-1230 Trigs County Market Pharmacy 1600 Academy Ave
Stevens Point WI 54481 (715) 341-6102 Walgreens 10 Park Ridge Dr
Stevens Point WI 54481 (715) 344-7368 Walgreens 3301 Church St Stevens Point WI 54481 (715) 345-2843 Walgreens 900 Illinois Ave Stevens Point WI 54481 (715) 344-6834
Network Health Medicare Advantage Plans Pharmacy Directory 12
2014 Part D Pharmacy Directory
Retail Pharmacies
Two Rivers Aurora Pharmacy 2219 Garfield St STE 100 Two Rivers WI 54241 (920) 794-8029
Medicine Shoppe Pharmacy 1500 Washington St
Two Rivers WI 54241 (920) 794-1225 Walgreens 2206 Washington St
Two Rivers WI 54241 (920) 793-8352
Waupaca Kmart Pharmacy 830 W Fulton St Waupaca WI 54981 (715) 258-4285 Shopko 800 Riverside Dr Waupaca WI 54981 (715) 256-1115 Shopko Pharmacy 825 W Fulton St Waupaca WI 54981 (715) 258-9000 Stratton Drug Store 107 N Main St Waupaca WI 54981 (715) 258-7057
Waupaca Hometown Pharmacy 115 N Western Ave Unit 8 Waupaca WI 54981 (715) 256-0400
Waupun Agnesian Pharmacy 904 W Main St Waupun WI 53963 (920) 324-3010 Walgreens 999 E Main St Waupun WI 53963 (920) 324-4696
Wautoma Aurora Pharmacy 900 E Division St Wautoma WI 54982 (920) 787-6940 CHN Pharmacy N2934 State Road 22 Wautoma WI 54982 (920) 787-5757
Westfield Bentley Pharmacy 206 S Main St Westfield WI 53964 (608) 296-2877
Winneconne Shopko Pharmacy 916 E Main St Winneconne WI 54986 (920) 582-4414
Wittenberg Gwidt HM Pharmacy 203 E Westgor Ave
Wittenberg WI 54499 (715) 253-2164
Wrightstown Bellin Health Remote Disp 555 Quality Ct
Wrightstown WI 54180 (920) 532-0700
Shopko Pharmacy N2585 Plaza Rd Wautoma WI 54982 (920) 787-2090
Network Health Medicare Advantage Plans Pharmacy Directory 13
Retail Pharmacies
Aurora Pharmacy 5300 Memorial Dr Two Rivers WI 54241 (920) 793-7380
Walgreens 925 W Fulton St Waupaca WI 54981 (715) 258-9228
2014 Part D Pharmacy Directory
Mail Order Pharmacy
Mail Order Pharmacy
Express Scripts, Inc. (800) 316-3107
TTY (800) 899-2114
Network Health Medicare Advantage Plans Pharmacy Directory 14
2014 Part D Pharmacy Directory
Home Infusion Pharmacies Network Health Medicare Advantage Plans will cover Part D drugs used for home infusion therapy if: Your prescription drug is on Network Health Medicare Advantage Plan's formulary or you have a formulary exception; Network Health Medicare Advantage Plans has approved your prescription drug for
home infusion therapy; and Your prescription is written by an authorized prescriber. Ministry Home Care Plus (HI) 1927 N Central Ave STE B Marshfield WI 54449 (715) 387-0755
Bio Rx (HI) 10828 Kenwood Rd Blue Ash OH 45242 (513) 792-7080
Nufactor (HI) 41093 County Center Dr Temecula CA 92591 (800) 323-6832
Chartwell Midwest Wisconsin (HI) 2241 Pinehurst Dr Middleton WI 53562 (608) 831-8555
Option Care (HI) 985 Avenue Of The Cities Silvis IL 61282 (309) 762-7979
Coram Specialty Infusion Svcs (HI) 5345 S Moorland Rd STE 101 New Berlin WI 53151 (262) 207-1590 Home Care Pharmacy (HI) 5665 S Westridge Dr New Berlin WI 53151 (262) 786-9870 Igg of America (HI) 514 Progress Dr STE X Linthicum MD 21090 (877) 674-9700
Pentech Health (HI) 4 Creek Pkwy STE A Boothwyn PA 19061 (800) 223-4376
US Bioservices (HI) 109 Chelsea Pkwy Boothwyn PA 19061 (800) 400-9549 US Bioservices (HI) 501 W 44th Ave Unit A Denver CO 80216 (800) 809-0647 US Bioservices (HI) 3200 Internet Blvd Frisco TX 75034 (888) 518-7246 US Bioservices (HI) 8028 Reeder Rd Lenexa KS 66214 (800) 860-6581
Thedacare Infusion Pharmacy (HI) 1818 N Meade St Appleton WI 54911 (920) 831-1892 US Bioservices (HI) 5100 E Hunter Ave STE 101 Anaheim CA 92807 (800) 801-1140
Network Health Medicare Advantage Plans Pharmacy Directory 15
Home Infusion Pharmacies
Affinity Home Care Plus (HI) 2074 American Dr STE A Neenah WI 54956 (715) 387-0755
2014 Part D Pharmacy Directory
Long-Term Care Pharmacies Residents of a long-term care facility may access their prescription drugs covered under Network Health Medicare Advantage Plans through the facility's long-term care pharmacy or another network long-term care pharmacy.
Appleton NCS Healthcare (LTC) 3101 E Enterprise Ave
Appleton WI 54913 (800) 236-5665 Shopko Rxcare (LTC) 3701 E Evergreen Dr
Appleton WI 54913 (920) 739-5900
Long-Term Care Pharmacies
Beaver Dam Hillside Unit Pharmacy (LTC) 707 S University Ave
Beaver Dam WI 53916 (920) 887-4038
Green Bay Krider Pharmacy and Gifts (LTC) 1119 W Mason St Green Bay WI 54303 (920) 499-6225
Genoa Healthcare (LTC) 625 W Washington Ave
Madison WI 53703 (608) 251-1838
Streus Pharmacy (LTC) 528 N Monroe Ave Green Bay WI 54301 (920) 437-0206
Pinnacle Pharmacy (LTC) 2818 Progress Rd
Madison WI 53716 (608) 216-0140
Streus Pharmacy (LTC) 635 Main St Green Bay WI 54301 (920) 437-0206
Willow Pharmacy (LTC) 2702 International Ln Madison WI 53704 (608) 240-2280
King
Mayville
Thrifty White Drug (LTC) 609 N Spring St
Beaver Dam WI 53916 (920) 885-3277
Wisconsin Veterans Home Phcy (LTC) N2665 County Rd Qq
King WI 54946 (715) 258-1674
Brownsville
La Crosse
Agnesian Pharmacy (LTC) 900 Main St Brownsville WI 53006 (920) 583-1310
Madison
Pinnacle Phcy of La Crosse (LTC) 3235 Airport Rd La Crosse WI 54603 (608) 781-7900
Agnesian Pharmacy (LTC) 360 S Mountain Dr Mayville WI 53050 (920) 387-7570
Menasha Morton Pharmacy (LTC)
712 Midway Rd Menasha WI 54952 (920) 886-2908
Network Health Medicare Advantage Plans Pharmacy Directory 16
2014 Part D Pharmacy Directory
Long-Term Care Pharmacies
Milwaukee Genoa Healthcare (LTC) 10424 W Bluemound Rd
STE B Milwaukee WI 53226 (414) 244-9844 Roeschen's Omnicare Pharmacy (LTC) 5185 S 9th St Milwaukee WI 53221 (414) 486-3100
Monona Shopko Rxcare (LTC) 2217 Industrial Dr Monona WI 53713 (608) 223-0054
New London
Bentley Drug (LTC) 528 W Water St Princeton WI 54968 (920) 295-6271
Ripon Ripon Drug (LTC) 328 Watson St Ripon WI 54971 (920) 748-5174
Two Rivers Medicine Shoppe Pharmacy (LTC) 1500 Washington St
Two Rivers WI 54241 (920) 794-1225
Wittenberg Gwidt Pharmacy (LTC) 203 E Westgor Ave STE 1
Wittenberg WI 54499 (715) 253-2164
Oshkosh LHO Pharmacy (LTC) 225 N Eagle St
Oshkosh WI 54902 (920) 966-1345
Pewaukee Pharmerica (LTC) N29 W23721 Woodgate Ct
W Pewaukee WI 53072 (262) 347-0030
Network Health Medicare Advantage Plans Pharmacy Directory 17
Long-Term Care Pharmacies
Jernegan's Health Mart (LTC) 1301 Mill St New London WI 54961 (920) 982-7670
Princeton
Indian Health Service/Tribal/Urban Indian Health Program
2014 Part D Pharmacy Directory
Indian Health Service/Tribal/Urban Indian Health Program (I/T/U)
Pharmacies Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through Network Health Medicare Advantage Plan's pharmacy network. Those other than Native Americans and Alaskan Natives may be able to access these pharmacies under limited circumstances (e.g., emergencies).
Bowler Stockbridge-Munsee Hlth Ctr Phy (I/T/U) W12802 County Road A Bowler WI 54416 (715) 793-5027
Oneida Oneida Comm Health Center Phcy (I/T/U) 525 Airport Dr Oneida WI 54155 (920) 869-4826
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Network Health Medicare Advantage Plans Pharmacy Directory 18
For more information, please contact Network Health Medicare Advantage (PPO) Plans customer service at 800-316-3107, 24 hours a day/seven days a week (TTY users should call 800-899-2114). Or, visit NetworkHealthMedicare.com. This Pharmacy Directory was updated on 08/12/2013.
4 201 Pharmacy
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Directory
Network PlatinumPlus Pharmacy (PPO) Network PlatinumPremier Pharmacy (PPO) NetworkCares (PPO SNP) Network PlatinumSelect (PPO) For more information, please contact Network Health Medicare Advantage (PPO) Plans customer service at 800-316-3107, 24 hours a day/ seven days a week (TTY users should call 800-899-2114). Or, visit NetworkHealthMedicare. com. This Pharmacy Directory was updated on 08/12/2013.
