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Blue Cross Medicare Advantage Classic (PPO) SM Blue Cross Medicare Advantage Optimum (PPO) SM Blue Cross Medicare Advantage Choice Plus (PPO) SM Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy Directory This pharmacy directory was updated on 02/2022. For more recent information or other questions, please contact Blue Cross Medicare Advantage SM Customer Service at 1-877-774-8592 or, for TTY users, 711. We are open 8:00 a.m.- 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on weekends and holidays, or visit getbluemt.com/mapd/pharmacies. Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at getbluemt.com/mapd/pharmacies. You may also call Customer Service at 1-877-774-8592 (TTY/ TDD users should call TTY/TDD number) for updated information. Y0096_MTMAPDPHARMDIR22_C 350113.0222
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Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

May 05, 2022

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Page 1: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage Classic (PPO)SM

Blue Cross Medicare Advantage Optimum (PPO)SM

Blue Cross Medicare Advantage Choice Plus (PPO)SM

Blue Cross Medicare Advantage Flex (PPO)SM

2022 Pharmacy Directory

This pharmacy directory was updated on 02/2022. For more recent information or other questions, please contact Blue Cross Medicare AdvantageSM Customer Service at 1-877-774-8592 or, for TTY users, 711. We are open 8:00 a.m.- 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on weekends and holidays, or visit getbluemt.com/mapd/pharmacies.

Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at getbluemt.com/mapd/pharmacies. You may also call Customer Service at 1-877-774-8592 (TTY/TDD users should call TTY/TDD number) for updated information.

Y0096_MTMAPDPHARMDIR22_C 350113.0222

Page 2: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

i

Blue Cross Medicare Advantage

Pharmacy DirectoryIntroduction

This booklet provides a list of Blue Cross Medicare Advantage’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 Blue Cross Medicare Advantage’s formulary.

When this pharmacy directory refers to “we”, “us”, or “our”, it means Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC). When it refers to “plan” or “our plan,” it means Blue Cross Medicare Advantage.

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 Blue Cross Medicare Advantage 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 02/2022. 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 for some drugs may be less at pharmacies in this list that offer preferred cost sharing. We have marked these pharmacies with “SAVE” to distinguish them from other pharmacies in our network that offer standard cost sharing.

You can get prescription drugs shipped to your home through our network mail order delivery program. For more information, please contact us or see the mail order section of this pharmacy directory.

This directory is for the state of Montana which includes the area in which you live. However, we cover a larger service area, and there are more pharmacies where your prescriptions may be covered by our Plan. For information on more pharmacies in our plan network not listed in this directory, please contact Blue Cross Medicare Advantage Customer Service at 1-877-774-8592 or, for TTY users, 711. We are open 8:00 a.m.- 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on weekends and holidays, or visit getbluemt.com/mapd/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 Blue Cross Medicare Advantage.

Page 3: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

ii

Pharmacy Type Retail

Long-Term Care

Home Infusion

Extended Supply

Preferred Network

Preferred Extended

Supply Network

Total Number of Pharmacies

64,000 Pharmacies

4,600 Pharmacies

500 Pharmacies

60,000 Pharmacies

27,000 Pharmacies

27,000 Pharmacies

Pharmacies are listed alphabetically by county and city and by type of pharmacy. The types of pharmacies in this directory appear in this order:

• Mail Order Pharmacies• Chain Pharmacies• Retail Pharmacies, including Chain Pharmacies• Long-Term Care Pharmacies• Home Infusion Pharmacies• Specialty Pharmacies

Under each listing we also show additional pharmacy features. These features are identified on each page with the following key:

SAVE = Preferred cost sharing. Drugs from these pharmacies may cost less than other pharmacies in our network.

90 = 90-day supply. These are retail pharmacies that offer an extended (90-day) supply of medications.

24HR = Pharmacy is open 24-hours.

eRX = Pharmacy accepts electronic prescriptions from prescribers.

Page 4: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Mail Order Pharmacy

You can get prescription drugs shipped to your home through our network mail order delivery program.

For refills of your mail order prescriptions, please contact us 10 to 20 days before you think the drugs youhave on hand will run out to make sure your next order is shipped to you in time.

Typically, you should expect to receive your prescription drugs within 10 business days from the timethat the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time,please contact the numbers below (TTY users: 711) 24 hours a day, seven days a week, or visit the pharmacywebsite.

AllianceRx Walgreens Prime ....... (877) 277-7895 Express Scripts Pharmacy ...... (833) 599-0729(TTY users: 711) (TTY users: 711)www.alliancerxwp.com www.express-scripts.com

Chain Pharmacies

Below are chain pharmacies in our network. For locations and phone numbers of stores near you, call thenumbers below (TTY users: 711) or visit the pharmacy website.

SAVE = Preferred cost sharing90 = 90-day supply

1

Costco ........................................... (800) 607-6861 Smith's Pharmacy ..................... (800) 576-4377www.costco.com www.smithsfoodanddrug.com90 SAVE, 90

CVS ................................................ (800) 746-7287 Walgreens ................................. (800) 925-4733www.cvs.com www.walgreens.com90 SAVE, 90

Jewel-Osco ................................... (877) 728-6655 Walmart ..................................... (800) 925-6278www.jeweloscopharmacies.com www.walmart.comSAVE, 90 SAVE, 90

Safeway ......................................... (800) 723-3929www.safeway.comSAVE, 90

Page 5: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

ANACONDA Montana Pharmacy Listing

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

2

ANACONDA

COMMUNITY HOSP ANACONDAPHCY....................................................(406) 563-8650401 PENNSYLVANIA • 5971190, eRX

CVS PHARMACY #08618................... (406) 563-52661300 E PARK AVE • 5971190, eRX

PINTLER PHARMACY........................ (406) 563-0433203 E PARK AVE • 59711eRX

STOKES PHARMACY ANACONDA... (406) 563-84101525 WEST PARK AVENUE • 59711SAVE, 90, eRX

THRIFTY DRUG...................................(406) 563-8441201 E PARK ST • 5971190, eRX

ASHLAND

BIGHORN VALLEY PHARMACY -ASHLAND............................................ (406) 784-2346501 MAIN STREET • 5900390, eRX

BAKER

BAKER DRUG LLC............................. (406) 778-2214103 S MAIN • 59313SAVE, 90, eRX

BELGRADE

OSCO PHARMACY #0009.................. (406) 388-16966999 JACKRABBIT LN • 59714SAVE, 90, eRX

TOWN AND COUNTRY FOODSPHARMACY.........................................(406) 388-4111205 W MADISON AVE • 59714SAVE, 90, eRX

BIG SANDY

BIG SANDY PHARMACY....................(406) 378-5588158 JOHANNES AVE • 59520eRX

BIG TIMBER

COLE DRUG........................................(406) 932-5316136 MCLEOD • 59011SAVE, 90, eRX

BIGFORK

BIGFORK DRUG................................. (406) 837-43708111 MT HIGHWAY 35 STE 7 • 5991190, eRX

BILLINGS

BILLINGS CLINIC ALLCARE PHARMACYSOLUTIONS.........................................(406) 435-59701015 BROADWATER AVENUE SUITE 201 • 5910290, eRX

BILLINGS CLINIC ATRIUMPHARMACY.........................................(406) 238-20842800 10TH AVE N • 5910190, 24HR, eRX

BILLINGS CLINIC SPECIALTYPHARMACY.........................................(406) 657-45451015 BROADWATER • 5910290, eRX

COSTCO PHARMACY #69................. (406) 652-85562290 KING AVE W • 5910290, eRX

CVS PHARMACY #05301................... (406) 259-70341311 GRAND AVENUE • 5910290, eRX

CVS PHARMACY #05302................... (406) 259-7861425 MAIN STREET • 5910590, eRX

CVS PHARMACY #08623................... (406) 252-63342402 GRAND AVE • 5910290, eRX

CVS PHARMACY #08944................... (406) 256-4924617 CENTRAL AVE • 5910290, eRX

Page 6: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing BILLINGS

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

3

CVS PHARMACY #16037................... (406) 652-22632601 CENTRAL AVE • 5910290, eRX

GENOA HEALTHCARE, LLC............. (406) 545-45713737 GRAND AVE, SUITE 6, ROOM P • 59102eRX

JUROS UNITED DRUGS.....................(406) 259-25622043 GRAND AVE • 5910290, eRX

OMNICARE OF BILLINGS.................. (406) 896-33992747 ENTERPRISE AVE • STE 1 • 59102eRX

OSCO PHARMACY #0038.................. (406) 248-55441212 GRAND AVE • 59102SAVE, 90, eRX

OSCO PHARMACY #0047.................. (406) 245-4301511 CENTRAL AVE • 59102SAVE, 90, eRX

OSCO PHARMACY #0630.................. (406) 656-66522334 CENTRAL AVE • 59102SAVE, 90, eRX

OSCO PHARMACY #1227.................. (406) 245-6979670 MAIN ST • 59105SAVE, 90, eRX

OSCO PHARMACY #4025.................. (406) 259-1441611 N 27TH ST • 59101SAVE, 90, eRX

OSCO PHARMACY #4041.................. (406) 652-83593137 GRAND AVE • 59102SAVE, 90, eRX

PHARMACY 1......................................(406) 245-67172900 12TH AVE N SUITE 110A • 59101SAVE, eRX

PHARMACY 1 AT THE MHC.............. (406) 601-33921245 N 29TH STREET SUITE 100 • 5910190, eRX

PHARM406, INC.................................. (406) 717-61001410 38TH ST W • 59102SAVE, 90, eRX

PLANNED PARENTHOOD OFMONTANA........................................... (406) 248-36361116 GRAND AVE STE 201 • 5910290

RIVERSTONEHEALTH PHARMACY..(406) 247-3330123 S 27TH ST • 5910190, eRX

SAMS PHARMACY 10-4805............... (406) 256-01774420 KING AVE E • 5910190, eRX

SCL HEALTH PHARMACY SERVICES - SAINTVINCENT PHARMACY........................ (406) 237-81171233 N 30TH ST • STE W103 • 59101SAVE, 90, eRX

ST JOHNS PHARMACY......................(406) 655-58273940 RIMROCK RD • 5910290, eRX

WALGREENS #10652......................... (406) 245-01781602 MAIN ST • 59105SAVE, 90, eRX

WALGREENS #11503......................... (406) 652-16203333 GRAND AVE • 59102SAVE, 90, eRX

WALGREENS #12155......................... (406) 252-00961330 GRAND AVE • 59102SAVE, 90, eRX

WALMART PHARMACY 10-1956....... (406) 652-96882525 KING AVE W • 59102SAVE, 90, eRX

WALMART PHARMACY 10-2923....... (406) 254-29471649 MAIN ST • 59105SAVE, 90, eRX

Page 7: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

BOULDER Montana Pharmacy Listing

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

4

BOULDER

ELKHORN PHARMACY INC...............(406) 225-3240215 N MAIN • 59632SAVE, eRX

BOZEMAN

BOZEMAN CHP PHARMACY............. (406) 922-0843214 E MENDENHALL ST • 59715SAVE, eRX

COSTCO PHARMACY #96................. (406) 585-75752505 CATRON ST • 5971890, eRX

CVS PHARMACY #08621................... (406) 587-9252115 NORTH 19TH AVENUE • 5971890, 24HR, eRX

GENOA HEALTHCARE, LLC............. (406) 404-6978699 FARMHOUSE LANE, STE P • 59715eRX

HIGHLAND PARK PHARMACY..........(406) 414-1030925 HIGHLAND BLVD • 59715SAVE, 90, eRX

MSU STUDENT HEALTH SERVICEPHARMACY.........................................(406) 994-5498MSU STUDENT HEALTH SERVICE RX • 7TH ANDGRANT • 5971590, eRX

OSCO PHARMACY #0006.................. (406) 587-8800200 S 23RD AVE • 59718SAVE, 90, eRX

PRICE RITE DRUG............................. (406) 587-0608910 N 7TH AVE • 59715SAVE, 90, eRX

ROSAUERS PHARMACY #40............ (406) 587-40053255 TECHNOLOGY BLVD • 5971890, eRX

SAFEWAY PHARMACY #2999...........(406) 585-91551735 W MAIN ST • 59715SAVE, 90, eRX

SMITHS PHARMACY #170................. (406) 586-35501400 N 19TH AVE • 59715SAVE, 90, eRX

WALMART PHARMACY 10-2084....... (406) 585-87531500 N 7TH AVE • 59715SAVE, 90, eRX

WESTERN DRUG OF BOZEMAN.......(406) 587-3145200 HIGHLAND BLVD • 5971590, eRX

BROADUS

BROADUS IGA....................................(406) 436-2270120 S PARK • 5931790, eRX

BUTTE

COMMUNITY HEALTH CENTERPHARMACY.........................................(406) 496-60261145 S MONTANA ST • 59701SAVE, 90, eRX

CVS PHARMACY #08627................... (406) 723-94081275 HARRISON ST • 5970190, eRX

MEDICAL ARTS PHARMACY............ (406) 723-2441435 S CRYSTAL ST • STE 230 • 59701SAVE, 90, eRX

SAFEWAY PHARMACY #3279...........(406) 494-37542500 MASSACHUSETTS AVE • 59701SAVE, 90, eRX

THREE BEARS PHARMACY.............. (406) 494-411645 THREE BEARS DR • 59701SAVE, 90, eRX

WALGREENS #13818......................... (406) 782-54712611 HARRISON AVE • 59701SAVE, 90, eRX

WALMART PHARMACY 10-1901....... (406) 494-12253901 HARRISON AVE • 59701SAVE, 90, eRX

Page 8: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing DILLON

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

5

CHESTER

CHESTER PHARMACY INC............... (406) 759-505030 MAIN STREET • 5952290, eRX

REMEDIES PHARMACY & GIFT........ (406) 262-8492500 EAST WASHINGTON AVE. • 59522eRX

CHINOOK

CHINOOK PHARMACY.......................(406) 357-3333300 INDIANA ST • 59523eRX

CHOTEAU

CHOTEAU DRUG................................ (406) 466-2700102 MAIN AVE N • 59422SAVE, 90, eRX

CLYDE PARK

WESTERN DRUG, TOO...................... (406) 686-4270105 E 1ST • 59018SAVE, eRX

COLSTRIP

COLSTRIP FAMILY PHARMACY....... (406) 213-70106230 MAIN ST STE B101 • 5932390, eRX

COLUMBIA FALLS

LOGAN HEALTH PHARMACY COLUMBIAFALLS.................................................. (406) 892-99972100 9TH ST W • 5991290, eRX

SMITHS PHARMACY #168................. (406) 892-9088419 NUCLEUS AVE • 59912SAVE, 90, eRX

SYKES PHARMACY COLUMBIAFALLS.................................................. (406) 206-7277500 12TH AVE W STE 1A • SYKES PHARMACY •5991290, eRX

COLUMBUS

STILLWATER FAMILY PHARMACY.. (406) 322-5652133 N 5TH STREET • 59019SAVE, 90, eRX

CONRAD

OLSON'S DRUG..................................(406) 278-32615 4TH AVE SE • 59425SAVE, 90, eRX

VILLAGE DRUG.................................. (406) 278-3267600 S MAIN ST • SUITE 2 • 5942590, eRX

CORVALLIS

CORVALLIS DRUG............................. (406) 961-32211029 MAIN ST • 5982890, eRX

CULBERTSON

CULBERTSON FAMILY PHARMACY (406) 787-5313115 BROADWAY • 59218SAVE, 90, eRX

CUT BANK

GLACIER PHARMACY....................... (406) 873-0404601 W MAIN ST STE 1A • 5942790, eRX

OSCO PHARMACY #0033.................. (406) 873-2055501 W MAIN ST • 59427SAVE, 90, eRX

DEER LODGE

KEYSTONE FAMILY PHARMACY......(406) 846-2120407 MAIN ST • 5972290, eRX

SAFEWAY PHARMACY #1158...........(406) 846-1414201 N MAIN ST • 59722SAVE, 90, eRX

DILLON

BLACKTAIL PHARMACY................... (406) 988-0772125 E GLENDALE ST • 59725SAVE, 90, eRX

Page 9: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

EKALAKA Montana Pharmacy Listing

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

6

SAFEWAY PHARMACY #1581...........(406) 683-6226570 N MONTANA ST • 59725SAVE, 90, eRX

EKALAKA

DAHL MEMORIAL HEALTHCARE COMMUNITYPHARMACY.........................................(406) 775-8896215 SANDY STREET • 59324SAVE, 90, eRX

EUREKA

EUREKA DRUG...................................(406) 297-7748546 US HIGHWAY 93 N • 59917SAVE, eRX

FAIRFIELD

FAIRFIELD DRUG INC........................(406) 467-2336407 CENTRAL AVE • 59436SAVE, 90, eRX

FLORENCE

FLORENCE PHARMACY.................... (406) 273-79795549 OLD US HIGHWAY 93 • 59833eRX

FORSYTH

YELLOWSTONE PHARMACY............ (406) 346-21341025 MAIN ST • 59327SAVE, 90, eRX

FORT BENTON

BENTON PHARMACY........................ (406) 622-55881418 FRONT ST • 59442eRX

FRENCHTOWN

GRANITE PHARMACYFRENCHTOWN....................................(406) 626-411316862 BECKWITH ST • SUITE P • 59834SAVE, eRX

GARDINER

GARDINER PHARMACY.................... (406) 848-9430318 PARK STREET • 59030eRX

GLASGOW

WESTERN DRUG................................(406) 228-4308537 2ND AVE S • 59230SAVE, 90, eRX

5TH AVENUE PHARMACY ANDGIFT..................................................... (406) 228-3693621 3RD ST S • 5923090, eRX

GLENDIVE

OSCO PHARMACY #4023.................. (406) 365-5209307 HARMON ST • 59330SAVE, 90, eRX

REYNOLDS PHARMACY....................(406) 377-49201014 WEST BELL • 59330SAVE, 90, eRX

GREAT FALLS

ALLUVION HEALTH PHARMACY......(406) 791-7903105 6TH ST N • 5940190, eRX

ANDERSON FAMILY PHARMACY.....(406) 216-31022828 10TH AVE S • 59405eRX

ANDERSON SPECIALTYPHARMACY.........................................(406) 216-31022828 10TH AVE S • 59405eRX

BENEFIS AMBULATORYPHARMACY.........................................(406) 455-2170500 15TH AVE S STE 2 • 59405eRX

BIG SKY MANAGED CARE HELENA (406) 502-1800900 JACKSON ST STE A • 59601eRX

BIG SKY MANAGED CARE................(406) 315-1989900 13TH AVE S • 5940590, eRX

Page 10: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing HARLOWTON

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

7

BIG SKY MANAGED CARE GREATFALLS.................................................. (406) 403-7224915 1ST AVE S STE 110 • 5940190, eRX

CLINIC PHARMACY............................(406) 771-33991400 29TH ST S • 59405SAVE, 90, eRX

CVS PHARMACY #08624................... (406) 453-13182001 10TH AVE S • 5940590, eRX

OSCO PHARMACY #0035.................. (406) 761-84201414 3RD ST NW • 59404SAVE, 90, eRX

OSCO PHARMACY #0037.................. (406) 727-98802250 10TH AVE S • 59405SAVE, 90, eRX

PHARMERICA..................................... (406) 770-4420625 CENTRAL AVE WEST • SUITE 105 • 59405eRX

PLAZA UNITED PHARMACY............. (406) 727-00702800 11TH AVE S • 59405SAVE, 90, eRX

PUBLIC DRUG CO.............................. (406) 453-1497324 CENTRAL AVE • 59401SAVE, 90, eRX

SAMS PHARMACY 10-6379............... (406) 453-3466401 NORTHWEST BYP • 5940490, eRX

SMITHS PHARMACY #166................. (406) 771-04751601 MARKET PLACE DRIVE • 59404SAVE, 90, eRX

WALGREENS #10083......................... (406) 727-13762301 10TH AVE S • 59405SAVE, 90, eRX

WALGREENS #10859......................... (406) 761-02141213 3RD ST NW • 59404SAVE, 90, eRX

WALMART PHARMACY 10-2455....... (406) 761-1456701 SMELTER AVE NE • 59404SAVE, 90, eRX

WALMART PHARMACY 10-7199....... (406) 770-60705320 10TH AVE S • 59405SAVE, 90, eRX

HAMILTON

BITTERROOT DRUG.......................... (406) 363-3611211 W MAIN ST • 5984090, eRX

HEALTHCARE PROVIDERS...............(406) 363-62031900 N FIRST ST • 59840SAVE, 90, eRX

OSCO PHARMACY #4040.................. (406) 363-70891313 N FIRST ST • 59840SAVE, 90, eRX

TIMBER RIDGE PHARMACY............. (406) 363-90031131 N 1ST ST • 5984090, eRX

WALGREENS #11891......................... (406) 375-2264901 N 1ST STREET • 59840SAVE, 90, eRX

HARDIN

BIGHORN VALLEY PHARMACY........(406) 867-414110 WEST 4TH STREET • STE B • 5903490, eRX

HARDIN FAMILY PHARMACY........... (406) 665-1201901 N CENTER AVE • 59034SAVE, 90, eRX

HARLEM

MILK RIVER PHARMACY...................(406) 353-353542465 US HWY 2 • 59526SAVE, 90, eRX

HARLOWTON

REMEDIES PHARMACY..................... (406) 632-453227 S CENTRAL AVE • 59036eRX

Page 11: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

HAVRE Montana Pharmacy Listing

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

8

HAVRE

BULLHOOK COMMUNITY HEALTH CENTERPHARMACY.........................................(406) 395-6906521 4TH ST • 59501SAVE, 90, eRX

GARY & LEO'S PHARMACY.............. (406) 265-1229730 1ST ST • 5950190, eRX

NORTHERN MONTANA HOSPITAL...(406) 262-125030 W 13TH ST • 59501

NORTHERN MONTANA PHARMACY (406) 262-170120 W 13 ST • 59501SAVE, 90, eRX

WALMART PHARMACY 10-4247....... (406) 262-91743510 US HWY 2 W • 59501SAVE, 90, eRX

WESTERN DRUG PHARMACY.......... (406) 265-9601123 5TH AVE • STE B • 59501SAVE, 90, eRX

HELENA

CAPITAL RX........................................(406) 422-11002600 WINNE AVE STE A • 59601SAVE, 90, eRX

COSTCO PHARMACY #633............... (406) 495-70492195 E CUSTER AVE • 5960290, eRX

CVS PHARMACY #04278................... (406) 443-33313095 N MONTANA AVE • 5960190, eRX

CVS PHARMACY #08617................... (406) 442-9800603 N MONTANA • 5960190, eRX

CVS PHARMACY #08619................... (406) 442-2196526 EUCLID • 5960190, eRX

GENEVA WOODS PHARMACY#48550..................................................(406) 443-25401310 ELM ST • 59601eRX

OSCO PHARMACY #4008.................. (406) 449-22953151 N MONTANA AVE • 59602SAVE, 90, eRX

PUREVIEW HEALTH CENTERPHARMACY.........................................(406) 500-20801930 9TH AVE • 5960190, eRX

SAFEWAY PHARMACY #1486...........(406) 443-4508611 N MONTANA AVE • 59601SAVE, 90, eRX

ST PETER'S HEALTH PHARMACY... (406) 444-23502475 BROADWAY • 59601SAVE, 90, 24HR, eRX

ST PETERS HEALTH BROADWAYPHARMACY.........................................(406) 444-22002550 BROADWAY • 59601SAVE, 90, eRX

WALGREENS #10084......................... (406) 442-12651150 11TH AVE • 59601SAVE, 90, eRX

WALMART PHARMACY 10-1872....... (406) 443-34552750 PROSPECT AVE • 59601SAVE, 90, eRX

KALISPELL

COSTCO PHARMACY #745............... (406) 758-25282330 US HWY 93 N • 5990190, eRX

MEDICAL ARTS PHARMACY............ (406) 752-2492209 CONWAY DR • 59901SAVE, 90, eRX

OSCO PHARMACY #0018.................. (406) 257-7556900 W IDAHO • 59901SAVE, 90, eRX

Page 12: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing LOLO

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

9

ROSAUERS PHARMACY #37............ (406) 755-50992150 US HWY 93 S • 5990190, eRX

SMITHS PHARMACY #172................. (406) 257-1397195 3RD AVE NORTH EAST • 59901SAVE, 90, eRX

SYKES PHARMACY........................... (406) 257-4806202 2ND AVE WEST • 5990190, eRX

SYKES PHARMACY LTC................... (406) 257-4806202 2ND AVE W • 59901eRX

THE CLINICAL PHARMACY...............(406) 751-7600200 CONWAY DRIVE • 59901SAVE, 90, eRX

WALGREENS #9242........................... (406) 257-071440 W IDAHO ST • 59901SAVE, 90, 24HR, eRX

WALMART PHARMACY 10-2259....... (406) 756-7256170 HUTTON RANCH RD • 59901SAVE, 90, eRX

LAKESIDE

REMEDIES LAKESIDE....................... (406) 844-2103206 STONER LOOP • 59922eRX

LAUREL

CVS PHARMACY #05305................... (406) 628-8746307 SE 4TH • 5904490, eRX

WALMART PHARMACY 10-4412....... (406) 628-1762101 BERNHARDT RD • 59044SAVE, 90, eRX

LEWISTOWN

OSCO PHARMACY #0019.................. (406) 538-6674117 W JANEAUX ST • 59457SAVE, 90, eRX

SEIDEN DRUG CO.............................. (406) 535-1470310 WENDELL AVE • STE 102 • 59457SAVE, eRX

LIBBY

CABINET PEAKS MEDICALCENTER...............................................(406) 283-7189209 HEALTH PARK DRIVE • 5992390, eRX

GRANITE PHARMACY LIBBY............(406) 293-37841401 MINNESOTA AVE • 59923SAVE, eRX

GRANITE PHARMACY LIBBY............(406) 293-37841401 MINNESOTA AVE • 59923eRX

NORTHWEST COMMUNITY HEALTHCENTER...............................................(406) 283-6979320 E 2ND ST • 5992390, eRX

ROSAUERS PHARMACY #14............ (406) 293-7702703 W 9TH ST • 5992390, eRX

LIVINGSTON

OSCO PHARMACY #0042.................. (406) 222-11882120 PARK ST S • 59047SAVE, 90, eRX

WESTERN DRUG LONG TERMCARE................................................... (406) 222-73321313 W PARK STREET SUITE B • STE B • 59047eRX

WESTERN DRUG OF LIVINGSTON... (406) 222-73321313 W PARK STREET • 59047SAVE, 90, eRX

LOLO

LOLO DRUG........................................(406) 273-2322103 GLACIER DR • 59847SAVE, 90, eRX

Page 13: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

MALTA Montana Pharmacy Listing

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

10

MALTA

VALLEY DRUG OF MALTA, INC........ (406) 654-2632131 S 1ST AVE E • 59538eRX

MILES CITY

BIG SKY PHARMACY.........................(406) 234-1241701 MAIN ST • 5930190, eRX

HOLY ROSARY HEALTH CENTER....(406) 233-42102600 WILSON • 59301eRX

ONEHEALTH PHARMACY................. (406) 874-8733305 S 4TH ST • 5930190, eRX

OSCO PHARMACY #0039.................. (406) 232-4627519 S HAYNES AVE • 59301SAVE, 90, eRX

WALMART PHARMACY 10-2608....... (406) 232-73203205 STOWER ST • 59301SAVE, 90, eRX

MISSOULA

COSTCO PHARMACY #67................. (406) 542-38073220 N RESERVE ST • 5980890, eRX

CREDENA HEALTH PHARMACY STPATRICK..............................................(406) 327-1650500 W BROADWAY • 5980290, eRX

CVS PHARMACY #08622................... (406) 728-13801902 BROOKS ST • 5980190, eRX

CVS PHARMACY #16320................... (406) 543-40002420 N RESERVE ST • 5980890, eRX

GRANITE PHARMACY HEALTHSOLUTIONS.........................................(406) 926-29402230 27TH AVE WEST • STE 1 • 59804SAVE, 90, eRX

GRANITE PHARMACY MISSOULA....(406) 926-29402230 27TH AVE WEST • STE 2 • 59804SAVE, eRX

HEALTH SERVICE PHARMACY UNI OFMT........................................................ (406) 243-5171634 EDDY AVE • 5980190, eRX

MISSOULA FRESH MARKET PHARMACY#1-3416................................................ (406) 251-54153801 S RESERVE STREET • 59801SAVE, 90, eRX

MISSOULA FRESH MARKET PHARMACY#1-3417................................................ (406) 721-6009800 WEST BROADWAY STREET • 59802SAVE, 90, eRX

MISSOULA PHARMACY, INC.............(406) 728-56501211 S RESERVE ST • STE 102 • 59801SAVE, 90, eRX

NORTH RIDGE PHARMACY.............. (406) 258-71334718 23RD AVE STE 100 • 59803eRX

OSCO PHARMACY #0020.................. (406) 549-51272205 OXFORD ST • 59801SAVE, 90, eRX

OSCO PHARMACY #0024.................. (406) 549-61631003 E BROADWAY ST • 59802SAVE, 90, eRX

OSCO PHARMACY #0043.................. (406) 728-11182230 N RESERVE ST • 59808SAVE, 90, eRX

OSCO PHARMACY #1010.................. (406) 549-77173800 RUSSELL ST • 59801SAVE, 90, eRX

PALMER'S DRUG CO......................... (406) 549-4125918 SW HIGGINS AVE • 59803SAVE, eRX

Page 14: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing RONAN

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

11

PARTNERSHIP HEALTH CENTERPHARMACY.........................................(406) 258-4139401 RAILROAD ST W • 59802SAVE, 90, eRX

ROSAUERS PHARMACY #27............ (406) 721-53302350 RESERVE ST • 5980190, eRX

SAVMOR DRUG.................................. (406) 721-60171610 S 3RD ST W • SUITE 100 • 59801SAVE, 90, eRX

WALGREENS #10726......................... (406) 728-20892100 BROOKS ST • 59801SAVE, 90, eRX

WALGREENS #9351........................... (406) 543-11632527 N RESERVE ST • 59808SAVE, 90, eRX

WALMART PHARMACY 10-2147....... (406) 251-60664000 HWY 93 S • 59804SAVE, 90, eRX

WALMART PHARMACY 10-3259....... (406) 829-85323555 MULLAN RD • 59808SAVE, 90, eRX

406 CLINIC PHARMACY.....................(406) 541-40601315 WYOMING ST STE A • 5980190, eRX

406 CLINIC PHARMACY SUITE B......(406) 541-40601315 WYOMING ST STE B • 59801SAVE, 90, eRX

PHILIPSBURG

GRANITE PHARMACY....................... (406) 859-3784106 N. MONTGOMERY ST • 59858SAVE, eRX

PLAINS

PLAINS DRUG.....................................(406) 826-3552214 RAILROAD ST • 59859SAVE, 90, eRX

PLENTYWOOD

PLENTYWOOD DRUG INC................. (406) 765-1810119 N MAIN ST • 59254eRX

POLSON

CREDENA HEALTH PHARMACYLAKESHORE....................................... (406) 883-034250331 US-93 • 5986090, eRX

CREDENA HEALTH PHARMACY STJOSEPH............................................... (406) 883-84446 13TH AVE E • 5986090, eRX

HEALTHCARE PLUS.......................... (406) 883-0565ONE 7TH AVE E • SUITE C • 59860eRX

SAFEWAY PHARMACY #1646...........(406) 883-367440774 MT HIGHWAY 35 • 59860SAVE, 90, eRX

WALGREENS #16084......................... (406) 300-604240770 MT HIGHWAY 35 • 59860SAVE, 90, eRX

WALMART PHARMACY 10-2607....... (406) 883-922136318 MEMORY LN • 59860SAVE, 90, eRX

POPLAR

POPLAR PHARMACY.........................(406) 768-6147213 H ST EAST • 59255SAVE, 90, eRX

RED LODGE

RED LODGE DRUG............................ (406) 446-1017211 NORTH BROADWAY • 59068SAVE, 90, eRX

RONAN

FAMILY HEALTH PHARMACY...........(406) 676-211163307 US HWY 935 • 59864SAVE, 90, eRX

Page 15: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

ROUNDUP Montana Pharmacy Listing

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

12

R & R HEALTH CARE SOLUTIONS... (406) 676-560063802 US HIGHWAY 93 • STE B • 59864SAVE, 90, eRX

ROUNDUP

ROUNDUP FAMILY PHARMACY....... (406) 323-2200148 MAIN ST • 5907290, eRX

SAINT IGNATIUS

MISSION DRUG...................................(406) 745-3000110 N MAIN • 59865eRX

SCOBEY

SERVICE DRUG INC...........................(406) 487-5911119 MAIN ST • 5926390, eRX

SEELEY LAKE

SEELEY SWAN PHARMACY............. (406) 677-89893027 MT HIGHWAY 83 N • 59868SAVE, 90, eRX

SHELBY

MARIAS HEALTHCARE SERVICES INC -PHARMACY.........................................(406) 966-7120670 PARK AVE • 5947490, eRX

NORTHTOWN DRUG.......................... (406) 434-5115100 MAIN ST • 59474SAVE, 90, eRX

SHERIDAN

MAC'S CHC PHARMACY................... (406) 842-7434317 MADISON ST • 59749SAVE, 90, eRX

SIDNEY

CLINIC PHARMACY............................(406) 488-6563214 14TH AVE SW • 5927090, eRX

WHITE DRUG #25............................... (406) 482-1420402 EAST MAIN • 5927090, eRX

STEVENSVILLE

FAMILY PHARMACY INC................... (406) 777-50023804 EASTSIDE HWY • 5987090, eRX

RIDGEWAY PHARMACY.................... (406) 777-441039 STEVENSVILLE CUTOFF RD W • 5987090, eRX

VALLEY DRUG & VARIETY............... (406) 777-5591301 MAIN ST • 5987090, eRX

SUPERIOR

MINERAL PHARMACY....................... (406) 822-4681207 RIVER ST • 5987290, eRX

THOMPSON FALLS

THOMPSON FALLS FAMILYPHARMACY.........................................(406) 827-43491221 MAIN ST • 59873SAVE, 90, eRX

THREE FORKS

THREE FORKS FAMILY PHARMACY(406) 285-3883117 MAIN ST UNIT A • 59752SAVE, 90, eRX

TOWNSEND

TOWNSEND DRUG............................. (406) 266-4379308 BROADWAY • 59644eRX

TROY

KOOTENAI DRUG...............................(406) 295-4361611 E MISSOULA AVE • 59935SAVE, 90, eRX

Page 16: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing WOLF POINT

Retail Pharmacies, Including Chain Pharmacies

For TTY users, please dial 711.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

13

WARM SPRINGS

MONTANA STATE HOSPITALPHARMACY.........................................(406) 693-717858 GARNET WAY • 59756SAVE, 90

WEST YELLOWSTONE

SILVERTIP PHARMACY..................... (406) 646-7056120 N CANYON ST • STE F • 59758SAVE, 90, eRX

WHITEFISH

SAFEWAY PHARMACY #2106...........(406) 862-25266580 HIGHWAY 93 SOUTH • 59937SAVE, 90, eRX

WALGREENS #12347......................... (406) 862-7391700 E 13TH ST • 59937SAVE, 90, eRX

WHITEFISH PHARMACY.................... (406) 862-70701111 BAKER AVE • 59937SAVE, 90, eRX

WHITEHALL

WHITEHALL DRUG.............................(406) 287-3931411 E. LEGION AVE. • 59759SAVE, eRX

WOLF POINT

WOLF POINT PHARMACY................. (406) 653-65721115 4TH AVE NORTH • 59201SAVE, 90, eRX

Page 17: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing

Long Term Care Pharmacies

For TTY users, please dial 711.Residents of a long-term care facility may access their prescription drugs covered under our plan through thefacility's long-term care pharmacy or another network long-term care pharmacy.

For more information, please see your Evidence of Coverage.

14

ANDERSON SPECIALTYPHARMACY.........................................(406) 216-31022828 10TH AVE S • GREAT FALLS • 59405

BENEFIS AMBULATORYPHARMACY.........................................(406) 455-2170500 15TH AVE S STE 2 • GREAT FALLS • 59405

BENTON PHARMACY........................ (406) 622-55881418 FRONT ST • FORT BENTON • 59442

BIG SANDY PHARMACY....................(406) 378-5588158 JOHANNES AVE • BIG SANDY • 59520

BIG SKY MANAGED CARE HELENA (406) 502-1800900 JACKSON ST STE A • GREAT FALLS • 59601

BIG SKY MANAGED CARE................(406) 315-1989900 13TH AVE S • GREAT FALLS • 59405

BILLINGS CLINIC ALLCARE PHARMACYSOLUTIONS.........................................(406) 435-59701015 BROADWATER AVENUE SUITE 201 •BILLINGS • 59102

BITTERROOT DRUG.......................... (406) 363-3611211 W MAIN ST • HAMILTON • 59840

CAPITAL RX........................................(406) 422-11002600 WINNE AVE STE A • HELENA • 59601

CASTLE MOUNTAIN DRUG............... (406) 547-23164271 US HIGHWAY 12 E • WHITE SULPHURSPRINGS • 59645

CLINIC PHARMACY............................(406) 488-6563214 14TH AVE SW • SIDNEY • 59270

COMMUNITY HOSP ANACONDAPHCY....................................................(406) 563-8650401 PENNSYLVANIA • ANACONDA • 59711

GENEVA WOODS PHARMACY#48550..................................................(406) 443-25401310 ELM ST • HELENA • 59601

GENOA HEALTHCARE, LLC............. (406) 545-45713737 GRAND AVE, SUITE 6, ROOM P • BILLINGS •59102

GENOA HEALTHCARE, LLC............. (406) 404-6978699 FARMHOUSE LANE, STE P • BOZEMAN •59715

GRANITE PHARMACY HEALTHSOLUTIONS.........................................(406) 926-29402230 27TH AVE WEST • STE 1 • MISSOULA •59804

GRANITE PHARMACY LIBBY............(406) 293-37841401 MINNESOTA AVE • LIBBY • 59923

HEALTHCARE PLUS.......................... (406) 883-0565ONE 7TH AVE E • SUITE C • POLSON • 59860

HOLY ROSARY HEALTH CENTER....(406) 233-42102600 WILSON • MILES CITY • 59301

MONTANA STATE HOSPITALPHARMACY.........................................(406) 693-717858 GARNET WAY • WARM SPRINGS • 59756

NORTH RIDGE PHARMACY.............. (406) 258-71334718 23RD AVE STE 100 • MISSOULA • 59803

NORTHERN MONTANA HOSPITAL...(406) 262-125030 W 13TH ST • HAVRE • 59501

NORTHTOWN DRUG.......................... (406) 434-5115100 MAIN ST • SHELBY • 59474

OLSON'S DRUG..................................(406) 278-32615 4TH AVE SE • CONRAD • 59425

OMNICARE OF BILLINGS.................. (406) 896-33992747 ENTERPRISE AVE • STE 1 • BILLINGS •59102

PHARMACY 1 AT THE MHC.............. (406) 601-33921245 N 29TH STREET SUITE 100 • BILLINGS •59101

PHARMERICA..................................... (406) 770-4420625 CENTRAL AVE WEST • SUITE 105 • GREATFALLS • 59405

PINTLER PHARMACY........................ (406) 563-0433203 E PARK AVE • ANACONDA • 59711

PLAZA UNITED PHARMACY............. (406) 727-00702800 11TH AVE S • GREAT FALLS • 59405

Page 18: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing

Long Term Care Pharmacies

For TTY users, please dial 711.Residents of a long-term care facility may access their prescription drugs covered under our plan through thefacility's long-term care pharmacy or another network long-term care pharmacy.

For more information, please see your Evidence of Coverage.

15

R & R HEALTH CARE SOLUTIONS... (406) 676-560063802 US HIGHWAY 93 • STE B • RONAN • 59864

ST JOHNS PHARMACY......................(406) 655-58273940 RIMROCK RD • BILLINGS • 59102

SYKES PHARMACY LTC................... (406) 257-4806202 2ND AVE W • KALISPELL • 59901

THE CLINICAL PHARMACY...............(406) 751-7600200 CONWAY DRIVE • KALISPELL • 59901

THREE BEARS PHARMACY.............. (406) 494-411645 THREE BEARS DR • BUTTE • 59701

TIMBER RIDGE PHARMACY............. (406) 363-90031131 N 1ST ST • HAMILTON • 59840

VALLEY DRUG OF MALTA, INC........ (406) 654-2632131 S 1ST AVE E • MALTA • 59538

VILLAGE DRUG.................................. (406) 278-3267600 S MAIN ST • SUITE 2 • CONRAD • 59425

WESTERN DRUG LONG TERMCARE................................................... (406) 222-73321313 W PARK STREET SUITE B • STE B •LIVINGSTON • 59047

WHITE DRUG #25............................... (406) 482-1420402 EAST MAIN • SIDNEY • 59270

YELLOWSTONE PHARMACY............ (406) 346-21341025 MAIN ST • FORSYTH • 59327

406 CLINIC PHARMACY.....................(406) 541-40601315 WYOMING ST STE A • MISSOULA • 59801

5TH AVENUE PHARMACY ANDGIFT..................................................... (406) 228-3693621 3RD ST S • GLASGOW • 59230

Page 19: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network PharmaciesMontana Pharmacy Listing

Home Infusion Pharmacies

For TTY users, please dial 711.For more information, please see your Evidence of Coverage.

16

BIG SKY IV CARE...............................(406) 752-0440560 CASCADE LOOP STE #1 • STE 1 • KALISPELL• 59901

OPTION CARE.................................... (406) 587-10502304 N 7TH AVE STE H • BOZEMAN • 59715

THE CLINICAL PHARMACY...............(406) 751-7600200 CONWAY DRIVE • KALISPELL • 59901

Page 20: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Blue Cross Medicare Advantage’s Network Pharmacies

Montana Pharmacy Listing

Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies

For TTY users, please dial 711.

Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban Indian HealthProgram (I/T/U) Pharmacies through our plan's pharmacy network. Those other than Native Americans andAlaskan Natives may be able to access these pharmacies under limited circumstances (e.g., emergencies).

For more information, please see your Evidence of Coverage.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

17

CSKT POLSON HEALTH CENTERPHARMACY.........................................(406) 745-35255 4TH AVE EAST • POLSON • 5986090, eRX

CSKT SAINT IGNATIUS HEALTH CENTERPHARMACY.........................................(406) 745-352535401 MISSION DRIVE • SAINT IGNATIUS • 5986590, eRX

Page 21: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

Montana Pharmacy Listing

Specialty Pharmacies

The pharmacies listed below deliver specialty medications to your door. There are other pharmacies in theprevious section of this document in our network that may also be able to provide specialty medications.

AllianceRx Walgreens Prime(800) 533-7606TTY: 711

www.alliancerxwp.com

Hours of operation: 7 a.m. to 7 p.m. Central Time, Monday through Friday, and 8 a.m. to 8 p.m. Eastern Time,Monday through Friday.

Accredo Specialty Pharmacy(833) 721-1619TTY: 711

www.accredo.com

Hours of operation: 7 a.m. to 7 p.m. Central Time, Monday through Friday, and 8 a.m. to 8 p.m. Eastern Time,Monday through Friday.

SAVE = Preferred cost sharing 24HR = Open 24 hours90 = 90-day supply eRX = Electronic prescribingS = Specialty Pharmacy

18

Page 22: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

Blue Cross and Blue Shield of Montana complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of Montana does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Blue Cross and Blue Shield of Montana:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

○ Qualified sign language interpreters

○Written information in other formats (large print, audio, accessible electronic formats, other formats)

• Provides free language services to people whose primary language is not English, such as:

○ Qualified interpreters

○ Information written in other languages

If you need these services, contact Civil Rights Coordinator

If you believe that Blue Cross and Blue Shield of Montana has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, Office of Civil Rights Coordinator, 300 E. Randolph St., 35th floor, Chicago, Illinois 60601, 1-855-664-7270, TTY/TDD: 1-855-661-6965, Fax: 1-855-661-6960, [email protected]. You can filea grievance in person or by mail, fax, or email. If you need help filing a grievance, Civil Rights Coordinator isavailable to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services 200 Independence Avenue, SW

Room 509F, HHH Building Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Page 23: Blue Cross Medicare Advantage Flex (PPO) SM 2022 Pharmacy ...

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-877-774-8592 (TTY: 711).

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia linguística. Llame al 1-877-774-8592 (TTY: 711).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfugung. Rufnummer: 1-877-774-8592 (TTY: 711).

注意:如果您使用繁體中文, 您可以免費獲得語言援助服務。請致電 1-877-774-8592 (TTY: 711)。

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-877-774-8592 (TTY:711) まで、お電話にてご連絡ください。

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-877-774-8592 (TTY: 711).

ATTENTION: Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-877-774-8592 (ATS : 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-877-774-8592 (телетайп: 711).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-877-774-8592 (TTY: 711) 번으로 전화해 주십시오.

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-877-774-8592)رقم هاتف الصم والبكم : 711(

เรยน: ถาคณพดภาษาไทยคณสามารถใชบรการชวยเหลอทางภาษาไดฟร โทร 1-877-774-8592 (TTY: 711).

MERK: Hvis du snakker norsk, er gratis språkassistansetjenester tilgjengelige for deg. Ring 1-877-774-8592 (TTY: 711).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-877-774-8592 (TTY: 711).

УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-877-774-8592 (телетайп: 711).

Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-877-774-8592 (TTY: 711).

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-877-774-8592 (TTY: 711).

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Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at getbluemt.com/mapd/pharmacies. You may also call Customer Service at 1-877-774-8592 (TTY/TDD users should call TTY/TDD number) for updated information.

Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

Prime Therapeutics LLC has an ownership interest in AllianceRx Walgreens Prime, a central specialty pharmacy and home delivery pharmacy. Prime Therapeutics LLC provides pharmacy benefit management services for Blue Cross and Blue Shield of Montana and is owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those plans.

HMO and PPO plans provided by Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HMO plans available for employer/union groups only. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSC’s plans depends on contract renewal.

This pharmacy directory was updated on 02/2022. For more recent information or other questions, please contact Blue Cross Medicare Advantage Customer Service at 1-877-774-8592 or, for TTY users, 711. We are open 8:00 a.m. - 8:00 p.m., local time, 7 days a week. If you are calling from April 1 through September 30, alternate technologies (for example, voicemail) will be used on weekends and holidays, or visit getbluemt.com/mapd/pharmacies.