STREET LEGAL ENTITY ORGANIZATION PHONE … · 601 Mainstream Drive Nashville TN 37228 Alabama...

STATELEGAL ENTITY

NAME ORGANIZATION

NAMEORGANIZATION DESCRIPTION TITLE LAST NAME FIRST NAME MI PHONE

PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Alabama

AETNA LIFE INSURANCE COMPANY Aetna Medicare PFFS

Director, Medicare Clinical Pharmacy Programs Stern Jody L

1-386-963-2453

1-860-754-1481

[email protected]

5350 148th Place Wellborn FL

32094-2362

Alabama

AETNA LIFE INSURANCE COMPANY Aetna Medicare PDP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Alabama

BCBS OF ALABAMA AND BCBS OF TENNESSEE

Blue Cross and Blue Shield of Alabama PDP

Clinical Pharmacy Admin Barry Lesley

1-334-213-6653

[email protected]

450 Riverchase Parkway East Birmingham AL 35244

Alabama

BLUE CROSS AND BLUE SHIELD OF ALABAMA

Blue Cross Blue Shield of Alabama Local CCP


1-334-213-6653

[email protected]

4465 Park Boulevard Montgomery AL

36116-1626

Alabama

CONNECTICUT GENERAL LIFE INSURANCE COMPANY CIGNATURE Rx PDP Zheng Yi

1-860-226-6731

[email protected]

900 Cottage Grove Road B5PHR Bloomfield CT 06002

Alabama

COVENTRY HEALTH AND LIFE INSURANCE COMPANY Advantra® Freedom PFFS Stephens Debbie

1-804-965-7658

[email protected]

Coventry Health Care, Inc

4300 Cox Road Glen Allen VA 23060

Alabama

COVENTRY HEALTH AND LIFE INSURANCE COMPANY Coventry AdvantraRx PDP

Director, Quality Improvement Stephens Debbie

1-804-965-7658

[email protected] 4300 Cox Road Glen Allen VA 23060

Alabama

ENVISION INSURANCE COMPANY EnvisionRx Plus PDP

Pharmacy Director Peterson Amanda

1-330-405-8080 6320

1-330-405-8081

[email protected]

2181 E Aurora Rd Suite 201 Twinsburg OH 44087

AlabamaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]

One Express Way St. Louis MO 63121

Alabama

FIRST HEALTH LIFE AND HEALTH INSURANCE COMPANY First Health Part D PDP


1-804-965-7658


Alabama

HEALTH NET LIFE INS CO/HEALTH NET INS OF NY Health Net PDP

Director, Clinical Pharmacy Services

Misquitta, Pharm. D. Cathrine V

1-916-463-9603

1-916-463-9750

[email protected]

10540 White Rock Rd.., Ste. 280

Mail Stop: CA-175-02-02

Rancho Cordova CA 95670

Alabama

HEALTHSPRING INC. HEALTHSPRING OF ALABAMA, INC.

HealthSpring Prescription Drug Plan PDP

Director, Government Programs Christopher Kelly

1-615-565-8110

1-615-234-2154

[email protected]

601 Mainstream Drive Nashville TN 37228

AlabamaHEALTHSPRING OF ALABAMA, INC.

Healthspring of Alabama, Inc. Local CCP


1-615-565-8110

[email protected]


Alabama

HUMANA INSURANCE COMPANY

Humana Insurance Company PFFS Ewing Joy

1-502-580-3538

[email protected]

500 West Main Street Louisville KY 40202

Alabama


Humana Insurance Company Regional CCP Ewing Joy

1-502-580-3538

[email protected]


Alabama


Humana Insurance Company PDP Ewing Joy

1-502-580-3538

[email protected]


Alabama

MEDCO CONTAINMENT LIFE INSURANCE COMPANY Medco YOURx PLAN PDP

Chief Medical Officer

Eisenberg, MD Edward

1-201-269-6717

1-201-269-1008

[email protected]

100 Parsons Pond Drive E2-7 Franklin Lakes NJ 07417

MTMP Contacts, Updated 11/15/07 1

STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

AlabamaMEMBERHEALTH, INC. MEMBERHEALTH PDP

VP Clinical Operations Rajan Samuel

1-440-248-8448 135

1-440-248-1729

[email protected]

29100 Aurora Rd., Ste. 301 Solon OH 44139

Alabama

NMHC GROUP SOLUTION INSURANCE, INC.

NMHC Group Solutions PDP

DIRECTOR, CLINICAL MEDICARE SERVICES MARKS INY R

1-516-605-6966

1-412-322-2066

[email protected]

600 WATERFRONT DR. STE 225 PITTSBURGH PA 15222

Alabama

PACIFICARE LIFE AND HEALTH INSURANCE COMPANY

SecureHorizons MedicareDirect PFFS

Vice President, Chief Medical Officer Addiego Joseph

1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street

Mail Stop: CA134-0404 Irvine CA 92614

Alabama

PENNSYLVANIA LIFE INSURANCE COMPANY

Pennsylvania Life Insurance Company PDP

Medicare Clinical Pharmacist Brown Nancy J

1-401-333-3987 7941

1-800-373-0238

[email protected]

695 George Washington Highway Lincoln RI 02865

Alabama RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]

221 N. Charles Lindbergh Dr. SLC UT 84116

Alabama

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. SierraRx PDP

Director, Pharmacy Services Evans, M.D. Steven

1-702-877-8377

[email protected]

2716 N. Tenaya Way Las Vegas NV 89128

Alabama

SILVERSCRIPT INSURANCE COMPANY SilverScript PDP Help Desk MTM

1-866-443-0934

[email protected]

9501 E. Shea Blvd Scottsdale AZ 85260

Alabama

STERLING LIFE INSURANCE COMPANY

Sterling Life Insurance Company PDP

VP Compliance & Regulatory Affairs Bodway Craig A

1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive

PO Box 5348 Bellingham WA

98227-5348

Alabama

UNICARE LIFE AND HEALTH INS. COMPANY

Unicare Life & Health Ins. Company PFFS Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]

8407 Fallbrook Avenue

Mail Stop CAAF West Hills CA 91304

Alabama

UNICARE LIFE AND HEALTH INSURANCE COMPANY Unicare PDP

Pharmacist Clinical Hettich Lisa

1-765-526-2515

[email protected]

8990 Duke Drive

Mail Stop OH2104-A844 Mason OH 45040

Alabama

UNITED AMERICAN INSURANCE COMPANY

United American Insurance Company PDP

Vice President and Health Actuary Hendee Peter G

1-972-569-3646

1-972-569-3679

[email protected]

3700 S. Stonebridge Drive McKinney TX 75070

Alabama

UNITED HEALTH CARE INS. CO. AND UNITED NEW YORK UnitedHealthcare PDP Bowen Jo

1-949-252-4339

[email protected]

2300 Main Street


Alabama

UNITED HEALTHCARE INSURANCE COMPANY UnitedHealthcare PDP Bowen Jo

1-949-252-4339

[email protected]

2300 Main Street

Mail Stop: CA1340404 Irvine CA 92614

Alabama

UNITED HEALTHCARE OF ALABAMA, INC. SecureHorizons Local CCP

Vice President, Chief Medical Officer

Addiego Jr., MD Joseph E

1-949-221-9994

1-949-747-4237

[email protected]

2300 Main Street

Mail Stop CA134-0404 Irvine CA 92614

Alabama VIVA HEALTH, INC. VIVA Medicare Plus Local CCP

Manager of Quality Improvement Scott Jan P

1-205-930-5520

1-205-930-5597

[email protected]

1222 14th Avenue South Birmingham AL 35205

Alabama

WELLCARE HEALTH INSURANCE OF ARIZONA, INC. WellCare PFFS

Director Medication Therapy Management Delancy Lisa

1-813-290-6200 3768

[email protected]

8735 Henderson Rd Tampa FL 33634

Alabama

WELLCARE PRESCRIPTION INSURANCE, INC. WellCare PDP

Director Clinical Pharmacy Delancey Lisa

1-813-290-6200 3768

[email protected]

8735 Henderson Road, Ren 2 Tampa FL 33634

AlabamaWINDSOR HEALTH PLAN, INC Windsor Rx PDP

Pharmacy Director King Sonya

1-615-782-7860

1-615-782-7822

[email protected]

7100 Commerce Way, Ste 285 Brentwood TN 37027


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Alaska



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Alaska



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Alaska


1-860-226-6731

[email protected]


Alaska



1-330-405-8080 6320

1-330-405-8081

[email protected]


AlaskaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Alaska

FIRST HEALTH LIFE AND HEALTH INSURANCE COMPANY Coventry AdvantraRx PDP


1-804-965-7658


Alaska



1-804-965-7658


Alaska




1-916-463-9603

1-916-463-9750

[email protected]




Alaska




1-615-565-8110

1-615-234-2154

[email protected]


Alaska



1-502-580-3538

[email protected]


Alaska



1-502-580-3538

[email protected]


Alaska




1-201-269-6717

1-201-269-1008

[email protected]


AlaskaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Alaska




1-516-605-6966

1-412-322-2066

[email protected]


Alaska




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Alaska RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Alaska


1-866-443-0934

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Alaska


Sterling Life Insurance Company PFFS

V.P. Compliance & Regulatory Affairs Bodway Craig

1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Alaska




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Alaska



1-714-637-1282

1-714-637-1209

[email protected]



Alaska



1-765-526-2515

[email protected]

8990 Duke Drive


Alaska




1-972-569-3646

1-972-569-3679

[email protected]


Alaska


1-949-252-4339

[email protected]

2300 Main Street


Alaska


1-949-252-4339

[email protected]

2300 Main Street


Alaska



1-813-290-6200 3768

[email protected]


American Samoa


1-949-252-4339

[email protected]

2300 Main Street


Arizona

ABRAZO ADVANTAGE HEALTH PLAN

Abrazo Advantage Health Plan Local CCP

Pharmacy Director Cruz Patti

1-602-824-3773

1-602-824-3762

[email protected] 7878 N. 16th St. Suite 105 Phoenix AZ 85020

Arizona AETNA HEALTH INC. Aetna Medicare Local CCP

Director, Medicare Clinical Programs Stern Jody L

1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Arizona

AETNA LIFE INSURANCE COMPANY Aetna Medicare Local CCP


1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Arizona



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Arizona



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

ArizonaARCADIAN HEALTH PLAN, INC.

Desert Canyon Community Care Local CCP

Vice President of Pharmacy Services Owens Glenda

1-909-971-6816

1-909-971-6866

[email protected]

955 Overland Court., Second Floor San Dimas CA 91773

Arizona

ARIZONA PHYSICIANS IPA, INC.

APIPA Personal Care Plus Local CCP

Director, Pharmacy Management Hatch Vanessa

1-703-226-3126

[email protected]

8045 Leesburg Pike Suite 600 Vienna VA 22182


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

ArizonaCARE1ST HEALTH PLAN OF ARIZONA

ONECare by Care1st Health Plan Of Arizona Local CCP

Director of Pharmacy Griffith Jacque

1-602-778-1850 1819

[email protected]

2355 E. Camelback Rd., Ste. 300 Phoenix AZ 85016

Arizona

CIGNA HEALTHCARE OF ARIZONA, INC.

CIGNA HealthCare for Seniors Local CCP Chief Pharmacist Zheng Yi

1-860-226-6731

[email protected]

900 Cottage Grove Rd. Wilde Hartford CT 06152

Arizona


1-860-226-6731

[email protected]


Arizona


1-804-965-7658

[email protected]



Arizona



1-804-965-7658


Arizona



1-330-405-8080 6320

1-330-405-8081

[email protected]


ArizonaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Arizona



1-804-965-7658


ArizonaFOX INSURANCE COMPANY

FOX Insurance Company PDP VP, Pharmacy Arloro Anthony

1-877-369-9564 113

[email protected]

40 West 25th Street 6th Floor New York NY 10010

ArizonaHEALTH CHOICE ARIZONA, INC.

Health Choice Generations Local CCP

Director, Pharmacy Sartor Lynn

1-480-303-4431

1-480-350-2231

[email protected]

1600 W. Broadway, Suite 110 Tempe AZ 85282

Arizona




1-916-463-9603

1-916-463-9750

[email protected]




Arizona

HEALTH NET LIFE INSURANCE COMPANY Health Net Regional CCP

Senior Vice President, Chief Clinical Officer White Virginia E

1-916-463-9603

[email protected]

10540 White Rock Rd., Ste 280


Rancho Cordove CA 95670

ArizonaHEALTH NET OF ARIZONA, INC.

Health Net of Arizona, Inc. Local CCP

Senior Vice President

White, Pharm. D. Virginia E

1-916-463-9603

1-916-463-9750

[email protected]

10540 White Rock Rd., Ste. 280


Arizona




1-615-565-8110

1-615-234-2154

[email protected]


ArizonaHUMANA HEALTH PLAN, INC.

Humana Health Plan, Inc. Local CCP Ewing Joy

1-502-580-3538

[email protected]


Arizona


Humana Insurance Company Local CCP Ewing Joy

1-502-580-3538

[email protected]


Arizona



1-502-580-3538

[email protected]


Arizona



1-502-580-3538

[email protected]


Arizona



1-502-580-3538

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Arizona




1-201-269-6717

1-201-269-1008

[email protected]


ArizonaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Arizona




1-516-605-6966

1-412-322-2066

[email protected]


Arizona




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


ArizonaPACIFICARE OF ARIZONA, INC

Secure Horizons Medicare Advantage Plan Local CCP


1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Arizona




1-401-333-3987 7941

1-800-373-0238

[email protected]


Arizona

PYRAMID LIFE INSURANCE COMPANY Today's Option PFFS

Manager of Pharmacy Clinical Services Thomas, R.Ph Chelsea

1-713-770-1265

1-866-553-0396

[email protected]

4888 Loop Central Drive Suite 800 Houston TX 77081

Arizona RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


ArizonaSCAN HEALTH PLAN OF ARIZONA

SCAN Health Plan Arizona Local CCP

Director of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

[email protected]

3800 Kilroy Airport Way Suite 100 Long Beach CA 90806

Arizona

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. Sierra Spectrum Local CCP


1-702-877-8377

[email protected]


Arizona



1-702-877-8377

[email protected]


Arizona


1-866-443-0934

[email protected]


Arizona

SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION

Mercy Care Advantage Local CCP

Corporate Director of Pharmacy Clark Mark

1-602-659-1100

[email protected]

4645 E Cotton Center Blvd

Building 1, Suite 200 Phoenix AZ 85040

Arizona




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Arizona




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

ArizonaSUN HEALTH MEDISUN, INC.

Sun Health MediSunONE Local CCP

Director of Pharmacy Nesemann Lydia

1-623-974-7474

1-623-974-7495

[email protected] P.O. Box 1489

13632 N. 99th Ave, Suite B Sun City AZ 85372

Arizona



1-714-637-1282

1-714-637-1209

[email protected]



Arizona



1-765-526-2515

[email protected]

8990 Duke Drive



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Arizona




1-972-569-3646

1-972-569-3679

[email protected]


Arizona


1-949-252-4339

[email protected]

2300 Main Street


Arizona

UNITED HEALTHCARE INSURANCE COMPANY

United HealthCare Insurance Company Local CCP


Addiego, Jr., M.D. Joseph E

1-949-221-9994

1-949-474-4237

[email protected] 2300 Main St

CA134-0404 Irvine CA 92614

Arizona


UNITED HEALTHCARE INSURANCE COMPANY Demo



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Arizona


1-949-252-4339

[email protected]

2300 Main Street


ArizonaUNITEDHEALTHCARE OF ARIZONA INC SecureHorizons Local CCP Addiego Joseph

1-949-221-9994

[email protected]

2300 Main Street


Arizona

UNIVERSAL HEALTH CARE INSURANCE COMPANY

Universal Health Care Insurance Company, Inc. PFFS

Vice President Clinical Programs Schoening Shellie K

1-800-546-5677 1110

1-866-632-7946

[email protected] PO Box 407 Boys town NE 68010

Arizona



1-813-290-6200 3768

[email protected]


Arizona



1-813-290-6200 3768

[email protected]


Arkansas



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Arkansas



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

ArkansasARKANSAS BCBS, A MUTUAL INS CO

Arkansas Blue Cross and Blue Shield PDP


1-401-333-3987 7941

1-800-373-0238

[email protected]


Arkansas

ARKANSAS BLUE CROSS AND BLUE SHIELD, A MUTUAL INS.

Arkansas Blue Cross - Medi-Pak Advantage PFFS


1-401-333-3987 7941

1-800-373-0238

[email protected]


ArkansasARKANSAS COMMUNITY CARE

Arkansas Community Care, Inc. Local CCP


1-909-971-6816

1-909-971-6866

[email protected]


Arkansas

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.

Care Improvement Plus Regional CCP Moyna Audrey

1-847-555-9399

1-847-559-4733

[email protected]

2211 Sanders Road Suite 100 Northbrook IL 60062


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Arkansas


1-860-226-6731

[email protected]


Arkansas


1-804-965-7658

[email protected]



Arkansas



1-804-965-7658


Arkansas



1-330-405-8080 6320

1-330-405-8081

[email protected]


ArkansasEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Arkansas



1-804-965-7658


ArkansasFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


Arkansas




1-916-463-9603

1-916-463-9750

[email protected]




Arkansas




1-615-565-8110

1-615-234-2154

[email protected]


Arkansas



1-502-580-3538

[email protected]


Arkansas



1-502-580-3538

[email protected]


Arkansas



1-502-580-3538

[email protected]


Arkansas




1-201-269-6717

1-201-269-1008

[email protected]


ArkansasMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Arkansas




1-516-605-6966

1-412-322-2066

[email protected]


Arkansas




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Arkansas




1-401-333-3987 7941

1-800-373-0238

[email protected]


Arkansas



1-713-770-1265

1-866-553-0396

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Arkansas RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Arkansas



1-702-877-8377

[email protected]


Arkansas


1-866-443-0934

[email protected]


Arkansas




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Arkansas




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Arkansas



1-714-637-1282

1-714-637-1209

[email protected]



Arkansas



1-765-526-2515

[email protected]

8990 Duke Drive


Arkansas




1-972-569-3646

1-972-569-3679

[email protected]


Arkansas


1-949-252-4339

[email protected]

2300 Main Street


Arkansas

UNITED HEALTHCARE INSURANCE COMPANY SecureHorizons PFFS Addiego Joseph

1-949-221-9994

[email protected]

2300 Main Street


Arkansas


1-949-252-4339

[email protected]

2300 Main Street


Arkansas

UNITEDHEALTHCARE OF ARKANSAS, INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Arkansas

WELLCARE HEALTH INSURANCE OF ILLINOIS, INC. WellCare PFFS


1-813-290-6200 3768

[email protected]

8735 Henderson Rd Ren 2 Tampa FL 33634

Arkansas



1-813-290-6200 3768

[email protected]


ArkansasWINDSOR HEALTH PLAN, INC Windsor Rx PDP


1-615-782-7860

1-615-782-7822

[email protected]


ArkansasWINDSOR HEALTH PLANS, INC.

Windsor Medicare Extra Local CCP


1-615-782-7860

1-615-782-7822

[email protected]


CaliforniaAETNA HEALTH OF CALIFORNIA,INC. Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

California



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

California



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

CaliforniaAIDS HEALTHCARE FOUNDATION

POSITIVE HEALTHCARE PARTNERS Local CCP

REGIONAL MGR. OF UM & CASE MGMT. KIRKORIAN CYNTHIA

1-323-436-5016

1-323-436-5034

[email protected]

1001 N. MARTEL AVE. LOS ANGELES CA 90046

California

ANTHEM INSURANCE COMPANIES, INC.

Blue Cross of California PDP


1-765-526-2515

[email protected]

8990 Duke Drive

Mailstop OH2104-A844 Mason OH 45040

CaliforniaARTA MEDICARE HEALTH PLAN, INC.

Arta Medicare Health Plan Local CCP

Pharmacy Director Sefain Hani

1-818-368-7538

1-818-368-7169

[email protected]

19641 Tulsa Street Chatsworth CA 91311

California

BC LIFE and HEALTH INSURANCE COMPANY

BC LIFE & HEALTH INSURANCE COMPANY Regional CCP Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]



CaliforniaBLUE CROSS OF CALIFORNIA

Blue Cross of California Local CCP Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]



CaliforniaBLUE CROSS OF CALIFORNIA

Blue Cross Of California PFFS Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]



California

BRAVO HEALTH INSURANCE COMPANY, INC. Bravo by Elder Health PDP

Clinical Pharmacist Owens Heather

1-800-625-9432

1-866-464-0709

[email protected]

3601 O'Donnell Street Baltimore MD 21224

California

CA PHYSICIANS' SERVICE DBA BLUE SHIELD OF CA

Blue Shield of California PDP

Medication Management Coordinator Becker-Ellison Dawn

1-916-350-6624

1-916-350-6216

[email protected]

4205 Town Center Blvd

El Dorado Hills El Dorado Hills CA 95762

California

CALIFORNIA PHYSICIANS' SERVICE

Blue Shield of California Local CCP

Medication Management Coordinator Becker-Ellison Dawn

1-916-350-6624

1-916-350-6216

[email protected]

4205 Town Center Blvd El Dorado Hills CA 95762

CaliforniaCARE1ST HEALTH PLAN

Care1st Medicare Advantage Plan Local CCP

Pharmacy Director Lasconia Michael

1-323-889-6638 6260

[email protected]

601 Potrero Grande Drive Monterey Park CA 91755

CaliforniaCAREMORE HEALTH PLAN

CareMore Health Plan Local CCP

Director of Pharmacy Rose James

1-562-622-2982

1-562-622-2814

[email protected]

12900 Park Plaza Drive Suite 150 Cerritos CA 90703

California

CENTRAL HEALTH PLAN OF CALIFORNIA, INC.

Central Health Medicare Plan Local CCP

Pharmacy Operations Manager Britton, MD Timothy

1-866-314-2427 2229

1-626-388-2363

[email protected]

1051 Park View Drive Suite 120 Covina CA 91724

California

CHINESE COMMUNITY HEALTH PLAN

Chinese Community Health Plan Local CCP Hill Jerry

1-415-955-8800 3235

1-415-955-8814

[email protected]

445 Grant Avenue, Suite 700 San Francisco CA 94108

CaliforniaCITIZENS CHOICE HEALTHPLAN

Citizens Choice Healthplan Local CCP

Director, Health Care Services Maxon, RN Marcie

1-323-728-7232 2108

1-323-728-8494

[email protected]

5400 E. Olympic Blvd. Suite 130 Los Angeles CA 90022

California


1-860-226-6731

[email protected]


California

CONTRA COSTA CO MED SVCS DBA CONTRA COSTA HEALTH

Contra Costa Health Plan Local CCP Lawson Mark

1-215-937-5352

1-215-937-8450

[email protected]

200 Stevens Drive Philadelpha PA 19113


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

California



1-330-405-8080 6320

1-330-405-8081

[email protected]


CaliforniaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


California



1-804-965-7658


California



1-804-965-7658


CaliforniaGEMCARE HEALTH PLAN INC.

GEMCARE Health Plan Local CCP


1-800-546-5677 1110

1-866-632-7946

[email protected] P.O. Box 407 Boys Town NE 68010

California




1-916-463-9603

1-916-463-9750

[email protected]




California

HEALTH NET LIFE INSURANCE COMPANY

Health Net Life Insurance Company Local CCP

Senior Vice President, Chief Clinical Officer


1-916-463-9603

[email protected]



Rancho cordova CA 95670

California HEALTH NET_OF CA Health Net Of CA Local CCP V.P. OperationsWhite, Pharm. D. Virginia E

1-916-463-9603

1-916-463-9750

[email protected]




California




1-615-565-8110

1-615-234-2154

[email protected]


California HMO CALIFORNIA HMO California Local CCP

Vice President Medicare Operations & Compliance Snyder Connie

1-562-981-5054

1-562-981-5818

[email protected]

1600 East Hill Street Signal Hill CA 90755

California



1-502-580-3538

[email protected]


California



1-502-580-3538

[email protected]


CaliforniaIEHP HEALTH ACCESS

IEHP Medicare DualChoice Local CCP

Director of Pharmaceutical Services Chan Chris

1-909-890-2943

1-909-890-2995

[email protected]

303 E. Vanderbilt Way, Suite 100 San Bernardino CA 92408

CaliforniaINTER VALLEY HEALTH PLAN, INC.

Inter Valley Health Plan Local CCP

VP of Health Services Tenorio Susan

1-800-251-8191 631

1-909-620-8092

[email protected] PO Box 6002

300 South Park Ave, Suite 300 Pomona CA

91769-6002

California

KAISER FOUNDATION HP, INC. Kaiser Permanente Local CCP

Director, Medicare Compliance Hall Jason

1-626-405-5333

[email protected]

393 E. Walnut Street, 5th Floor Pasadena CA 91188

California




1-201-269-6717

1-201-269-1008

[email protected]


California MEDCORE HP Medcore HP Local CCPClinical Program Manager Robertson Teisha A

1-301-218-6202

1-301-576-4442

[email protected]

13341 Burleigh Street Upper Marlboro MD 20774

CaliforniaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


California

MOLINA HEALTHCARE OF CALIFORNIA

Molina Healthcare of California Local CCP

Director, Pharmacy Schatzman Benjamin

1-562-951-1509

1-562-437-9315

[email protected]

One Golden Shore Drive Long Beach CA 90802


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

California




1-516-605-6966

1-412-322-2066

[email protected]


California

ORANGE COUNTY HEALTH AUTHORITY OneCare Local CCP

Director of Clinical Pharmacy Gericke Kristin

1-714-246-8471

1-714-246-8649

[email protected]

1120 West La Veta Avenue Orange CA 92868

California




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


California

PACIFICARE OF CALIFORNIA/SECURE HORIZONS



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


California




1-401-333-3987 7941

1-800-373-0238

[email protected]


California



1-713-770-1265

1-866-553-0396

[email protected]


California RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


California

SAN MATEO HEALTH COMMISSION

Health Plan of San Mateo Local CCP

Pharmacy Manager Cheung Barrie

1-650-616-2073

[email protected]

701 Gateway Blvd, Ste 400

South San Francisco CA 94080

California

SANTA CLARA COUNTY HEALTH AUTHORITY Healthy Generations Local CCP Garg Angeli

1-408-874-1818

1-408-874-1961

[email protected]

210 East Hacienda Ave Campbell CA 95008

California SCAN HEALTH PLAN SCAN Health Plan Local CCPDirector of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

[email protected]


California SCAN HEALTH PLAN SCAN Health Plan DemoDirector of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

[email protected]


California SCAN HEALTH PLAN VillageHealth DemoDirector of Pharmacy Bakshi Sharon

1-562-989-5168

1-562-997-3196

[email protected]


California



1-702-877-8377

[email protected]


California


1-866-443-0934

[email protected]


California

SOLANO-NAPA-YOLO COMMISSION ON MEDICAL CARE

Partnership HealthPlan of California Local CCP Medical Director Cammisa Chris

1-707-863-4228

1-707-863-4118

[email protected]

360 Campus Lane, Suite 100 Fairfield CA 94534

California



1-765-526-2515

[email protected]

8990 Duke Drive


California




1-972-569-3646

1-972-569-3679

[email protected]


California


1-949-252-4339

[email protected]

2300 Main Street


California


1-949-252-4339

[email protected]

2300 Main Street



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

California



1-813-290-6200 3768

[email protected]


California



1-813-290-6200 3768

[email protected]


CaliforniaWESTERN HEALTH ADVANTAGE

Western Health Advantage Local CCP

Clinical Pharmacist Fischer Joe

1-916-563-2273

1-916-563-3182

[email protected]

2349 Gateway Oaks Drive, Suite 100 Sacramento CA 95833

Colorado



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Colorado



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

ColoradoANTHEM BC/BS OF COLORADO

Anthem Blue Cross & Blue Shield Local CCP Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]

8407 Fallbrook Ave


Colorado


Anthem Insurance Companies, Inc. PFFS Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]


Mailstop CAAF West Hills CA 91304

Colorado


Blue Cross Blue Shield of Colorado PDP


1-765-526-2515

[email protected]

8990 Duke Drive


ColoradoCOLORADO ACCESS Colorado Access Local CCP

Director of Pharmacy Services McDow Chuck

1-720-744-5526

1-720-744-5127

[email protected]

10065 E. Harvard Ave Ste 600 Denver CO 80231

Colorado


1-860-226-6731

[email protected]


Colorado


1-804-965-7658

[email protected]



Colorado



1-804-965-7658


ColoradoDENVER HEALTH MEDICAL PLAN, INC.

Denver Health Medical Plan Local CCP Medical Director Brody, MD David

1-720-956-2361

1-720-956-2303

[email protected]

777 Bannock Street

Mail Code 6000 Denver CO 80204

Colorado



1-330-405-8080 6320

1-330-405-8081

[email protected]


ColoradoEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Colorado



1-804-965-7658


Colorado




1-916-463-9603

1-916-463-9750

[email protected]





STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Colorado




1-615-565-8110

1-615-234-2154

[email protected]


Colorado



1-502-580-3538

[email protected]


Colorado



1-502-580-3538

[email protected]


Colorado



1-502-580-3538

[email protected]


Colorado

KAISER FOUNDATION HP OF CO Kaiser Permanente Local CCP

Quality & Clinical Pharmacy Manager Chester Beth

1-303-326-7612

1-303-739-3574

[email protected]

16601 E. Centretech Parkway Aurora CO 80011

Colorado




1-201-269-6717

1-201-269-1008

[email protected]


ColoradoMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Colorado




1-516-605-6966

1-412-322-2066

[email protected]


Colorado




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


ColoradoPACIFICARE OF COLORADO, INC


VP, Chief Medical Officer Addiego Joseph

1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Colorado




1-401-333-3987 7941

1-800-373-0238

[email protected]


Colorado



1-713-770-1265

1-866-553-0396

[email protected]


Colorado

ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION

Rocky Mountain Health Plans PDP

Director, Pharmacy Department Nolan Steve

1-970-244-7760

[email protected] PO Box 10600 Grand Junction CO

81502-5600

ColoradoROCKY MOUNTAIN HEALTH PLANS

Rocky Mountain Health Plans 1876 Cost

Pharmacy Director Nolan Steve

1-970-244-7760 5182

[email protected] PO Box 10600 Grand Junction CO 81502

Colorado RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Colorado



1-702-877-8377

[email protected]


Colorado


1-866-443-0934

[email protected]


Colorado




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Colorado




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Colorado



1-714-637-1282

1-714-637-1209

[email protected]



Colorado



1-765-526-2515

[email protected]

8990 Duke Drive


Colorado




1-972-569-3646

1-972-569-3679

[email protected]


Colorado


1-949-252-4339

[email protected]

2300 Main Street


Colorado





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Colorado


United Healthcare Insurance Company Local CCP



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Colorado


1-949-252-4339

[email protected]

2300 Main Street


Colorado



1-813-290-6200 3768

[email protected]


Colorado



1-813-290-6200 3768

[email protected]


Connecticut AETNA HEALTH INC. Aetna Health Inc. Local CCP

Director, Medicare Clinical Pharmacy Management Stern Jody L

1-386-963-2543

1-386-963-2544

[email protected]


32094-2362

Connecticut



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Connecticut



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Connecticut

AMERICAN PROGRESSIVE LIFE/HLTH INS. Today's Option PFFS

Manager of Pharmacy Clinical Services

Thomas, R.Ph. Chelsea

1-866-245-5190

1-866-553-0396

[email protected]


ConnecticutANTHEM HEALTH PLANS, INC

Anthem Blue Cross and Blue Shield Local CCP

Director of Clinical Operations Moyna Audrey

1-847-559-3999

1-847-559-4733

[email protected]

2211 Sanders Road Northbrook IL 60062

Connecticut



1-714-637-1282

1-714-637-1209

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Connecticut BLUE MEDICARERXAnthem Blue Cross and Blue Shield PDP

Clinical Pharmacist Hettich Lisa

1-765-526-2515

[email protected]

8990 Duke Drive


Connecticut


1-860-226-6731

[email protected]


Connecticut



1-330-405-8080 6320

1-330-405-8081

[email protected]


ConnecticutEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Connecticut



1-804-965-7658


Connecticut



1-804-965-7658


Connecticut




1-916-463-9603

1-916-463-9750

[email protected]




Connecticut

HEALTH NET LIFE INSURANCE COMPANY, INC. Health Net PFFS V.P., Operations


1-916-463-9603

1-916-463-8056

[email protected]




ConnecticutHEALTH NET OF CONNECTICUT

Health Net of Connecticut Local CCP

Senior Vice President, Chief Clinical Officer

White, Pharm D. Virginia E

1-916-463-9603

1-916-463-9750

[email protected]




Connecticut




1-615-565-8110

1-615-234-2154

[email protected]


Connecticut



1-502-580-3538

[email protected]


Connecticut



1-502-580-3538

[email protected]


Connecticut




1-201-269-6717

1-201-269-1008

[email protected]


ConnecticutMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Connecticut




1-516-605-6966

1-412-322-2066

[email protected]


ConnecticutOXFORD HEALTH PLANS (CT), INC. SecureHorizons Local CCP Addiego Joseph

1-949-221-9994

[email protected]

2300 Main Street


Connecticut




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Connecticut




1-401-333-3987 7941

1-800-373-0238

[email protected]


Connecticut RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

ConnecticutSENIOR WHOLE HEALTH, LLC

Senior Whole Health of Connecticut Local CCP

Director of Pharmacy Services Dichter Gayle

1-617-494-5353 6324

1-617-494-5599

[email protected]

58 Charles Street Cambridge MA 02141

Connecticut


1-866-443-0934

[email protected]


Connecticut




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Connecticut



1-714-637-1282

1-714-637-1209

[email protected]



Connecticut



1-765-526-2515

[email protected]

8990 Duke Drive


Connecticut




1-972-569-3646

1-972-569-3679

[email protected]


Connecticut


1-949-252-4339

[email protected]

2300 Main Street


Connecticut





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Connecticut


1-949-252-4339

[email protected]

2300 Main Street


ConnecticutWELLCARE OF CONNECTICUT, INC. WellCare Local CCP Director of MTM Delancy Lisa

1-813-290-6200 3768

[email protected] PO Box 25858 Tampa FL

33622-5858

Connecticut



1-813-290-6200 3768

[email protected]


Delaware AETNA HEALTH, INC Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Delaware



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Delaware

AETNA LIFE INSURANCE COMPANY Aetna Medicare Regional CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Delaware



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

DelawareBRAVO HEALTH MID-ATLANTIC INC. Bravo by Elder Health PFFS

Vice President, Pharmacy Services Owens Heather

1-410-864-4583

1-866-464-0709

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

DelawareBRAVO HEALTH MID-ATLANTIC, INC. Bravo by Elder Health PDP


1-800-625-9432

1-866-464-0709

[email protected]

3601 O'Donnell St Baltimore MD 21224

Delaware


1-860-226-6731

[email protected]


Delaware


1-804-965-7658

[email protected]



Delaware



1-804-965-7658


Delaware

DELAWARE PHYSICIANS CARE, INC.

Delaware Physicians Care Advantage Local CCP

Director Corporate Pharmacy Clark Mark

1-602-659-2062

[email protected]

4645 E Cotton Center BLVD Phoenix AZ 85004

Delaware



1-330-405-8080 6320

1-330-405-8081

[email protected]


DelawareEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Delaware FIRST CARE, INC.Medi-CareFirst BlueCross BlueShield PDP

Director, Pharmacy Management Wong Winston

1-410-528-7897

[email protected]

1501 S. Clinton St 8th Floor Baltimore MD 21224

Delaware



1-804-965-7658


Delaware




1-916-463-9603

1-916-463-9750

[email protected]




Delaware




1-615-565-8110

1-615-234-2154

[email protected]


Delaware



1-502-580-3538

[email protected]


Delaware



1-502-580-3538

[email protected]


Delaware




1-201-269-6717

1-201-269-1008

[email protected]


DelawareMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Delaware




1-516-605-6966

1-412-322-2066

[email protected]


Delaware




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Delaware




1-401-333-3987 7941

1-800-373-0238

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Delaware RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Delaware



1-702-877-8377

[email protected]


Delaware


1-866-443-0934

[email protected]


Delaware




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Delaware




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Delaware



1-714-637-1282

1-714-637-1209

[email protected]



Delaware



1-765-526-2515

[email protected]

8990 Duke Drive


Delaware




1-972-569-3646

1-972-569-3679

[email protected]


Delaware


1-949-252-4339

[email protected]

2300 Main Street


Delaware





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Delaware


1-949-252-4339

[email protected]

2300 Main Street


Delaware



1-813-290-6200 3768

[email protected]


Florida AETNA HEALTH INC. Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Florida



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Florida



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Florida



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Florida AVMED, INCAvMed Medicare Preferred Local CCP

Manager of Clinical Pharmacy Kuznik Melissa

1-352-337-8785

1-352-337-8737

[email protected]

AvMed Health Plans

4300 NW 89 Blvd. Gainesville FL 32606

Florida AVMED, INC.AvMed Medicare Preferred PPO Local CCP

Manager of Clinical Pharmacy Kuznik Melissa

1-352-337-8785

1-352-337-8737

[email protected]

AvMed Health Plans

4300 NW 89th Blvd. Gainesville FL 32606

Florida

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.

Blue Cross and Blue Shield of Florida Local CCP

Director, Government Pharmacy Programs Griffin Cynthia

1-904-905-6307

1-904-905-5907

[email protected]

4800 Deerwood Campus Pkwy

DCC Building 300, 3rd Floor Jacksonville, FL 32246

Florida

BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.

Blue Cross and Blue Shield of Florida, Inc. PDP


1-904-905-6307

1-904-905-5907

[email protected]


DCC Building 300, 3rd Floor Jacksonville FL 32246

Florida



1-800-625-9432

1-866-464-0709

[email protected]


FloridaCAPITAL HEALTH PLAN Capital Health Plan Local CCP

Clinical Pharmacist Johnston April

1-850-523-7416

1-850-383-3495

[email protected] P.O. Box 15349 Tallahassee FL 32317

FloridaCARE PLUS HEALTH PLAN

CarePlus Health Plans, Inc. Local CCP Ewing Joy

1-502-580-3538

[email protected]


FloridaCITRUS HEALTH CARE, INC.

Citrus Health Care, Inc. Local CCP

Vice President Clinical Programs Schoening Shellie

1-402-965-8800 1110

1-402-965-9774

[email protected] PO BOX 407 Boys town NE 68010

Florida


1-860-226-6731

[email protected]


Florida



1-330-405-8080 6320

1-330-405-8081

[email protected]


FloridaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Florida



1-804-965-7658


Florida



1-804-965-7658


FloridaFLORIDA HEALTH CARE PLAN, INC.

Florida Health Care Plan, Inc. Local CCP

Pharmacy Administrator Klein Gary

1-800-352-9824 7173

1-386-676-7165

[email protected]

1340 Ridgewood Avenue Holly Hill FL 32117

FloridaFREEDOM HEALTH PLAN, INC. Freedom Health, Inc. Local CCP

Pharmacy Director Keilty Mike

1-888-796-0946

1-727-471-2108

[email protected]

5501 49th Street N St. Petersburg FL 33709

Florida

HEALTH FIRST HEALTH PLANS, INC.

Health First Medicare Plans Local CCP

Compliance Analyst Breisch Laura

1-321-434-5660

1-321-434-4361

[email protected]

6450 US Highway 1 Rockledge FL

32955-5747

Florida




1-916-463-9603

1-916-463-9750

[email protected]




FloridaHEALTH OPTIONS, INC

Health Options, Inc.\BCBSF Local CCP


1-904-905-6307

1-904-905-5907

[email protected]


DCC Building 300, 3rd Floor Jacksonville FL 32246

Florida




1-615-565-8110

1-615-234-2154

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Florida

HEALTHSUN HEALTH PLANS, INC.

HealthSun Health Plans, Inc. Local CCP

Compliance Officer de la Llama Marianela

1-305-234-9292

1-305-444-9148

[email protected]

1205 SW 37th Avenue Miami FL 33135

Florida

HUMANA HEALTH INSURANCE COMPANY OF FL, INC.

Humana Health Insurance Company Of Fl, Inc. Local CCP Ewing Joy

1-502-580-3538

[email protected]


Florida



1-502-580-3538

[email protected]


Florida



1-502-580-3538

[email protected]


Florida



1-502-580-3538

[email protected]


FloridaHUMANA MEDICAL PLAN, INC

Humana Medical Plan, Inc. Local CCP Ewing Joy

1-502-580-3538

[email protected]


Florida

LEON MEDICAL CENTERS HEALTH PLANS, INC

Leon Medical Centers Health, Inc. Local CCP VP of UM Hernandez Henry

1-305-559-5366

1-305-644-2530

[email protected]

11501 SW 40th Street Miami FL 33165

FloridaMD MEDICARE CHOICE

PartnerCare Golden Advocate Plan Local CCP

Pharmacy Director Limberg Cari

1-813-901-9208 1101

1-813-901-9209

[email protected]

5501 West Waters Ave. Suite 401 Tampa FL 33634

Florida




1-201-269-6717

1-201-269-1008

[email protected]


Florida

MEDICA HEALTHCARE PLANS, INC.

Medica HealthCare Plans, Inc. Local CCP

Clinical Pharmacist Borges Alejandro M

1-305-460-0690

1-305-460-0613

[email protected]

4000 Ponce de Leon Blvd. Suite 650 Coral Gables FL 33146

FloridaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


FloridaMETCARE HEALTH PLANS, INC. AdvantageCare Local CCP

Chief Medical Officer Kenney, M.D. Robert

1-561-805-8500

1-561-805-8501

[email protected]

250 South Australian Avenue, Suite 400

West Palm Beach FL 33401

Florida




1-516-605-6966

1-412-322-2066

[email protected]


FloridaOPTIMUM HEALTHCARE, INC.

Optimum HealthCare, Inc. Local CCP

Supervisor, MTM DUR Programs Lawson Mark

1-215-937-5352

1-215-937-8450

[email protected]

200 Stevens Drive Philadelphia PA 19113

Florida




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Florida




1-401-333-3987 7941

1-800-373-0238

[email protected]


FloridaPHYSICIANS UNITED PLAN, INC.

Physicians United Plan Local CCP

Pharmacy Clinical Services Hittich Lisa

1-765-526-2515

[email protected]

8407 Fallbrook Avenue #CAAF01

Attn: Network Management West Hills CA 91304

FloridaPREFERRED CARE PARTNERS INC.

Preferred Care Partners, Inc. Local CCP

Pharmacy Team Leader Sang Jamelle

1-305-670-8440 1220

1-786-888-1964

[email protected]

9100 S. Dadeland Blvd. Suite 1250 Miami FL 33156

Florida



1-713-770-1265

1-866-553-0396

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

FloridaQUALITY HEALTH PLANS, INC

QUALITY HEALTH PLANS PDP

Director of Pharmacy McDowell John

1-727-945-8400 158

1-727-756-1080

[email protected]

2435 US Highway 19 Suite 470 Holiday FL 34691

FloridaQUALITY HEALTH PLANS, INC.

Quality Health Plans, Inc. Local CCP McDowell John

1-727-945-8400 158

1-727-945-8434

[email protected]

2435 US Hwy 19 Suite 470 Holiday FL 34691

Florida RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Florida


1-866-443-0934

[email protected]


Florida




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Florida




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

FloridaSUMMIT HEALTH PLAN, INC.

Summit Health Plan, Inc. Local CCP

Chief Medical Officer Hogan, MD Michael

1-954-858-3007

1-954-858-3695

[email protected]

1340 Concord Terrrace Sunrise FL 33323

Florida



1-714-637-1282

1-714-637-1209

[email protected]



Florida



1-765-526-2515

[email protected]

8990 Duke Drive


Florida




1-972-569-3646

1-972-569-3679

[email protected]


Florida


1-949-252-4339

[email protected]

2300 Main Street


Florida

UNITED HEALTHCARE INSURANCE COMPANY SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Florida

UNITED HEALTHCARE INSURANCE COMPANY SecureHorizons Regional CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Florida





1-949-221-9994

1-949-474-4237

[email protected] 2300 Main St.

CA134-0404 Irvine CA 92614

Florida





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Florida


1-949-252-4339

[email protected]

2300 Main Street


Florida

UNITED HEALTHCARE OF FL, INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street

Mail Station CA134-0404 Irvine CA 92614


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Florida

UNITED HEALTHCARE OF FLORIDA INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Florida




1-800-546-5677 1110

1-866-632-7946


FloridaUNIVERSAL HEALTH CARE, INC.

Universal Health Care, Inc. Local CCP


1-800-546-5677 1110

1-866-632-7946

[email protected] PO BOX 407 Boys town NE 68010

FloridaUNIVERSAL HEALTH CARE, INC.

Universal Health Care, Inc. Local CCP

Vice President, Clinical Programs Schoening Shellie K

1-800-546-5677 1110

1-866-632-7946


Florida

VISTA HEALTHPLAN OF SOUTH FLORIDA, INC.

Vista Healthplan of South Florida, Inc. Local CCP


1-954-858-3007

1-954-858-3695

[email protected]

1340 Concord Terrace Sunrise FL 33323

FloridaVISTA HEALTHPLAN, INC. Vista Healthplan, Inc. Local CCP


1-954-858-3007

1-954-858-3695

[email protected]

1340 Concord Terrace Sunrise FL 33323

FloridaWELL CARE OF FLORIDA, INC. WellCare Local CCP

Dir, Clinical Pharmacy delancy Lisa

1-813-290-6200 3768


33622-5858

Florida



1-813-290-6200 3768

[email protected]


Florida



1-813-290-6200 3768

[email protected]


GeorgiaAETNA HEALTH INC.(GEORGIA) Aetna Medicare Local CCP


1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Georgia



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Georgia



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Georgia



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Georgia



1-714-637-1282

1-714-637-1209

[email protected]



Georgia


Blue Cross Blue Shield of Georgia PDP


1-765-526-2515

[email protected]

8990 Duke Drive


Georgia

ARCADIAN HEALTH PLAN OF GEORGIA, INC.

Southeast Community Care Local CCP


1-909-971-6816

1-909-971-6866

[email protected]


Georgia

BLUE CROSS BLUE SHIELD OF GEORGIA

Blue Cross Blue Shield Healthcare Plan of Georgia Local CCP Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Georgia

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO


1-847-559-3999

1-847-559-4733

[email protected]


Georgia


1-860-226-6731

[email protected]


Georgia


1-804-965-7658

[email protected]



Georgia



1-804-965-7658


Georgia

COVENTRY HEALTH CARE OF GEORGIA, INC. Advantra Local CCP Stephens Debbie

1-804-965-7658

[email protected]

Coventry Health Care Inc

4300 Cox Road Glen allen VA 23060

Georgia



1-330-405-8080 6320

1-330-405-8081

[email protected]


GeorgiaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Georgia



1-804-965-7658


Georgia




1-916-463-9603

1-916-463-9750

[email protected]




Georgia




1-615-565-8110

1-615-234-2154

[email protected]


Georgia



1-502-580-3538

[email protected]


Georgia



1-502-580-3538

[email protected]


Georgia



1-502-580-3538

[email protected]


Georgia



1-502-580-3538

[email protected]


Georgia

INSTIL HEALTH INSURANCE COMPANY

Instil Health Insurance Company Local CCP

Director Medical Services Lachuk Lester

1-803-763-6559

1-803-935-1605

[email protected]

InStil Health Insurance Company

17 Technology Circle Columbia SC 29203

Georgia


InStil Health Insurance Company Regional CCP


1-803-763-6559

1-803-935-1605

[email protected]


Georgia


InStil Health Insurance Company PDP


1-803-763-6559

1-803-935-1605

[email protected]

17 Technology Circle, AG-790 Columbia SC 29203

Georgia

KAISER FOUNDATION HP OF GA, INC.

Kaiser Permanente Senior Advantage Local CCP

Pharmacy Director Washington Adrian

1-404-364-4765

[email protected]

3495 Piedmont Road NE Atlanta GA 30305


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Georgia




1-201-269-6717

1-201-269-1008

[email protected]


GeorgiaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Georgia




1-516-605-6966

1-412-322-2066

[email protected]


Georgia




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Georgia




1-401-333-3987 7941

1-800-373-0238

[email protected]


Georgia



1-713-770-1265

1-866-553-0396

[email protected]


Georgia RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Georgia



1-702-877-8377

[email protected]


Georgia


1-866-443-0934

[email protected]


Georgia




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Georgia




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Georgia



1-714-637-1282

1-714-637-1209

[email protected]



Georgia



1-765-526-2515

[email protected]

8990 Duke Drive


Georgia




1-972-569-3646

1-972-569-3679

[email protected]


Georgia


1-949-252-4339

[email protected]

2300 Main Street


Georgia





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Georgia


United HealthCare Insurance Company Demo



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Georgia


1-949-252-4339

[email protected]

2300 Main Street


Georgia

UNITED HEALTHCARE OF GEORGIA, INC. SecureHorizons Local CCP



1-949-221-9994

1-929-474-4237

[email protected]

2300 Main Street


Georgia




1-800-546-5677 1110

1-866-632-7946


Georgia



1-813-290-6200 3768

[email protected]


GeorgiaWELLCARE OF GEORGIA, INC. WellCare Local CCP

Director, Clinical Pharmacy Delancy Lisa

1-813-290-6200 3768


33622-5858

Georgia



1-813-290-6200 3768

[email protected]


Guam


1-949-252-4339

[email protected]

2300 Main Street


Hawaii



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Hawaii



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Hawaii ALOHACARE AlohaCare Local CCPClinical Pharmacist Nishimura Lee Rachel A

1-808-973-0828

1-808-973-0726

[email protected]

1357 Kapiolani Blvd., Suite 1250 Honolulu HI 96814

Hawaii


1-860-226-6731

[email protected]


Hawaii



1-330-405-8080 6320

1-330-405-8081

[email protected]


HawaiiEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Hawaii



1-804-965-7658


Hawaii



1-804-965-7658


HawaiiHAWAII MED. SRVC. ASSN. HMSA's 65C Plus 1876 Cost

HMSA Clinical Pharmacist Zarella Wendy

1-808-948-5544

1-808-948-5510

[email protected] 550B - PM

818 Keeaumoku St Honolulu HI 96814

Hawaii

HAWAII MEDICAL SERVICES ASSOCIATION

HMSA's Medicare Rx Plan PDP

HMSA Clinical Pharmacist Zarella Wendy

1-808-948-5544

1-808-948-5510

[email protected] 550B - PM

818 Keeaumoku St Honolulu HI 96814


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Hawaii




1-916-463-9603

1-916-463-9750

[email protected]




Hawaii




1-615-565-8110

1-615-234-2154

[email protected]


Hawaii



1-502-580-3538

[email protected]


Hawaii



1-502-580-3538

[email protected]


Hawaii

KAISER FOUNDATION HP, INC.

Kaiser Foundation Health Plan, Inc. (Hawaii) Local CCP

Quality Management Coordinator Wilson Susan T

1-808-432-7533

[email protected]

Kaiser Permanente

501 Alakawa Street Honolulu HI 96819

Hawaii




1-201-269-6717

1-201-269-1008

[email protected]


HawaiiMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Hawaii




1-516-605-6966

1-412-322-2066

[email protected]


Hawaii




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Hawaii RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Hawaii


1-866-443-0934

[email protected]


Hawaii




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Hawaii




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Hawaii



1-714-637-1282

1-714-637-1209

[email protected]



Hawaii



1-765-526-2515

[email protected]

8990 Duke Drive


Hawaii




1-972-569-3646

1-972-569-3679

[email protected]


Hawaii


1-949-252-4339

[email protected]

2300 Main Street


Hawaii

UNITED HEALTHCARE INSURANCE COMPANY SecureHorizons Local CCP Addiego Joseph

1-949-221-9994




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Hawaii

UNITED HEALTHCARE INSURANCE COMPANY SecureHorizons Regional CCP Addiego Joseph

1-949-221-9994

[email protected] 2300 Main ST


Hawaii


1-949-252-4339

[email protected]

2300 Main Street


Hawaii



1-813-290-6200 3768

[email protected]


Hawaii



1-813-290-6200 3768

[email protected]


Idaho



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Idaho



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Idaho

BLUE CROSS OF IDAHO HEALTH SERVICES, INC

Blue Cross Of Idaho Hlth Services Inc Local CCP

Pharmacy Clinical Services Hettich Lisa

1-765-526-2515

[email protected]

8407 Fallbrook Ave # CAAF01 West Hills CA 91304

Idaho

BLUE CROSS OF IDAHO HEALTH SERVICES, INC.

Blue Cross Of Idaho Hlth Services Inc PFFS


1-765-526-2515

[email protected]

8407 Fallbrook Ave # CAAF01

attn: Network Management West Hills CA

91304-3226

Idaho

BLUE CROSS OF IDAHO HLTH SERVICES INC

Blue Cross Of Idaho Hlth Services Inc Local CCP


1-765-526-2515

[email protected]

8407 Fallbrook Ave #CAAF01

Attn: Network Management West Hills CA 91304

Idaho


1-860-226-6731

[email protected]


Idaho

EDUCATORS MUTUAL INSURANCE ASSOCIATION

Educators Mutual Insurance Association PDP Gallegos Jennifer

1-801-262-7476

[email protected]

852 East Arrowhead Lane Murray UT 84107

Idaho



1-330-405-8080 6320

1-330-405-8081

[email protected]


IdahoEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Idaho



1-804-965-7658


Idaho



1-804-965-7658


Idaho




1-916-463-9603

1-916-463-9750

[email protected]





STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Idaho




1-615-565-8110

1-615-234-2154

[email protected]


Idaho



1-502-580-3538

[email protected]


Idaho



1-502-580-3538

[email protected]


Idaho




1-201-269-6717

1-201-269-1008

[email protected]


IdahoMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Idaho




1-516-605-6966

1-412-322-2066

[email protected]


Idaho




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Idaho




1-401-333-3987 7941

1-800-373-0238

[email protected]


IdahoREGENCE BLUE SHIELD OF IDAHO

Regence BlueShield Of Idaho Local CCP

Manager Clinical Pharmacy Leonard Ruth J

1-208-395-7732

1-208-395-7744

[email protected]

1211 West Myrtle Suite 110

PO Box 2560 Boise ID 87301

Idaho

REGENCE LIFE AND HEALTH INSURANCE COMPANY

Regence Life and Health PDP


1-208-395-7732

1-208-395-7744

[email protected]



Idaho RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Idaho



1-702-877-8377

[email protected]


Idaho


1-866-443-0934

[email protected]


Idaho




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Idaho




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Idaho



1-714-637-1282

1-714-637-1209

[email protected]



Idaho



1-765-526-2515

[email protected]

8990 Duke Drive


Idaho




1-972-569-3646

1-972-569-3679

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Idaho


1-949-252-4339

[email protected]

2300 Main Street


Idaho


1-949-221-9994

[email protected]

2300 Main Street


Idaho


1-949-221-9994

[email protected]

2300 Main Street


Idaho


1-949-252-4339

[email protected]

2300 Main Street


Idaho



1-813-290-6200 3768

[email protected]


Idaho



1-813-290-6200 3768

[email protected]


IllinoisAETNA HEALTH OF ILLINOIS, INC. Aetna Medicare Local CCP


1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Illinois



1-386-963-2543

1-860-754-1481

[email protected] 5350 148th Place Wellborn FL

32094-2362

Illinois



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Illinois



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

IllinoisBRAVO HEALTH MID-ATLANTIC, INC. Bravo by Elder Health PDP


1-800-625-9432

1-866-464-0709

[email protected]


Illinois


1-860-226-6731

[email protected]


Illinois


1-804-965-7658

[email protected]



Illinois



1-804-965-7658


Illinois



1-330-405-8080 6320

1-330-405-8081

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Illinois ESSENCE INC. Essence Inc. Local CCPdirector of QI and Compliance Keys Mary Kay

1-314-851-3664

[email protected] 12655 Olive 4th Floor saint louis MO 63141

IllinoisEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Illinois



1-804-965-7658


IllinoisGROUP HEALTH PLAN, INC.

Group Health Plan, Inc. Local CCP Stephens Debbie

1-804-965-7658


Illinois

HARMONY HEALTH PLAN OF ILLINOIS, INC. WellCare Local CCP


1-813-290-6200 3768


33622-5858

Illinois

HCSC INSURANCE SERVICES COMPANY

HISC - Blue Cross Blue Shield of Illinois PDP

Pharmacy Director Nguyen Marie

1-651-286-4206

1-651-286-4403

[email protected]

Prime Therapeutics, LLC

1020 Discovery Road Eagen MN 55121

IllinoisHEALTH ALLIANCE MEDICAL PLANS

Health Alliance Medical Plans Local CCP

Director of Pharmacy Barrington Christina

1-217-337-8141

1-217-255-4598

[email protected] 301 S. Vine St. Urbana IL 61801

IllinoisHEALTH ALLIANCE MEDICAL PLANS

Health Alliance Medical Plans Local CCP

Director of Pharmacy Barrington Christina

1-217-337-8141

1-217-255-4598

[email protected] 301 S. Vine St. Urbana IL 61801

Illinois




1-916-463-9603

1-916-463-9750

[email protected]




Illinois




1-615-565-8110

1-615-234-2154

[email protected]


IllinoisHEALTHSPRING, INC. HealthSpring, Inc. Local CCP


1-615-565-8110

1-615-291-7011

[email protected]


IllinoisHUMANA HEALTH PLAN, INC.


1-502-580-3538

[email protected]


Illinois



1-502-580-3538

[email protected]


Illinois



1-502-580-3538

[email protected]


Illinois



1-502-580-3538

[email protected]


Illinois



1-502-580-3538

[email protected]


Illinois




1-201-269-6717

1-201-269-1008

[email protected]


IllinoisMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Illinois

MERCY HEALTH PLANS OF MISSOURI INC.

Mercy Health Plans, Inc. Local CCP

Director of Clinical Pharmacy Linsin Cathy

1-314-214-2489

1-314-214-8101

[email protected]

14528 S. Outer 40, Ste. 300 Chesterfield MO 63017

Illinois




1-516-605-6966

1-412-322-2066

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

IllinoisOSF HEALTHPLANS, INC. OSF Care Advantage Local CCP

Associate Director of Pharmacy Porch William

1-309-677-8553

1-309-677-8354

[email protected]

7915 N Hale Ave, Ste D Peoria IL 61615

IllinoisOSF HEALTHPLANS, INC. OSF Care Preferred Local CCP

Associate Director of Pharmacy Porch Willaim

1-309-677-8553

1-309-677-8354

[email protected]

7915 N Hale Ave, Ste D Peoria IL 61615

Illinois




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Illinois




1-401-333-3987 7941

1-800-373-0238

[email protected]


Illinois



1-713-770-1265

1-866-553-0396

[email protected]


Illinois RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Illinois



1-702-877-8377

[email protected]


Illinois


1-866-443-0934

[email protected]


Illinois




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Illinois




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Illinois



1-714-637-1282

1-714-637-1209

[email protected]



Illinois



1-765-526-2515

[email protected]

8990 Duke Drive


Illinois




1-972-569-3646

1-972-569-3679

[email protected]


Illinois


1-949-252-4339

[email protected]

2300 Main Street


Illinois

UNITED HEALTHCARE INS. COMPANY, INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Illinois


1-949-221-9994

[email protected]

2300 Main Street


Illinois




1-949-221-9994

1-949-474-3237

[email protected]

2300 Main Street



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Illinois





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Illinois


1-949-252-4339

[email protected]

2300 Main Street


Illinois

UNITED HEALTHCARE OF THE MIDWEST, INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Illinois

UNITED HEALTHCARE PLAN OF THE RIVER VALLEY, INC.

UnitedHealthcare Plan of the River Valley, Inc. Local CCP

Prescriptions Solutions Graham Phyllis

1-972-866-1501

1-972-866-1911

[email protected]

5001 LBJ Fwy, Suite 600 Dallas TX 75244

Illinois



1-813-290-6200 3768

[email protected]


Illinois



1-813-290-6200 3768

[email protected]


Indiana

ADVANTAGE HEALTH SOLUTIONS, INC.

Advantage Health Solutions, Inc. Local CCP

Director, Pharmacy and Data Analysis Musial Brian

1-317-573-6691

[email protected]

9490 Priority Way West Drive Indianapolis IN 46240

Indiana



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Indiana



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Indiana


Anthem Blue Cross and Blue Shield Local CCP Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]



Indiana



1-714-637-1282

1-714-637-1209

[email protected]



Indiana


Anthem Blue Cross and Blue Shield Regional CCP Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]



Indiana


Anthem Blue Cross and Blue Shield PDP


1-765-526-2515

[email protected]

8990 Duke Drive


Indiana


1-860-226-6731

[email protected]


Indiana


1-804-965-7658

[email protected]



Indiana



1-330-405-8080 6320

1-330-405-8081

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

IndianaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Indiana



1-804-965-7658


Indiana



1-804-965-7658


Indiana




1-916-463-9603

1-916-463-9750

[email protected]




Indiana




1-615-565-8110

1-615-234-2154

[email protected]


Indiana



1-502-580-3538

[email protected]


Indiana



1-502-580-3538

[email protected]


Indiana



1-502-580-3538

[email protected]


Indiana



1-502-580-3538

[email protected]


Indiana



1-502-580-3538

[email protected]


Indiana




1-201-269-6717

1-201-269-1008

[email protected]


IndianaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Indiana




1-516-605-6966

1-412-322-2066

[email protected]


Indiana




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Indiana




1-401-333-3987 7941

1-800-373-0238

[email protected]


Indiana



1-713-770-1265

1-866-553-0396

[email protected]


Indiana RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Indiana



1-702-877-8377

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Indiana


1-866-443-0934

[email protected]


Indiana




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Indiana




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Indiana



1-714-637-1282

1-714-637-1209

[email protected]



Indiana



1-765-526-2515

[email protected]

8990 Duke Drive


Indiana




1-972-569-3646

1-972-569-3679

[email protected]


Indiana


1-949-252-4339

[email protected]

2300 Main Street


Indiana


1-949-221-9994

[email protected]

2300 Main Street


Indiana


1-949-221-9994

[email protected]

2300 Main Street


Indiana


1-949-252-4339

[email protected]

2300 Main Street


Indiana



1-813-290-6200 3768

[email protected]


Indiana



1-813-290-6200 3768

[email protected]


Iowa



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Iowa



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Iowa

BLUE CROSS BLUE SHIELD NORTHERN PLAINS ALLIANCE

Wellmark Blue Cross and Blue Shield of Iowa Regional CCP

Director of Pharmacy Heaton Alan

1-651-662-8758

1-651-662-6009

[email protected]

Blue Cross and Blue Shield of Minnesota

3400 Yankee Drive Eagan MN 55122

Iowa


Wellmark Blue Cross and Blue Shield of Iowa PDP


1-651-662-8758

1-651-662-6009

[email protected]

Blue Cross Blue Shield of Minnesota



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Iowa


1-860-226-6731

[email protected]


Iowa

COVENTRY HEALTH AND LIFE INS COMPANY

Coventry Health and Life Insurance Company Local CCP Stephens Debbie

1-804-965-7658

1-804-290-4831


Iowa


1-804-965-7658

[email protected]



Iowa

COVENTRY HEALTH CARE OF IOWA, INC.

Coventry Health Care of Iowa, Inc. Local CCP Stephens Debbie

1-804-965-7658

1-804-290-4831


Iowa



1-330-405-8080 6320

1-330-405-8081

[email protected]


IowaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Iowa



1-804-965-7658


Iowa



1-804-965-7658


IowaFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


Iowa




1-916-463-9603

1-916-463-9750

[email protected]




Iowa




1-615-565-8110

1-615-234-2154

[email protected]


Iowa



1-502-580-3538

[email protected]


Iowa



1-502-580-3538

[email protected]


Iowa




1-201-269-6717

1-201-269-1008

[email protected]


IowaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Iowa




1-516-605-6966

1-412-322-2066

[email protected]


Iowa




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Iowa




1-401-333-3987 7941

1-800-373-0238

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Iowa



1-713-770-1265

1-866-553-0396

[email protected]


Iowa RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Iowa


1-866-443-0934

[email protected]


Iowa




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Iowa




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Iowa



1-714-637-1282

1-714-637-1209

[email protected]



Iowa



1-765-526-2515

[email protected]

8990 Duke Drive


Iowa




1-972-569-3646

1-972-569-3679

[email protected]


Iowa


1-949-252-4339

[email protected]

2300 Main Street


Iowa


1-949-221-9994

[email protected]

2300 Main Street


Iowa




1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Iowa


1-949-252-4339

[email protected]

2300 Main Street


Iowa

UNITED HEALTHCARE OF THE MIDLANDS, INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Iowa




1-972-866-1501

1-972-866-1911

[email protected]


Iowa



1-813-290-6200 3768

[email protected]


Iowa



1-813-290-6200 3768

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Kansas



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Kansas



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

KansasBLUE CROSS BLUE SHIELD OF KANSAS Blue MedicareRx PDP


1-765-526-2515

[email protected]

8990 Duke Drive


Kansas


1-860-226-6731

[email protected]


Kansas

COVENTRY HEALTH AND LIFE INS. COMPANY

Coventry Health And Life Ins. Company Local CCP Stephens Debbie

1-804-965-7658


Kansas


1-804-965-7658

[email protected]



Kansas



1-804-965-7658


Kansas

COVENTRY HEALTH CARE OF KANSAS, INC.

Coventry Health Care of Kansas, Inc. Local CCP Stephens Debbie

1-804-965-7658


Kansas



1-330-405-8080 6320

1-330-405-8081

[email protected]


KansasEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Kansas



1-804-965-7658


Kansas




1-916-463-9603

1-916-463-9750

[email protected]




Kansas




1-615-565-8110

1-615-234-2154

[email protected]


KansasHUMANA HEALTH PLAN, INC.


1-502-580-3538

[email protected]


Kansas



1-502-580-3538

[email protected]


Kansas



1-502-580-3538

[email protected]


Kansas



1-502-580-3538

[email protected]


Kansas



1-502-580-3538

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Kansas




1-201-269-6717

1-201-269-1008

[email protected]


KansasMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Kansas




1-516-605-6966

1-412-322-2066

[email protected]


Kansas




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Kansas




1-401-333-3987 7941

1-800-373-0238

[email protected]


Kansas



1-713-770-1265

1-866-553-0396

[email protected]


Kansas RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Kansas



1-702-877-8377

[email protected]


Kansas


1-866-443-0934

[email protected]


Kansas




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Kansas




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Kansas



1-714-637-1282

1-714-637-1209

[email protected]



Kansas



1-765-526-2515

[email protected]

8990 Duke Drive


Kansas




1-972-569-3646

1-972-569-3679

[email protected]


Kansas


1-949-252-4339

[email protected]

2300 Main Street


Kansas


1-949-221-9994

[email protected]

2300 Main Street


Kansas


1-949-252-4339

[email protected]

2300 Main Street



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Kansas



1-813-290-6200 3768

[email protected]


Kansas



1-813-290-6200 3768

[email protected]


Kentucky



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Kentucky



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Kentucky

ANTHEM HEALTH PLANS OF KENTUCKY, INC.


1-714-637-1282

1-714-637-1209

[email protected]



Kentucky

ANTHEM HEALTH PLANS OF KENTUCKY, INC.


1-714-637-1282

1-714-637-1209

[email protected]



Kentucky



1-714-637-1282

1-714-637-1209

[email protected]



Kentucky




1-765-526-2515

[email protected]

8990 Duke Drive


Kentucky


1-860-226-6731

[email protected]


Kentucky


1-804-965-7658

[email protected]



Kentucky



1-330-405-8080 6320

1-330-405-8081

[email protected]


KentuckyEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Kentucky



1-804-965-7658


Kentucky



1-804-965-7658


Kentucky




1-916-463-9603

1-916-463-9750

[email protected]




Kentucky




1-615-565-8110

1-615-234-2154

[email protected]


Kentucky



1-502-580-3538

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Kentucky



1-502-580-3538

[email protected]


Kentucky



1-502-580-3538

[email protected]


Kentucky



1-502-580-3538

[email protected]


Kentucky



1-502-580-3538

[email protected]


Kentucky




1-201-269-6717

1-201-269-1008

[email protected]


KentuckyMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Kentucky




1-516-605-6966

1-412-322-2066

[email protected]


Kentucky




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Kentucky




1-401-333-3987 7941

1-800-373-0238

[email protected]


Kentucky



1-713-770-1265

1-866-553-0396

[email protected]


Kentucky RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Kentucky



1-702-877-8377

[email protected]


Kentucky


1-866-443-0934

[email protected]


Kentucky




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Kentucky




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Kentucky



1-714-637-1282

1-714-637-1209

[email protected]



Kentucky



1-765-526-2515

[email protected]

8990 Duke Drive


Kentucky




1-972-569-3646

1-972-569-3679

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Kentucky


1-949-252-4339

[email protected]

2300 Main Street


Kentucky


1-949-221-9994

[email protected]

2300 Main Street


Kentucky


1-949-252-4339

[email protected]

2300 Main Street


KentuckyUNIVERSITY HEALTH CARE, INC. Passport Advantage Local CCP

Supervisor, Pharmacy DUR/MTM Lawson Mark

1-215-937-5352

1-215-937-8450

[email protected]

200 Stevens Drive 4th Floor Philadelphia PA 19113

Kentucky



1-813-290-6200 3768

[email protected]


Kentucky



1-813-290-6200 3768

[email protected]


Louisiana



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Louisiana



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Louisiana


1-860-226-6731

[email protected]


Louisiana


1-804-965-7658

[email protected]



Louisiana



1-804-965-7658


Louisiana



1-330-405-8080 6320

1-330-405-8081

[email protected]


LouisianaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Louisiana



1-804-965-7658


Louisiana




1-916-463-9603

1-916-463-9750

[email protected]




Louisiana




1-615-565-8110

1-615-234-2154

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Louisiana

HUMANA HEALTH BENEFIT PLAN OF LA, INC.

Humana Health Benefit Plan of LA, Inc. PFFS Ewing Joy

1-502-580-3538

[email protected]


Louisiana

HUMANA HEALTH BENEFIT PLAN OF LOUISIANA INC

Humana Health Benefit Plan Of Louisiana Inc Local CCP Ewing Joy

1-502-580-3538

[email protected]


Louisiana



1-502-580-3538

[email protected]


Louisiana



1-502-580-3538

[email protected]


Louisiana

LOUISIANA HEALTH SERVICE AND INDEMNITY COMPANY

Blue Cross and Blue Shield of Louisiana PDP

Medicare Part D Pharmacy Manager McLean Gionne

1-800-417-8164

1-877-837-5922

[email protected]

5525 Reitz Avenue Baton Rouge LA 70809

Louisiana




1-201-269-6717

1-201-269-1008

[email protected]


LouisianaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Louisiana




1-516-605-6966

1-412-322-2066

[email protected]


Louisiana




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Louisiana




1-401-333-3987 7941

1-800-373-0238

[email protected]


Louisiana



1-713-770-1265

1-866-553-0396

[email protected]


Louisiana RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Louisiana



1-702-877-8377

[email protected]


Louisiana


1-866-443-0934

[email protected]


Louisiana




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Louisiana




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Louisiana

TENET CHOICES, INC. / PEOPLES HEALTH NETWORK Peoples Health Local CCP

Clinical Pharmacist Smith Shannon

1-504-849-4500 8887

1-504-849-6901

[email protected]

Three Lakeway Center

3838 N Causeway Blvd, Suite 2200 Metairie LA 70002

Louisiana

TENET CHOICES, INC. / PEOPLES HEALTH NETWORK Peoples Health Local CCP PharmD Smith Shannon

1-504-849-4500 8887

1-504-849-6901

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Louisiana



1-714-637-1282

1-714-637-1209

[email protected]



Louisiana



1-765-526-2515

[email protected]

8990 Duke Drive


Louisiana




1-972-569-3646

1-972-569-3679

[email protected]


Louisiana


1-949-252-4339

[email protected]

2300 Main Street


Louisiana


1-949-252-4339

[email protected]

2300 Main Street


Louisiana




1-800-546-5677 1110

1-866-632-7946


LouisianaVANTAGE HEALTH PLAN, INC.

Vantage Health Plan, Inc. Local CCP

Director of UR/QM Halley Melissa

1-318-361-0900 110

[email protected] 130 DeSiard St Suite 300 Monroe LA 71201

Louisiana



1-813-290-6200 3768

[email protected]


LouisianaWELLCARE OF LOUISIANA, INC. WellCare Local CCP


1-813-290-6200 3768


33622-5858

Louisiana



1-813-290-6200 3768

[email protected]


Maine



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Maine



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Maine




1-866-245-5190

1-866-553-0396

[email protected]


Maine




1-765-526-2515

[email protected]

8990 Duke Drive


MaineARCADIAN HEALTH PLAN, INC.

Northeast Community Care Local CCP


1-909-971-6816

1-909-971-6866

[email protected]


Maine


1-860-226-6731

[email protected]


Maine



1-330-405-8080 6320

1-330-405-8081

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

MaineEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Maine



1-804-965-7658


Maine



1-804-965-7658


MaineFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


Maine




1-916-463-9603

1-916-463-9750

[email protected]




Maine




1-615-565-8110

1-615-234-2154

[email protected]


Maine



1-502-580-3538

[email protected]


Maine



1-502-580-3538

[email protected]


MaineMARTINS POINT GENERATIONS, LLC

Martin's Point Generations Advantage Local CCP

Director of Pharmacy Services Takach Michael

1-207-791-3745

1-207-828-2494

[email protected]

331 Veranda Street

PO Box 9746 Portland ME

04104-5040

Maine




1-201-269-6717

1-201-269-1008

[email protected]


MaineMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Maine




1-516-605-6966

1-412-322-2066

[email protected]


Maine




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Maine




1-401-333-3987 7941

1-800-373-0238

[email protected]


Maine RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Maine


1-866-443-0934

[email protected]


Maine




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Maine




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Maine



1-714-637-1282

1-714-637-1209

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Maine



1-765-526-2515

[email protected]

8990 Duke Drive


Maine




1-972-569-3646

1-972-569-3679

[email protected]


Maine


1-949-252-4339

[email protected]

2300 Main Street


Maine


1-949-221-9994

[email protected]

2300 Main Street


Maine





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Maine


1-949-252-4339

[email protected]

2300 Main Street


Maine



1-813-290-6200 3768

[email protected]


MarylandAETNA HEALTH INC. (MARYLAND) Aetna Medicare Local CCP


1-386-963-2543

1-386-963-2544

[email protected]


32094-2362

Maryland



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Maryland



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Maryland



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Maryland



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Maryland




1-866-245-5190

1-866-553-0396

[email protected]


MarylandAMERIGROUP MARYLAND, INC.

AMERIGROUP Community Care Local CCP

AVP Clinical Pharmacy Radzin Richard

1-757-518-3152

[email protected]

4425 Corporation Lane, #300 Virginia Beach VA 23462

MarylandBRAVO HEALTH MID-ATLANTIC INC. Bravo by Elder Health Local CCP


1-800-625-9432

1-866-464-0709

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

MarylandBRAVO HEALTH MID-ATLANTIC INC. Bravo by Elder Health PFFS


1-410-864-4583

1-866-464-0709

[email protected]


MarylandBRAVO HEALTH MID-ATLANTIC, INC. Bravo by Elder Health PDP


1-800-625-9432

1-866-464-0709

[email protected]


Maryland

CARE IMPROVEMENT PLUS OF MARYLAND, INC.

Care Improvement Plus Local CCP Moyna Audrey

1-847-559-3999

1-847-559-4733

[email protected]


Maryland


1-860-226-6731

[email protected]


Maryland


1-804-965-7658

[email protected]



Maryland



1-804-965-7658


Maryland



1-330-405-8080 6320

1-330-405-8081

[email protected]


MarylandEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Maryland FIRST CARE, INC.Medi-CareFirst BlueCross BlueShield PDP


1-410-528-7897

[email protected]


Maryland



1-804-965-7658


Maryland




1-916-463-9603

1-916-463-9750

[email protected]




Maryland




1-615-565-8110

1-615-234-2154

[email protected]


Maryland



1-502-580-3538

[email protected]


Maryland



1-502-580-3538

[email protected]


Maryland

KAISER FNDN HP OF THE MID-ATLANTIC STS

Kaiser Permanente Medicare Plus 1876 Cost

Pharmacy Director Downard Susan

1-301-816-6835

[email protected]

2101 East Jefferson St Rockville MD 20852

MarylandMARYLAND CARE - MEDICARE, INC.

Golden Advantage Plus Local CCP

Director Corporate Pharmacy Clark Mark

1-602-659-2062

[email protected]

4645 E Cotton Center Blvd Phoenix AZ 85040

Maryland




1-201-269-6717

1-201-269-1008

[email protected]


MarylandMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Maryland




1-516-605-6966

1-412-322-2066

[email protected]


Maryland




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Maryland




1-401-333-3987 7941

1-800-373-0238

[email protected]


Maryland RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Maryland



1-702-877-8377

[email protected]


Maryland


1-866-443-0934

[email protected]


Maryland




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Maryland



1-714-637-1282

1-714-637-1209

[email protected]



Maryland



1-765-526-2515

[email protected]

8990 Duke Drive


Maryland




1-972-569-3646

1-972-569-3679

[email protected]


Maryland


1-949-252-4339

[email protected]

2300 Main Street


Maryland





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Maryland





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Maryland


1-949-252-4339

[email protected]

2300 Main Street


Maryland



1-813-290-6200 3768

[email protected]


Maryland



1-813-290-6200 3768

[email protected]


Massachusetts



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Massachusetts



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Massachusetts

BLUE CROSS AND BLUE SHIELD OF MA HMO BLUE, INC.

Blue Cross And Blue Shield Of Massachusetts, Inc. Local CCP

Clinical Pharmacist Flori, RPh Jeremy J

1-617-246-6654

[email protected]

Landmark Center

401 Park Drive Boston MA 02215

Massachusetts

BLUE CROSS and BLUE SHIELD OF MA HMO BLUE, INC.

Blue Cross and Blue Shield of Massachusetts, Inc. Local CCP

Clinical Pharmacist Flori, RPh Jeremy J

1-617-246-6654

[email protected]

Landmark Center

401 Park Drive Boston MA 02215

Massachusetts BLUE MEDICARERX

Blue Cross and Blue Shield of Massachusetts PDP


1-765-526-2515

[email protected]

8990 Duke Drive


MassachusettsCOMMONWEALTH CARE ALLIANCE

Commonwealth Care Alliance Local CCP

Director of Pharmacy Shebli Basem

1-617-426-0600

1-617-426-1311

[email protected]

30 Winter Street, 7th Floor Boston MA 02108

Massachusetts

COMMONWEALTH CARE ALLIANCE, INC.

Commonwealth Care Alliance, Inc. Demo

Director of Pharmacy Shebli Basem

1-617-426-0600

1-617-426-1311

[email protected]

30 Winter Street, 7th Floor Boston MA 02108

Massachusetts


1-860-226-6731

[email protected]


Massachusetts


1-804-965-7658

[email protected]



Massachusetts



1-330-405-8080 6320

1-330-405-8081

[email protected]


MassachusettsEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Massachusetts

FALLON COMMUNITY HEALTH PLAN

Fallon Community Health Plan Local CCP Pharmacist Haji Mojgan

1-800-333-2535 69916

[email protected]

One Chestnut Place

10 Chestnut Street Worcester MA 01608

Massachusetts

FALLON COMMUNITY HEALTH PLAN

Fallon Community Health Plan Local CCP Pharmacist Haji Mojgan

1-800-333-2535 69916

[email protected]

One Chestnut Place

10 Chestnut Street Worcester MA 01608

Massachusetts



1-804-965-7658


Massachusetts



1-804-965-7658


MassachusettsHARVARD PILGRIM HEALTH CARE INC.

HARVARD PILGRIM HEALTH CARE INC. PFFS

Medical Director, Pharmacy Minkoff, MD Neil

1-617-509-0170

1-617-509-6031

[email protected]

1600 Crown Colony Drive Quincy MA 02169

Massachusetts




1-916-463-9603

1-916-463-9750

[email protected]




Massachusetts




1-615-565-8110

1-615-234-2154

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Massachusetts



1-502-580-3538

[email protected]


Massachusetts



1-502-580-3538

[email protected]


Massachusetts




1-201-269-6717

1-201-269-1008

[email protected]


MassachusettsMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Massachusetts




1-516-605-6966

1-412-322-2066

[email protected]


Massachusetts




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Massachusetts




1-401-333-3987 7941

1-800-373-0238

[email protected]


Massachusetts RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


MassachusettsSENIOR WHOLE HEALTH, LLC Senior Whole Health Demo


1-617-494-5353 6324

1-617-494-5599

[email protected]

58 Charles Street, 2nd Floor Cambridge MA 02141

Massachusetts


1-866-443-0934

[email protected]


Massachusetts




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

MassachusettsTUFTS ASSOCIATED HMO, INC. Tufts Health Plan Local CCP

Senior Clinical Pharmacist Calcagni Christophe

1-617-972-9400 3217

1-617-673-0133

[email protected]

705 Mt Auburn Street Watertown MA 02472

MassachusettsTUFTS ASSOCIATED HMO, INC. Tufts Health Plan Local CCP

Senior Clinical Pharmacist Calcagni Christophe

1-617-972-9400 3217

1-617-673-0133

[email protected]

705 Mt Auburn Street Watertown MA 02472

Massachusetts



1-714-637-1282

1-714-637-1209

[email protected]



Massachusetts



1-765-526-2515

[email protected]

8990 Duke Drive


Massachusetts




1-972-569-3646

1-972-569-3679

[email protected]


Massachusetts


1-949-252-4339

[email protected]

2300 Main Street


Massachusetts

UNITED HEALTHCARE INSURANCE COMPANY United Health Group Demo



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Massachusetts





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Massachusetts





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Massachusetts


1-949-252-4339

[email protected]

2300 Main Street


Massachusetts



1-813-290-6200 3768

[email protected]


Michigan



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Michigan



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Michigan

ALLIANCE HEALTH AND LIFE INSURANCE, CO

Alliance Medicare PPO Local CCP

Director, Pharmacy Care Management Pindolia Vanita

1-248-443-8849

[email protected]

2850 W. Grand Blvd. Detroit MI 48202

Michigan

BLUE CARE NETWORK OF MICHIGAN Blue Care Network Local CCP

Pharmacy Manager Cavanaugh Jeanne

1-248-455-3592

1-248-455-3692

[email protected]

20500 Civic Center Drive Southfield MI 48076

Michigan

BLUE CROSS BLUE SHIELD OF MICHIGAN

Blue Cross Blue Shield of Michigan PFFS Director Welford Lisa

1-248-448-6172

[email protected]

27300 West 11 Mile Road MC B776 Southfield MI 48034

Michigan

BLUE CROSS BLUE SHIELD OF MICHIGAN

Blue Cross Blue Shield of Michigan PDP Director Welford Lisa

1-248-448-6172

[email protected]

27300 West Eleven Mile Road MC B776 Southfield MI 48034

Michigan



1-800-625-9432

1-866-464-0709

[email protected]


Michigan


1-860-226-6731

[email protected]


Michigan


1-804-965-7658

[email protected]



Michigan



1-804-965-7658


Michigan



1-330-405-8080 6320

1-330-405-8081

[email protected]


MichiganEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Michigan

FIDELIS SECURECARE OF MICHIGAN

Fidelis SecureCare Of Michigan Local CCP Wilborn Jerome

1-734-779-1680

1-734-779-1681

[email protected]

38777 West Six Mile Road Suite 207 Livonia MI 48152


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Michigan



1-804-965-7658


MichiganHEALTH ALLIANCE PLAN OF MICHIGAN HAP Senior Plus Local CCP

Director, Pharmacy Care Management Pindolia Vanita

1-248-443-8849

[email protected]

2850 West Grand Blvd Detroit MI 48202

Michigan




1-916-463-9603

1-916-463-9750

[email protected]




MichiganHEALTHPLUS OF MICHIGAN

HealthPlus of Michigan Local CCP

Pharmacy Project and Development Manager Sopo Deborah A

1-810-230-2276

1-810-720-2757

[email protected]

2050 S. Linden Road Flint MI 48532

Michigan




1-615-565-8110

1-615-234-2154

[email protected]


Michigan



1-502-580-3538

[email protected]


Michigan



1-502-580-3538

[email protected]


Michigan



1-502-580-3538

[email protected]


Michigan




1-201-269-6717

1-201-269-1008

[email protected]


MichiganMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


MichiganMIDWEST HEALTH PLAN, INC. Midwest Advantage Local CCP

SR. DIRECTOR OF HEALTH SERVICES ANDERSON ELLEN

1-313-586-6033

1-313-586-6045

[email protected]

5050 SCHAEFER ROAD DEARBORN MI 48126

Michigan

MOLINA HEALTHCARE OF MICHIGAN

Molina Healthcare of Michigan Local CCP

Director, Pharmacy SCHATZMAN BENJAMIN

1-562-951-1509 1509

1-562-437-9315

[email protected]

ONE GOLDEN SHORE DRIVE LONG BEACH CA 90802

Michigan




1-516-605-6966

1-412-322-2066

[email protected]


Michigan




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


MichiganPARAMOUNT CARE, INC Paramount Elite Local CCP

Coordinator, Prescription Drug PRogram Bogner Craig M

1-419-887-2249

1-419-887-2015

[email protected]

1901 Indian Wood Circle Maumee OH 43537

Michigan




1-401-333-3987 7941

1-800-373-0238

[email protected]


Michigan PRIORITY HEALTH PriorityMedicare Local CCPDirector, Pharmacy Wassom Rhonda

1-616-464-8832

[email protected]

1231 East Beltline, NE Grand Rapids MI 49525

Michigan

PRIORITY HEALTH INSURANCE COMPANY PriorityMedicareRx PDP

Director, Pharmacy Wassom Rhonda

1-616-464-8832

[email protected]

1231 East Beltline NE Grand Rapids MI 49525


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Michigan



1-713-770-1265

1-866-553-0396

[email protected]


Michigan RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Michigan


1-866-443-0934

[email protected]


Michigan




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Michigan




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Michigan



1-714-637-1282

1-714-637-1209

[email protected]



Michigan



1-765-526-2515

[email protected]

8990 Duke Drive


Michigan




1-972-569-3646

1-972-569-3679

[email protected]


Michigan


1-949-252-4339

[email protected]

2300 Main Street


Michigan


1-949-221-9994

[email protected]

2300 Main Street


Michigan





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Michigan


1-949-252-4339

[email protected]

2300 Main Street


Michigan



1-813-290-6200 3768

[email protected]


Michigan



1-813-290-6200 3768

[email protected]


Minnesota



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Minnesota



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Minnesota


Blue Cross and Blue Shield of Minnesota Regional CCP


1-651-662-8758

1-651-662-6009

[email protected]



Minnesota


Blue Cross and Blue Shield of Minnesota PDP


1-651-662-8758

1-651-662-6009

[email protected]



Minnesota BLUE PLUS SecureBlue DemoManager, Special Needs Plans Nesset Diane

1-651-662-2133

[email protected]


Minnesota


1-860-226-6731

[email protected]


Minnesota



1-330-405-8080 6320

1-330-405-8081

[email protected]


MinnesotaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Minnesota



1-804-965-7658


Minnesota



1-804-965-7658


MinnesotaFIRST PLAN OF MINNESOTA First Plan Blue Demo

Director of Pharmacy First Plan of Minnesota McDannold Roger

1-218-740-2330 7263

1-218-834-9531

[email protected]

SuperiorHealth Pharmacy

1010 Fourth Street Two Harbors MN 55616

MinnesotaFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


MinnesotaGROUP HEALTH PLAN, INC. HealthPartners Local CCP

Director Pharmacy Services Cooper Susan

1-952-967-5818

[email protected]

8170 33rd Avenue South

PO Box 1309 Minneapolis MN

55440-1309

Minnesota




1-916-463-9603

1-916-463-9750

[email protected]




Minnesota HEALTHPARTNERS HealthPartners 1876 Cost

Director Pharmacy Services Cooper Susan

1-952-967-5818

[email protected]

8170 33rd Avenue South

PO Box 1309 Minneapolis MN

55440-1309

Minnesota HEALTHPARTNERS

HealthPartners Classic MN Senior Health Options Demo

Director Pharmacy Services Cooper Sue

1-952-967-5818

[email protected]

8170 33rd Avenue South, PO Box 1309

MS: 21111B Minneapolis MN 55440

Minnesota




1-615-565-8110

1-615-234-2154

[email protected]


MinnesotaHMO MINNESOTA D/B/A BLUE PLUS CareBlue Local CCP

Manager, Special Needs Plans Nesset Diane

1-651-662-2133

1-651-662-2133

[email protected]


Minnesota



1-502-580-3538

[email protected]


Minnesota



1-502-580-3538

[email protected]


MinnesotaITASCA MEDICAL CARE Itasca Medical Care Demo MTM, Manager Moyna Audry

1-847-559-3999

1-847-559-4733

[email protected]

9501 E. Shea Blvd. Scottsdale AZ 85260


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Minnesota




1-201-269-6717

1-201-269-1008

[email protected]


MinnesotaMEDICA HEALTH PLANS Medica Dual Solution Demo Weiss Justin

1-952-992-2469

[email protected]

401 Carlson Parkway Minnetonka MN 55305

MinnesotaMEDICA HEALTH PLANS Medica Health Plans PFFS Weiss Justin

1-952-992-2469

[email protected]


Minnesota

MEDICA INSURANCE COMPANY

Medica Insurance Company 1876 Cost Weiss Justin

1-952-992-2469

[email protected]


MinnesotaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


MinnesotaMETROPOLITAN HEALTH PLAN

Metropolitan Health Plan MSHO Demo

Director of Medical Administration Moore Ned

1-612-596-0725

1-612-904-4265

[email protected]

400 South 4th Street Suite 201 Minneapolis MN 55415

MinnesotaMETROPOLITAN HEALTH PLAN

North Star Advantage / North Star Advantage Plus Local CCP

Director of Medical Administration Moore Ned

1-612-596-0725

1-612-904-4265

[email protected]

400 South 4th Street Suite 201 Minneapolis MN 55415

Minnesota




1-516-605-6966

1-412-322-2066

[email protected]


Minnesota




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Minnesota




1-401-333-3987 7941

1-800-373-0238

[email protected]


MinnesotaPRIMEWEST HEALTH SYSTEM

Primewest Health System Demo

Pharmacy Director Government Programs Nguyen Marie

1-651-286-4206

1-651-286-4403

[email protected]


PO Box 64812, Mail Route PWEST St. Paul MN 55164

Minnesota



1-713-770-1265

1-866-553-0396

[email protected]


Minnesota RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Minnesota


1-866-443-0934

[email protected]


MinnesotaSOUTH COUNTRY HEALTH ALLIANCE

South Country Health Alliance Demo Nguyen Marie

1-651-286-4206

1-651-286-4424

[email protected]

Prime Therapeutics Inc.

1020 Discovery Road No. 100 Eagan MN 55121

MinnesotaSOUTH COUNTRY HEALTH ALLIANCE

South Country Health Alliance Local CCP Nguyen Marie

1-651-286-4206

1-651-286-4424

[email protected]

Prime Therapeutics Inc.

1020 Discovery Road No. 100 Eagan MN 55121

Minnesota




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Minnesota




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Minnesota UCARE MINNESOTA UCare Minnesota Demo Medical Director Christianson Craig1-612-676-3375

1-612-676-6501

[email protected] PO Box 52 Minneapolis MN 55440


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Minnesota UCARE MINNESOTA UCare Minnesota Demo Medical Director Christianson Craig1-612-676-3375

1-612-676-6501


Minnesota UCARE MINNESOTA UCare Minnesota Local CCP Medical Director Christianson Craig1-612-676-3375

1-612-676-6501


Minnesota



1-714-637-1282

1-714-637-1209

[email protected]



Minnesota



1-765-526-2515

[email protected]

8990 Duke Drive


Minnesota




1-972-569-3646

1-972-569-3679

[email protected]


Minnesota


1-949-252-4339

[email protected]

2300 Main Street


Minnesota


1-949-252-4339

[email protected]

2300 Main Street


Minnesota



1-813-290-6200 3768

[email protected]


Minnesota



1-813-290-6200 3768

[email protected]


Mississippi



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Mississippi



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Mississippi


1-860-226-6731

[email protected]


Mississippi


1-804-965-7658

[email protected]



Mississippi



1-804-965-7658


Mississippi



1-330-405-8080 6320

1-330-405-8081

[email protected]


MississippiEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Mississippi



1-804-965-7658



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Mississippi




1-916-463-9603

1-916-463-9750

[email protected]




Mississippi




1-615-565-8110

1-615-234-2154

[email protected]


MississippiHEALTHSPRING OF TENNESSEE, INC. Healthspring, Inc. Local CCP


1-615-565-8110

1-615-234-2154

[email protected]


Mississippi



1-502-580-3538

[email protected]


Mississippi



1-502-580-3538

[email protected]


Mississippi



1-502-580-3538

[email protected]


Mississippi




1-201-269-6717

1-201-269-1008

[email protected]


MississippiMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Mississippi




1-516-605-6966

1-412-322-2066

[email protected]


Mississippi




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Mississippi




1-401-333-3987 7941

1-800-373-0238

[email protected]


Mississippi



1-713-770-1265

1-866-553-0396

[email protected]


Mississippi RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Mississippi



1-702-877-8377

[email protected]


Mississippi


1-866-443-0934

[email protected]


Mississippi




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Mississippi



1-714-637-1282

1-714-637-1209

[email protected]



Mississippi



1-765-526-2515

[email protected]

8990 Duke Drive



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Mississippi




1-972-569-3646

1-972-569-3679

[email protected]


Mississippi


1-949-252-4339

[email protected]

2300 Main Street


Mississippi


1-949-252-4339

[email protected]

2300 Main Street


Mississippi



1-813-290-6200 3768

[email protected]


Mississippi



1-813-290-6200 3768

[email protected]


MississippiWINDSOR HEALTH PLAN, INC Windsor Rx PDP


1-615-782-7860

1-615-782-7822

[email protected]


MississippiWINDSOR HEALTH PLANS, INC.



1-615-782-7860

1-615-782-7822

[email protected]


Missouri



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Missouri



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Missouri


Blue Cross Blue Shield of Missouri PDP


1-765-526-2515

[email protected]

8990 Duke Drive


Missouri

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.


1-847-555-9399

1-847-559-4733

[email protected]

2211 Sanders Road Suite 100 Northbrook IL 60062

Missouri


1-860-226-6731

[email protected]


Missouri


Coventry Health And Life Ins. Company Local CCP Stephens Debbie

1-804-965-7658


Missouri


1-804-965-7658

[email protected]



Missouri



1-804-965-7658


Missouri

COVENTRY HEALTH CARE OF KANSAS, INC.

Coventry Health Care of Kansas, Inc. Local CCP Stephens Debbie

1-804-965-7658



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Missouri



1-330-405-8080 6320

1-330-405-8081

[email protected]


Missouri ESSENCE INC. Essence Inc. Local CCPdirector of QI and Compliance Keys Mary Kay

1-314-851-3664

[email protected] 12655 Olive 4th Floor saint louis MO 63141

MissouriEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Missouri



1-804-965-7658


MissouriGROUP HEALTH PLAN, INC.

Group Health Plan, Inc. Local CCP Stephens Debbie

1-804-965-7658


Missouri




1-916-463-9603

1-916-463-9750

[email protected]




Missouri




1-615-565-8110

1-615-234-2154

[email protected]


Missouri

HEALTHY ALLIANCE LIFE INSURANCE COMPANY

Blue Cross Blue Shield of Missouri PFFS Client Manager Drummond Michelle

1-714-637-1282

1-714-637-1209

[email protected]



MissouriHUMANA HEALTH PLAN, INC.


1-502-580-3538

[email protected]


Missouri



1-502-580-3538

[email protected]


Missouri



1-502-580-3538

[email protected]


Missouri



1-502-580-3538

[email protected]


Missouri



1-502-580-3538

[email protected]


Missouri




1-201-269-6717

1-201-269-1008

[email protected]


MissouriMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Missouri

MERCY HEALTH PLANS OF MISSOURI INC.

Mercy Health Plans, Inc. Local CCP


1-314-214-2489

1-314-214-8101

[email protected]


Missouri




1-516-605-6966

1-412-322-2066

[email protected]


Missouri




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Missouri




1-401-333-3987 7941

1-800-373-0238

[email protected]


Missouri

PREMIER HEALTH INSURANCE COMPANY, INC.

Premier Health Insurance Company, Inc. Local CCP


1-314-214-2489

1-314-214-8101

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Missouri



1-713-770-1265

1-866-553-0396

[email protected]


Missouri RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Missouri



1-702-877-8377

[email protected]


Missouri


1-866-443-0934

[email protected]


Missouri




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Missouri




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Missouri



1-765-526-2515

[email protected]

8990 Duke Drive


Missouri




1-972-569-3646

1-972-569-3679

[email protected]


Missouri


1-949-252-4339

[email protected]

2300 Main Street


Missouri




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Missouri


1-949-252-4339

[email protected]

2300 Main Street


Missouri

UNITED HEALTHCARE OF THE MIDWEST, INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Missouri



1-813-290-6200 3768

[email protected]


Missouri



1-813-290-6200 3768

[email protected]


Montana



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Montana



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Montana


Blue Cross and Blue Shield of Montana Regional CCP


1-651-662-8758

1-651-662-6009

[email protected]



Montana


Blue Cross and Blue Shield of Montana PDP


1-651-662-8758

1-651-662-6009

[email protected]



Montana


1-860-226-6731

[email protected]


Montana



1-330-405-8080 6320

1-330-405-8081

[email protected]


MontanaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Montana



1-804-965-7658


Montana



1-804-965-7658


MontanaFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


Montana




1-916-463-9603

1-916-463-9750

[email protected]




Montana




1-615-565-8110

1-615-234-2154

[email protected]


Montana



1-502-580-3538

[email protected]


Montana



1-502-580-3538

[email protected]


Montana




1-201-269-6717

1-201-269-1008

[email protected]


MontanaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


MontanaNEW WEST HEALTH SERVICES New West Medicare Local CCP Quality Director Wassell Monica

1-406-457-2210

1-406-457-2255

[email protected]

130 Neill Avenue Helena MT 59601

Montana




1-516-605-6966

1-412-322-2066

[email protected]


Montana




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Montana




1-401-333-3987 7941

1-800-373-0238

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Montana RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Montana


1-866-443-0934

[email protected]


Montana




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Montana




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Montana

STERLING LIFE INSURANCE COMPANY (MT)



1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Montana



1-714-637-1282

1-714-637-1209

[email protected]



Montana



1-765-526-2515

[email protected]

8990 Duke Drive


Montana




1-972-569-3646

1-972-569-3679

[email protected]


Montana


1-949-252-4339

[email protected]

2300 Main Street


Montana


1-949-252-4339

[email protected]

2300 Main Street


Montana



1-813-290-6200 3768

[email protected]


Montana



1-813-290-6200 3768

[email protected]


Nebraska



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Nebraska



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Nebraska


Blue Cross and Blue Shield of Nebraska Regional CCP


1-651-662-8758

1-651-662-6009

[email protected]



Nebraska


Blue Cross and Blue Shield of Nebraska PDP


1-651-662-8758

1-651-662-6009

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Nebraska


1-860-226-6731

[email protected]


Nebraska


1-804-965-7658

[email protected]



Nebraska



1-330-405-8080 6320

1-330-405-8081

[email protected]


NebraskaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Nebraska



1-804-965-7658


Nebraska



1-804-965-7658


NebraskaFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


Nebraska




1-916-463-9603

1-916-463-9750

[email protected]




Nebraska




1-615-565-8110

1-615-234-2154

[email protected]


Nebraska



1-502-580-3538

[email protected]


Nebraska



1-502-580-3538

[email protected]


Nebraska




1-201-269-6717

1-201-269-1008

[email protected]


NebraskaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Nebraska




1-516-605-6966

1-412-322-2066

[email protected]


Nebraska




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Nebraska




1-401-333-3987 7941

1-800-373-0238

[email protected]


Nebraska RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Nebraska


1-866-443-0934

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Nebraska




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Nebraska




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Nebraska



1-714-637-1282

1-714-637-1209

[email protected]



Nebraska



1-765-526-2515

[email protected]

8990 Duke Drive


Nebraska




1-972-569-3646

1-972-569-3679

[email protected]


Nebraska


1-949-252-4339

[email protected]

2300 Main Street


Nebraska


1-949-221-9994

[email protected]

2300 Main Street


Nebraska




1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Nebraska


1-949-252-4339

[email protected]

2300 Main Street


Nebraska

UNITED HEALTHCARE OF THE MIDLANDS, INC. SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Nebraska



1-813-290-6200 3768

[email protected]


Nevada



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Nevada



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Nevada


Blue Cross Blue Shield of Nevada PDP


1-765-526-2515

[email protected]

8990 Duke Drive


Nevada


1-860-226-6731

[email protected]


Nevada


1-804-965-7658

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Nevada



1-804-965-7658


Nevada



1-330-405-8080 6320

1-330-405-8081

[email protected]


NevadaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Nevada



1-804-965-7658


Nevada




1-916-463-9603

1-916-463-9750

[email protected]




NevadaHEALTH PLAN OF NEVADA, INC. Senior Dimensions Local CCP


1-702-877-8377

[email protected]


NevadaHEALTH PLAN OF NEVADA, INC. Senior Dimensions Demo


1-702-877-8377

[email protected]


Nevada




1-615-565-8110

1-615-234-2154

[email protected]


NevadaHOMETOWN HEALTH PLAN Senior Care Plus Local CCP Pharmacist Britt Judy

1-775-982-3089

1-775-982-3748

[email protected]

830 Harvard Way Reno NV 89502

NevadaHOMETOWN HEALTH PLAN Senior Care Plus Local CCP Pharmacist Britt Judy

1-775-982-3089

1-775-982-3748

[email protected]

830 Harvard Way Reno NV 89502

Nevada



1-502-580-3538

[email protected]


Nevada



1-502-580-3538

[email protected]


Nevada




1-201-269-6717

1-201-269-1008

[email protected]


NevadaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Nevada

MOLINA HEALTHCARE OF NEVADA, INC.

Molina Healthcare of Nevada Local CCP

Corporate Director of Pharmacy Services Schatzman Benjamin

1-562-951-1509

[email protected]

One Golden Shore Drive Long Beach CA 90802

Nevada




1-516-605-6966

1-412-322-2066

[email protected]


Nevada




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


NevadaPACIFICARE OF NEVADA, INC



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Nevada




1-401-333-3987 7941

1-800-373-0238

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Nevada RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Nevada

SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.

Sierra Nevada Spectrum Regional CCP

Director, Phrmacy Services Evans, M.D. Steven

1-702-877-8377

[email protected]


Nevada



1-702-877-8377

[email protected]


Nevada



1-702-877-8377

[email protected]


Nevada


1-866-443-0934

[email protected]


Nevada




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Nevada




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Nevada



1-714-637-1282

1-714-637-1209

[email protected]



Nevada



1-765-526-2515

[email protected]

8990 Duke Drive


Nevada




1-972-569-3646

1-972-569-3679

[email protected]


Nevada


1-949-252-4339

[email protected]

2300 Main Street


Nevada


1-949-252-4339

[email protected]

2300 Main Street


Nevada




1-800-546-5677 1110

1-866-632-7946


Nevada



1-813-290-6200 3768

[email protected]


Nevada



1-813-290-6200 3768

[email protected]


New Hampshire



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New Hampshire



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

New Hampshire




1-866-245-5190

1-866-553-0396

[email protected]


New Hampshire




1-765-526-2515

[email protected]

8990 Duke Drive


New Hampshire



1-714-637-1282

1-714-637-1209

[email protected]



New Hampshire


1-860-226-6731

[email protected]


New Hampshire



1-330-405-8080 6320

1-330-405-8081

[email protected]


New HampshireEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


New Hampshire



1-804-965-7658


New Hampshire



1-804-965-7658


New HampshireFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


New HampshireHARVARD PILGRIM HEALTH CARE INC.

HARVARD PILGRIM HEALTH CARE INC. PFFS

Medical Director, Pharmacy Minkoff, MD Neil

1-617-509-0170

1-617-509-6031

[email protected]

1600 Crown Colony Drive Quincy MA 02169

New Hampshire




1-916-463-9603

1-916-463-9750

[email protected]




New Hampshire




1-615-565-8110

1-615-234-2154

[email protected]


New Hampshire



1-502-580-3538

[email protected]


New Hampshire



1-502-580-3538

[email protected]


New Hampshire




1-201-269-6717

1-201-269-1008

[email protected]


New HampshireMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


New Hampshire




1-516-605-6966

1-412-322-2066

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New Hampshire




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


New Hampshire




1-401-333-3987 7941

1-800-373-0238

[email protected]


New Hampshire RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


New Hampshire


1-866-443-0934

[email protected]


New Hampshire




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New Hampshire




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New Hampshire



1-714-637-1282

1-714-637-1209

[email protected]



New Hampshire



1-765-526-2515

[email protected]

8990 Duke Drive


New Hampshire




1-972-569-3646

1-972-569-3679

[email protected]


New Hampshire


1-949-252-4339

[email protected]

2300 Main Street


New Hampshire


1-949-252-4339

[email protected]

2300 Main Street


New Hampshire



1-813-290-6200 3768

[email protected]


New JerseyAETNA HEALTH, INC. Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

New Jersey



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

New Jersey



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

New Jersey



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New Jersey



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

New Jersey




1-866-245-5190

1-866-553-0396

[email protected]


New JerseyAMERICHOICE OF NEW JERSEY, INC

AmeriChoice Personal Care Plus Local CCP

Pharmacy Director Hatch Vanessa

1-703-226-3126

1-703-506-3556

[email protected]

8045 Leesburg Pike Vienna VA 22182

New JerseyAMERIHEALTH HMO, INC. AmeriHealth Rx PDP

Senior Clinical Pharmacist DaCosta Maribel

1-215-241-7928

[email protected]

1901 Market Street 22nd Fl. Philadelphia PA 19103

New JerseyAMERIHEALTH HMO_INC AmeriHealth 65 Local CCP

Manager, Population Health & Wellness Siejak Kimberly

1-215-241-4016

[email protected]

1901 Market Street 29th Fl. Philadelphia TX 19103

New Jersey



1-800-625-9432

1-866-464-0709

[email protected]


New Jersey


1-860-226-6731

[email protected]


New Jersey



1-330-405-8080 6320

1-330-405-8081

[email protected]


New JerseyEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


New Jersey



1-804-965-7658


New Jersey



1-804-965-7658


New Jersey




1-916-463-9603

1-916-463-9750

[email protected]




New Jersey




1-615-565-8110

1-615-234-2154

[email protected]


New Jersey

HORIZON HEALTHCARE OF NEW JERSEY, INC.

Horizon Blue Cross Blue Shield of New Jersey, Inc. Local CCP

Director, Clinical Programs Jan Saira

1-973-466-4575

[email protected]

3 Penn Plaza East - PP 13Q Newark NJ

07105-2200

New Jersey

HORIZON HEALTHCARE SERVICES DBA HORIZON BCBS NJ

Horizon Blue Cross Blue Shield of New Jersey, Inc. PDP

Director, Clinical Programs Jan Saira

1-973-466-4575

[email protected]

Three Penn Plaza East PP-13Q Newark NJ 07105

New Jersey



1-502-580-3538

[email protected]


New Jersey



1-502-580-3538

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New Jersey




1-201-269-6717

1-201-269-1008

[email protected]


New JerseyMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


New Jersey




1-516-605-6966

1-412-322-2066

[email protected]


New JerseyOXFORD HEALTH PLANS (NJ), INC. SecureHorizons Local CCP Addiego Joseph

1-949-221-9994

[email protected]

2300 Main Street


New Jersey

OXFORD HEALTH PLANS OF NEW JERSEY, INC Evercare Local CCP



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

New Jersey




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


New Jersey




1-401-333-3987 7941

1-800-373-0238

[email protected]


New JerseyQMEDCARE OF NEW JERSEY, INC QMedCare Local CCP VP Admin Keller Vivian

1-732-544-5544 1302

1-732-544-5404

[email protected]

25 Christopher Way Eatontown NJ 07724

New Jersey RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


New Jersey



1-702-877-8377

[email protected]


New Jersey


1-866-443-0934

[email protected]


New Jersey




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New Jersey




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New Jersey



1-714-637-1282

1-714-637-1209

[email protected]



New Jersey



1-765-526-2515

[email protected]

8990 Duke Drive


New Jersey




1-972-569-3646

1-972-569-3679

[email protected]


New Jersey


1-949-252-4339

[email protected]

2300 Main Street


New Jersey


United HealthCare Insuance Company Demo



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New Jersey


1-949-252-4339

[email protected]

2300 Main Street


New Jersey



1-813-290-6200 3768

[email protected]


New Mexico



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

New Mexico


1-860-226-6731

[email protected]


New Mexico



1-330-405-8080 6320

1-330-405-8081

[email protected]


New MexicoEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


New Mexico



1-804-965-7658


New Mexico



1-804-965-7658


New Mexico


HISC - Blue Cross Blue Shield of New Mexico Local CCP

Pharmacy Director, Government Programs Nguyen Marie

1-651-286-4206

1-651-283-4403

[email protected]

Prime Therapeutics

1020 Discovery Road, No.100 Egan MN 55121

New Mexico


HISC - Blue Cross Blue Shield of New Mexico PDP


1-651-286-4206

1-651-286-4403

[email protected]



New Mexico




1-916-463-9603

1-916-463-9750

[email protected]




New Mexico




1-615-565-8110

1-615-234-2154

[email protected]


New Mexico



1-502-580-3538

[email protected]


New Mexico



1-502-580-3538

[email protected]


New MexicoLOVELACE HEALTH SYSTEM, INC. Lovelace Senior Plan Local CCP

Director Pharmacy Services Murvin Thomas

1-505-232-1804

[email protected]

4101 Indian School Rd, NE Albuquerque NM 87110

New Mexico

LOVELACE INSURANCE COMPANY

Lovelace Insurance Company Local CCP

Director: Pharmacy Services Murvin Thomas E

1-505-232-1804

1-505-262-7390

[email protected]

4101 Indian School R. NE Suite 110S Albuquerque NM 87111

New Mexico




1-201-269-6717

1-201-269-1008

[email protected]


New MexicoMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New Mexico




1-516-605-6966

1-412-322-2066

[email protected]


New Mexico




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


New Mexico




1-401-333-3987 7941

1-800-373-0238

[email protected]


New MexicoPRESBYTERIAN HEALTH PLAN

Presbyterian Senior Care Local CCP

Pharmacy Director Georgopoulos Larry

1-505-923-5530

1-505-923-5540

[email protected] P.O. Box 27489 Albuquerque NM

87125-7489

New Mexico

PRESBYTERIAN INSURANCE COMPANY, INC.

Presbyterian MediCare PPO Local CCP


1-505-923-5530

1-505-923-5201

[email protected] P.O. Box 26267 Albuquerque NM

87125-6267

New Mexico

PRESBYTERIAN INSURANCE COMPANY, INC.

Presbyterian Prescription Drug Plan PDP


1-505-923-5530

1-505-923-5540

[email protected] P.O. Box 26267 New Mexico NM

87125-6267

New Mexico RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


New Mexico



1-702-877-8377

[email protected]


New Mexico


1-866-443-0934

[email protected]


New Mexico




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New Mexico




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New Mexico



1-714-637-1282

1-714-637-1209

[email protected]



New Mexico



1-765-526-2515

[email protected]

8990 Duke Drive


New Mexico




1-972-569-3646

1-972-569-3679

[email protected]


New Mexico


1-949-252-4339

[email protected]

2300 Main Street


New Mexico


1-949-221-9994

[email protected]

2300 Main Street


New Mexico


1-949-221-9994



New Mexico





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New Mexico


1-949-252-4339

[email protected]

2300 Main Street


New Mexico



1-813-290-6200 3768

[email protected]


New Mexico



1-813-290-6200 3768

[email protected]


New York AETNA HEALTH INC. Aetna Medicare Local CCP


1-386-963-2543

1-386-963-2544

[email protected]


32094-2362

New York



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

New York



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

New York



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

New YorkAFFINITY HEALTH PLAN, INC. Affinity Health Plan Local CCP

Clinical Pharmacist Anzisi Lisa

1-718-794-7173

1-718-536-3383

[email protected]

2500 Halsey Street Bronx NY 10461

New York

AMERICAN PROGRESSIVE LIFE AND HEALTH INS CO NY

American Progressive Life & Health Ins Co of NY PDP


1-401-333-3987 7941

1-800-373-0238

[email protected]


New York




1-866-245-5190

1-866-553-0396

[email protected]


New YorkAMERICHOICE OF NEW YORK, INC

AmeriChoice Personal Care Plus Local CCP

Director Pharmacy Management Hatch Vanessa

1-703-226-3126

[email protected]

8045 Leesburg Pike Vienna VA 22182

New York



1-800-625-9432

1-866-464-0709

[email protected]


New York

CAMBRIDGE LIFE INSURANCE COMPANY Advantra® Freedom PFFS Stephens Debbie

1-804-965-7658

[email protected]



New York

CAMBRIDGE LIFE INSURANCE COMPANY Coventry AdvantraRx PDP

Director. Quality Improvement Stephens Debbie

1-804-965-7658


New York

CAMBRIDGE LIFE INSURANCE COMPANY First Health Part D PDP


1-804-965-7658


New York

CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.

CDPHP Medicare Choice Local CCP

Academic Intervention Pharmacist Winn Sue

1-518-641-3225

1-518-641-3208

[email protected]

500 Patroon Creek Blvd Albany NY 12206


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New YorkCDPHP UNIVERSAL BENEFITS, INC.

CDPHP Medicare RxCare PDP

Academic Intervention Pharmacist Winn Sue

1-518-641-3225

1-518-641-3208

[email protected]

500 Patroon Creek Blvd Albany NY 12206

New York

COMPREHENSIVE CARE MANAGEMENT CORP.

Comprehensive Care Management Corp. Local CCP M.D. Eisenberg Edward

1-201-269-6717

1-201-269-1008

[email protected]

100 Parsons Pond Drive Franklin Lakes NJ 07417

New York


1-860-226-6731

[email protected]


New York ELDERPLAN, INC. Elderplan, Inc. Local CCPAVP Medical Management Montella Lynda

1-718-921-8409

1-718-921-8813

[email protected]

6323 Seventh Avenue Brooklyn NY 11220

New YorkELDERPLAN, INC. - SHMO Elderplan, Inc. Demo

AVP Medical Management Montella Lynda

1-718-921-8409

1-718-921-8813

[email protected]

6323 Seventh Avenue Brooklyn NY 11220

New York

EMPIRE HEALTHCHOICE ASSURANCE, INC.

Empire BlueCross BlueShield Local CCP


1-847-559-3999

1-847-559-4733

[email protected]


New York

EMPIRE HEALTHCHOICE ASSURANCE, INC.

Empire BlueCross BlueShield PFFS Hettich Lisa

1-765-526-2515

[email protected]

8407 Fallbrook Avenue West Hills CA 91304

New York

EMPIRE HEALTHCHOICE HMO, INC.

Empire BlueCross BlueShield HMO Local CCP


1-847-559-3999

1-847-559-4733

[email protected]


New York



1-330-405-8080 6320

1-330-405-8081

[email protected]


New YorkEXCELLUS HEALTH PLAN, INC Simply Prescriptions PDP

Director, FLRx Clinical Operations Rocco Darlene

1-585-327-7544

[email protected] 165 Court Street Rochester NY 14647

New YorkEXCELLUS HEALTH PLAN, INC.

Excellus Health Plan, Inc. Local CCP


1-585-327-7544



Excellus Health Plan, Inc. Local CCP


1-585-327-7544



Excellus Health Plan, Inc. 1876 Cost


1-585-327-7544


New YorkEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


New York

FIRST UNITED AMERICAN LIFE INSURANCE COMPANY

First United American Life Insurance Company PDP


1-972-569-3646

1-972-569-3679

[email protected]


New York

GHI (GROUP HEALTH INCORPORATED)

GHI Medicare Prescription Drug Plan PDP Manager Sebastian Tobin

1-212-615-4567

1-212-563-8500

[email protected]

441 Ninth Avenue New York NY 10001

New YorkGROUP HEALTH INCORPORATED

GHI Medicare Choice PPO Local CCP Manager Sebastian Tobin

1-212-615-4567

[email protected] 441 Ninth Ave New York NY 10001

New York




1-916-463-9603

1-916-463-9750

[email protected]




New YorkHEALTHNOW NEW YORK INC Senior Blue Local CCP

Director Clinical Pharmacy Services Baker Philip

1-716-887-8765

[email protected]

257 West Genesee Street Buffalo NY 14202

New YorkHEALTHNOW NEW YORK INC.

HealthNow New York Inc. PDP


1-716-887-8765

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New YorkHEALTHNOW NEW YORK INC.

Traditional Blue Medicare PPO Local CCP


1-716-887-8765

[email protected]


New York




1-615-565-8110

1-615-234-2154

[email protected]


New YorkHIP HEALTH PLAN OF NEW YORK

HIP Insurance Company of New York PDP Director Aral Jasmine

1-646-447-7186

[email protected] 55 Water Street New York NY 10041

New YorkHIP OF GREATER NEW YORK

HIP Health Plan of Greater New York Local CCP Aral Jasmine

1-646-447-7186

[email protected] 55 Water Street New York NY 11401

New York

HUMANA INSURANCE COMPANY OF NEW YORK

Humana Insurance Company of New York PFFS Ewing Joy

1-502-580-3538

[email protected]


New York

HUMANA INSURANCE COMPANY OF NEW YORK

Humana Insurance Company of New York PDP Ewing Joy

1-502-580-3538

[email protected]


New York

INDEPENDENT HEALTH ASSOCIATION, INC. Independent Health Local CCP

Utilization Management Pharmacist Verrall Kelly

1-716-635-4885

1-716-631-0149

[email protected]

511 Faber Lakes Drive Buffalo NY 14221

New York

INDEPENDENT HEALTH BENEFITS CORP Independent Health Local CCP


1-716-635-4885

1-716-631-0149

[email protected]

511 Farber Lakes Drive Buffalo NY 14221

New York

INDEPENDENT HEALTH BENEFITS CORPORATION Independent Health PFFS


1-716-635-4885

1-716-631-0149

[email protected]

511 Farber Lakes Drive Buffalo NY 14221

New YorkLIBERTY HEALTH ADVANTAGE, INC.

Liberty Health Advantage Local CCP

Vice President Clinical Programs Schoening Shellie

1-800-546-5677 1110

1-866-632-7946

[email protected] PO Box 407 Boystown NE 68010

New YorkMANAGED HEALTH, INC.

Healthfirst Medicare Plan Local CCP

VP, Regulatory Affairs Helzner Christine

1-646-313-8967

1-646-313-4644

[email protected]

25 Broadway, 9th Floor New York NY 10004

New York

MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK Medco YOURx PLAN PDP



1-201-269-6717

1-201-269-1008

[email protected]


New YorkMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


New YorkMVP HEALTH PLAN, INC, MVP Gold Local CCP

Pharmacy Director Colin Wendy

1-585-327-2577

1-585-258-8621

[email protected] 259 Monroe Ave Rochester NY 14607

New York

NEIGHBORHOOD HEALTH PROVIDERS LLC

Neighborhood Health Providers Local CCP

Vice President, Care Management Campbell Deborah S

1-704-329-7065 4402

1-704-329-0211

[email protected]

4944 Pkwy. Plaza Blvd. Suite 110 Charlotte NC 28217

New York

NEW YORK STATE CATHOLIC HLTH PLAN INC Fidelis Local CCP CMO Michelson Marco

1-718-896-6500 1036

[email protected]

9525 Queens Blvd. Rego Park NY 11374

New York




1-516-605-6966

1-412-322-2066

[email protected]


New YorkOXFORD HEALTH PLANS (NY) INC. SecureHorizons Local CCP Addiego Joseph

1-949-221-9994

[email protected]

2300 Main Street


New York

ROCHESTER AREA HEALTH MAINTENANCE ORG.

Preferred Care GoldAnywhere Local CCP

Pharmacy Coordinator Colin Wendy

1-585-327-2577

[email protected]

259 Monroe Ave. Rochester NY 14607


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New York

ROCHESTER AREA HMO/ DBA PREFERRED CARE Preferred Care Gold Local CCP

Clinical Pharmacy Coordinator Colin Wendy

1-585-327-2577

[email protected]

259 Monroe Ave. Rochester NY 14607

New York RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


New YorkSENIOR WHOLE HEALTH, LLC

Senior Whole Health of New York Local CCP


1-617-494-5353 6324

1-617-494-5599

[email protected]

58 Charles Street, 2nd Floor Cambridge MA 02141

New York


1-866-443-0934

[email protected]


New York




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New York




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

New YorkTOUCHSTONE HEALTH HMO, INC. Health Net Of NY Local CCP VP, Pharmacy Mednick Darlene

1-212-294-1653

1-212-294-8210

[email protected] 14 Wall Street New York NY 10005

New YorkTOUCHSTONE HEALTH HMO, INC. Touchstone Health Local CCP VP of Pharmacy Mednick Darlene

1-212-294-1653

1-212-294-8210

[email protected] 14 Wall Street New York NY 10005

New York



1-714-637-1282

1-714-637-1209

[email protected]



New York



1-765-526-2515

[email protected]

8990 Duke Drive


New York


1-949-252-4339

[email protected]

2300 Main Street


New York

UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK SecureHorizons PFFS Addiego Joseph

1-949-221-9994

[email protected]

2300 Main Street


New York

UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK SecureHorizons Regional CCP Addiego Joseph

1-949-221-9994



New York

UNITED HEALTHCARE INSURANCE COMPANY OF NEW YORK UnitedHealthcare PDP Bowen Jo

1-949-252-4339

[email protected]

2300 Main Street


New York

UNITED HEALTHCARE OF NEW YORK, INC. SecureHorizons Local CCP Addiego Joseph

1-949-221-9994

[email protected]

2300 Main Street


New York VNS CHOICE VNS CHOICE Select Local CCP Brown Nancy1-401-333-3987 7941

1-401-335-7941

[email protected]

PharmaCare Management Services, Inc.


New York

WELLCARE HEALTH INSURANCE OF NEW YORK, INC. WellCare PFFS

Director Medication Therapy Management Delancey Lisa

1-813-290-6200 3768

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

New York



1-813-290-6200 3768

[email protected]


New YorkWELLCARE_OF NEW YORK, INC. WellCare Local CCP


1-813-290-6200 3917


33622-5858

North Carolina



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

North Carolina



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

North Carolina

BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA

Blue Cross Blue Shield of North Carolina PDP

Director, Health Services Miller Debra

1-336-201-4310

[email protected]

Blue Cross and Blue Shield of North Carolina

P.O. Box 17509 Winston-Salem NC

27116-7509

North Carolina


1-860-226-6731

[email protected]


North Carolina


1-804-965-7658

[email protected]



North Carolina



1-804-965-7658


North Carolina



1-330-405-8080 6320

1-330-405-8081

[email protected]


North CarolinaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


North Carolina

FIDELIS SECURECARE OF NORTH CAROLINA

Fidelis SecureCare of North Carolina Local CCP Medical Director Herman Chris

1-877-372-8080

1-877-372-8081

[email protected]

11301 Carmel Commons Boulevard Suite 215 Charlotte NC 28226

North Carolina



1-804-965-7658


North Carolina




1-916-463-9603

1-916-463-9750

[email protected]




North Carolina




1-615-565-8110

1-615-234-2154

[email protected]


North Carolina



1-502-580-3538

[email protected]


North Carolina



1-502-580-3538

[email protected]


North Carolina



1-502-580-3538

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

North Carolina



1-502-580-3538

[email protected]


North Carolina




1-201-269-6717

1-201-269-1008

[email protected]


North CarolinaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


North Carolina




1-516-605-6966

1-412-322-2066

[email protected]


North Carolina




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


North Carolina

PARTNERS NATIONAL HEALTH PLANS OF NC INC

PARTNERS Medicare Options Local CCP

Director Health Services Miller Debra

1-336-201-4310

[email protected]

5660 University Parkway Winston-Salem NC 27105

North Carolina

PARTNERS NATIONAL HEALTH PLANS OF NC, INC.

PARTNERS Medicare Choice Local CCP

Director Health Services Miller Debra

1-336-201-4310

[email protected]

5660 University Parkway Winston-Salem NC 27105

North Carolina




1-401-333-3987 7941

1-800-373-0238

[email protected]


North Carolina



1-713-770-1265

1-866-553-0396

[email protected]


North Carolina RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


North Carolina


1-866-443-0934

[email protected]


North Carolina




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

North Carolina




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

North Carolina



1-714-637-1282

1-714-637-1209

[email protected]



North Carolina



1-765-526-2515

[email protected]

8990 Duke Drive


North Carolina




1-972-569-3646

1-972-569-3679

[email protected]


North Carolina


1-949-252-4339

[email protected]

2300 Main Street


North Carolina




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

North Carolina


1-949-221-9994

[email protected]

2300 Main Street


North Carolina


1-949-252-4339

[email protected]

2300 Main Street


North Carolina

UNITED HEALTHCARE OF NORTH CAROLINA SecureHorizons Local CCP



1-949-221-9994

1-949-747-4237

[email protected]

2300 Main Street


North Carolina



1-813-290-6200 3768

[email protected]


North Carolina



1-813-290-6200 3768

[email protected]


North Dakota



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

North Dakota



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

North Dakota


Blue Cross Blue Shield of North Dakota Regional CCP


1-651-662-8758

1-651-662-6009

[email protected]



North Dakota


Blue Cross Blue Shield of North Dakota PDP


1-651-662-8758

1-651-662-6009

[email protected]



North Dakota


1-860-226-6731

[email protected]


North Dakota


1-804-965-7658

[email protected]



North Dakota



1-330-405-8080 6320

1-330-405-8081

[email protected]


North DakotaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


North Dakota



1-804-965-7658


North Dakota



1-804-965-7658


North DakotaFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

North Dakota




1-916-463-9603

1-916-463-9750

[email protected]




North Dakota




1-615-565-8110

1-615-234-2154

[email protected]


North Dakota



1-502-580-3538

[email protected]


North Dakota



1-502-580-3538

[email protected]


North Dakota




1-201-269-6717

1-201-269-1008

[email protected]


North DakotaMEDICA HEALTH PLANS Medica Health Plans PFFS Weiss Justin

1-952-992-2469

[email protected]


North Dakota



1-952-992-2469

[email protected]


North DakotaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


North Dakota




1-516-605-6966

1-412-322-2066

[email protected]


North Dakota




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


North Dakota




1-401-333-3987 7941

1-800-373-0238

[email protected]


North Dakota RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


North Dakota


1-866-443-0934

[email protected]


North Dakota




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

North Dakota




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

North Dakota



1-714-637-1282

1-714-637-1209

[email protected]



North Dakota



1-765-526-2515

[email protected]

8990 Duke Drive


North Dakota




1-972-569-3646

1-972-569-3679

[email protected]


North Dakota


1-949-252-4339

[email protected]

2300 Main Street



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

North Dakota


1-949-252-4339

[email protected]

2300 Main Street


North Dakota



1-813-290-6200 3768

[email protected]


Northern Mariana Islands


1-949-252-4339

[email protected]

2300 Main Street


OhioAETNA HEALTH OF (OHIO) Aetna Medicare Local CCP

Director, Medicare clinical Pharmacy Programs Stern Jody L

1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Ohio



1-386-963-2543

1-860-754-1481

[email protected]


21094-2362

Ohio



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Ohio



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Ohio



1-714-637-1282

1-714-637-1209

[email protected]



Ohio




1-765-526-2515

[email protected]

8990 Duke Drive


Ohio



1-800-625-9432

1-866-464-0709

[email protected]


Ohio

COMMUNITY INSURANCE COMPANY


1-714-637-1282

1-714-637-1209

[email protected]



Ohio

COMMUNITY INSURANCE COMPANY


1-714-637-1282

1-714-637-1209

[email protected]



Ohio


1-860-226-6731

[email protected]


Ohio


Carelink Advantra PPO Local CCP Stephens Debbie

1-804-965-7658

[email protected]



Ohio


1-804-965-7658

[email protected]



Ohio



1-804-965-7658



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Ohio



1-330-405-8080 6320

1-330-405-8081

[email protected]


OhioEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Ohio



1-804-965-7658


OhioGATEWAY HEALTH PLAN OF OHIO, INC.

Gateway Health Plan Medicare Assured Local CCP

Clinical Pharmacist Scalise Lorraine

1-412-255-1349

1-888-245-2049

[email protected]

600 Grant Street, 41st Floor Pittsburgh PA 15219

Ohio




1-916-463-9603

1-916-463-9750

[email protected]




Ohio

HEALTH PLAN OF THE UPPER OHIO VALLEY The Health Plan Local CCP

Director pharmacy services neal steve

1-740-695-7638

1-740-695-7925

[email protected] The Health Plan

52160 National Road East St. Clairsville OH 43950

Ohio




1-615-565-8110

1-615-234-2154

[email protected]


OhioHOMETOWN HEALTH PLAN The Health Plan Local CCP


1-740-695-7686

1-740-695-8103



Ohio



1-502-580-3538

[email protected]


Ohio



1-502-580-3538

[email protected]


Ohio



1-502-580-3538

[email protected]


Ohio



1-502-580-3538

[email protected]


Ohio

KAISER FOUNDATION HP OF OHIO

Kaiser Foundation Health Plan of Ohio 1876 Cost

Clinical Pharmacy Specialist Dzurec Maryann

1-216-265-4407

1-216-265-4415

[email protected] 12301 Snow Rd.

Clinical Pharmacy Services Parma OH 44130

Ohio

MCKINLEY LIFE INSURANCE COMPANY

PrimeTime Health Plan Local CCP

Clinical Pharmacist Kmiecik Karen

1-330-363-2250

[email protected]

2600 Sixth Street SW Canton OH 44710

Ohio


PrimeTime Health Plan Local CCP


1-330-363-2250

[email protected]


Ohio


PrimeTime Health Plan PFFS


1-330-363-2250

[email protected]


Ohio




1-201-269-6717

1-201-269-1008

[email protected]


OhioMEDICAL MUTUAL OF OHIO

Advantage Plans from Medical Mutual of Ohio Local CCP

Mgr. Pharmaceutical Benefits Hendricks Chad

1-216-687-2882

[email protected]

2060 East Ninth Street Cleveland OH 44115

OhioMEDICAL MUTUAL OF OHIO

Advantage Plans from Medical Mutual of Ohio PDP

Mgr. Pharmaceutical Benefits Hendricks Chad

1-216-687-2882

[email protected]

2060 East Ninth Street Cleveland OH 44115

OhioMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

OhioMT. CARMEL HEALTH PLAN, INC. MediGold Local CCP

Director, Clinical Operations Moyna Audrey

1-847-559-3999

1-847-559-4733

[email protected]


Ohio




1-516-605-6966

1-412-322-2066

[email protected]


Ohio




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


OhioPARAMOUNT CARE, INC Paramount Elite Local CCP

Coordinator, Prescription Drug PRogram Bogner Craig M

1-419-887-2249

1-419-887-2015

[email protected]


Ohio

PARAMOUNT INSURANCE COMPANY

Paramount Prescription Drug Plan PDP Bogner Craig

1-419-887-2249

1-419-887-2015

[email protected]


Ohio




1-401-333-3987 7941

1-800-373-0238

[email protected]


Ohio



1-713-770-1265

1-866-553-0396

[email protected]


Ohio RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Ohio



1-702-877-8377

[email protected]


Ohio


1-866-443-0934

[email protected]


Ohio




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Ohio




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Ohio SUMMACARE INC. SummaCare Local CCPPharmacy Director Colligan Tim

1-800-996-8411

1-330-996-8580

[email protected] P.O. Box 3620 Akron OH

44309-3620

Ohio



1-714-637-1282

1-714-637-1209

[email protected]



Ohio



1-765-526-2515

[email protected]

8990 Duke Drive


Ohio




1-972-569-3646

1-972-569-3679

[email protected]


Ohio


1-949-252-4339

[email protected]

2300 Main Street


Ohio



Vice President, Chief Medical Officer Addiego Joseph E

1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Ohio


1-949-252-4339

[email protected]

2300 Main Street


Ohio

UNITED HEALTHCARE OF OHIO, INC. SecureHorizons Local CCP


Addiego, Jr. M.D. Joseph E

1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

OhioUPMC HEALTH BENEFITS, INC UPMC Health Plan PDP

Manager, Medicare Operations Cain John O

1-412-454-5539

1-412-454-5539

[email protected]

112 Washington Place Pittsburgh PA 15219

Ohio



1-813-290-6200 3768

[email protected]


Ohio



1-813-290-6200 3768

[email protected]


Oklahoma AETNA HEALTH INC. Aetna Medicare Local CCP

Director, Medicare Clinical Pharmacy Programs Stern Jody l

1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Oklahoma



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Oklahoma



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

OklahomaARKANSAS COMMUNITY CARE



1-909-971-6816

1-909-971-6866

[email protected]


OklahomaCOMMUNITY CARE HMO, INC

CommunityCare Senior Health Plan Local CCP QI Analyst Beyersdorf Lee Ann

1-918-594-5295 4053

1-918-877-9729

[email protected]

218 W. 6th Street Tulsa OK 74119

Oklahoma


1-860-226-6731

[email protected]


Oklahoma


1-804-965-7658

[email protected]



Oklahoma



1-804-965-7658


Oklahoma



1-330-405-8080 6320

1-330-405-8081

[email protected]


OklahomaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Oklahoma



1-804-965-7658



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

OklahomaGLOBALHEALTH, INC.

Generations Healthcare Local CCP



1-713-770-1265

1-866-553-0396

[email protected]


Oklahoma


Blue Cross And Blue Shield Of Oklahoma Local CCP

Clinical Pharmacy Manager Hettich Lisa

1-765-526-2515 6346

1-765-391-1023

[email protected]

8407 Fallbrook Ave West Hills CA 91304

Oklahoma


BLUE CROSS AND BLUE SHIELD OF OKLAHOMA PDP


1-651-286-4403

[email protected]

Prime Therapeutics


Oklahoma




1-916-463-9603

1-916-463-9750

[email protected]




Oklahoma




1-615-565-8110

1-615-234-2154

[email protected]


Oklahoma



1-502-580-3538

[email protected]


Oklahoma



1-502-580-3538

[email protected]


Oklahoma



1-502-580-3538

[email protected]


Oklahoma




1-201-269-6717

1-201-269-1008

[email protected]


OklahomaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Oklahoma




1-516-605-6966

1-412-322-2066

[email protected]


Oklahoma




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


OklahomaPACIFICARE OF OKLAHOMA, INC.



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Oklahoma




1-401-333-3987 7941

1-800-373-0238

[email protected]


Oklahoma



1-713-770-1265

1-866-553-0396

[email protected]


Oklahoma RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


OklahomaSELECTCARE OF OKLAHOMA, INC.

SelectCare of Oklahoma Local CCP



1-713-770-1265

1-866-553-0396

[email protected]


Oklahoma



1-702-877-8377

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Oklahoma


1-866-443-0934

[email protected]


Oklahoma




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Oklahoma




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Oklahoma



1-714-637-1282

1-714-637-1209

[email protected]



Oklahoma



1-765-526-2515

[email protected]

8990 Duke Drive


Oklahoma




1-972-569-3646

1-972-569-3679

[email protected]


Oklahoma


1-949-252-4339

[email protected]

2300 Main Street


Oklahoma


1-949-252-4339

[email protected]

2300 Main Street


Oklahoma



1-813-290-6200 3768

[email protected]


Oregon



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Oregon



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Oregon

ASURIS NORTHWEST HEALTH

Asuris Northwest Health PDP


1-208-395-7732

1-208-395-7744

[email protected]

1211 West Myrtle


OregonATRIO HEALTH PLANS ATRIO MyAdvantage Local CCP

Director of Compliance and Quality Management

Hergenrader, RN Diana D

1-541-672-8620 5383

1-541-672-8670

[email protected]

500 SE Cass Ave. Suite 230 Roseburg OR 97470

Oregon

CLEAR CHOICE HEALTH PLANS, INC.

Clear Choice Health Plans Local CCP Olsen Colleen

1-541-385-5315 4980

1-541-382-4225

[email protected]

2650 NE Courtney Dr. Bend OR 97701

Oregon


1-860-226-6731

[email protected]


Oregon



1-330-405-8080 6320

1-330-405-8081

[email protected]


OregonEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Oregon

FAMILYCARE HEALTH PLANS, INC.

FamilyCare Health Plans, Inc. Local CCP

Director of Pharmacy Operations Thanem Michael

1-503-471-2147

1-503-471-2197

[email protected]

2121 SW Broadway Suite 300 Portland OR 97201

Oregon



1-804-965-7658


Oregon



1-804-965-7658


OregonFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


Oregon




1-916-463-9603

1-916-463-9750

[email protected]




Oregon


Health Net Medicare Advantage Local CCP

Vice President, Operations - HNPS


1-916-463-9603

[email protected]


Mail Top: CA-175-02-02


OregonHEALTH PLAN OF CAREOREGON, INC.

CareOregon Advantage Local CCP

Clinical Pharmacy Program Coordinator Benkstein Kristen

1-503-416-1734

1-503-416-1428

[email protected]

CareOregon Advantage

315 SW Fifth Avenue, Suite 900 Portland OR 97204

Oregon




1-615-565-8110

1-615-234-2154

[email protected]


Oregon



1-502-580-3538

[email protected]


Oregon



1-502-580-3538

[email protected]


Oregon

KAISER FOUNDATION HP OF THE N W

Kaiser Foundation Health Plan of the NW Local CCP

Pharmacy Benefit Manager Logan Steve

1-503-261-7980

[email protected]

5725 NE 138th Ave Portland OR 97230

Oregon


Kaiser Foundation Health Plan of the NW Demo


1-503-261-7980

[email protected]


Oregon

MARION POLK COMMUNITY HEALTH PLAN ADVANTAGE, INC.

Marion Polk Community Health Plan Advantage Local CCP

Medical Management Coordinator Morgan Roberta

1-503-371-7701 145

1-503-371-8046

[email protected]

245 Commercial St. SE, Ste. 220 Salem OR 97301

Oregon




1-201-269-6717

1-201-269-1008

[email protected]


OregonMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Oregon

MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION CareSource Local CCP

Director of Medical Affairs Ackerman Cynthia

1-541-471-4106

1-541-471-1524

[email protected]

740 SE 7th Street Grants Pass OR 97526

Oregon




1-516-605-6966

1-412-322-2066

[email protected]


OregonODS HEALTH PLAN, INC. ODS Advantage Local CCP

Vice President Medical Services Richardson Robin

1-503-243-4491

1-503-948-5557

[email protected]

601 SW Second Ave Portland OR 97204


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

OregonODS HEALTH PLAN, INC. ODS Advantage Rx PDP


1-503-243-4491

1-503-948-5557

[email protected]


Oregon




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


OregonPACIFICARE OF OREGON, INC.



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Oregon




1-401-333-3987 7941

1-800-373-0238

[email protected]


OregonPROVIDENCE HEALTH PLAN

Providence Health Plan Local CCP

PHARMACY DIRECTOR NOONAN HELEN M

1-503-574-5708

1-503-574-8646

[email protected] PO BOX 3125 PORTLAND OR

97208-3125

Oregon



1-713-770-1265

1-866-553-0396

[email protected]


Oregon

REGENCE BLUECROSS BLUESHIELD OF OR

Regence BlueCross BlueShield of Oregon Local CCP


1-208-395-7732

1-208-395-7744

[email protected]



Oregon RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Oregon

SAMARITAN HEALTH PLANS, INC.

Samaritan Advantage Health Plan Local CCP

Pharmacy Coordinator Tracer Tamatha

1-541-768-5207

1-541-768-4294

[email protected] PO Box M Corvallis OR 97339

Oregon



1-702-877-8377

[email protected]


Oregon


1-866-443-0934

[email protected]


Oregon




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Oregon




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Oregon

TRILLIUM COMMUNITY HEALTH PLAN Trillium Advantage Local CCP

Clinical Pharmacist Wick Shauna

1-541-485-2155

[email protected]

1800 Millrace Drive Eugene OR 97403

Oregon



1-714-637-1282

1-714-637-1209

[email protected]



Oregon



1-765-526-2515

[email protected]

8990 Duke Drive


Oregon




1-972-569-3646

1-972-569-3679

[email protected]


Oregon


1-949-252-4339

[email protected]

2300 Main Street



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Oregon




1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Oregon


1-949-221-9994

[email protected]

2300 Main Street


Oregon


1-949-221-9994

[email protected]

2300 Main Street


Oregon


1-949-252-4339

[email protected]

2300 Main Street


Oregon



1-813-290-6200 3768

[email protected]


Oregon



1-813-290-6200 3768

[email protected]


Pennsylvania AETNA HEALTH INC Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Pennsylvania



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Pennsylvania



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Pennsylvania



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Pennsylvania




1-866-245-5190

1-866-553-0396

[email protected]


PennsylvaniaAMERIHEALTH HMO_INC AmeriHealth 65 Local CCP


1-215-241-4016

[email protected]

1901 Market Street 29th Fl. Philadelphia PA 19103

Pennsylvania

AVALON INSURANCE COMPANY

Avalon Insurance Company PDP

Pharmacy Manager Frost Lisa

1-717-703-8466

[email protected]

2500 Elmerton Avenue Harrisburg PA 17177

Pennsylvania



1-800-625-9432

1-866-464-0709

[email protected]


PennsylvaniaBRAVO HEALTH PENNSYLVANIA INC. Bravo by Elder Health Local CCP


1-800-625-9432

1-866-464-0709

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Pennsylvania

CAPITAL ADVANTAGE INSURANCE COMPANY

Capital Advantage Insurance Company Local CCP


1-717-703-8466

[email protected]


Pennsylvania


1-860-226-6731

[email protected]


Pennsylvania


1-804-965-7658

[email protected]



Pennsylvania



1-804-965-7658


Pennsylvania



1-330-405-8080 6320

1-330-405-8081

[email protected]


PennsylvaniaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Pennsylvania



1-804-965-7658


PennsylvaniaGATEWAY HEALTH PLAN, INC.

Gateway Health Plan Medicare Assured Local CCP

Clinical Pharmacist Scalise Lorraine

1-412-255-1349

1-888-245-2049

[email protected]

600 Grant Street - 41st Floor Pittsburgh PA

15219-2704

PennsylvaniaGEISINGER HEALTH PLAN

Geisinger Health Plan Gold Local CCP

Clinical Pharmacist Collins Vanessa

1-570-214-9606

1-570-214-6768

[email protected]

100 N. Academy Ave. Danville PA

17822-3245

Pennsylvania

GEISINGER INDEMNITY INSURANCE COMPANY

Geisinger Health Plan Gold Choice PFFS


1-570-214-9606

1-570-214-6768

[email protected]

100 North Academy Avenue Danville PA

17822-3245

Pennsylvania


Geisinger Health Plan Gold Preferred Local CCP

Clinical Pharmacist Collins Vanessa L

1-570-214-9606

1-570-214-6768

[email protected]


17822-3245

Pennsylvania


Geisinger Health Plan Gold Rx PDP


1-570-214-9606

1-570-271-5268

[email protected]


17822-3245

Pennsylvania

HEALTH ASSURANCE PENNSYLVANIA, INC. Advantra PPO Local CCP Stephens Debbie

1-804-965-7658

[email protected]



Pennsylvania




1-916-463-9603

1-916-463-9750

[email protected]




Pennsylvania

HEALTHAMERICA PENNSYLVANIA, INC.

HealthAmerica Advantra Local CCP Stephens Debbie

1-804-965-7658

[email protected]



Pennsylvania




1-615-565-8110

1-615-234-2154

[email protected]


PennsylvaniaHIGHMARK SENIOR RESOURCES INC.

Highmark Senior Resources Inc. PDP

Manager, Clinical Pharmacy Services Culley Eric

1-412-544-4005

1-412-544-4092

[email protected]

120 Fifth Avenue Ste. 1812 Pittsburgh PA 15222


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Pennsylvania HIGHMARK, INC. Highmark Inc. Local CCPManager- Clincal Services Culley Eric

1-412-544-4005

1-412-544-7546

[email protected]

120 Fifth Avenue Place Suite 1812 Pittsburgh PA

15222-3099

Pennsylvania



1-502-580-3538

[email protected]


Pennsylvania



1-502-580-3538

[email protected]


Pennsylvania



1-502-580-3538

[email protected]


PennsylvaniaINDEPENDENCE BLUE CROSS Personal Choice 65 Local CCP


1-215-241-4016

[email protected]


PennsylvaniaKEYSTONE HEALTH PLAN CENTRAL,INC.

Keystone Health Plan Central, Inc. Local CCP Frost Lisa

1-717-703-8466

[email protected]


PennsylvaniaKEYSTONE HEALTH PLAN EAST, INC. Keystone 65 Local CCP


1-215-241-4016

[email protected]


PennsylvaniaKEYSTONE HEALTH PLAN WEST, INC.

Keystone Health Plan West, Inc. Local CCP

Manager - Clinical Services Culley Eric

1-412-544-4005

1-412-544-7546

[email protected]


15222-3099

Pennsylvania




1-201-269-6717

1-201-269-1008

[email protected]


PennsylvaniaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Pennsylvania




1-516-605-6966

1-412-322-2066

[email protected]


Pennsylvania




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Pennsylvania




1-401-333-3987 7941

1-800-373-0238

[email protected]


Pennsylvania

QCC INS CO D/B/A AMERIHEALTH INS CO

AmeriHealth Advantage PDP


1-215-937-5352

[email protected]


Pennsylvania

QCC INS CO D/B/A AMERIHEALTH INS CO AmeriHealth Rx PDP


1-215-241-7928

[email protected]

1901 Market Street 22nd Floor Philadelphia PA 19103

Pennsylvania RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


PennsylvaniaSENIOR PARTNERS BY BRAVO HEALTH Senior Partners Local CCP


1-800-625-9432

1-866-464-0709

[email protected]


Pennsylvania



1-702-877-8377

[email protected]


Pennsylvania


1-866-443-0934

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Pennsylvania




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Pennsylvania




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Pennsylvania



1-714-637-1282

1-714-637-1209

[email protected]



Pennsylvania



1-765-526-2515

[email protected]

8990 Duke Drive


Pennsylvania

UNISON HEALTH PLAN OF PENNSYLVANIA, INC. Unison Advantage Local CCP Brekosky Robert

1-412-349-6167

1-412-457-1616

[email protected] Unison Plaza

1001 Brinton Road Pittsburgh PA 15221

Pennsylvania




1-972-569-3646

1-972-569-3679

[email protected]


Pennsylvania


1-949-252-4339

[email protected]

2300 Main Street


Pennsylvania


1-949-221-9994

[email protected]

2300 Main Street


Pennsylvania


1-949-221-9994

[email protected]

2300 Main Street


Pennsylvania



Director - Clinical Programs & Education Anderson Michael J

1-952-936-3112

1-952-936-4933

[email protected]

UnitedHealth Group

9900 Bren Road East MN008-T500 Minnetonka MN 55343

Pennsylvania



Vice President, Chief Medical Officer Addiego Joseph E

1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Pennsylvania


1-949-252-4339

[email protected]

2300 Main Street


Pennsylvania

UNIVERSITY OF PITTSBURGH MEDICAL CENTER UPMC Health Plan Local CCP

Manager, Medicare Operations Cain John

1-412-454-5539

1-412-454-7711

[email protected]

112 Washington Place Suite 800 Pittsburgh PA 15219

PennsylvaniaUPMC HEALTH BENEFITS, INC UPMC Health Plan PDP


1-412-454-5539

[email protected]


PennsylvaniaUPMC HEALTH NETWORK UPMC Health Plan Local CCP


1-412-454-5539

1-412-454-7711

[email protected]

112 Washington Place Suite 800 Pittsburgh PA 15219

Pennsylvania



1-813-290-6200 3768

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Pennsylvania



1-813-290-6200 3768

[email protected]


Puerto RicoAMERICAN HEALTH, INC.

American Health Medicare Local CCP

Pharmacy and Delegated Entities Manager Hernandez Carmen

1-787-620-1919 4054

1-787-620-0929

[email protected]

American Health Medicare

P.O. Box 11320 San Juan PR 00922

Puerto RicoAUXILIO PLATINO, INC. Auxilio Platino Local CCP

Clinical Pharmacist Smith Shannon

1-504-849-4500 8887

1-504-849-6901

[email protected]



Puerto Rico

COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO

Cooperativa de Seguros de Vida de PR (COSVI) Local CCP

WHI Account Manager Rodriguez Awilda

1-787-751-3663

1-787-751-3713

[email protected]

273 Ave Ponce de Le≤n Suite 801

San Juan, Puerto Rico 00917-1923 SAN JUAN PR

00917-1923

Puerto Rico

COOPERATIVE DE SEGUROS DE VIDA DE PUERTO RICO

Cooperativa de Seguros de Vida de PR, COSVI PDP Pharmacist Rodriguez Ivonne

1-787-751-5656

[email protected] PO Box 363428 San Juan PR

00936-3428

Puerto RicoEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Puerto RicoFIRST MEDICAL HEALTH PLAN, INC

First Medical Health Plan, Inc. PDP Moyna Audrey

1-847-559-3999

1-847-559-4733

[email protected]


Puerto RicoFIRST MEDICAL HEALTH PLAN, INC.

First Medical Health Plan, Inc. Local CCP Moyna Audrey

1-847-559-3999

1-847-559-4733

[email protected]


Puerto RicoFIRST MEDICAL HEALTH PLAN, INC.

First Medical Health Plan, Inc. Local CCP Moyna Audrey

1-847-559-3999

1-847-559-4733

[email protected]


Puerto Rico

HUMANA HEALTH PLANS OF PUERTO RICO INC

Humana Health Plans Of Puerto Rico Inc Local CCP Ewing Joy

1-502-580-3538

[email protected]


Puerto Rico

HUMANA INSURANCE OF PUERTO RICO, INC

Humana Insurance Of Puerto Rico, Inc PFFS Ewing Joy

1-502-580-3538

[email protected]


Puerto Rico

HUMANA INSURANCE OF PUERTO RICO, INC

Humana Insurance of Puerto Rico, Inc PDP Ewing Joy

1-502-580-3538

[email protected]


Puerto Rico

MAPFRE LIFE INSURANCE COMPANY

MAPFRE LIFE Insurance Company Local CCP Moyna Audrey

1-847-559-3999

1-847-559-4733

[email protected]


Puerto RicoMCS ADVANTAGE INC. MCS Classicare Local CCP

Research Academic Pharmacist Santiago Edgardo

1-787-758-2500 4907

1-787-622-7766


00919-1720

Puerto RicoMCS ADVANTAGE, INC. MCS Classicare PDP


1-787-758-2500 4907

1-787-622-7766


00919-1720

Puerto Rico

MCS LIFE INSURANCE COMPANY MCS Classicare PFFS


1-787-758-2500 4907

1-787-622-7766


00919-1720

Puerto Rico




1-201-269-6717

1-201-269-1008

[email protected]


Puerto RicoMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Puerto RicoMMM HEALTHCARE, INC.

Medicare y Mucho Más Local CCP Vice President Bou Clara I

1-787-622-3000 8602

1-787-625-3370

[email protected]

Bechara Industrial Park, Marginal Avenue

Kennedy Segarra Street Bldg., No. 411 San Juan PR 00936

Puerto Rico




1-516-605-6966

1-412-322-2066

[email protected]


Puerto Rico

PHARMACY INSURANCE CORPORATION OF AMERICA

Pharmacy Insurance Corporation of America - PICA PDP Clinical Echevarria Irma

1-787-625-4343 4711

1-787-625-4363


00936-8232

Puerto Rico

PREFERRED MEDICARE CHOICE, INC.

Preferred Medicare Choice, Inc. Local CCP

Vice President, Pharmacy Services Bou Clara I

1-787-622-3000 8602

1-787-625-3370

[email protected]

Bechara Industrial Park

Marginal Avenue, Kennedy Segarra Street Bldg., No. 411 San Juan PR 00936

Puerto Rico

PREFERRED MEDICARE CHOICE, INC.

Preferred Medicare Choice, Inc. PDP

VP Pharmacy Services Bou Clara

1-787-622-3000 8602

1-787-625-3375

[email protected]

350 Chardon Ave.

Suite 500 Torre Chardon. San Juan PR 00918

Puerto RicoRED MEDICA DE PUERTO RICO, INC. Red Med Local CCP Valle Oliveras JosΘ W

1-787-620-7772

1-787-620-7774

[email protected]

Capital Center Building, South Tower, Ste 704

239 Ave Arterial Hostos San Juan PR

00918-1476

Puerto RicoSDM HEALTHCARE MANAGEMENT, INC.

Salud Dorada con Medicare Local CCP Medical Director Irizarry Maria

1-787-999-4848

1-787-999-7941

[email protected] P.O Box 3078 Bayamon PR

00960-3078

Puerto Rico


1-866-443-0934

[email protected]


Puerto Rico TRIPLE-S, INC. Triple-S PDP

Manager for Member Education Department Fernßndez Zenaida

1-787-749-4012

1-787-749-4093

[email protected]

PO BOX 363628 San Juan PR

00936-3628

Puerto Rico TRIPLE-S, INC. Triple-S, Inc. Local CCP


1-787-749-4012

1-787-749-4093


00936-3628

Puerto Rico TRIPLE-S, INC. Triple-S, Inc. Local CCP


1-787-749-4012

1-787-749-4093


00936-3628

Puerto Rico


1-949-252-4339

[email protected]

2300 Main Street


Rhode Island



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Rhode Island



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Rhode Island

BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND

Blue Cross & Blue Shield Of Rhode Island Local CCP

MTM Clinical Interventions Manager Hettich Lisa

1-765-526-2515

1-765-391-1023

[email protected]

8407 Fallbrook Ave West Hills CA 91304

Rhode Island BLUE MEDICARERX

Blue Cross & Blue Shield of Rhode Island PDP


1-765-526-2515

[email protected]

8990 Duke Drive


Rhode Island


1-860-226-6731

[email protected]


Rhode Island



1-330-405-8080 6320

1-330-405-8081

[email protected]


Rhode IslandEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Rhode Island



1-804-965-7658


Rhode Island



1-804-965-7658


Rhode Island




1-916-463-9603

1-916-463-9750

[email protected]




Rhode Island




1-615-565-8110

1-615-234-2154

[email protected]


Rhode Island



1-502-580-3538

[email protected]


Rhode Island



1-502-580-3538

[email protected]


Rhode Island




1-201-269-6717

1-201-269-1008

[email protected]


Rhode IslandMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Rhode Island




1-516-605-6966

1-412-322-2066

[email protected]


Rhode Island




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Rhode Island




1-401-333-3987 7941

1-800-373-0238

[email protected]


Rhode Island RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Rhode Island


1-866-443-0934

[email protected]


Rhode Island




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Rhode Island



1-714-637-1282

1-714-637-1209

[email protected]



Rhode Island



1-765-526-2515

[email protected]

8990 Duke Drive


Rhode Island




1-972-569-3646

1-972-569-3679

[email protected]


Rhode Island


1-949-252-4339

[email protected]

2300 Main Street


Rhode Island

UNITED HEALTH PLANS OF NEW ENGLAND, INC.

UnitedHealthcare of New England, Inc. Local CCP


Addiego, Jr. M.D. Joseph E

1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Rhode Island





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Rhode Island





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Rhode Island


1-949-252-4339

[email protected]

2300 Main Street


Rhode Island



1-813-290-6200 3768

[email protected]


South Carolina



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

South Carolina



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

South Carolina

ARCADIAN HEALTH PLAN OF GEORGIA, INC.

Southeast Community Care Local CCP


1-909-971-6816

1-909-971-6866

[email protected]


South CarolinaARCADIAN HEALTH PLAN, INC.

Southeast Community Care Local CCP President Freeman Nancy

1-310-204-1101

1-510-817-1033

[email protected]

825 Washington Street, Suite 300 Oakland CA 94607

South Carolina

BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA

Blue Cross Blue Shield of South Carolina Local CCP

Director - Provider Contracting Baughman Angie

1-803-264-3234

1-803-419-8020

[email protected]

I-20 at Alpine Road Columbia SC 29219

South Carolina

BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA

Blue Cross Blue Shield of South Carolina PDP

Director - Provider contracts Baughman Angie

1-803-264-3234

1-803-419-8020

[email protected]

2401 Faraway Drive Columbia SC 29223

South Carolina

BLUECHOICE HEALTHPLAN OF SOUTH CAROLINA, INC.

BlueChoice HealthPlan Local CCP McManus Lisa

1-803-382-5527

1-803-714-6463

[email protected] P.O. Box 6170 Columbia SC 29260


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

South Carolina

CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO


1-847-559-3999

1-847-559-4733

[email protected]


South Carolina


1-860-226-6731

[email protected]


South Carolina


1-804-965-7658

[email protected]



South Carolina



1-804-965-7658


South Carolina



1-330-405-8080 6320

1-330-405-8081

[email protected]


South CarolinaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


South Carolina



1-804-965-7658


South Carolina




1-916-463-9603

1-916-463-9750

[email protected]




South Carolina




1-615-565-8110

1-615-234-2154

[email protected]


South Carolina



1-502-580-3538

[email protected]


South Carolina



1-502-580-3538

[email protected]


South Carolina



1-502-580-3538

[email protected]


South Carolina


InStil Health Insurance Company Regional CCP


1-803-763-6559

1-803-935-1605

[email protected]


South Carolina


InStil Health Insurance Company PDP


1-803-763-6559

1-803-935-1605

[email protected]

17 Technology Circle, AG-790 Columbia SC 29203

South Carolina




1-201-269-6717

1-201-269-1008

[email protected]


South CarolinaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


South Carolina




1-516-605-6966

1-412-322-2066

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

South Carolina




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


South Carolina




1-401-333-3987 7941

1-800-373-0238

[email protected]


South Carolina



1-713-770-1265

1-866-553-0396

[email protected]


South Carolina RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


South Carolina

SELECT HEALTH OF SOUTH CAROLINA, INC. PerformRx PDP


1-215-937-5352

[email protected]


South Carolina



1-702-877-8377

[email protected]


South Carolina


1-866-443-0934

[email protected]


South Carolina




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

South Carolina




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

South Carolina



1-714-637-1282

1-714-637-1209

[email protected]



South Carolina



1-765-526-2515

[email protected]

8990 Duke Drive


South Carolina




1-972-569-3646

1-972-569-3679

[email protected]


South Carolina


1-949-252-4339

[email protected]

2300 Main Street


South Carolina


1-949-252-4339

[email protected]

2300 Main Street


South Carolina




1-800-546-5677 1110

1-866-632-7946


South Carolina



1-813-290-6200 3768

[email protected]


South Carolina



1-813-290-6200 3768

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

South Dakota



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

South Dakota



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

South Dakota


Wellmark Blue Cross Blue Shield of South Dakota Regional CCP


1-651-662-8758

1-651-662-6009

[email protected]



South Dakota


Wellmark Blue Cross Blue Shield of South Dakota PDP


1-651-662-8758

1-651-662-6009

[email protected]



South Dakota


1-860-226-6731

[email protected]


South Dakota


1-804-965-7658

[email protected]



South Dakota



1-330-405-8080 6320

1-330-405-8081

[email protected]


South DakotaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


South Dakota



1-804-965-7658


South Dakota



1-804-965-7658


South DakotaFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


South Dakota




1-916-463-9603

1-916-463-9750

[email protected]




South Dakota




1-615-565-8110

1-615-234-2154

[email protected]


South Dakota



1-502-580-3538

[email protected]


South Dakota



1-502-580-3538

[email protected]


South Dakota




1-201-269-6717

1-201-269-1008

[email protected]


South Dakota



1-952-992-2469

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

South DakotaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


South Dakota




1-516-605-6966

1-412-322-2066

[email protected]


South Dakota




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


South Dakota




1-401-333-3987 7941

1-800-373-0238

[email protected]


South Dakota RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


South Dakota


1-866-443-0934

[email protected]


South Dakota

SOUTH DAKOTA STATE MEDICAL HOLDING COMPANY, INC. DAKOTACARE Local CCP

Director of Pharmacy Benefits Lounsbery Christine

1-866-437-3288 3150

[email protected] 2600 W 49th St Sioux Falls SD 57117

South Dakota




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

South Dakota




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

South Dakota



1-714-637-1282

1-714-637-1209

[email protected]



South Dakota



1-765-526-2515

[email protected]

8990 Duke Drive


South Dakota




1-972-569-3646

1-972-569-3679

[email protected]


South Dakota


1-949-252-4339

[email protected]

2300 Main Street


South Dakota


1-949-221-9994

[email protected]

2300 Main Street


South Dakota


1-949-252-4339

[email protected]

2300 Main Street


South Dakota



1-813-290-6200 3768

[email protected]


Tennessee AETNA HEALTH INC. Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Tennessee



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Tennessee



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Tennessee

BCBS OF ALABAMA AND BCBS OF TENNESSEE

BlueCross BlueShield of Tennessee PDP


1-334-213-6653

[email protected]

450 Riverchase Parkway East Birmingham AL 35244

Tennessee

BLUECROSS BLUESHIELD OF TENNESSEE

BlueCross BlueShield of Tennessee PFFS Colbaugh Janine

1-423-535-7023

[email protected] 801 Pine Street Chattanooga TN 37402

TennesseeCARITEN HEALTH PLAN IN Cariten Senior Health Local CCP

Pharmacy supervisor Feliciano Susan

1-865-670-7340

[email protected]

1420 Centerpoint Blvd Knoxville TN 37932

Tennessee

CARITEN INSURANCE COMPANY

Cariten Senior Health (PPO) Local CCP

Pharmacy Director Ciufo John

1-865-670-7382

1-865-670-7205

[email protected]

1420 Centerpoint Blvd Knoxville TN 37932

Tennessee


1-860-226-6731

[email protected]


Tennessee


1-804-965-7658

[email protected]



Tennessee



1-804-965-7658


Tennessee



1-330-405-8080 6320

1-330-405-8081

[email protected]


TennesseeEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Tennessee



1-804-965-7658


Tennessee




1-916-463-9603

1-916-463-9750

[email protected]




Tennessee




1-615-565-8110

1-615-234-2154

[email protected]


TennesseeHEALTHSPRING OF TENNESSEE, INC. Healthspring Local CCP


1-615-565-8110

1-615-234-2154

[email protected]


Tennessee



1-502-580-3538

[email protected]


Tennessee



1-502-580-3538

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Tennessee



1-502-580-3538

[email protected]


Tennessee



1-502-580-3538

[email protected]


Tennessee




1-201-269-6717

1-201-269-1008

[email protected]


TennesseeMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Tennessee




1-516-605-6966

1-412-322-2066

[email protected]


Tennessee




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Tennessee




1-401-333-3987 7941

1-800-373-0238

[email protected]


Tennessee



1-713-770-1265

1-866-553-0396

[email protected]


Tennessee RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Tennessee



1-702-877-8377

[email protected]


Tennessee


1-866-443-0934

[email protected]


Tennessee




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Tennessee




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Tennessee

UAHC HEALTH PLAN OF TENNESSEE, INC. UAHC Gold Plus Local CCP

Pharmacy, Clinical Services Director Hettich Lisa

1-765-526-2515

[email protected]


Well Point NextRx West Hills CA 91304

Tennessee



1-714-637-1282

1-714-637-1209

[email protected]



Tennessee



1-765-526-2515

[email protected]

8990 Duke Drive


Tennessee

UNISON HEALTH PLAN OF TENNESSEE, INC. Unison Advantage Local CCP Brekosky Robert

1-412-349-6167

1-412-457-1616

[email protected] Unison Plaza

1001 Brinton Road Pittsburgh PA 15221

Tennessee




1-972-569-3646

1-972-569-3679

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Tennessee


1-949-252-4339

[email protected]

2300 Main Street


Tennessee


1-949-221-9994

[email protected]

2300 Main Street


Tennessee





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Tennessee


1-949-252-4339

[email protected]

2300 Main Street


Tennessee

UNITED HEALTHCARE OF TENNESSEE, INC. SecureHorizons Local CCP Addiego Joseph

1-949-221-9994



Tennessee




1-972-866-1501

1-972-866-1911

[email protected]


Tennessee

UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.


AmeriChoice Pharmacy Medical Management Hatch Vanessa L

1-703-226-3126

1-703-506-3536

[email protected]

8045 Leesburg Pike Ste. 650 Vienna VA 22182

Tennessee



1-813-290-6200 3768

[email protected]


Tennessee



1-813-290-6200 3768

[email protected]


TennesseeWINDSOR HEALTH PLAN, INC Windsor Rx PDP


1-615-782-7860

1-615-782-7822

[email protected]


TennesseeWINDSOR HEALTH PLAN, INC.

Windsor Medicare Extra PFFS


1-615-782-7860

1-615-782-7822

[email protected]


TennesseeWINDSOR HEALTH PLANS, INC.



1-615-782-7860

1-615-782-7822

[email protected]


Texas AETNA HEALTH INC. Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Texas



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Texas



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Texas



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

TexasAMERIGROUP TEXAS, INC.

AMERIGROUP Community Care Local CCP

AVP Clincal Pharmacy Radzin Richard

1-757-518-3152

[email protected]

4425 Corporation Lane, #300 Virginia Beach, VA 23462

TexasARCADIAN HEALTH PLAN, INC.

Texas Community Care Local CCP


1-909-971-6816

1-909-971-6866

[email protected]


TexasARKANSAS COMMUNITY CARE



1-909-971-6816

1-909-971-6866

[email protected]


TexasBRAVO HEALTH TEXAS, INC. Bravo by Elder Health Local CCP


1-800-625-9432

1-866-464-0709

[email protected]


TexasBRAVO HEALTH TEXAS, INC. Bravo by Elder Health PDP


1-800-625-9432

1-866-464-0709

[email protected]


Texas

CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY


1-847-559-3999

1-847-559-4733

[email protected]


Texas


1-860-226-6731

[email protected]


Texas


1-804-965-7658

[email protected]



Texas



1-804-965-7658


Texas



1-330-405-8080 6320

1-330-405-8081

[email protected]


TexasEVERCARE OF TEXAS, LLC

Evercare Of Texas, LLC Local CCP



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

TexasEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Texas

FIDELIS SECURECARE OF TEXAS, INC.

Fidelis SecureCare of Texas, Inc. Local CCP

Chief Medical Officer Sarran Scott

1-877-372-6203

1-847-517-1085

[email protected]

1700 East Golf Road Suite 1115 Schaumburg IL 60173

Texas



1-804-965-7658


Texas


HISC - Blue Cross Blue Shield of Texas Local CCP

Pharmacy Director, Government Programs Nguyen Marie

1-651-286-4206

1-651-286-4403

[email protected]

Prime Therapeutics

1020 Discovery Road, No. 100 Egan MN 55121

Texas


HISC - Blue Cross Blue Shield of Texas PDP


1-651-286-4206

1-651-286-4403

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Texas




1-916-463-9603

1-916-463-9750

[email protected]




Texas




1-615-565-8110

1-615-234-2154

[email protected]


Texas

HUMANA HEALTH PLAN OF TEXAS,INC.

Humana Health Plan of Texas, Inc. Local CCP Ewing Joy

1-502-580-3538

[email protected]


Texas



1-502-580-3538

[email protected]


Texas



1-502-580-3538

[email protected]


Texas



1-502-580-3538

[email protected]


Texas



1-502-580-3538

[email protected]


Texas




1-201-269-6717

1-201-269-1008

[email protected]


TexasMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Texas




1-516-605-6966

1-412-322-2066

[email protected]


Texas




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


TexasPACIFICARE OF TEXAS, INC.



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Texas




1-401-333-3987 7941

1-800-373-0238

[email protected]


TexasPSO HEALTH SERVICES, LLC

PHYSICIANS HEALTH CHOICE Local CCP

Vice President of Pharmacy - Envision Peterson Amanda

1-330-405-8080 263

[email protected]

2181 E. Aurora Rd. STE 201 Twinsburg OH 44087

Texas



1-713-770-1265

1-866-553-0396

[email protected]


Texas RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


TexasSCOTT AND WHITE HEALTH PLAN

Scott and White Health Plan SeniorCare 1876 Cost PharmD Gabrillo Evelyn

1-254-298-6152

1-254-298-6189

[email protected]

4236 Lowes Drive Suite 100 Temple TX 76502

TexasSCOTT AND WHITE HEALTH PLAN Texas Rx Plan PDP

Patient Care Pharmacist Gabrillo Evelyn

1-254-298-6152

1-254-298-6189

[email protected]

4236 Lowes Drive Suite 100 Temple TX 76502

Texas

SELECTCARE HEALTH PLANS, INC.

TexasFirst Health Plans Local CCP


1-713-770-1265

1-866-553-0396

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

TexasSELECTCARE OF TEXAS, L.L.C.

SelectCare of Texas, LLC Local CCP



1-713-770-1265

1-866-553-0396

[email protected]


Texas SHA, L.L.C FirstCare Advantage Local CCP

Director of Pharmacy Services Crognale III Louis

1-512-257-6206

1-512-257-6016

[email protected]

12940 North Highway 183 Austin TX 78750

Texas



1-702-877-8377

[email protected]


Texas


1-866-443-0934

[email protected]


Texas




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Texas




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

TexasTEXAS HEALTHSPRING LLC Texas HealthSpring Local CCP


1-615-565-8110

1-615-234-2154

[email protected]


Texas



1-714-637-1282

1-714-637-1209

[email protected]



Texas



1-765-526-2515

[email protected]

8990 Duke Drive


Texas




1-972-569-3646

1-972-569-3679

[email protected]


Texas


1-949-252-4339

[email protected]

2300 Main Street


Texas


1-949-221-9994



Texas


UNITED HEALTHCARE INSURANCE COMPANY Demo



1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Texas


1-949-252-4339

[email protected]

2300 Main Street


Texas




1-800-546-5677 1110

1-866-632-7946


Texas

VALLEY BAPTIST INSURANCE COMPANY

Valley Baptist Health Plans Local CCP

Directory of Pharmacy Services Crognale III Louis

1-512-257-6206

1-512-257-6016

[email protected]

12940 N. Highway 183 Austin TX 78750

Texas



1-813-290-6200 3768

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Texas



1-813-290-6200 3768

[email protected]


Utah



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Utah



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Utah


1-860-226-6731

[email protected]


Utah


1-804-965-7658

[email protected]



Utah

EDUCATORS MUTUAL INSURANCE ASSOCIATION

Educators Mutual Insurance Association PDP Gallegos Jennifer

1-801-262-7476

[email protected]

852 East Arrowhead Lane Murray UT 84107

Utah



1-330-405-8080 6320

1-330-405-8081

[email protected]


UtahEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Utah



1-804-965-7658


Utah



1-804-965-7658


Utah




1-916-463-9603

1-916-463-9750

[email protected]




Utah




1-615-565-8110

1-615-234-2154

[email protected]


Utah



1-502-580-3538

[email protected]


Utah



1-502-580-3538

[email protected]


Utah



1-502-580-3538

[email protected]


Utah




1-201-269-6717

1-201-269-1008

[email protected]


UtahMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Utah

MOLINA HEALTHCARE OF UTAH, INC.

Molina Healthcare of Utah Local CCP

Director, Pharmacy Schatzman Benjamin

1-562-951-1509 1509

1-562-437-9315

[email protected]


Utah




1-516-605-6966

1-412-322-2066

[email protected]


Utah




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Utah




1-401-333-3987 7941

1-800-373-0238

[email protected]


Utah



1-713-770-1265

1-866-553-0396

[email protected]


Utah

REGENCE BLUECROSS BLUESHIELD OF UT

Regence BlueCross BlueShield of Utah Local CCP


1-208-395-7732

1-208-395-7744

[email protected]



Utah

REGENCE LIFE AND HEALTH INSURANCE COMPANY

Regence Life and Health PDP


1-208-395-7732

1-208-395-7744

[email protected]



Utah RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Utah



1-702-877-8377

[email protected]


Utah



1-702-877-8377

[email protected]


Utah


1-866-443-0934

[email protected]


Utah




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Utah




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Utah



1-714-637-1282

1-714-637-1209

[email protected]



Utah



1-765-526-2515

[email protected]

8990 Duke Drive


Utah




1-972-569-3646

1-972-569-3679

[email protected]


Utah


1-949-252-4339

[email protected]

2300 Main Street



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Utah


1-949-221-9994

[email protected]

2300 Main Street


Utah


1-949-252-4339

[email protected]

2300 Main Street


UtahUNITEDHEALTHCARE OF UTAH, INC. SecureHorizons Local CCP Addiego Joseph

1-949-221-9994



Utah




1-800-546-5677 1110

1-866-632-7946


Utah



1-813-290-6200 3768

[email protected]


Utah



1-813-290-6200 3768

[email protected]


Vermont



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Vermont



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Vermont




1-866-245-5190

1-866-553-0396

[email protected]


Vermont BLUE MEDICARERXBlue Cross and Blue Shield of Vermont PDP


1-765-526-2515

[email protected]

8990 Duke Drive


Vermont


1-860-226-6731

[email protected]


Vermont



1-330-405-8080 6320

1-330-405-8081

[email protected]


VermontEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Vermont



1-804-965-7658


Vermont



1-804-965-7658


Vermont




1-916-463-9603

1-916-463-9750

[email protected]





STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Vermont




1-615-565-8110

1-615-234-2154

[email protected]


Vermont



1-502-580-3538

[email protected]


Vermont



1-502-580-3538

[email protected]


Vermont




1-201-269-6717

1-201-269-1008

[email protected]


VermontMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Vermont




1-516-605-6966

1-412-322-2066

[email protected]


Vermont




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Vermont




1-401-333-3987 7941

1-800-373-0238

[email protected]


Vermont RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Vermont


1-866-443-0934

[email protected]


Vermont




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Vermont




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Vermont



1-714-637-1282

1-714-637-1209

[email protected]



Vermont



1-765-526-2515

[email protected]

8990 Duke Drive


Vermont




1-972-569-3646

1-972-569-3679

[email protected]


Vermont


1-949-252-4339

[email protected]

2300 Main Street


Vermont


1-949-252-4339

[email protected]

2300 Main Street


Vermont



1-813-290-6200 3768

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Virgin Islands

MCS LIFE INSURANCE COMPANY MCS Classicare PFFS


1-787-758-2500 4907

1-787-622-7766


00919-1720

Virgin IslandsMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Virgin Islands


1-949-252-4339

[email protected]

2300 Main Street


Virginia AETNA HEALTH INC. Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Virginia



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Virginia



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Virginia



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Virginia

ANTHEM HEALTH PLANS OF VIRGINIA, INC.

Anthem Blue Cross and Blue Shield Local CCP Hettich Lisa

1-765-526-2515

[email protected]

8407 Fallbrook Avenue West Hills CA 91304

Virginia




1-765-526-2515

[email protected]

8990 Duke Drive


Virginia



1-714-637-1282

1-714-637-1209

[email protected]



Virginia


1-860-226-6731

[email protected]


Virginia


1-804-965-7658

[email protected]



Virginia



1-804-965-7658


Virginia



1-330-405-8080 6320

1-330-405-8081

[email protected]


VirginiaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Virginia



1-804-965-7658



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Virginia




1-916-463-9603

1-916-463-9750

[email protected]




Virginia




1-615-565-8110

1-615-234-2154

[email protected]


Virginia



1-502-580-3538

[email protected]


Virginia



1-502-580-3538

[email protected]


Virginia



1-502-580-3538

[email protected]


Virginia




1-301-816-6835

[email protected]


Virginia




1-201-269-6717

1-201-269-1008

[email protected]


VirginiaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Virginia




1-516-605-6966

1-412-322-2066

[email protected]


Virginia

OPTIMA HEALTH INSURANCE COMPANY

Optima Medicare Preferred Local CCP

Clinical Pharmacist Brusig Elizabeth

1-757-552-7519

1-757-552-7516

[email protected]

4417 Corporation Lane Virginia Beach VA 23462

Virginia




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Virginia




1-401-333-3987 7941

1-800-373-0238

[email protected]


Virginia



1-713-770-1265

1-866-553-0396

[email protected]


Virginia RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Virginia



1-702-877-8377

[email protected]


Virginia


1-866-443-0934

[email protected]


Virginia




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Virginia




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Virginia



1-714-637-1282

1-714-637-1209

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Virginia



1-765-526-2515

[email protected]

8990 Duke Drive


Virginia




1-972-569-3646

1-972-569-3679

[email protected]


Virginia


1-949-252-4339

[email protected]

2300 Main Street


Virginia


1-949-221-9994

[email protected]

2300 Main Street


Virginia




1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Virginia





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Virginia





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Virginia


1-949-252-4339

[email protected]

2300 Main Street


Virginia




1-972-866-1501

1-972-866-1911

[email protected]


Virginia



1-813-290-6200 3768

[email protected]


Virginia



1-813-290-6200 3768

[email protected]


Washington



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Washington



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

WashingtonARCADIAN HEALTH PLAN

Spokane Community Care Local CCP


1-909-971-6816

1-909-971-6866

[email protected]

955 Overland Court, Second Floor San Dimas CA 91773

Washington


Asuris Northwest Health Local CCP


1-208-395-7732

1-208-395-7744

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Washington


Asuris Northwest Health PDP


1-208-395-7732

1-208-395-7744

[email protected]

1211 West Myrtle


Washington

COMMUNITY HEALTH PLAN OF WASHINGTON

Community HealthFirst Medicare Advantage Plan Local CCP

Pharmacy Director Koh Rachel

1-206-613-8859

1-206-521-8834

[email protected] 720 Olive Way Suite 300 Seattle WA

98101-1830

Washington


1-860-226-6731

[email protected]


Washington


1-804-965-7658

[email protected]



Washington



1-330-405-8080 6320

1-330-405-8081

[email protected]


WashingtonEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Washington



1-804-965-7658


Washington



1-804-965-7658


WashingtonFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


WashingtonGROUP HEALTH COOPERATIVE

Group Health Cooperative Local CCP

Associate Director of Clinical Pharmacy Operations Reitz Shirley

1-206-901-4334 [email protected]

Group Health Cooperative

12400 E. Marginal Way South Seattle WA

98168-2559

Washington




1-916-463-9603

1-916-463-9750

[email protected]




Washington


Health Net Medicare Advantage Local CCP

Vice President, Operations - HNPS


1-916-463-9603

[email protected]


Mail Top: CA-175-02-02


Washington




1-615-565-8110

1-615-234-2154

[email protected]


Washington



1-502-580-3538

[email protected]


Washington



1-502-580-3538

[email protected]


Washington


Kaiser Foundation Health Plan of the NW Local CCP


1-503-261-7980

[email protected]


Washington


Kaiser Foundation Health Plan of the NW Demo


1-503-261-7980

[email protected]


Washington




1-201-269-6717

1-201-269-1008

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

WashingtonMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Washington

MOLINA HEALTHCARE OF WASHINGTON, INC.

Molina Healthcare of Washington, Inc. Local CCP

Director, Pharmacy SCHATZMAN BENJAMIN

1-562-951-1509

1-562-437-9315

[email protected]


Washington




1-516-605-6966

1-412-322-2066

[email protected]


WashingtonODS HEALTH PLAN, INC. ODS Advantage Rx PDP


1-503-243-4491

1-503-948-5557

[email protected]


Washington




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


WashingtonPACIFICARE OF WASHINGTON, INC.



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Washington




1-401-333-3987 7941

1-800-373-0238

[email protected]


WashingtonPROVIDENCE HEALTH PLAN

Providence Health Plan Local CCP

PHARMACY DIRECTOR NOONAN HELEN M

1-503-574-5708

1-503-574-8646

[email protected] PO BOX 3125 PORTLAND OR

97208-3125

Washington

REGENCE BLUECROSS BLUESHIELD OF OR

Regence BlueCross BlueShield of Oregon Local CCP


1-208-395-7732

1-208-395-7744

[email protected]



WashingtonREGENCE BLUESHIELD Regence BlueShield Local CCP

Clinical Pharmacist Consultant III Leonard Ruth J

1-208-395-7732

1-208-395-7744

[email protected]

1211 West Myrtle


Washington RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Washington



1-702-877-8377

[email protected]


Washington


1-866-443-0934

[email protected]


Washington




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Washington




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Washington



1-714-637-1282

1-714-637-1209

[email protected]



Washington



1-765-526-2515

[email protected]

8990 Duke Drive


Washington




1-972-569-3646

1-972-569-3679

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Washington


1-949-252-4339

[email protected]

2300 Main Street


Washington




1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Washington


1-949-221-9994

[email protected]

2300 Main Street


Washington





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Washington


1-949-252-4339

[email protected]

2300 Main Street


Washington



1-813-290-6200 3768

[email protected]


Washington



1-813-290-6200 3768

[email protected]


Washington D.C. AETNA HEALTH INC. Aetna Medicare Local CCP


1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Washington D.C.



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Washington D.C.



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Washington D.C.



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Washington D.C.



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Washington D.C.

BRAVO HEALTH MID-ATLANTIC INC. Bravo by Elder Health Local CCP


1-800-625-9432

1-866-464-0709

[email protected]


Washington D.C.

BRAVO HEALTH MID-ATLANTIC INC. Bravo by Elder Health PFFS


1-410-864-4583

1-866-464-0709

[email protected]


Washington D.C.

BRAVO HEALTH MID-ATLANTIC, INC. Bravo by Elder Health PDP


1-800-625-9432

1-866-464-0709

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Washington D.C.


1-860-226-6731

[email protected]


Washington D.C.


1-804-965-7658

[email protected]



Washington D.C.



1-804-965-7658


Washington D.C.



1-330-405-8080 6320

1-330-405-8081

[email protected]


Washington D.C.

EXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Washington D.C. FIRST CARE, INC.

Medi-CareFirst BlueCross BlueShield PDP


1-410-528-7897

[email protected]


Washington D.C.



1-804-965-7658


Washington D.C.




1-916-463-9603

1-916-463-9750

[email protected]




Washington D.C.




1-615-565-8110

1-615-234-2154

[email protected]


Washington D.C.



1-502-580-3538

[email protected]


Washington D.C.




1-301-816-6835

[email protected]


Washington D.C.




1-201-269-6717

1-201-269-1008

[email protected]


Washington D.C.

MEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Washington D.C.




1-516-605-6966

1-412-322-2066

[email protected]


Washington D.C.




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Washington D.C.




1-401-333-3987 7941

1-800-373-0238

[email protected]


Washington D.C. RXAMERICA, LLC RxAmerica PDP

Director of PDP Operations Low Jeff

1-801-961-6251

[email protected]


Washington D.C.



1-702-877-8377

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Washington D.C.


1-866-443-0934

[email protected]


Washington D.C.




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Washington D.C.




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Washington D.C.



1-714-637-1282

1-714-637-1209

[email protected]



Washington D.C.



1-765-526-2515

[email protected]

8990 Duke Drive


Washington D.C.




1-972-569-3646

1-972-569-3679

[email protected]


Washington D.C.


1-949-252-4339

[email protected]

2300 Main Street


Washington D.C.





1-949-221-9994

1-949-474-4237


CA134-0404 Irvine CA 92614

Washington D.C.


1-949-252-4339

[email protected]

2300 Main Street


Washington D.C.



1-813-290-6200 3768

[email protected]


Washington D.C.



1-813-290-6200 3768

[email protected]


West Virginia



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

West Virginia



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

West Virginia




1-866-245-5190

1-866-553-0396

[email protected]


West Virginia

AVALON INSURANCE COMPANY

Avalon Insurance Company PDP


1-717-703-8466

[email protected]


West Virginia



1-800-625-9432

1-866-464-0709

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

West Virginia


1-860-226-6731

[email protected]


West Virginia


Carelink Advantra PPO Local CCP Stephens Debbie

1-804-965-7658

[email protected]



West Virginia


1-804-965-7658

[email protected]



West Virginia



1-804-965-7658


West Virginia



1-330-405-8080 6320

1-330-405-8081

[email protected]


West VirginiaEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


West Virginia



1-804-965-7658


West Virginia


Geisinger Health Plan Gold Rx PDP


1-570-214-9606

1-570-271-5268

[email protected]


17822-3245

West Virginia




1-916-463-9603

1-916-463-9750

[email protected]




West Virginia

HEALTH PLAN OF THE UPPER OHIO VALLEY The Health Plan Local CCP


1-740-695-7638

1-740-695-7925



West Virginia




1-615-565-8110

1-615-234-2154

[email protected]


West Virginia

HIGHMARK HEALTH INSURANCE COMPANY

Mountain State Blue Cross Blue Shield Local CCP

Manager -- Clinical Services Culley Eric

1-412-544-4005

1-412-544-7546

[email protected]


15222-3099

West VirginiaHIGHMARK SENIOR RESOURCES INC.

Highmark Senior Resources Inc. PDP

Manager, Clinical Pharmacy Services Culley Eric

1-412-544-4005

1-412-544-4092

[email protected]

120 Fifth Avenue Ste. 1812 Pittsburgh PA 15222

West Virginia



1-502-580-3538

[email protected]


West Virginia



1-502-580-3538

[email protected]


West Virginia



1-502-580-3538

[email protected]


West Virginia




1-201-269-6717

1-201-269-1008

[email protected]


West VirginiaMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

West Virginia




1-516-605-6966

1-412-322-2066

[email protected]


West Virginia




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


West Virginia




1-401-333-3987 7941

1-800-373-0238

[email protected]


West Virginia

QCC INS CO D/B/A AMERIHEALTH INS CO

AmeriHealth Advantage PDP


1-215-937-5352

[email protected]


West Virginia

QCC INS CO D/B/A AMERIHEALTH INS CO AmeriHealth Rx PDP


1-215-241-7928

[email protected]

1901 Market Street 22nd Floor Philadelphia PA 19103

West Virginia RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]


West Virginia



1-702-877-8377

[email protected]


West Virginia


1-866-443-0934

[email protected]


West Virginia




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

West Virginia




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

West Virginia



1-714-637-1282

1-714-637-1209

[email protected]



West Virginia



1-765-526-2515

[email protected]

8990 Duke Drive


West Virginia




1-972-569-3646

1-972-569-3679

[email protected]


West Virginia


1-949-252-4339

[email protected]

2300 Main Street


West Virginia


1-949-252-4339

[email protected]

2300 Main Street


West VirginiaUPMC HEALTH BENEFITS, INC UPMC Health Plan PDP


1-412-454-5539

[email protected]


West Virginia



1-813-290-6200 3768

[email protected]


West Virginia



1-813-290-6200 3768

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

WisconsinABRI HEALTH PLAN, INC Today's Health Local CCP

Manager of Pharmacy Clinical Services Thomas R.Ph Chelsea

1-713-770-1265

1-866-553-0396

[email protected]


Wisconsin



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Wisconsin



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Wisconsin



1-714-637-1282

1-714-637-1209

[email protected]



Wisconsin


Blue Cross Blue Shield of Wisconsin PDP


1-765-526-2515

[email protected]

8990 Duke Drive


WisconsinCARE WISCONSIN HEALTH PLAN, INC.

Elder Care Health Plan, Inc Local CCP Pharmacist Hetzel Jean

1-608-245-3037

1-608-245-3077

[email protected]

2802 International Lane Madison WI 53704

WisconsinCARE WISCONSIN HEALTH PLAN, INC.

Elder Care Health Plan, Inc. Demo Pharmacist Hetzel Jean

1-608-245-3037

1-608-245-3077

[email protected]

2802 International Lane Madison WI 53704

WisconsinCOMMUNITY CARE HEALTH PLAN, INC Community Care Demo

Clinical Pharmacist Supervisor Mueller Richard J

1-414-902-2397

1-414-274-8490

[email protected]

1555 S. Layton Blvd. Milwaukee WI 53215

Wisconsin


1-860-226-6731

[email protected]


Wisconsin


1-804-965-7658

[email protected]



Wisconsin



1-804-965-7658


WisconsinDEAN HEALTH INSURANCE, INC.

Dean Health Insurance, Inc. PDP Staresnic Anthony

1-608-827-7513

[email protected]

999 Fourier Drive, Suite 301 Madison WI 53717

Wisconsin



1-330-405-8080 6320

1-330-405-8081

[email protected]


WisconsinEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Wisconsin



1-804-965-7658


Wisconsin

GROUP HEALTH COOPERATIVE OF EAU CLAIRE

Wisconsin Personal Care Plan Local CCP Medical Director Blaser Lon

1-715-852-2080

1-715-836-7683

[email protected] P.O. Box 3217 Eau Claire WI

54702-3217

Wisconsin

GUNDERSEN LUTHERAN HEALTH PLAN

Gundersen Lutheran Health Plan, Inc. Local CCP

Pharmacy Director Schuth Grant C

1-608-775-8059 58059

1-608-775-8790

[email protected]

1900 South Avenue

Mail Stop NCA2-01 La Crosse WI 54601


STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Wisconsin




1-916-463-9603

1-916-463-9750

[email protected]




Wisconsin

HEALTH PLAN FOR COMMUNITY LIVING, INC.

Health Plan for Community Living Demo Pharmacist Schea-Holmes Lani M

1-608-242-8335 2190

1-608-240-7060

[email protected]

1414 MacArthur Road

PO Box 8028 Madison WI

53708-8028

Wisconsin




1-615-565-8110

1-615-234-2154

[email protected]


Wisconsin



1-502-580-3538

[email protected]


Wisconsin



1-502-580-3538

[email protected]


Wisconsin



1-502-580-3538

[email protected]


Wisconsin



1-502-580-3538

[email protected]


Wisconsin

INDEPENDENT CARE HEALTH PLAN, INC. iCare Local CCP Tirado Breanne

1-414-231-1087

1-414-231-1075

[email protected]

1555 N Rivercenter Drive Suite 202A Milwaukee WI 53211

Wisconsin




1-201-269-6717

1-201-269-1008

[email protected]


Wisconsin

MEDICA HEALTH PLAN S OF WISCONSIN

Medica Health Plans of Wisconsin PFFS Weiss Justin

1-952-992-2469

[email protected]


Wisconsin



1-952-992-2469

[email protected]


WisconsinMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Wisconsin

NETWORK HEALTH INSURANCE CORPORATION Network PlatinumPlus Local CCP

Pharmacy Director Rynearson Chuck

1-920-720-1603

[email protected]

1570 Midway Place

P.O. Box 120 Menasha WI 54952

Wisconsin




1-516-605-6966

1-412-322-2066

[email protected]


Wisconsin




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


WisconsinPARTNERSHIP HEALTH PLAN, INC.

Community Health Partnership Demo Pharmacist Maslonkowski Chris

1-715-858-7008

[email protected]

2240 EastRidge Center Eau Claire WI 54701

Wisconsin




1-401-333-3987 7941

1-800-373-0238

[email protected]


Wisconsin



1-713-770-1265

1-866-553-0396

[email protected]


Wisconsin RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Wisconsin

SECURITY HEALTH PLAN OF WISCONSIN, INC

Security Health Plan Of Wisconsin, Inc Local CCP

Clinical Pharmacy Specialist Proudfit Jennifer

1-715-221-9920

1-715-221-9989

[email protected]

1515 Saint Joseph Avenue Marshfield WI 54449

Wisconsin


1-866-443-0934

[email protected]


Wisconsin




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Wisconsin



1-714-637-1282

1-714-637-1209

[email protected]



Wisconsin



1-765-526-2515

[email protected]

8990 Duke Drive


Wisconsin




1-972-569-3646

1-972-569-3679

[email protected]


Wisconsin


1-949-252-4339

[email protected]

2300 Main Street


Wisconsin


1-949-221-9994

[email protected]

2300 Main Street


Wisconsin


1-949-252-4339

[email protected]

2300 Main Street


Wisconsin

UNITED HEALTHCARE OF WISCONSIN, INC SecureHorizons Local CCP



1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Wisconsin



1-813-290-6200 3768

[email protected]


Wisconsin



1-813-290-6200 3768

[email protected]


Wisconsin

WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION

WPS Health Insurance PDP

Director Pharmacy Benefits Armstrong David

1-608-226-7883

[email protected]

1717 West Broadway

PO Box 8190 Madison WI 53708

Wyoming



1-386-963-2453

1-860-754-1481

[email protected]


32094-2362

Wyoming



1-386-963-2543

1-860-754-1481

[email protected]


32094-2362

Wyoming


Blue Cross Blue Shield of Wyoming Regional CCP


1-651-662-8758

1-651-662-6009

[email protected]




STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Wyoming


Blue Cross Blue Shield of Wyoming PDP


1-651-662-8758

1-651-662-6009

[email protected]



Wyoming


1-860-226-6731

[email protected]


Wyoming


1-804-965-7658

[email protected]



Wyoming



1-330-405-8080 6320

1-330-405-8081

[email protected]


WyomingEXPRESS SCRIPTS INSURANCE CO. SAMAscript PDP Hirsch Jeff

1-314-810-6102

[email protected]


Wyoming



1-804-965-7658


Wyoming



1-804-965-7658


WyomingFOX INSURANCE COMPANY


1-877-369-9564 113

[email protected]


Wyoming




1-916-463-9603

1-916-463-9750

[email protected]




Wyoming




1-615-565-8110

1-615-234-2154

[email protected]


Wyoming



1-502-580-3538

[email protected]


Wyoming



1-502-580-3538

[email protected]


Wyoming




1-201-269-6717

1-201-269-1008

[email protected]


WyomingMEMBERHEALTH, INC. MEMBERHEALTH PDP


1-440-248-8448 135

1-440-248-1729

[email protected]


Wyoming




1-516-605-6966

1-412-322-2066

[email protected]


Wyoming




1-949-221-9994

1-949-474-4237

[email protected]

2300 Main Street


Wyoming




1-401-333-3987 7941

1-800-373-0238

[email protected]


WyomingROCKY MOUNTAIN HEALTH PLANS

Rocky Mountain Health Plans 1876 Cost

Pharmacy Director Nolan Steve

1-970-244-7760 5182

[email protected] PO Box 10600 Grand Junction CO 81502

Wyoming RXAMERICA, LLC RxAmerica PDPDirector of PDP Operations Low Jeff

1-801-961-6251

[email protected]



STATELEGAL ENTITY

NAME ORGANIZATION


PHONE EXT FAX EMAIL

STREET ADDRESS

STREET ADDRESS

2 CITY STATE ZIP

Wyoming


1-866-443-0934

[email protected]


Wyoming




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Wyoming




1-360-647-9080 29098

1-360-647-8632

[email protected]

2219 Rimland Drive


98227-5348

Wyoming



1-714-637-1282

1-714-637-1209

[email protected]



Wyoming



1-765-526-2515

[email protected]

8990 Duke Drive


Wyoming




1-972-569-3646

1-972-569-3679

[email protected]


Wyoming


1-949-252-4339

[email protected]

2300 Main Street


Wyoming


1-949-252-4339

[email protected]

2300 Main Street


Wyoming



1-813-290-6200 3768

[email protected]


Wyoming



1-813-290-6200 3768

[email protected]



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