Associated Insurance Services, LLC Workers Compensation Claims Folder

Transcription

1 Associated Insurance Services, LLC Workers Compensation Claims Folder 54 Third Avenue * P.O. Box 4070 * Burlington, MA Telephone: / Fax:

2 Associated Insurance Services, LLC 54 Third Avenue, Burlington, MA Workers Compensation Claim Reporting Options - Massachusetts In the event of a serious accident, call us immediately at (toll free 24-hour/7 day a week claim reporting) Choose from several different ways to report your workers compensation claims to us: By Fax: For Medical Only claims, complete and fax the Medical Only/Med-Fax form into us at OR If this, or any work-related injury results in the employee s total or partial incapacity to earn wages for five (5) or more calendar days, complete and fax the Form 101 (Employers First Report of Injury) to us at (Remember to give a copy of the Form 101 to the injured employee.) We will submit the Form 101 to the Department of Industrial Accidents (DIA) when the employee has been totally or partially incapacitated from earning wages for five (5) or more calendar days. On-Line, over the Internet: Sign on to and click Report A Claim. Select To Report A Claim Online and then click on Massachusetts. You will be prompted to answer a series of questions similar to the information necessary to complete a Form 101. After answering all of the questions and clicking on SEND, you will receive a message stating your claim has been submitted. It will also state that a Claim Acknowledgement letter containing the claim number and assigned claim representative will be mailed to your company after registration has been completed. Click Print for a copy of the information you sent. We will submit the Form 101 to the Department of Industrial Accidents (DIA) when the employee has been totally or partially incapacitated from earning wages for five (5) or more calendar days. We will also file a Form 101 with the DIA when a Medical Only claim has been changed to a lost time claim. In the event an employee is incapacitated from earning wages for five (5) calendar days or more, you are responsible for giving the employee a copy of the Form 101. By Phone: Report claims by calling toll free: This line is established for reporting new claims only, and facilitates the initial claim reporting process (see reverse side for outline of required information). You will receive a completed Form 101 and a confirmation letter, followed by a claim acknowledgment letter including the name of the Claim Representative assigned to your case. We will submit the Form 101 to the Department of Industrial Accidents (DIA) when the employee has been totally or partially incapacitated from earning wages for five (5) or more calendar days. We will also file a Form 101 with the DIA when a Medical Only claim has been changed to a lost time claim. In the event an employee is incapacitated from earning wages for five (5) calendar days or more, you are responsible for giving the employee a copy of the Form 101. After the initial claim report: Please direct ongoing claim and service inquiries to your Claim Representative at our toll free telephone number: By Mail: Please refer to the Claim Reporting Procedures in your Claims Folder for instructions.

3 Guide For Reporting Workers Compensation Injuries by phone Call (Toll free 24-hour/7 day a week claim reporting) Here are some key items to note beforehand when calling our toll-free number to report Workers Compensation injuries. However, do not delay in calling if you do not have answers to all of these questions. Insured Information: 13 digit policy number: Line of Business Loss Date Employer Name: Employer Address: Zip Code: Telephone # Fax # Type of Business: Location code, if any (important): Is this the address where the accident happened/loss occurred?: (Y or N) Injured Employee Information: Employee Name: Social Security #: Employee Address: Zip Code: Home Telephone #: Work Telephone #: Gender: Marital Status: # of Dependents: Date of Birth: Job Title: Department: Employment Status: Pay Type ( S-salary, H-hourly) Hired Date: If Salary, what is Annual Salary: If Hourly, what is Hourly Wage: Daily Hours Worked: Days in work week: Supervisor Name: Supervisor Telephone: Time employee began work on day of injury: Employer Notified Date: Regular Occupation: How long has employee been in current job/position: Did the employee miss work beyond his/her normal shift: Accident Information: Time of day or night the incident occurred: Has the employee been disabled 5 or more days: Will the employee be disabled 5 or more days: Has employee Returned To Work (RTW): Date disability began: RTW date # of work days lost: Did employee return to full duty Injury Activity: Injury Description: Type of Inj: Category of Inj: Cause of Inj: Body part: Severity of Injury: Was Medical Treatment provided: Initial place of treatment: Date of fatality: Last day worked: Medical Facility Type: Hospital Name: Address: Zip Code: Telephone #: Admitted to Hospital: Still in Hospital: Is Physician info available: Were there any witnesses present when the injury occurred: Witness Name: Witness Address: Zip Code: Home Telephone #: Work Telephone #: Contact information (if different from person reporting the claim, then name, address and work telephone is needed)

4 Associated Insurance Services, LLC Workers Compensation Claim Reporting Procedures IT IS IMPORTANT THE INSTRUCTIONS IN THESE PROCEDURES BE FOLLOWED EXACTLY AS OUTLINED. Prompt filing of the correct forms with all the necessary information helps speed necessary claim investigations and the proper payments of benefits when due. LATE FILINGS, OR LATE PAYMENTS MAY ALSO RESULT IN PENALTIES IMPOSED ON YOUR COMPANY AND/OR ASSOCIATED INSURANCE SERVICE CORP. Keep in mind: If it s a serious accident, call us immediately: We will file the Massachusetts Form 101 with the Department of Industrial Accidents regardless of the method you use to report a claim to us. If you need additional forms, request them from Associated Insurance Services, LLC ( Claim Services Department).

5 Faxing or Mailing Medical Only Claims to Us Medical Only / Med-Fax Report If you choose to notify us of a Medical Only claim by fax or mail, you need to complete the Associated Insurance Services, LLC Medical Only / Med-Fax Report whenever: you receive a report of an alleged illness or injury, AND that illness or injury IS NOT expected to result in the employee being disabled for five or more calendar days. Section A - The injured worker s supervisor or similar person in authority should complete Section A and the Supervisor action section at the bottom of the form. Don t forget to fill in your location code. Section B - The injured worker should review, sign and date Section B. Section C - If the injured worker requires medical attention, he or she should take the form to the medical provider. The medical provider must complete Section C. Distribution of Copies The medical provider should keep the yellow copy of the form, and the employee should keep the pink copy. The employer should fax the white copy to Associated Insurance Services, LLC at and keep the white copy for its files. Note: Do not file this form with the Department of Industrial Accidents (D.I.A.) If this work related injury results in the employee being disabled for five (5) or more calendar days, please complete a Form 101 and submit it to us by fax or mail. (Remember to give a copy of the Form 101 to the injured employee.) We will then file the Form 101 with the Department of Industrial Accidents. Form 101 Employer s First Report of Injury or Fatality The timely filing of Form 101 is very important. Whenever an alleged work-related injury is reported to you resulting in the employee being disabled for five (5) or more calendar days, a "Form 101-Employer's First Report of Injury" must be completed. A copy of the Form 101 must be given to the injured employee. Don t forget to fill in your location code in Block 22. 2

6 Fax or mail the Form 101 to Associated Insurance Services, LLC as soon as possible. Indemnity payments must be sent out fourteen (14) days from Associated Insurance Services, LLC s receipt of the form. The distribution of Form 101 is as follows: Original: Copy: Copy: ASSOCIATED INSURANCE SERVICES, LLC Claim Department 54 Third Avenue P.O. Box 4070 Burlington, MA Employee Employer's File Copy Associated Insurance Services, LLC will file the Form 101 with the: Department of Industrial Accidents Department Congress Street 10 th Floor Boston, MA ON THE DAY AN EMPLOYEE who had five (5) or more calendar days of disability RETURNS TO WORK, PLEASE CALL Associated Insurance Services, LLC s Claim Department at and report the return. FORM 127 Average Weekly Wage Computation Schedule FORM 127 or a similar 52-week gross payroll report must be completed and distributed by the employer immediately after filing Form 101. It is to be distributed as follows: Original: Copy: ASSOCIATED INSURANCE SERVICES, LLC Claim Department 54 Third Avenue P.O. Box 4070 Burlington, MA Employer's File Copy This form is necessary every time a Form 101 is filed. It is used to calculate accurate benefits for the injured employee. 3

7 FORM AIS 20 Request for Medical Services Whenever there is a work related injury that requires medical attention, a form, "AIS 20 - Request for Medical Services," should be completed. It should be signed by the employer, and then given to the employee. The completed form should then be presented by the employee to the hospital or physician when the employee seeks medical services. This will facilitate the medical provider's billing to Associated Insurance Services, LLC. IMPORTANT 1. THE FILING OF FORM 101 with the Department of Industrial Accidents and/or Associated Insurance Service LLC IS NOT AN AGREEMENT THERE HAS BEEN A WORKPLACE INJURY. 2. Associated Insurance Services, LLC will be filing the Form 101 with the Department of Industrial Accidents. If a claim originally reported as a medical only claim becomes a lost time claim, notify the Claim Department at (Note: A copy of the Form 101 must be provided to the injured employee.) 3. FORM 127 OR SIMILAR PAYROLL REPORT SHOULD BE FILED IMMEDIATELY AFTER FORM 101 IS FILED. This report is used to determine the amount of the employee's indemnity payment. Failure to make these payments within the time allowed by law may result in penalties. 4. If you have any questions regarding the requirements of the Department of Industrial Accidents, you may call their Information Desk on the toll free hotline: or call Associated Insurance Services, LLC s Claim Department at For assistance in completing these forms, follow the enclosed samples and instructions. 4

8 A.I.M. Works TM Fax this report to AIS LLC at Tel. No S E C T I O N A S U P E R V I S O R DO NOT File This Form With The Dept. of Industrial Accidents MedFax Rev. 1/06 Employee Name (Last, First, MI): Employee Telephone: Social Security Number: ( ) Employee Address: Sex: Date of Birth: ( ) F ( ) M / / Insurer: Location Code: Marital Status: P.O. Box 4070, Burlington, MA ( ) Single ( ) Married Employer: Employer Telephone: Policy Number: ( ) - Employee Occupation: Witness to Accident: Date of incident: Time of incident: / / ( )AM ( )PM Date of hire: Date assigned to present position: Date incident reported: To Whom: Returned to work: / / / / / / ( ) Yes ( ) No Address where injury occurred (If different from Employer above): Date of Return to Work: Returned to Regular Job: / / ( ) Yes ( ) No Type of injury (Burn, Fracture, Cut, etc.): Average 52 Week Wage: $ ( ) Estimated ( ) Actual Injured Body Part(s) (Arm, Leg, Back, etc.): Source of injury (Chemicals, Machinery, Name of Employer s Claim Coordinator: etc.): Height: ft. in. Weight: Smoker: ( ) Yes ( ) No If yes, # pack(s) per day: Describe what happened: Supervisor Signature: Date: / / S E C T I O N B S E C T I O N C M E D I C A L P R O V I D E R Medical Authorization: In accordance with state law, I, the undersigned, authorize Associated Insurance Services LLC, as a workers compensation claim service provider, and its authorized agents or representatives, as well as my employer to be furnished with any information or facts regarding this injury only, including records, diagnosis, medical treatment and prognosis, estimates of disability and recommendations for further treatment. This information is to be used for the sole purpose of evaluating and handling my claim and to assure timely medical care as a result of the incident occurring on or about the above noted date and for no other purpose, now or in the future. I also agree that a photocopy of this release is as valid as the original. Employee Signature: Date: / / I do not want medical treatment for this injury Employee Signature: Date: / / TREATMENT AREA USE ONLY (To be filled out by Medical Care Provider) Name of Provider: Date: / / Arrival Time: ( )AM ( )PM Accident Description: Preliminary Diagnosis: New Injury/Illness: ( )Yes( )No Related to above incident at work: ( )Yes ( )No ( )Undetermined Pre-existing Condition: ( )Yes ( )No Height: ft. in Weight: lbs. Smoker: ( ) Yes ( ) No If yes, # pack(s) per day Recommended Work Status: (Check one and provide additional information as appropriate) Full Duty ( ) Modified Duty ( ) Full Duty to resume on: / / Unable To Immediately Return To Work ( ) Modified duty to begin: / / Full Duty to resume on: / / May lift up to: 5 lbs. ( ) 25 lbs. ( ) 40 lbs. ( ) 75 lbs. ( ) No lifting ( ) May carry up to: 5 lbs. ( ) 25 lbs. ( ) 40 lbs. ( ) 75 lbs. ( ) No carrying ( ) May Push/Pull up to: 5 lbs. ( ) 25 lbs. ( ) 40 lbs. ( ) 75 lbs. ( ) No pushing/pulling ( ) Other Duty Modifications: Physician Comments: Follow-Up Appointment With: Date: / / Time: ( ) AM ( ) PM Physician/Clinician Name: Tel. #: ( ) - (Please print legibly) Physician/Clinician Signature: Date: / / SUPERVISOR ACTION: ( ) Returned to Work ( ) Modified Duty ( ) Send Home ( ) Send for Treatment ( ) Notice Only ( ) Medical Only ( ) Lost Industry Code: (see instruction sheet) Employer Copy - WHITE Medical Provider YELLOW Employee Copy PINK

9 Supervisor s Instructions for Completion of the MEDICAL ONLY/MED FAX Report All work related incidents are to be promptly reported to the immediate department supervisor on duty who will complete this form. EMERGENCIES In life threatening situations, seek medical attention immediately; then proceed with completion of this form. NON-EMERGENCIES SUPERVISOR - EMPLOYEE - PHYSICIAN - Complete SUPERVISOR SECTION (top portion) upon report of injury. If medical attention is refused or not needed, complete SUPERVISOR ACTION section, (bottom of form) and send all copies to Human Resources office. Sign the AUTHORIZATION section. If you do not want medical treatment; also sign the next section indicating you do not wish to have medical treatment. Complete the MEDICAL TREATMENT SECTION and sign. Keep the Yellow copy. When outside medical attention is needed, employee is escorted to appropriate treatment site with WHITE and YELLOW copies. The PINK copy is for the Employee. The YELLOW copy is for the Physician. Return the WHITE copy to Human Resources. AIM Works Immediate Care Facility EMPLOYEE AFTER IMMEDIATE CARE RENDERED - Return to supervisor following treatment with completed WHITE form. Keep the YELLOW form. SUPERVISOR - Based on medical instructions (MEDICAL TREATMENT section) employee will return to work on full or modified duty, or be sent home. - Forward the completed WHITE form to AIS LLC within 24 hours. Agriculture, Forestry and Fishing 01 Agriculture Production - Crops 02 Agriculture Production - Livestock 03 Agriculture Services 04 Forestry 05 Fishing, Hunting and Trapping Mining 10 Metal Mining 12 Coal Mining 13 Oil and Gas Extraction 14 Nonmetallic Minerals, Except Fuels Construction 15 General Building Contractors 16 Heavy Construction, Ex. Building 17 Special Trade Contractors Manufacturing 20 Food and Kindred Productions 21 Tobacco Products 22 Textile Mill Products 23 Apparel and Other Textile Products 24 Lumber and Wood Products 25 Furniture and Fixtures 26 Paper and Allied Products 27 Printing and Publishing 28 Chemicals and Allied Products 29 Petroleum and Coal Products 30 Rubber and Misc. Plastics Products 31 Leather and Leather Products 32 Stone, Clay and Glass Products 33 Primary Metal Industries 34 Fabricated Metal Products 35 Industrial Machinery and Equipment 36 Electronic and Other Electric Equipment 37 Transportation Equipment 38 Instruments and Related Products 39 Miscellaneous Manufacturing Industries Transportation and Public Utilities 40 Railroad Transportation 41 Local and Interurban Passenger Transit 42 Trucking and Warehousing 43 U.S. Postal Service 44 Water Transportation 45 Transportation by Air 46 Pipelines, Except Natural Gas 47 Transportation Services 48 Communications 49 Electric Gas and Sanitary Services INDUSTRY CODES Wholesale Trade 50 Wholesale Trade Durable Goods 51 Wholesale Trade Nondurable Goods Retail Trade 52 Building Materials and Garden Supplies 53 General Merchandising Stores 54 Food Stores 55 Automotive Dealers and Service Stations 56 Apparel and Accessory Stores 57 Furniture and Homefurnishing Stores 58 Eating and Drinking Places 59 Miscellaneous Retail Finance, Insurance and Real Estate 60 Depository Institutions 61 Nondepository Institutions 62 Security and Commodity Brokers 63 Insurance Carriers 64 Insurance Agents, Brokers and Service 65 Real Estate 67 Holding and Other Investment Offices Services 70 Hotels and Other Lodging Places 72 Personal Services 73 Business Services 75 Auto Repair Services and Parking 76 Miscellaneous Repair Services 78 Motion Pictures 79 Amusement and Recreation Services 80 Health Services 81 Legal Services 82 Educational Services 83 Social Services 84 Museums, Botanical, Zoological Gardens 86 Membership Organizations 87 Engineering and Management Services 88 Private Households 89 Services, NEC Public Administration 91 Executive, Legislative and Garden 92 Justice, Public Order and Safety 93 Finance, Taxation and Monetary Policy 94 Administration of Human Resources 95 Environmental Quality and Housing 96 Administration of Economic Programs 97 National Security and International Affairs Nonclassifiable Establishments 99 Nonclassifiable Establishments

10 Associated Insurance Services, LLC HOW TO COMPLETE THE MEDICAL ONLY / MED-FAX REPORT Section A Supervisor #1 Please print or type the employee's last name, first name and middle initial, as you know it. #2 Please print or type the employee's current home telephone number. #3 Please print or type the nine (9) digit employee's social security number. #4 Please print or type the employee's current full home address. #5 Please check box indicating employee's sex. #6 Please print or type employee's birth date (MM/DD/YY). #7 Insurer name and address is already printed here for you. #8 If applicable, please print or type the location code. #9 Please check box indicating marital status. #10 Please print or type employer's name. #11 Please print or type employer's telephone number. #12 Please print or type your Workers Compensation policy number. #13 Please print or type employee's regular occupation or job description. #14 Please indicate if there was a witness(es) to the injury. If yes, specify name and position of individual(s). #15 Please print or type the date the injury or illness happened or was alleged to have happened. #16 Please print or type the time the injury or illness happened or was alleged to have happened. Check a.m. or p.m. #17 Please print or type employee's date of hire (MM/DD/YY). #18 Please print or type the date the employee was assigned to his/her present position (MM/DD/YY). #19 Please print or type the date the injury or illness was reported. #20 Please print or type the person and position to whom the injury or illness was reported. #21 Please indicate if employee has returned to work. #22 Please print or type the address where injury occurred. #23 Please print or type the date of return to work (MM/DD/YY) if employee has returned to work. #24 Please indicate if employee has returned to his/her regular position. #25 Please print or type a description of injury or illness. #26 Please print or type the average 52-week wage amount earned. Also check box indicating if estimated salary or actual salary earned. #27 Please specify the injured body part(s). #28 Please print or type the source of injury (e.g., machine, tool, substance, etc.) #29 Please print or type the name of the employer s claim coordinator. #30 Record the employee s height in feet and inches. #31 Record the employee s weight. #32 Indicate if the employee is a smoker and, if yes, how many packs per day he/she smokes. #33 Please describe in detail what happened. #34 The supervisor should sign and date the form. 5/2006

11 Section B: #1 The employee must sign and date where indicated in Section B to either: a) provide medical authorization, or (b) decline medical treatment for this injury Section C: To be filled out by Medical Care Provider #1 Please print or type the name of the medical care provider. #2 Please print the date and time the employee arrived in the medical care facility. Check a.m. or p.m. #3 Please provide a description of the accident. #4 Please provide the preliminary diagnosis and indicate whether this is a new injury or illness. Indicate if this diagnosis is related to the incident being reported or if it is a pre-existing condition. #5 Please provide height and weight information as well as any smoking history. #6 Please indicate whether full or modified duty work status is recommended. #7 If modified duty is recommended, specify when full duty can resume. #8 Check here if employee is unable to immediately return to work. Then specify when modified duty can begin and when full duty can resume. #9 Specify what limits employee may lift up to, carry up to, and push or pull up to. #10 Please note any other duty modifications that may be necessary. #11 Please include additional comments that the employer should know about. #12 Please note with whom the employee has a follow-up appointment as well as the date and time of the appointment. #13 Please print the name of the treating physician or clinician and his/her phone number. #14 The treating physician or clinician should then sign and date the Report. Supervisor Action #1 Check what action was taken following the injury or illness: returned to work, modified duty, sent home, or sent for treatment. #2 Indicate whether this was a notice only (no treatment necessary), whether the incident required medical attention only, or whether lost work time was involved. #3 Please print or type the exact two (2) digit industry code number from the chart below that best describes the main product produced or the service or type of business the employer is engaged in. Agriculture, Forestry and Fishing 01 Agriculture Production - Crops 02 Agriculture Production - Livestock 03 Agriculture Services 04 Forestry 05 Fishing, Hunting and Trapping Mining 10 Metal Mining 12 Coal Mining 13 Oil and Gas Extraction 14 Nonmetallic Minerals, Except Fuels Construction 15 General Building Contractors 16 Heavy Construction, Ex. Building 17 Special Trade Contractors Manufacturing 20 Food and Kindred Productions 21 Tobacco Products 22 Textile Mill Products 23 Apparel and Other Textile Products 24 Lumber and Wood Products 25 Furniture and Fixtures 26 Paper and Allied Products 27 Printing and Publishing 28 Chemicals and Allied Products 29 Petroleum and Coal Products 30 Rubber and Misc. Plastics Products 31 Leather and Leather Products 32 Stone, Clay and Glass Products 33 Primary Metal Industries 34 Fabricated Metal Products 35 Industrial Machinery and Equipment 36 Electronic and Other Electric Equipment 37 Transportation Equipment 38 Instruments and Related Products 39 Miscellaneous Manufacturing Industries Transportation and Public Utilities 40 Railroad Transportation 41 Local and Interurban Passenger Transit 42 Trucking and Warehousing 43 U.S. Postal Service 44 Water Transportation 45 Transportation by Air 46 Pipelines, Except Natural Gas 47 Transportation Services 48 Communications 49 Electric Gas and Sanitary Services INDUSTRY CODES Wholesale Trade 50 Wholesale Trade Durable Goods 51 Wholesale Trade Nondurable Goods Retail Trade 52 Building Materials and Garden Supplies 53 General Merchandising Stores 54 Food Stores 55 Automotive Dealers and Service Stations 56 Apparel and Accessory Stores 57 Furniture and Homefurnishing Stores 58 Eating and Drinking Places 59 Miscellaneous Retail Finance, Insurance and Real Estate 60 Depository Institutions 61 Nondepository Institutions 62 Security and Commodity Brokers 63 Insurance Carriers 64 Insurance Agents, Brokers and Service 65 Real Estate 67 Holding and Other Investment Offices Services 70 Hotels and Other Lodging Places 72 Personal Services 73 Business Services 75 Auto Repair Services and Parking 76 Miscellaneous Repair Services 78 Motion Pictures 79 Amusement and Recreation Services 80 Health Services 81 Legal Services 82 Educational Services 83 Social Services 84 Museums, Botanical, Zoological Gardens 86 Membership Organizations 87 Engineering and Management Services 88 Private Households 89 Services, NEC Public Administration 91 Executive, Legislative and Garden 92 Justice, Public Order and Safety 93 Finance, Taxation and Monetary Policy 94 Administration of Human Resources 95 Environmental Quality and Housing 96 Administration of Economic Programs 97 National Security and International Affairs Nonclassifiable Establishments 99 Nonclassifiable Establishments 5/2006

12 E M P L O Y E E FORM 101 The Commonwealth of Massachusetts Department of Industrial Accidents Department Congress Street 10th Floor, Boston, Massachusetts Info. Line ext. 470 in Mass. Outside Mass ext EMPLOYER S FIRST REPORT OF INJURY OR FATALITY DIA USE ONLY THIS FORM MUST BE FILED BY THE EMPLOYER IN THE EVENT OF AN INJURY THAT RESULTS IN DEATH OR FIVE OR MORE CALENDAR DAYS OF TOTAL OR PARTIAL INCAPACITY FROM EARNING WAGES. INSTRUCTIONS AND CODES ON THE REVERSE SIDE - Please Print Legibly or Type - Unreadable forms will be returned. 1. Employee s Name (Last, First, MI): 2. Home Telephone Number: 3. Social Security Number*: 4. Sex: M 5. Home Address (No., Street, City, State & Zip Code): 5a. Native Language Code: 6. Marital Status: 7. No. of Dependents: M S Other: 8. Date of Hire (mm/dd/yyyy): 9. Date of Birth (mm/dd/yyyy): 10. Average Weekly Wage: $ Estimated Actual 11. Employer s Name: 12. Federal Tax I.D. Number: F E M P L O Y E R I N J U R Y I N F O R M A T I O N 13. Employer s Address (No., Street, City, State & Zip Code): 14. Employer s Telephone Number: 16. Workers Compensation Insurance Carrier and Tel. No. (NOT LOCAL AGENT/ADMINISTRATOR): 17. W.C. Policy Number: 18. Self-Insured? Yes No If Yes, Self-Insurer Number: 20. DATE OF INJURY (mm/dd/yyyy): 21. Was Employee Injured on Employer s Premises? Yes No 23. FIRST day of Total or Partial Incapacity to Earn Wages (mm/dd/yyyy): 25. If Employee has Died, Date of Death (mm/dd/yyyy): 27. Briefly Describe How Injury/Exposure Occurred and Body Part(s) involved: 28. Person to Whom Injury was Reported (list position): 31. Injury Code(s) a. to body part b. to body part c. to body part Body Part Code(s) a. b. c. 15. Industry Code (See Reverse Side): 19. Business Type : Service Wholesale Mfg. Retail Other 20a. Insurer s Case/Claim File No.: 22. Location of Injury if not on Employer s Premises: 24. FIFTH day of Total or Partial Incapacity to Earn Wages (mm/dd/yyyy): 26. Source of Injury (Chemicals, Machinery, etc.): 29. Date Reported (mm/dd/yyyy): 30. Date Reported as work related (mm/dd/yyyy): 32. Witness(es) to Injury - Give Full Name(s), if none state as such: 33. Has Employee Returned to Work? Yes No 34. Date Employee Returned to Work(mm/dd/yyyy): 35. Employee s Regular Occupation: 36. Has Employee Returned to Regular Occupation: Yes No P R E P A R E R 37. PREPARER S Name (SEE INSTRUCTIONS ON REVERSE SIDE): 38. PREPARER S Title: 39. PREPARER S Signature (SEE INSTRUCTIONS ON REVERSE SIDE): 40. Date Prepared (mm/dd/yyyy): 40a. PREPARER S address: *Disclosure of Social Security Number is Voluntary. It will aid in the processing of your report. Form Revised 5/ Reproduce as needed. THIS FORM DOES NOT CONSTITUTE AN EMPLOYEE S CLAIM FOR BENEFITS UNDER WORKERS COMPENSATION.

13 EMPLOYER S FIRST REPORT OF INJURY OR FATALITY FILING INSTRUCTIONS 1. WHEN TO FILE: File this form within 7 calendar days, not including Sundays and legal holidays, of receipt of notice of any injury alleged to have arisen out of and in the course of employment, which totally or partially incapacitates an employee for a period of 5 or more calendar days from earning wages. This form is not an admission of liability, but must be filed even though the Employer may believe that the Employee is not injured, or that the Employee is not entitled to benefits under M.G.L. Chapter WHERE TO FILE: This form should be mailed to the Department of Industrial Accidents at the address shown on the front of the form. Copies must also be provided to the Employee and to the Employer s Workers Compensation insurer. 3. PENALTIES: Failure to report injuries on this form may result in a fine of $ in accordance with M.G.L. Chapter 152, Section EMPLOYER S NAME & SIGNATURE IN BOXES 37 & 39: This form must be filed by the employer or an authorized agent/representative of the employer. NATIVE LANGUAGE CODES 1 English / 2 Portuguese / 3 Haitian Creole / 4 Spanish / 5 Chinese / 6 Vietnamese / 7 Cape Verdean / 9 Other INDUSTRY CODES Agriculture, Forestry and Fishing 01 Agriculture Production - Crops 02 Agriculture Production - Livestock 07 Agricultural Services 08 Forestry 09 Fishing, Hunting and Trapping Mining 10 Metal Mining 12 Coal Mining 13 Oil and Natural Gas 14 Nonmetallic Minerals, Except Fuels Construction 15 General Building Contractors 16 Heavy Construction, Ex. Building 17 Special Trade Contractors Manufacturing 20 Food and Kindred Products 21 Tobacco Products 22 Textile Mill Products 23 Apparel and Other Textile Products 24 Lumber and Wood Products 25 Furniture and Fixtures 26 Paper and Allied Products 27 Printing and Publishing 100 Amputation or Erucloation 110 Asphyxia or Strangulation Etc. 120 Burns (Heat) 130 Burns (Chemical) 140 Concussion 160 Contusion, Crushing, Bruise 170 Cut, Laceration, Puncture 190 Dislocation 200 Electric Shock, Electrocution 210 Fracture 250 Hernia, Rupture 300 Scratches, Abrasions 310 Sprains, Strains 400 Multiple Injuries 900 No Injury 950 Damage to Prosthetic Devices 995 No Other Injury, NEC** 999 Non-classifiable Infective or Parasitic Disease 150 Infective or Parasitic Disease, UNS* 151 Amebiasis 152 Anthrax 153 Brucellosis 154 Conjunctivitis and Opthalmia 156 Tetanus Head 100 Head, UNS* 110 Brain 120 Ear(s), UNS* 121 Ear(s), External 124 Ear(s), Internal 130 Eye(s), UNS* 140 Face, UNS* 141 Jaw, Chin 144 Mouth and Throat (vocal chords, larynx) 146 Nose 148 Face, Multiple Parts 149 Face, NEC** 150 Scalp 28 Chemicals and Allied Products 29 Petroleum and Coal Products 30 Rubber and Misc. Plastic Products 31 Leather and Leather Products 32 Stone, Clay and Glass Products 33 Primary Metal Industries 34 Fabricated Metal Products 35 Industrial Machinery and Equipment 36 Electronic and Other Electrical Equipment 37 Transportation Equipment 38 Instruments and Related Products 39 Miscellaneous Manufacturing Industries Transportation and Public Utilities 40 Railroad Transportation 41 Local and Interurban Passenger Transit 42 Trucking and Warehousing 43 U.S. Postal Service 44 Water Transportation 45 Transportation by Air 46 Pipelines, Except Natural Gas 47 Transportation Services 48 Communications 49 Electric, Gas and Sanitary Services Wholesale Trade 50 Wholesale Trade - Durable Goods 51 Wholesale Trade - Non-durable Goods Retail Trade 52 Building Materials and Garden Supplies 53 General Merchandizing 54 Food Stores 55 Automotive Dealers and Service Stations 56 Apparel and Accessory Stores 57 Furniture and Home Furnishing Stores 58 Eating and Drinking Establishments 59 Miscellaneous Retail Finance, Insurance and Real Estate 60 Depository Institutions 61 Non-depository Institutions 62 Security and Commodity Brokers 63 Insurance Carriers 64 Insurance Agents, Brokers and Service 65 Real Estate 67 Holding and Other Investment Officers Services 70 Hotels and Other Lodging Places 72 Personal Services 73 Business Services 75 Auto Repair Services and Parking 76 Miscellaneous Repair Services NATURE OF INJURY OR ILLNESS CODES 157 Tuberculosis 159 Other Infective or Parasitic Diseases Dermatitis 180 Dermatitis, UNS* 183 Primary Infections of the Skin 184 Other Skin Conditions 185 Dermatitis, Allergenic or Contact 189 Skin Condition, NEC** Poisoning Systemic 270 Poisoning, Systemic, UNS* 271 Due to Toxic Materials other than Lead 272 Diseases of the Blood and Blood Forming Organs 273 Upper Respiratory Conditions 274 Influenza, Pneumonia, Etc. 276 Other Diseases of the Gastro-Intestinal Tract 278 Effects of Lead 279 Other Toxic Effects of One System Only Respiratory Systems, Conditions of 570 Respiratory Systems, Conditions of 571 Upper Respiratory 572 Asthma, Influenza, Pneumonia Pneumoconiosis 280 Pneumoconiosis 160 Skull 198 Head Multiple 200 Neck & Cervical Vertebrae UPPER EXTREMITIES 300 Upper Extremities, NEC** 310 Arm(s), UNS* 311 Upper Arm 313 Elbow(s) 315 Forearm(s) 318 Arm(s), Multiple 319 Arm(s), NEC** 320 Wrist(s) 330 Hand(s), Not Wrists or Fingers 340 Finger(s) 281 Aluminosis 282 Anthracosis 283 Asbestosis 284 Byssinosis 285 Siderosis 286 Silicosis 287 Other Pneumoconioses 289 Pneumoconiosis and Tuberculosis Nervous System, Conditions of 560 Nervous System, Conditions of - NEC** 561 Diseases of the Central Nervous System 562 Diseases of the Nerves and Peripheral Ganglia Neoplasm Tumor 550 Neoplasm Tumor, UNS* 551 Malignant 552 Benign Radiation Effects 290 Radiation Effects, UNS* 291 Non-Ionizing Radiation 292 Microwaves 293 Ionizing Radiation - X-Ray 294 Ionizing Radiation - Isotopes 295 Welder s Flash BODY PART AFFECTED CODES 398 Upper Extremities, Multiple 400 Trunk, UNS* 410 Abdomen, Internal Organs, Inguinal Hernia 420 Back 430 Chest, Ribs, Breastbone, Internal Organs 440 Hip(s)..,Pelvis, Organs and Buttocks 450 Shoulder(s) 498 Trunk, Multiple LOWER EXTREMITIES 500 Lower Extremities 510 Leg(s), UNS* 78 Motion Pictures 79 Amusements and Recreation Services 80 Health Services 81 Legal Services 82 Educational Services 83 Social Services 84 Museums, Botanical, Zoological Gardens 86 Membership Organizations 87 Engineering and Management Services 88 Private Households 89 Services, NEC Public Administration 91 Executive, Legislative and Garden 92 Justice, Public Order, and Safety 93 Finance, Taxation, and Monetary Benefits 94 Administration of Human Services 95 Environmental Quality and Housing 96 Administration of Economic Program 97 National Security and International Affairs Non-classifiable Establishments 99 Non-classifiable Establishments Other 265 Carpal Tunnel Syndrome 510 Cardiovascular and Other Conditions of the Circulatory System 520 Complications Peculiar to Medical Care 500 Effects of Changes in Atmospheric Pressure 240 Effects of Environmental Heat 220 Effects of Exposure to Low Temperature 530 Eye, other Diseases of the Eye 230 Hearing Loss or Impairment 991 Heart Condition,Excludes Heart Attack 320 Hemorrhoids 330 Hepatitis, Serum and Infective 275 Hepatitis, Toxic 260 Inflammation of Joints, Etc. 540 Mental Disorders 900 No Illness 999 Non-classifiable 990 Occupational Disease, NEC** 580 Symptoms and Ill-defined Conditions 513 Knee(s) 515 Lower Leg(s) 518 Leg(s), Multiple 519 Leg(s), NEC** 520 Ankle(s) 530 Foot or Feet, Not Ankle 540 Toe(s) 598 Lower Extremities, Multiple 700 MULTIPLE PARTS Applies when more than one major body part as been effected such as an arm and a leg 999 NON-CLASSIFIABLE - Insufficient information to identify part of body effected. Includes damage to prosthetic devises. *UNS - UNSPECIFIED **NEC - NOT ELSEWHERE CLASSIFIED

14 HOW TO COMPLETE "EMPLOYER'S FIRST REPORT OF INJURY - FORM 101" Box #1 Box #2 Box #3 Box #4 Box #5 Please print or type the employee's last name, first name and middle initial, as you know it. Please print or type the employee's current home telephone number. Please print or type the nine (9) digit employee's social security number. Disclosing this number is voluntary, but it helps the Department of Industrial Accidents (DIA) keep more accurate records. Please check box indicating employee's sex. Please print or type the employee's current full home address. Box #5a Please print or type the Native Language Code (found on the reverse side of Form 101). Box #6 Box #7 Box #8 Box #9 Box #10 Box #11 Box #12 Box #13 Box #14 Box #15 Box #16 Box #17 Box #18 Box #19 Box #20 Rev. 5/2009 Please check box indicating marital status. Please print or type the number of dependents employee has (including spouse). Please print or type employee's date of hire (MM/DD/YY). Please print or type employee's birth date (MM/DD/YY). Please print or type the average 52-week wage amount earned. Also check box indicating if estimated salary or actual salary earned. Please print or type employer's name. Please print or type your nine (9) digit Federal Tax ID Number. Please print or type your full business address. This is important because this is the address that the DIA will use to correspond with you. Please print or type employer's telephone number, Please print or type the exact two (2) digit industry code number from the chart on the back of the form that best describes the main product produced or the service or type of business the employer is engaged in. Please print or type the name and phone of your Workers Compensation Insurance Carrier (Associated Insurance Services LLC ). Please print or type your Workers Compensation policy number. Please indicate yes in box. Please indicate nature of business in block which best describes the employer s operations. Please print or type the date the injury or illness was alleged or reported to you as having happened by any source (including the employee's legal representative).

15 Box #20a Box #21 Box #22 Box #23 Box #24 Box #25 Box #26 Box #27 Box #28 Please print or type the 10-digit Insurer s Case/Claim File Number if known. Please check appropriate box to indicate if injury occurred on employer's premises. Please print or type the address where injury occurred (if different from #13 above). Please print or type the first day, which an alleged injury totally or partially incapacitates an employee from earning full wages, no matter how minor the reduction. Please print or type the fifth calendar day for which an employee is incapacitated from earning full wages because of an alleged injury arising out of and in the course of employment Please print or type date of death (MM/DD/YY) if employee has died. Please print or type the source of injury (e.g., machine, tool, substance, etc.) Please print or type a description of injury or illness. Please print or type the name of the person and position, to whom the injury was reported. Box #29 Please print or type the date the injury was first reported to the individual in Box 28. Box #30 Box #31 Box #32 Box #33 Box #34 Box #35 Box #36 Box #37 Box #38 Box #39 Box #40 Box #40a Please print or type the date the injury was first reported as work related. Please print or type the nature of the injury or illness from the codes printed on the back of the form. You may have more than one type of illness or injury from an accident. What body part(s) has been injured or affected? Please indicate if there was a witness(es) to the injury in the appropriate box. If yes, specify name and position of individual(s). Please indicate if employee has returned to work. Please print or type the date of return (MM/DD/YY) if employee has returned to work. Please print or type employee's regular occupation or job description. Please indicate if employee has returned to his/her regular occupation. Please print or type your name. Please print or type your title. Please sign your name. Please date this form. Please include the preparer s address. Rev. 5/2009

16 E M P L O Y E E FORM 101 The Commonwealth of Massachusetts Department of Industrial Accidents Department Congress Street 10th Floor, Boston, Massachusetts Info. Line ext. 470 in Mass. Outside Mass ext EMPLOYER S FIRST REPORT OF INJURY OR FATALITY DIA USE ONLY THIS FORM MUST BE FILED BY THE EMPLOYER IN THE EVENT OF AN INJURY THAT RESULTS IN DEATH OR FIVE OR MORE CALENDAR DAYS OF TOTAL OR PARTIAL INCAPACITY FROM EARNING WAGES. INSTRUCTIONS AND CODES ON THE REVERSE SIDE - Please Print Legibly or Type - Unreadable forms will be returned. 1. Employee s Name (Last, First, MI): 2. Home Telephone Number: 3. Social Security Number*: 4. Sex: M 5. Home Address (No., Street, City, State & Zip Code): 5a. Native Language Code: 6. Marital Status: 7. No. of Dependents: M S Other: 8. Date of Hire (mm/dd/yyyy): 9. Date of Birth (mm/dd/yyyy): 10. Average Weekly Wage: $ Estimated Actual 11. Employer s Name: 12. Federal Tax I.D. Number: F E M P L O Y E R I N J U R Y I N F O R M A T I O N 13. Employer s Address (No., Street, City, State & Zip Code): 14. Employer s Telephone Number: 16. Workers Compensation Insurance Carrier and Tel. No. (NOT LOCAL AGENT/ADMINISTRATOR): 17. W.C. Policy Number: 18. Self-Insured? Yes No If Yes, Self-Insurer Number: 20. DATE OF INJURY (mm/dd/yyyy): SAMPLE 21. Was Employee Injured on Employer s Premises? Yes No 23. FIRST day of Total or Partial Incapacity to Earn Wages (mm/dd/yyyy): 25. If Employee has Died, Date of Death (mm/dd/yyyy): 27. Briefly Describe How Injury/Exposure Occurred and Body Part(s) involved: 28. Person to Whom Injury was Reported (list position): 31. Injury Code(s) a. to body part b. to body part c. to body part Body Part Code(s) a. b. c. 15. Industry Code (See Reverse Side): 19. Business Type : Service Wholesale Mfg. Retail Other 20a. Insurer s Case/Claim File No.: 22. Location of Injury if not on Employer s Premises: 24. FIFTH day of Total or Partial Incapacity to Earn Wages (mm/dd/yyyy): 26. Source of Injury (Chemicals, Machinery, etc.): 29. Date Reported (mm/dd/yyyy): 30. Date Reported as work related (mm/dd/yyyy): 32. Witness(es) to Injury - Give Full Name(s), if none state as such: 33. Has Employee Returned to Work? Yes No 34. Date Employee Returned to Work(mm/dd/yyyy): 35. Employee s Regular Occupation: 36. Has Employee Returned to Regular Occupation: Yes No P R E P A R E R 37. PREPARER S Name (SEE INSTRUCTIONS ON REVERSE SIDE): 38. PREPARER S Title: 39. PREPARER S Signature (SEE INSTRUCTIONS ON REVERSE SIDE): 40. Date Prepared (mm/dd/yyyy): 40a. PREPARER S address: *Disclosure of Social Security Number is Voluntary. It will aid in the processing of your report. Form Revised 5/ Reproduce as needed. THIS FORM DOES NOT CONSTITUTE AN EMPLOYEE S CLAIM FOR BENEFITS UNDER WORKERS COMPENSATION.

17 FORM 127 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street 10th Floor, Boston, Massachusetts Info. Line ext. 470 in Mass. Outside Mass ext AVERAGE WEEKLY WAGE COMPUTATION SCHEDULE DIA USE ONLY Print or Type 1. Employer s Name and Address: 2. Insurer s Case File #: 3. DIA Board # (if known): 4. Employee s Name and Address: 5. # of dependent children: 6. # of other dependents: 7. Date of Injury (mm/dd/yyyy): 8. Date of Disability (mm/dd/yyyy): 9. Date of Employment (mm/dd/yyyy): 10. Has employee been certified by U.S. Veterans Administration for any type of disability? Yes No Indicate only those wages earned by the injured worker during the 52 week period immediately preceding the accident. If the injured employee has worked for less than 52 weeks, report wages from the time worked and, for the remaining weeks on this schedule, substitute wages of a fellow employee in the same class of employment who has worked for one year or more. 11. Week No. Year: Week Ending Month Day Gross Amount Before Taxes Week No. Year: Week Ending Month Day Gross Amount Before Taxes Week No. Year: Week Ending Month Day Gross Amount Before Taxes Total: 12. Was room furnished to the employee? Yes No 13. If tips or other benefits were earned, describe and state value per week: THIS IS A TRUE COPY OF THE PAYROLL RECORD OF THE ABOVE NAMED EMPLOYEE OR FELLOW EMPLOYEE IN THE SAME CLASS OF EMPLOYEMENT 14. Name of Fellow Employee (if applicable): 15. Employer/Preparer Signature: 16. Date Signed (mm/dd/yyyy): Make any comments on the reverse side of this form or on a separate sheet. Form Created 8/2005 Reproduce as needed.

18 FORM 127 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street 10th Floor, Boston, Massachusetts Info. Line ext. 470 in Mass. Outside Mass ext AVERAGE WEEKLY WAGE COMPUTATION SCHEDULE DIA USE ONLY Print or Type 1. Employer s Name and Address: 2. Insurer s Case File #: 3. DIA Board # (if known): 4. Employee s Name and Address: 5. # of dependent children: 6. # of other dependents: 7. Date of Injury (mm/dd/yyyy): 8. Date of Disability (mm/dd/yyyy): 9. Date of Employment (mm/dd/yyyy): 10. Has employee been certified by U.S. Veterans Administration for any type of disability? Yes No Indicate only those wages earned by the injured worker during the 52 week period immediately preceding the accident. If the injured employee has worked for less than 52 weeks, report wages from the time worked and, for the remaining weeks on this schedule, substitute wages of a fellow employee in the same class of employment who has worked for one year or more. 11. Week No. Year: Week Ending Month Day Gross Amount Before Taxes Week No. Year: Week Ending Month Day Gross Amount Before Taxes Week No. Year: Week Ending Month Day Gross Amount Before Taxes Total: 12. Was room furnished to the employee? Yes No 13. If tips or other benefits were earned, describe and state value per week: THIS IS A TRUE COPY OF THE PAYROLL RECORD OF THE ABOVE NAMED EMPLOYEE OR FELLOW EMPLOYEE IN THE SAME CLASS OF EMPLOYEMENT 14. Name of Fellow Employee (if applicable): 15. Employer/Preparer Signature: 16. Date Signed (mm/dd/yyyy): Make any comments on the reverse side of this form or on a separate sheet. Form Created 8/2005 Reproduce as needed.

19 REQUEST FOR MEDICAL SERVICES Date Medical Care Provider: Address: City State Zip Kindly care for the injury sustained by: on: (Name of Employee) (Date) Description of accident: Name of Employer: Address: Telephone: W.C. Policy Number: Requested by: (Signature) The employee will present this slip to the medical care provider who will attach it to the original bill for services. PLEASE SEND BILLS DIRECTLY TO: Associated Insurance Services, LLC Claim Department 54 Third Avenue P.O. Box 4070 Burlington, MA MEDICAL BENEFITS ARE GOVERNED BY THE PROVISIONS OF THE WORKERS COMPENSATION LAW OF THE COMMONWEALTH OF MASSACHUSETTS. AIS 20

20 REQUEST FOR MEDICAL SERVICES Date 3/25/93 ABC Industrial Medical Clinic Medical Care Provider: Address: 114 Main Street City Andover State MA Zip Kindly care for the injury sustained by: on: Jane J. Doe 3/25/93 (Name of Employee) (Date) Cut hand on large staple while opening box. Description of accident: Able Manufacturing Name of Employer: 44 Elm Street, Andover, MA Address: Telephone: (508) W.C. Policy Number: John Smith Requested by: (Signature) The employee will present this slip to the medical care provider who will attach it to the original bill for services. PLEASE SEND BILLS DIRECTLY TO: Associated Insurance Services, LLC Claim Department 54 Third Avenue P.O. Box 4070 Burlington, MA MEDICAL BENEFITS ARE GOVERNED BY THE PROVISIONS OF THE WORKERS COMPENSATION LAW OF THE COMMONWEALTH OF MASSACHUSETTS. AIS 20

21 Massachusetts Statutory Benefit Provisions TEMPORARY TOTAL DISABILITY % Rate of compensation 60% of Employee's Gross Average Weekly Wage (AWW) Minimum weekly benefit 20% of State Average Weekly Wage (SAWW) Maximum weekly benefit Waiting period/retroactive Maximum duration SAWW 5 days. If incapacity extends 21 days or more, then compensation is paid back to date of incapacity; if incapacity extends for 5 days but less than 21 days, compensation is paid from 6th day of incapacity 156 weeks TEMPORARY PARTIAL DISABILITY % Rate of compensation AWW less earnings (or earning capacity) x 60% Maximum weekly benefit 75% of Temporary Total Benefits Waiting period/retroactive See Temporary Total Benefits Maximum duration 260 weeks of partial disability alone (or 364 weeks when combined with Temporary Total) 1 PERMANENT TOTAL DISABILITY % Rate of compensation 66 2/3 % of AWW Minimum weekly benefit 20% of SAWW Maximum weekly benefit SAWW Cost-of-Living Adjustment Employee eligibility will be reviewed following the required waiting period. State Average Weekly Wage (SAWW) effective October 1, 2012=$1, Page 1 of 2

22 FATAL Spouse and Children 2 % Rate of compensation 66 2/3 % of AWW Minimum weekly benefit $ Maximum weekly benefit SAWW Maximum aggregate payable Children benefit if spouse remarries 250 x SAWW $60 per child, but no more than would have been paid to surviving spouse Dependency Other than Spouse and Children % Rate of compensation 66 2/3% Maximum weekly benefit $80.00 Maximum aggregate payable Cost-of-Living Adjustment 250 x SAWW, subject to escalation Beneficiary will be eligible for a cost of living adjustment. 1 The 520 weeks combined limit for the temporary total and partial disability benefit limit applies if the employee has permanently lost 75% or more of the use of an eye, an arm, a hand, a leg or a foot, or if the employee has a permanently life threatening physical condition or a permanently disabling occupational disease which is of a physical nature and cause. 2 If spouse's benefit is under $150, the spouse will receive $6 per dependent. The sum of the employee's benefit plus the dependency benefit is limited to $150. If the spouse's benefit is over $150, no dependency is paid.

23 Primary Occupational Health Centers BDOHI Credentialed Affiliates in BLUE Boston Area All One Health*** 101 Arch St., Suite 20 Boston, MA Tel: (617) Fax: (617) Contact: Lois Picard Concentra Medical Center 1 Harborside Drive Logan Airport East Boston, MA Tel: (617) Fax: (617) Contact: Ed Bride (617) New England Baptist Occupational Health** 125 Parker Hill Ave. 6th Floor, Converse Building Boston, MA Tel: (617) Fax: (617) Contact: Patrice Carter Boston Medical Occupational & Environmental Medicine Preston Family Building 732 Harrison Avenue, 5th Floor Boston, MA Tel: (617) Fax: (617) Brighton St. Elizabeth s Occupational Health* Mother Mary Rose, 2nd floor 736 Cambridge St. Brighton, MA Tel: (617) Fax: (617) Contact: Keith Brinkley (617) *Most languages available through interpreter services. **Spanish only. ***No other languages. Cambridge Mount Auburn Hospital Occupational Health* 725 Concord Ave., Suite 5100 Cambridge, MA Tel: (617) Fax: (617) Contact: Bob Benoit Somerville Cambridge Health Alliance Occupational Health* Assembly Square Mall 5 Middlesex Ave. Somerville, MA Tel: (617) Fax: (617) Contact: John Babchak Metrowest Chelmsford Saints Memorial Corporate Well Care* 85 Parkhurst Road Chelmsford, MA Tel: (978) Fax: (978) Contact: Pam Huntley (978) Needham BI Deaconess Needham Hospital Occupational Health 148 Chestnut St. Needham, MA Tel: (781) Fax: (781) Contact: Karen Foulkro Framingham Fallon Clinic Oc Health*** 85 Lincoln St. Framingham, MA Tel: (508) Fax: (508) Contact: Mary Beth Colarusso (508) x Best Doctors and the star-in-cross logo are trademarks of Best Doctors, Inc. in the United States and other countries. October 2011

24 Primary Occupational Health Centers BDOHI Credentialed Affiliates in BLUE Milford Milford Hospital* Hill Executive Park 115 Water Street, 2nd Floor Milford, MA Tel: (508) Fax: (508) Contact: Dena Stetson (508) Natick All One Health*** Preplacement Screening & RTW Exam only 190 North Main St., Suite 2 Natick, MA Tel: (508) Fax: (508) Contact: Deborah Lada Norwood Davis Occupational Health*** 49 Walpole Suite 1 Norwood, MA Tel: (781) Fax: (781) Contact: Rachel Southborough Medworks 28 Newton St. Southborough, MA Tel: (508) Fax: (508) Contact: Anette Casco (508) Waltham Health at Work Sterling Medical Building 9 Hope Ave. Waltham, MA Tel: (617) Fax: (617) (Spanish, Creole, Arabic) Contact: Pat Schindeler Northshore Amesbury Anna Jacques Hospital Occupational Health*** 24 Morrill Place Amesbury, MA Tel: (978) Fax: (978) Contact: Pat Powers Beverly Quadrant Health Strategies*** 500 Cummings Center, Suite 4350 Beverly, MA Tel: (978) Fax: (978) Contact: Diane Talbot (978) Chelsea All One Health 1000 Broadway St., 2nd Floor Chelsea, MA Tel: (617) Fax: (617) (German, Portuguese) Contact: Nancy MacComber *Most languages available through interpreter services. **Spanish only. ***No other languages. 2 Best Doctors and the star-in-cross logo are trademarks of Best Doctors, Inc. in the United States and other countries. October 2011

25 Primary Occupational Health Centers BDOHI Credentialed Affiliates in BLUE Lawrence Work Health at Lawrence Hospital* 1 General Street Lawrence, MA Tel: (978) ext 2343 Fax: (978) Contact: Janet Sheehan Lowell Saints Medical Corporate WellCare 1230 Bridge St. Lowell, MA Tel: (978) Fax: (978) Contact: Pam Huntley (978) Middleton Occupational Health Services at Sports Medicine North Orthopedics 147 South main St. Middleton, MA Tel: (978) Fax: (978) Contact: Ann Persia (978) Wilmington Concentra Medical Center 66 B Concord St. Wilmington, MA Tel: (978) Fax: (978) Contact: Jill DeMarco (978) Woburn All One Health** 600 West Cumming St. Suite 3400 Woburn, MA Tel: (781) Fax: (781) Contact: Mary Ellen McAvoy Southcoast Region Fall River South Coast Occupational Health* 534 Prospect St. Fall River, MA Tel: (508) Fax: (508) Contact: Philomena Pemental (508) Trumed Inc. 528 Newton St. Fall River, MA Tel: (508) Fax: (508) (Portuguese) Contact: Paula New Bedford South Coast Occupational Health* 101 Page St. New Bedford, MA Tel: (508) Fax: (508) Contact: Philomena Pemental (508) Raynham Tristin Medical Enterprises 675 Paramount Drive Raynham, MA Tel: Contact: Joy Gagliardi *Most languages available through interpreter services. **Spanish only. ***No other languages. 3 Best Doctors and the star-in-cross logo are trademarks of Best Doctors, Inc. in the United States and other countries. October 2011

26 Primary Occupational Health Centers BDOHI Credentialed Affiliates in BLUE Taunton Tristin Medical Enterprises Occupational Health 2005 Bay Rd. Taunton, MA Tel: (508) Fax: (508) (Spanish, Portuguese) Contact: Donna Chase x316 South Shore Region Avon Tirstin Medical Enterprises Occupational Health 75 Stockwell Dr. Avon, MA Tel: (508) Fax: (508) Contact: Terry Sullivan Braintree Center for Occupational Health, Braintree Rehab*** 100 Baystate Drive Braintree, MA Tel: (781) Fax: (781) Contact: Dave Coleman (781) Milton Milton Hospital Occupational Health* 199 Reedsdale Road BrooksWing 2nd Floor Milton, MA Tel: (617) Fax: (617) Contact: Pat Griffin (617) Plymouth Jordan on the Job 45 Resnick Road Suite 201 Plymouth, MA Tel: (508) Fax: (508) Contact: Charlotte Thies (508) Quincy Quincy Medical Center Occupational Health* 114 Whitewell St. Quincy, MA Tel: (617) Fax: (617) Contact: Walter Fraser (781) Cape Cod Area Bourne Cape and Islands Occupational Medicine 3119 Cranberry Highway East Wareham, MA Tel: (508) Fax: (508) Contact: Kim Sawyer Hyannis Cape and Islands Occupational Medicine 700 Attuck Lane, Suite 1-E Hyannis, MA Tel: (508) Fax: (508) Contact: Kim Sawyer Orleans Orleans Medical Center 204 Main St. Orleans, MA Tel: (508) Fax: (508) *Most languages available through interpreter services. **Spanish only. ***No other languages. 4 Best Doctors and the star-in-cross logo are trademarks of Best Doctors, Inc. in the United States and other countries. October 2011

27 Primary Occupational Health Centers BDOHI Credentialed Affiliates in BLUE Dennis Cape Cod Medical Center 65 Route 134 Dennis, MA Tel: (508) Fax: (508) Contact: Natalie Amorim Vineyard Haven Dr. Michael Jacobs Walk-in Care 611 A State Road Vineyard Haven, MA Tel: Fax: Contact: Carol Fugione NP Central Region Auburn Fallon Clinic Occupational Health* 35 Millsbury St. Auburn, MA Tel: (508) Fax: (508) Contact: Mary Beth Colarusso (508) x51352 Worcester Fallon Clinic Occ. Health* 630 Plantation St. Worcester, MA Tel: (508) Fax: (508) Contact: Mary Beth Colarusso (508) x51352 Webster Square Medical** 255 Park Ave., Suite 400 Worcester, MA Tel: (508) Fax: (508) Contact: Judy Gedman x228 North Central Area Ayer Nashoba Valley Occupational Health* 200 Groton Road Ayer, MA Tel: (978) Fax: (978) Contact: Marcia Estes Leominster Take Charge at Leominster Hosp.* 60 Hospital Road Simmons Bldg., 2nd Floor Leominster, MA Tel: (978) Fax: (978) Contact: Marianne Pappas South Central Area Attleboro Sturdy Occupational Health* 211 Park St. 2nd floor Attleboro, MA Tel: (508) Fax: (508) Southbridge Comprecare Occupational Health* 32 Oakes Ave., 1st Floor Southbridge, MA Tel: (508) Fax: (508) Contact: Arlene Smith *Most languages available through interpreter services. **Spanish only. ***No other languages. 5 Best Doctors and the star-in-cross logo are trademarks of Best Doctors, Inc. in the United States and other countries. October 2011

28 Primary Occupational Health Centers BDOHI Credentialed Affiliates in BLUE Midwest Mass. Area Amherst AEIOU Occupational Health 170 University Drive, Suite 102 Amherst, MA Tel: (413) Fax: (413) Contact: Janice Hoffman Holyoke Work Connection at Holyoke Hospital* 575 Beech St. Holyoke, MA Tel: (413) Fax: (413) Contact: Leeann Herbert Springfield Pioneer Valley Occupational Health 1515 Allen St. Springfield, MA Tel: (413) Fax: (413) Work Mercy Hospital* Weldon Center at 233 Carew St. Springfield, MA Tel: (413) Fax: (413) Contact: Barbara Haswell Ware Business and Health at Mary Lane Hospital* 85 South St. Ware, MA Tel: (413) Fax: (413) Contact: Scott King *Most languages available through interpreter services. **Spanish only. ***No other languages. Western Mass. Area East Longmeadow Occu-Health 200 North Main St. Suite 5 East Longmeadow, MA Tel: (413) Fax: (413) Greenfield AEIOU Occupational Health and Urgent Care 489 Bernardston Road Greenfield, MA Tel: (413) Fax: (413) Contact: Kim DeKoschak BayState Franklin Medical Workplace Health 157 High St. Greenfield, MA Tel: (413) Fax: (413) Contact: Laurie Kline Hadley Occu-Health 106 Russell St. Hadley, MA Tel: (413) Fax: (413) Pittsfield Berkshire Medical Center Occupational Health* 610 North St. Pittsfield, MA Tel: (413) Fax: (413) Contact: Pat Brandi at (413) Occupational Medical Services** 15 Stoddard Ave. Pittsfield, MA Tel: (413) Fax: (413) Contact: Vicki Sommerville 6 Best Doctors and the star-in-cross logo are trademarks of Best Doctors, Inc. in the United States and other countries. October 2011

29 Primary Occupational Health Centers BDOHI Credentialed Affiliates in BLUE New Hampshire Nashua St. Joseph s Business & Health* Riverside Medical Center 17 Riverside St., Ste. 202 Nashua, NH Tel: (603) Fax: (603) Contact: Dianne Annon (603) Rhode Island North Smithfield Landmark Medical Occupational Health* 116 Eddie Dowling Highway North Smithfield, RI Tel: (401) Fax: (401) Contact: Scott Brodeur Salem Salem Occupational Acute Care*** 13 Red Roof Lane, Suite 2 Salem, NH Tel: (603) Fax: (603) Contact: Dianne Annon (603) Pawtucket Armistice Urgent Care and Occupational Health 209 Armistice Blvd. Pawtucket, RI Tel: (401) Fax: (401) (Spanish, Portguese) Contact: Cindy Swafford *Most languages available through interpreter services. **Spanish only. ***No other languages. 7 Best Doctors and the star-in-cross logo are trademarks of Best Doctors, Inc. in the United States and other countries. October 2011

30 To the Injured Worker: On your first visit, please give this notice to any pharmacy listed on the back side to speed processing your approved workers compensation prescriptions (based on the guidelines established by your employer). Questions or need assistance locating a participating retail network pharmacy? Call the Express Scripts Patient Care Contact Center at Atencion Trabajador Lesionado: Este formulario de identificación para servicios temporales de prescripción de recetas por compensación del trabajador DEBERÁ SER PRESENTADO a su farmacéutico al surtir su(s) receta(s) inicial(es). Si tiene cualquier duda o necesita localizar una farmacia participante, por favor contacte al área de Atención a Clientes de Express Scripts, en el teléfono To the Pharmacist: Express Scripts administers this workers compensation prescription program. Please follow the steps below to submit a claim. Standard claim limitations include quantity exceeding 150 pills or a day supply exceeding 14 days. This form is valid for up to 30 days from DOI. Limitations may vary. For assistance, call Express Scripts at AIM WORKS Thank you for using a participating retail network pharmacy. Even though there is no direct cost to you, it s important that we all do our part to help control the rising cost of healthcare. Please see other side for a list of participating retail network pharmacies. To the Supervisor: Please fill in the information requested for the injured worker. Pharmacy Processing Steps Step 1: Enter bin number Step 2: Enter processor control A4 Step 3: Enter the group number as it appears above Step 4: Enter the injured worker s nine-digit ID number Step 5: Enter the injured worker s first and last name Step 6: Enter the injured worker s date of injury (enter in PA field in the format YYYYMMDD)

31 A & P Acme Pharmacy Albertson s Albertson s/acme Albertson s/osco Albertson s/sav-on Amerisource Bergen Anchor Pharmacies Arrow Aurora Bartell Drugs Bigg s Bi-Lo Bi-Mart BJ s Wholesale Club Brooks Brookshire Brothers Brookshire Grocery Bruno Carrs Cash Wise Coborn s Costco Cub D&W Dahl s Dierbergs Discount Drugmart Doc s Drugs Dominicks Drug Emporium Drug Fair Drug Town Drug World Eckerd Econofoods EPIC Pharmacy Network FamilyMeds Farm Fresh Farmer Jack Food City Food Lion Fred s Gemmel Giant Giant Eagle Giant Foods Hannaford Harris Teeter H-E-B Hi-School Pharmacy Hy-Vee Jewel/Osco Kash n Karry Keltsch Kerr Kmart Knight Drugs Kroger LeaderNet (PSAO) Longs Drug Store Major Value Marsh Drugs Medic Discount Medicap Medistat Meijer Minyard NCS HealthCare Neighborcare Network Pharmaceuticals Northeast Pharmacy Services Osco P & C Food Markets Pamida Park Nicollet Pathmark Pavilions Price Chopper Publix Quality Markets Raley s Randalls Rite Aid Rosauers Rx Express RXD Safeway Sam s Club Sav-On Save Mart Schnucks Scolari s Sedano Shaw s Shop N Save Shopko ShopRite Snyder Stop & Shop Sun Mart Super Fresh Super Rx Target Texas Oncology Srvs The Pharm Thrifty White Times Tom Thumb Tops Ukrop s United Drugs United Supermarkets Vons Waldbaums Walgreens Wal-Mart Wegmans Weis Winn Dixie NOTE: This form is not valid in the state of Ohio. For all other states, liability of a workers compensation claim is not assumed based on the dispensing of medication(s) to a patient.

32 ABINGTON BELMONT MASSACHUSETTS ABINGTON BEMIS 6 BRIGHTON ST ABINGTON, MA (781) CENTRE AVE ABINGTON, MA (781) TARGET 385 CENTRE AVE ABINGTON, MA (781) BROCKTON AVE ABINGTON, MA (781) ACTON ACTON 563 MASSACHUSETTS AVE ACTON, MA (978) GREAT RD ACTON, MA (978) MASSACHUSETTS AVE ACTON, MA (978) POWDER MILL RD ACTON, MA (978) ADAMS BIG Y 1 MYRTLE ST ADAMS, MA (413) COLUMBIA ST ADAMS, MA (413) AGAWAM 287 SPRINGFIELD AVE AGAWAM, MA (413) SILVER ST AGAWAM, MA (413) SPRINGFIELD ST AGAWAM, MA (413) ALLSTON CENTRAL BOSTON 1304 COMMONWEALTH AVE ALLSTON, MA (617) COMMONWEALTH AVE ALLSTON, MA (617) JOSEPH M SMITH COMMUNITY HLTH 287 WESTERN AVE ALLSTON, MA (617) BRIGHTON AVE ALLSTON, MA (617) AMESBURY 194 MAIN ST AMESBURY, MA (978) HAVERHILL RD AMESBURY, MA (978) MACY ST AMESBURY, MA (978) AMHERST AMHERST 381 COLLEGE ST AMHERST, MA (413) N PLEASANT ST AMHERST, MA (413) UNIVERSITY DR AMHERST, MA (413) UNIVERSITY HEALTH SRVCS PHCY 150 INFIRMARY WAY AMHERST, MA (413) ANDOVER 68 MAIN ST ANDOVER, MA (978) LETOURNEAU'S 349 N MAIN ST ANDOVER, MA (978) N MAIN ST ANDOVER, MA (978) ARLINGTON 833 MASSACHUSETTS AVE ARLINGTON, MA (781) MASSACHUSETTS AVE # 25 ARLINGTON, MA (781) MAIDA 121 MASSACHUSETTS AVE ARLINGTON, MA (781) MASSACHUSETTS AVE ARLINGTON, MA (781) ASHBURNHAM ASHBURNHAM FAMILY 63 MAIN ST ASHBURNHAM, MA (978) FAMILY LTC 63A S MAIN ST ASHBURNHAM, MA (978) ASHLAND 47 POND ST ASHLAND, MA (508) UNION ST ASHLAND, MA (508) UNION ST ASHLAND, MA (508) POND ST ASHLAND, MA (508) ASSONET SEDELL'S 63 S MAIN ST ASSONET, MA (508) ATHOL ATHOL FAMILY 321 MAIN ST ATHOL, MA (978) MAIN ST ATHOL, MA (978) S MAIN ST ATHOL, MA (978) ATTLEBORO COUNTY SQUARE 289 COUNTY ST ATTLEBORO, MA (508) N MAIN ST ATTLEBORO, MA (508) PLEASANT ST ATTLEBORO, MA (508) WASHINGTON ST ATTLEBORO, MA (508) PLEASANT ST ATTLEBORO, MA (508) AUBURN 676 SOUTHBRIDGE ST AUBURN, MA (508) PROCARE 35 MILLBURY ST AUBURN, MA (508) AUBURNDALE KEYES 2090 COMMONWEALTH AVE AUBURNDALE, MA (617) AVON COSTCO 120 STOCKWELL DR AVON, MA (508) MEMORIAL DR AVON, MA (508) AYER MEDICINE SHOPPE 50 MAIN ST AYER, MA (978) BARRE BARRE FAMILY 547 SUMMERS ST BARRE, MA (978) BEDFORD 199 GREAT RD BEDFORD, MA (781) GREAT RD BEDFORD, MA (781) BELCHERTOWN 151 N MAIN ST BELCHERTOWN, MA (413) FEDERAL ST BELCHERTOWN, MA (413) BELLINGHAM 50 PULASKI BLVD BELLINGHAM, MA (508) HARTFORD AVE. BELLINGHAM, MA (508) BELMONT 60 LEONARD ST BELMONT, MA (617) TRAPELO RD BELMONT, MA (617) SHAWS 535 TRAPELO RD BELMONT, MA (617) SHORE 297 BELMONT ST BELMONT, MA (617) November 2011

33 BEVERLY BROCKTON BEVERLY 434 RANTOUL ST BEVERLY, MA (978) DODGE ST BEVERLY, MA (978) EATON APOTHECARY 100 CUMMINGS CTR STE 113A BEVERLY, MA (978) CABOT ST BEVERLY, MA (978) BILLERICA 700 BOSTON RD TOWN PLZ BILLERICA, MA (978) BOSTON POST RD BILLERICA, MA (978) BLACKSTONE 22 MAIN ST BLACKSTONE, MA (508) BOSTON 610 TREMONT 610 TREMONT ST BOSTON, MA (617) BIOSCRIP 21 STANHOPE ST # 23 BOSTON, MA (617) BOSTON MED CENTER OP 720 HARRISON AVE BOSTON, MA (617) BOSTON MEDICAL CENTER 850 HARRISON AVE BOSTON, MA (617) BRIGHAM'S WOMAN'S HOSPITAL 75 FRANCIS ST BOSTON, MA (617) LONGWOOD AVE BOSTON, MA (617) NEWBURY ST BOSTON, MA (617) BOYLSTON ST BOSTON, MA (617) BOYLSTON ST BOSTON, MA (617) CANAL ST BOSTON, MA (617) CENTER PLZ BOSTON, MA (617) COMMONWEALTH AVE BOSTON, MA (617) HANOVER ST BOSTON, MA (617) MASSACHUSETTS AVE BOSTON, MA (617) TREMONT ST BOSTON, MA (617) CAMBRIDGE ST BOSTON, MA (617) WASHINGTON ST BOSTON, MA (617) HARRISON AVE BOSTON, MA (617) CHARLES ST STE 157 BOSTON, MA (617) WASHINGTON ST BOSTON, MA (617) COLUMBUS AVE BOSTON, MA (617) LONGWOOD AVE BOSTON, MA (617) SUMMER ST BOSTON, MA (617) DANA FARBER CANCER INSTITUTE 44 BINNEY ST RM 294 BOSTON, MA (617) FENWAY 1340 BOYLSTON ST BOSTON, MA (617) FENWAY 142 BERKLEY ST BOSTON, MA (617) GARY 59 CHARLES ST BOSTON, MA (617) GREEN CROSS 393 HANOVER ST BOSTON, MA (617) HARVARD VANGUARD MED ASSOC 147 MILK ST BOSTON, MA (617) HARVARD VANGUARD MED ASSOC 185 DARTMOUTH STREET BOSTON, MA (617) HARVARD VANGUARD MED ASSOC 133 BROOKLINE AVE BOSTON, MA (617) KORNFIELD 2121 WASHINGTON ST BOSTON, MA (617) MCINNIS HOUSE CLINIC 780 ALBANY ST BOSTON, MA (857) MGH OPD 55 FRUIT ST BOSTON, MA (617) PHARMACARE SPECIALTY 35 KNEELAND ST BOSTON, MA (617) PHARMACARE SPECIALTY PHCY 350 LONGWOOD AVE STE B BOSTON, MA (617) PLANNED PARENTHOOD LGE OF MA 1055 COMMONWEATLH AVE BOSTON, MA (617) E BROADWAY BOSTON, MA (617) SARATOGA ST BOSTON, MA (617) CAMBRIDGE ST BOSTON, MA (617) BOYLSTON ST BOSTON, MA (617) SHAWS 1065 COMMONWEALTH AVE BOSTON, MA (617) TAI-TUNG 256 HARRISON AVE BOSTON, MA (617) TUFTS MEDICAL CENTER 800 WASHINGTON ST STE 420 BOSTON, MA (617) BOURNE 6 HEAD OF THE BAY RD BOURNE, MA (508) TROWBRIDGE PL BOURNE, MA (508) BRADFORD THE WHITTIER PHARMACIST 145 WARD HILL AVE BRADFORD, MA (978) BRAINTREE CRITICAL CARE SYSTEMS 191 BAY STATE DR BRAINTREE, MA (781) WASHINGTON ST BRAINTREE, MA (781) GROVE ST BRAINTREE, MA (781) HARVARD VANGUARD MED ASSOC 111 GROSSMAN DR BRAINTREE, MA (781) PEARL ST BRAINTREE, MA (781) GROVE ST BRAINTREE, MA (781) TARGET 250 GRANITE ST STE 121 BRAINTREE, MA (781) BRIDGEWATER 19 SUMMER ST BRIDGEWATER, MA (508) BROAD ST BRIDGEWATER, MA (508) BRIGHTON 427 WASHINGTON ST BRIGHTON, MA (617) MARKET ST BRIGHTON, MA (617) BEACON ST BRIGHTON, MA (617) MELVIN 1558 COMMONWEALTH AVE BRIGHTON, MA (617) STAR 370 WESTERN AVE BRIGHTON, MA (617) SUTHERLAND 1690 COMMONWEALTH AVE BRIGHTON, MA (617) BROCKTON APOTHECARE 720 CENTRE ST BROCKTON, MA (508) November 2011

34 BROCKTON CHICOPEE 230 E ASHLAND AVE BROCKTON, MA (508) MAIN ST BROCKTON, MA (508) CENTRE ST BROCKTON, MA (508) N PEARL ST BROCKTON, MA (508) BELMONT ST BROCKTON, MA (508) OAK ST BROCKTON, MA (508) EATON APOTHECARY 63 MAIN ST BROCKTON, MA (508) PEARL STREET 1 PEARL ST BROCKTON, MA (508) PHARMERICA 1123 PEARL ST BROCKTON, MA (508) CENTRE ST BROCKTON, MA (508) SHAWS/OSCO 609 BELMONT ST BROCKTON, MA (508) N MONTELLO ST BROCKTON, MA (508) BELMONT ST BROCKTON, MA (508) OAK ST BROCKTON, MA (508) BROOKLINE 294 HARVARD ST BROOKLINE, MA (617) BEACON ST BROOKLINE, MA (617) WASHINGTON ST BROOKLINE, MA (617) J.E. PIERCE APOTHECARY 1180 BEACON STREET BROOKLINE, MA (617) JE PIERCE APOTHECARY COMPOUND 1093 BEACON ST BROOKLINE, MA (617) BURLINGTON CRITICAL CARE SYSTEMS 1 NORTH AVE BURLINGTON, MA (781) CAMBRIDGE ST BURLINGTON, MA (781) CAMBRIDGE ST BURLINGTON, MA (781) HARVARD VANGUARD MED ASSOC 20 WALL ST BURLINGTON, MA (781) LAHEY CLINIC MED CTR 41 MALL RD BURLINGTON, MA (781) OSCO 180 CAMBRIDGE ST STE A BURLINGTON, MA (781) BYFIELD FREEDOM 12 KENT WAY BYFIELD, MA (800) CAMBRIDGE CAMBRIDGE HEALTH ALLIANCE 1493 CAMBRIDGE ST CAMBRIDGE, MA (617) CIAMPA APOTHECARY 425 CAMBRIDGE ST CAMBRIDGE, MA (617) MASSACHUSETTS AVE CAMBRIDGE, MA (617) MASSACHUSETTS AVE CAMBRIDGE, MA (617) ALEWIFE BROOK PKWY CAMBRIDGE, MA (617) WHITE ST CAMBRIDGE, MA (617) HARVARD UNIV HELTH SVCS PHCY 75 MOUNT AUBURN ST CAMBRIDGE, MA (617) HARVARD VANGUARD MED ASSOC 1611 CAMBRIDGE ST CAMBRIDGE, MA (617) INMAN 1414 CAMBRIDGE ST CAMBRIDGE, MA (617) MIT MEDICAL DEPT HLTH SVC CNTR 77 MASSACHUSETTES AVE CAMBRIDGE, MA (617) RIVER ST CAMBRIDGE, MA (617) MASSACHUSETTS AVE CAMBRIDGE, MA (617) SKENDERIAN APOTHECARY 1613 CAMBRIDGE ST CAMBRIDGE, MA (617) STAR/OSCO 699 MOUNT AUBURN ST CAMBRIDGE, MA (617) CANTON 95 WASHINGTON ST CANTON, MA (781) WASHINGTON ST CANTON, MA (781) CARVER 100D N MAIN ST CARVER, MA (508) SEDELL'S 90 MAIN ST CARVER, MA (508) CHARLESTOWN 509 MAIN ST CHARLESTOWN, MA (617) HIGH 54 HIGH ST CHARLESTOWN, MA (617) CHARLTON 142 WORCESTER RD CHARLTON, MA (508) CHATHAM 12 QUEEN ANNE RD CHATHAM, MA (508) CHELMSFORD 16 BOSTON RD CHELMSFORD, MA (978) CHELMSFORD ST CHELMSFORD, MA (978) DRUM HILL RD STE 2 CHELMSFORD, MA (978) HARVARD VANGUARD MED ASSOC 228 BILLERICA ROAD CHELMSFORD, MA (978) PARKHURST RD CHELMSFORD, MA (978) CHELSEA 1010 REVERE BEACH PKWY CHELSEA, MA (617) BROADWAY CHELSEA, MA (617) MARGOLIS 447 BROADWAY CHELSEA, MA (617) CHESTNUT HILL 647 VFW PKWY CHESTNUT HILL, MA (617) BOYLSTON ST CHESTNUT HILL, MA (617) HARVARD VANGUARD MED ASSOC 291 INDEPENDENCE DR CHESTNUT HILL, MA (617) CHICOPEE CHICOPEE HEALTH CENTER PHCY 505 FRONT ST CHICOPEE, MA (413) MEMORIAL DR CHICOPEE, MA (413) CENTER ST CHICOPEE, MA (413) GRANBY RD CHICOPEE, MA (413) LOUIS AND CLARK 1481 MEMORIAL DR CHICOPEE, MA (413) SAINT JAMES AVE CHICOPEE, MA (413) MEADOW ST CHICOPEE, MA (413) MEMORIAL DR CHICOPEE, MA (413) MEMORIAL DR CHICOPEE, MA (413) November 2011

35 CLINTON EASTHAMPTON CLINTON 792 MAIN ST CLINTON, MA (978) MAIN ST CLINTON, MA (978) COHASSET 790 JUSTICE CUSHING WAY COHASSET, MA (781) JUSTICE CUSHING HWY COHASSET, MA (781) CONCORD 199 SUDBURY RD CONCORD, MA (978) LOWELL RD UNIT 1-B CONCORD, MA (978) WEST CONCORD 1212 MAIN ST CONCORD, MA (978) DALTON O'LAUGHLIN'S 403 MAIN STREET DALTON, MA (413) DANVERS COSTCO 11 NEWBURY ST DANVERS, MA (978) NEWBURY ST DANVERS, MA (978) ENDICOTT ST DANVERS, MA (978) MAPLE ST DANVERS, MA (978) TARGET 240 INDEPENDENCE WAY DANVERS, MA (978) AVALON VILLAGE WAY DANVERS, MA (978) DEDHAM BOSTON HOME INFUSION 110 STERGIS WAY DEDHAM, MA (781) COSTCO 200 LEGACY BLVD DEDHAM, MA (781) PROVIDENCE HWY DEDHAM, MA (781) BUSSY ST DEDHAM, MA (781) EASTERN AVE DEDHAM, MA (781) PROVIDENCE HWY DEDHAM, MA (781) WARDLE'S 585 HIGH ST DEDHAM, MA (781) DENNIS PORT 711 ROUTE 28 DENNIS PORT, MA (508) DORCHESTER COMPTON 393 COLUMBIA RD DORCHESTER, MA (617) CRAWFORD 1735 DORCHESTER AVE DORCHESTER, MA (617) DORCHESTER AVE DORCHESTER, MA (617) BLUE HILL AVE DORCHESTER, MA (617) MORRISSEY BLVD DORCHESTER, MA (617) DUDLEY ST DORCHESTER, MA (617) DORCHESTER HOUSE MULTI SRVS 1353 DORCHESTER AVE DORCHESTER, MA (617) EATON APOTHECARY 950 DORCHESTER AVE DORCHESTER, MA (617) GEIGER GIBSON COMM HLTH CTR 250 MOUNT VERNON ST DORCHESTER, MA (617) HARVARD NEIGHBORHOOD 632 BLUE HILL AVE DORCHESTER, MA (617) KIMMY 1435 DORCHESTER AVE DORCHESTER, MA (617) MAXIM 1365 DORCHESTER AVE # 1377 DORCHESTER, MA (617) NEPONSET HEALTH CENTER PHCY 398 NEPONSET AVE DORCHESTER, MA (617) PRIME 201 HUMBOLT AVE DORCHESTER, MA (617) DORCHESTER AVE DORCHESTER, MA (617) GALLIVAN BLVD DORCHESTER, MA (617) SAIGON 1167 DORCHESTER AVE # A DORCHESTER, MA (617) STAR 45 MORRISSEY BLVD DORCHESTER, MA (617) ALLSTATE RD STE B DORCHESTER, MA (617) TARGET 7 ALLSTATE RD DORCHESTER, MA (617) UPHAM'S CORNER HLTH COMM PHCY 415 COLUMBIA RD DORCHESTER, MA (617) DORCHESTER CENTER 703 GALLIVAN BLVD DORCHESTER CENTER, MA (617) EATON APOTHECARY 637 WASHINGTON ST FL G DORCHESTER CENTER, MA (617) DRACUT ALEXANDER'S 505 NASHUA RD DRACUT, MA (978) BROADWAY RD DRACUT, MA (978) LAKEVIEW AVE DRACUT, MA (978) PLEASANT ST DRACUT, MA (978) DUDLEY 13 W MAIN ST DUDLEY, MA (508) DUXBURY 28 DEPOT ST DUXBURY, MA (781) EAST BOSTON 1150 SARATOGA ST EAST BOSTON, MA (617) BORDER ST EAST BOSTON, MA (617) E BOSTON NEIGHBORHOOD HLTH CTR 10 GOVE ST EAST BOSTON, MA (617) EAST BRIDGEWATER 225 BEDFORD ST EAST BRIDGEWATER, MA (508) DUVAL'S 1 COMPASS WAY STE 101 EAST BRIDGEWATER, MA (508) EAST FALMOUTH 415 E FALMOUTH HWY EAST FALMOUTH, MA (508) TEATICKET HWY EAST FALMOUTH, MA (508) EAST LONGMEADOW BIG Y 441 N MAIN ST EAST LONGMEADOW, MA (413) N MAIN ST EAST LONGMEADOW, MA (413) N MAIN ST EAST LONGMEADOW, MA (413) EAST WAREHAM 2992 CRANBERRY HWY EAST WAREHAM, MA (508) CRANBERRY HWY, RT 6 & 28 EAST WAREHAM, MA (508) EASTHAMPTON 118 NORTHAMPTON ST EASTHAMPTON, MA (413) November 2011

36 EASTHAMPTON GEORGETOWN LOUIS AND CLARK 238 NORTHAMPTON ST EASTHAMPTON, MA (413) UNION ST EASTHAMPTON, MA (413) EASTON 555 WASHINGTON ST EASTON, MA (508) ROBERT DR EASTON, MA (508) TARGET 41 ROBERT DR EASTON, MA (508) EDGARTOWN 245 VINEYARD HAVEN RD EDGARTOWN, MA (508) EVERETT COSTCO 2 MYSTIC VIEW RD EVERETT, MA (617) PRESCRIPTION SHOPPE 378 BROADWAY EVERETT, MA (617) BROADWAY EVERETT, MA (617) TARGET ONE MYSTIC VIEW RD EVERETT, MA (617) FAIRHAVEN 10 SARAHS WAY RTE 6 FAIRHAVEN, MA (508) KMART 9 PLAZA WAY FAIRHAVEN, MA (508) HUTTLESTON AVE FAIRHAVEN, MA (508) SHAWS 11 BERDON WAY FAIRHAVEN, MA (508) SOUTHCOAST CLINICAL 200 MILL RD STE 120 FAIRHAVEN, MA (508) HUTTLETSON AVE FAIRHAVEN, MA (508) FAIRHAVEN COMMONS WAY FAIRHAVEN, MA (508) FALL RIVER 1620 PRESIDENT AVE FALL RIVER, MA (508) N MAIN ST FALL RIVER, MA (508) WILLIAM S CANNING BLVD FALL RIVER, MA (508) PLEASANT ST FALL RIVER, MA (508) DEVILLERS 1392 RODMAN ST FALL RIVER, MA (508) HEALTH CARE 1030 PRESIDENT AVE FALL RIVER, MA (508) STAFFORD RD FALL RIVER, MA (508) S MAIN ST FALL RIVER, MA (508) S MAIN ST FALL RIVER, MA (508) PLEASANT ST FALL RIVER, MA (508) WM S CANNING BLVD FALL RIVER, MA (508) S MAIN ST FALL RIVER, MA (508) N MAIN ST FALL RIVER, MA (508) STANDARD 246 E MAIN ST FALL RIVER, MA (508) RODMAN ST FALL RIVER, MA (508) MARIANO BISHOP BLVD FALL RIVER, MA (508) WILLIAM S CANNINA BLVD FALL RIVER, MA (508) WALSH OF ROCK ST 202 ROCK ST FALL RIVER, MA (508) FALMOUTH CAPE COD HOME INFUSION SVCS 200 MAIN ST STE 205 FALMOUTH, MA (800) DAVIS STRAITS FALMOUTH, MA (508) HOME SOLUTIONS 295 MAIN ST FALMOUTH, MA (508) NORTH FALMOUTH 17 ACADEMY LN FALMOUTH, MA (508) MAIN ST FALMOUTH, MA (508) SHAWS 137 TEA TICKET HWY FALMOUTH, MA (508) FEEDING HILLS 1282 SPRINGFIELD ST FEEDING HILLS, MA (413) FITCHBURG COMMUNITY HEALTH CONNECTIONS 275 NICHOLS RD FITCHBURG, MA (978) WATER ST FITCHBURG, MA (978) ROLLSTONE RD FITCHBURG, MA (978) JOHN FITCH HWY FITCHBURG, MA (978) PROCARE 370 LUNENBURG ST FITCHBURG, MA (978) KMART 140 WHALON ST FITCHBURG, MA (978) FOXBORO 67 CENTRAL ST FOXBORO, MA (508) MAIN ST FOXBORO, MA (508) FRAMINGHAM 145 CONCORD ST FRAMINGHAM, MA (508) WATER ST FRAMINGHAM, MA (508) WORCESTER RD FRAMINGHAM, MA (508) EATON APOTHECARY 266 WAVERLY ST FRAMINGHAM, MA (508) OLD CONNECTICUT PATH FRAMINGHAM, MA (508) TARGET 400 COCHITUATE RD FRAMINGHAM, MA (508) WORCESTER RD FRAMINGHAM, MA (508) FRANKLIN 272 E CENTRAL ST FRANKLIN, MA (508) W CENTRAL ST FRANKLIN, MA (508) E CENTRAL ST FRANKLIN, MA (508) SHAWS 255 E CENTRAL ST FRANKLIN, MA (508) FRANKLIN VILLAGE DR FRANKLIN, MA (508) GARDNER 314 MAIN ST GARDNER, MA (978) FAMILY HEYWOOD HOSP 250 GREEN ST STE 101 GARDNER, MA (978) WEST ST GARDNER, MA (978) PEARSON BLVD GARDNER, MA (978) TIMPANY BLVD GARDNER, MA (978) TIMPANY BLVD GARDNER, MA (978) GEORGETOWN 65 CENTRAL ST GEORGETOWN, MA (978) GEORGETOWN 50 CENTRAL ST GEORGETOWN, MA (978) November 2011

37 GLOUCESTER HULL GLOUCESTER CONLEYS STORE 7 RAILROAD AVE GLOUCESTER, MA (978) MAIN ST GLOUCESTER, MA (978) THATCHER RD GLOUCESTER, MA (978) EASTERN AVE STE 8 GLOUCESTER, MA (978) GRANBY CENTER 242 STATE ST GRANBY, MA (413) GREAT BARRINGTON 362 MAIN ST STE 2 GREAT BARRINGTON, MA (413) FAIRVIEW HOSPITAL 29 LEWIS AVE GREAT BARRINGTON, MA (413) PRICE CHOPPER 300 STOCKBRIDGE RD GREAT BARRINGTON, MA (413) S MAIN ST GREAT BARRINGTON, MA (413) MAIN ST GREAT BARRINGTON, MA (413) GREENFIELD BIG Y 237 MOHAWK TRL GREENFIELD, MA (413) FEDERAL ST GREENFIELD, MA (413) MAIN ST GREENFIELD, MA (413) FRENCH KING HWY GREENFIELD, MA (413) GROTON 106 BOSTON RD GROTON, MA (978) SHAWS/OSCO 760A BOSTON RD GROTON, MA (978) HADLEY 440 RUSSELL ST HADLEY, MA (413) TARGET 367 RUSSELL ST HADLEY, MA (413) RUSSELL ST HADLEY, MA (413) HALIFAX 341 PLYMOUTH ST HALIFAX, MA (781) PLYMOUTH ST HALIFAX, MA (781) HANOVER 207 ROCKLAND ST HANOVER, MA (781) TARGET 1167 WASHINGTON ST HANOVER, MA (781) WASHINGTON ST HANOVER, MA (781) HANSON 471 LIBERTY ST HANSON, MA (781) SHAWS 476 LIBERTY ST HANSON, MA (781) HARWICH 148 ROUTE 137 HARWICH, MA (508) CHATHAM RD HARWICH, MA (508) HARWICH PORT 6 POST OFFICE SQ MAIN ST HARWICH PORT, MA (508) STAR 18 SISSON RD HARWICH PORT, MA (508) HAVERHILL 259 MAIN ST HAVERHILL, MA (978) LINCOLN AVE HAVERHILL, MA (978) LAFAYETTE SQ HAVERHILL, MA (978) LOWELL AVE HAVERHILL, MA (978) PREFERRED SOLUTIONS 35 AVCO RD HAVERHILL, MA (978) S MAIN ST HAVERHILL, MA (978) WATER ST HAVERHILL, MA (978) TARGET 35 COMPUTER DR HAVERHILL, MA (978) HINGHAM 405 LINCOLN ST HINGHAM, MA (781) SOUTH ST HINGHAM, MA (781) HINGHAM CENTRE 294 MAIN ST HINGHAM, MA (781) NEIGHBORCARE-LINDEN PONDS 203 LINDEN PONDS WAY HINGHAM, MA (781) DERBY ST HINGHAM, MA (781) LINCOLN ST HINGHAM, MA (781) LINCOLN ST HINGHAM, MA (781) HOLBROOK 842 S FRANKLIN ST HOLBROOK, MA (781) N FRANKLIN ST HOLBROOK, MA (781) HOLDEN 160 RESERVOIR ST HOLDEN, MA (508) SHREWSBURY ST HOLDEN, MA (508) HOLLISTON 101 CENTRAL ST HOLLISTON, MA (508) HOLYOKE 2213B NORTHAMPTON ST HOLYOKE, MA (413) BEECH ST HOLYOKE, MA (413) HOLYOKE HEALTH CENTER 230 MAPLE ST STE 1 HOLYOKE, MA (413) KMART 2203 NORTH HAMPTON ST HOLYOKE, MA (413) N HAMPTON ST HOLYOKE, MA (413) LINCOLN ST HOLYOKE, MA (413) N HAMPTON ST HOLYOKE, MA (413) TARGET 50 HOLYOKE ST HOLYOKE, MA (413) HOPKINTON HOPKINTON 52 MAIN ST HOPKINTON, MA (508) INTEGRITY 45 SOUTH ST STE 2 HOPKINTON, MA (508) HUDSON 234 WASHINGTON ST HUDSON, MA (978) WASHINGTON ST HUDSON, MA (978) WASHINGTON ST HUDSON, MA (978) HULL NANTASKET 480 NANTASKET AVE HULL, MA (781) November 2011

38 HYANNIS LUNENBURG HYANNIS APOTHECARE 201 MAIN ST HYANNIS, MA (508) CAPE COD HOSP EMPLOYEE PHCY 27 PARK ST HYANNIS, MA (508) NORTH ST HYANNIS, MA (508) FALMOUTH RD HYANNIS, MA (508) MEDICINE STORE 596 W MAIN ST HYANNIS, MA (508) BARNSTABLE RD HYANNIS, MA (508) W MAIN ST HYANNIS, MA (508) INDEPENDENCE DR HYANNIS, MA (508) HYDE PARK 942 HYDE PARKE AVE HYDE PARK, MA (617) HYDE PARK 1461 RIVER ST HYDE PARK, MA (617) HYDE PARK AVE HYDE PARK, MA (617) SHAWS 1377 HYDE PARK AVE HYDE PARK, MA (617) IPSWICH CONLEY'S STORE 146 HIGH ST UNIT H IPSWICH, MA (978) CENTRAL ST IPSWICH, MA (978) JAMAICA PLAIN 704 CENTER ST JAMAICA PLAIN, MA (617) CENTRE ST JAMAICA PLAIN, MA (617) CENTRE ST JAMAICA PLAIN, MA (617) KINGSTON 189 SUMMER ST KINGSTON, MA (781) SUMMER ST KINGSTON, MA (781) SUMMER ST KINGSTON, MA (781) TARGET 101 INDEPENDENCE MALL WAY KINGSTON, MA (781) TURA'S 85 SUMMER ST KINGSTON, MA (781) LAKEVILLE 11 MAIN ST LAKEVILLE, MA (508) SEDELL'S 290 BEDFORD ST LAKEVILLE, MA (508) LANESBOROUGH TARGET 655 CHESHIRE RD LANESBOROUGH, MA (412) LAWRENCE 205 S BROADWAY LAWRENCE, MA (978) GREATER LAWRENCE FHC 150 PARK ST LAWRENCE, MA (978) GREATER LAWRENCE FHC 34 HAVERHILL ST LAWRENCE, MA (978) GREATER LAWRENCE FHC 700 ESSEX ST LAWRENCE, MA (978) PACKARD MEDICAL 128 PARKER ST LAWRENCE, MA (978) PERROTTA'S SUPER 292 PROSPECT ST LAWRENCE, MA (978) WINTHROP AVE LAWRENCE, MA (978) ESSEX ST LAWRENCE, MA (978) LEE 25 PARK ST LEE, MA (413) LEICESTER 1666 MAIN ST LEICESTER, MA (508) LENOX ROUTE 7 AND 20 LENOX, MA (413) LENOX VILLAGE 5 WALKER ST LENOX, MA (413) LEOMINSTER 188 CENTRAL ST LEOMINSTER, MA (978) NELSON ST LEOMINSTER, MA (978) SACK BLVD LEOMINSTER, MA (978) PROCARE 165 MILL ST LEOMINSTER, MA (978) MERRIAM AVE LEOMINSTER, MA (978) LANCASTER ST LEOMINSTER, MA (978) TARGET 86 ORCHARD HILL PARK DR LEOMINSTER, MA (978) JUNGLE RD LEOMINSTER, MA (978) LEXINGTON 1735 MASSACHUSETTS AVE LEXINGTON, MA (781) THEATRE 1784 MASSACHUSETTS AVE LEXINGTON, MA (781) LITTLETON 10 MEETING HOUSE RD LITTLETON, MA (978) LONGMEADOW BIG Y 802 WILLIAMS ST LONGMEADOW, MA (413) BLISS RD LONGMEADOW, MA (413) LONGMEADOW ST LONGMEADOW, MA (413) LOWELL 1815 MIDDLESEX ST LOWELL, MA (978) MERRIMACK ST LOWELL, MA (978) BRIDGE ST LOWELL, MA (978) ROGERS RD LOWELL, MA (978) LONG TERM SOLUTIONS 225 STEDMAN ST STE 27 LOWELL, MA (978) PAWTUCKET OF LOWELL 65 SCHOOL ST LOWELL, MA (978) WOOD ST LOWELL, MA (978) CHURCH ST LOWELL, MA (978) DUMMER ST LOWELL, MA (978) TARGET 181 PLAIN ST LOWELL, MA (978) LUDLOW BIG Y 433 CENTER ST STE 3 LUDLOW, MA (413) CENTER ST LUDLOW, MA (413) LUNENBURG 454 ELECTRIC AVE LUNENBURG, MA (978) MASS AVE LUNENBURG, MA (978) MASSACHUSETTS AVE LUNENBURG, MA (978) November 2011

39 LYNN METHUEN LYNN CROWN 232 LEWIS ST LYNN, MA (781) S COMMON ST LYNN, MA (781) EASTERN AVE LYNN, MA (781) BOSTON ST LYNN, MA (781) EATON APOTHECARY 298 UNION ST LYNN, MA (781) EATON 12 MARKET SQ LYNN, MA (781) FLAG 7 WILLOW ST LYNN, MA (781) LYNN COMMUNITY HLTH CTR PHCY 298 UNION ST LYNN, MA (781) OSBORNE 59 ESSEX ST LYNN, MA (781) RICHMOND 499 EASTERN AVENUE LYNN, MA (781) BOSTON ST LYNN, MA (781) LEWIS ST LYNN, MA (781) SHAWS 43 STATE ST LYNN, MA (781) SPECTOR 289 ESSEX ST LYNN, MA (781) WASHINGTON ST LYNN, MA (781) LYNNWAY LYNN, MA (781) LYNNFIELD VILLAGE 590 MAIN ST LYNNFIELD, MA (781) MALDEN AUCELLA 705 SALEM ST MALDEN, MA (781) PLEASANT ST MALDEN, MA (781) BROADWAY MALDEN, MA (781) BROADWAY MALDEN, MA (781) ELMWOOD 299 PLEASANT ST MALDEN, MA (781) CHARLES ST MALDEN, MA (781) MANCHESTER ALLEN'S 40 BEACH ST MANCHESTER, MA (978) MANSFIELD 261 CHAUNCY ST MANSFIELD, MA (508) CHAUNCY ST MANSFIELD, MA (508) CHAUNCY ST MANSFIELD, MA (508) MARBLEHEAD 45 ATLANTIC AVE MARBLEHEAD, MA (781) VILLAGE 1 VILLAGE PLZ MARBLEHEAD, MA (781) MARLBOROUGH ACCREDO THERAPEUTICS 261 CEDAR HILL ST MARLBOROUGH, MA (508) BOUVIER 515 LINCOLN ST MARLBOROUGH, MA (508) E MAIN ST MARLBOROUGH, MA (508) BOSTON POST RD W MARLBOROUGH, MA (508) MEDICINE STORE 164 PLEASANT ST MARLBOROUGH, MA (508) PARTNERS OF MA 181 CEDAR HILL MARLBOROUGH, MA (508) S BOLTON ST MARLBOROUGH, MA (508) TARGET 605 BOSTON POST RD E MARLBOROUGH, MA (508) TARGET 423 DONALD LYNCH BLVD MARLBOROUGH, MA (508) WEST RIVER PHARM 140 LOCKE DR MARLBOROUGH, MA (508) MARSHFIELD 1880 OCEAN RD MARSHFIELD, MA (781) OCEAN ST MARSHFIELD, MA (781) STAR 16 WEBSTER SQ MARSHFIELD, MA (781) MARSTONS MILLS 1030 PUTNAM AVE MARSTONS MILLS, MA (508) FALMOUTH RD MARSTONS MILLS, MA (508) MASHPEE 11 MARKET ST MASHPEE, MA (508) NATHAN ELLIS HWY MASHPEE, MA (508) MATTAPAN 90 RIVER ST STE 7 MATTAPAN, MA (617) MAYNARD 105 MAIN ST MAYNARD, MA (978) MEDFIELD 555 MAIN ST MEDFIELD, MA (508) SHAWS 230 MAIN ST MEDFIELD, MA (508) MEDFORD 85 HIGH ST MEDFORD, MA (781) RIVERSIDE AVE MEDFORD, MA (781) FELLSWAY MEDFORD, MA (781) HARVARD VANGUARD MED ASSOC 26 CITY HALL MALL MEDFORD, MA (781) HIGH ST STE 497 MEDFORD, MA (781) SALEM ST MEDFORD, MA (781) SHAWS 61 LOCUST ST MEDFORD, MA (781) FELLSWAY MEDFORD, MA (781) MEDWAY 67 D MAIN ST MEDWAY, MA (508) MELROSE 516 MAIN ST # 522 MELROSE, MA (781) GREEN STREET 35 GREEN ST MELROSE, MA (781) MELROSE CENTER 462 MAIN ST MELROSE, MA (781) MAIN ST MELROSE, MA (781) METHUEN CONLIN'S 30 LAWRENCE ST METHUEN, MA (978) SWAN ST METHUEN, MA (978) BROADWAY ST METHUEN, MA (978) RESIDENT CARE 213 BROADWAY METHUEN, MA (978) PLEASANT ST METHUEN, MA (978) HAVERHILL ST METHUEN, MA (978) November 2011

40 METHUEN NORTH ATTLEBORO 90 PLEASANT VALLEY ST METHUEN, MA (978) TARGET 67 PLEASANT VALLEY ST METHUEN, MA (978) PLEASANT VALLEY ST METHUEN, MA (978) MIDDLEBORO 438 W GROVE ST STE B MIDDLEBORO, MA (508) MERCHANTS WAY MIDDLEBORO, MA (508) MAIN ST # 133 MIDDLEBORO, MA (508) MIDDLETON 220 MAPLE ST MIDDLETON, MA (978) MILFORD 137 S MAIN ST MILFORD, MA (508) MEDWAY RD MILFORD, MA (508) PROCARE 176 WEST ST MILFORD, MA (508) MEDWAY RD MILFORD, MA (508) PROSPECT ST MILFORD, MA (508) E MAIN ST MILFORD, MA (508) TARGET 250 FORTUNE BLVD MILFORD, MA (508) MILLBURY 65 CANAL ST MILLBURY, MA (508) PROCARE 110 ELM ST MILLBURY, MA (508) MAIN ST MILLBURY, MA (508) TARGET 70 WORCESTER PROVIDN TPKE MILLBURY, MA (508) MILLIS 2 MILLISTON RD MILLIS, MA (508) MILTON 10 BASSETT ST MILTON, MA (617) MONSON 117 MAIN ST MONSON, MA (413) NANTUCKET DAN'S 100 PLEASANT ST NANTUCKET, MA (508) ISLAND VALUE 122 PLEASANT ST NANTUCKET, MA (508) NANTUCKET 45 MAIN ST NANTUCKET, MA (508) NATICK 137 W CENTRAL ST NATICK, MA (508) JONES 7 MAIN ST NATICK, MA (508) WORCESTER ST NATICK, MA (508) NEEDHAM BIRDS HILL 401 GREAT PLAIN AVE NEEDHAM, MA (781) HIGHLAND AVE NEEDHAM, MA (781) GREAT PLAIN AVE NEEDHAM, MA (781) NEW BEDFORD 2100 ACUSHNET AVE NEW BEDFORD, MA (508) KEMPTON ST NEW BEDFORD, MA (508) ASHLEY BLVD NEW BEDFORD, MA (508) ASHLEY BLVD NEW BEDFORD, MA (508) PHARMAHEALTH 2206 ACUSHNET AVE NEW BEDFORD, MA (508) PHARMAHEALTH 458 DARTMOUTH ST NEW BEDFORD, MA (508) COVE RD NEW BEDFORD, MA (508) PURCHASE ST NEW BEDFORD, MA (508) ACUSHNET AVE NEW BEDFORD, MA (508) MILL ST NEW BEDFORD, MA (508) ACUSHNET AVE NEW BEDFORD, MA (508) SILVA 133 COUNTY ST NEW BEDFORD, MA (508) ST LUKE'S RETAIL 101 PAGE ST NEW BEDFORD, MA (508) KINGS HWY NEW BEDFORD, MA (508) DARTMOUTH ST NEW BEDFORD, MA (508) NEWBURYPORT 13 1/2 POND ST NEWBURYPORT, MA (978) DANIEL L. LYNCH 173 HIGH ST NEWBURYPORT, MA (978) STOREY AVE NEWBURYPORT, MA (978) NEWTON AMERICA'S COMPOUNDING CENTER 153 CALIFORNIA ST NEWTON, MA (617) BOYLSTON ST NEWTON, MA (617) NEWTON CENTER 1199 CENTER ST NEWTON CENTER, MA (617) NEWTONVILLE 304 WALNUT ST NEWTONVILLE, MA (617) NORTH ADAMS BIG Y SHOPPING CTR NORTH ADAMS, MA (413) LITTLES 109 EAGLE ST NORTH ADAMS, MA (413) LINCOLN ST NORTH ADAMS, MA (413) STATE RD NORTH ADAMS, MA (413) CURRAN MEMORIAL HWY NORTH ADAMS, MA (413) NORTH ANDOVER 110 TURNPIKE ST NORTH ANDOVER, MA (978) MAIN ST NORTH ANDOVER, MA (978) TURNPIKE ST NORTH ANDOVER, MA (978) TURNPIKE ST NORTH ANDOVER, MA (978) NORTH ATTLEBORO 8 E WASHINGTON ST NORTH ATTLEBORO, MA (508) ROBERT TONER BLVD NORTH ATTLEBORO, MA (508) SHAWS 125 TONER BLVD NORTH ATTLEBORO, MA (508) E WASHINGTON ST NORTH ATTLEBORO, MA (508) November 2011

41 NORTH ATTLEBORO PEMBROKE TARGET 1205 S WASHINGTON ST NORTH ATTLEBORO, MA (508) S WASHINGTON ST NORTH ATTLEBORO, MA (508) NORTH BILLERICA 210 BOSTON RD NORTH BILLERICA, MA (978) MEDICAL CENTER 221 BOSTON RD NORTH BILLERICA, MA (978) NORTH BROOKFIELD 5 GILBERT ST NORTH BROOKFIELD, MA (508) NORTH DARTMOUTH PHARMAHEALTH 535 FAUNCE CORNER RD NORTH DARTMOUTH, MA (508) FAUNCE CORNER MALL RD NORTH DARTMOUTH, MA (508) TARGET 479 STATE RD NORTH DARTMOUTH, MA (508) STATE RD NORTH DARTMOUTH, MA (508) NORTH EASTON 2 ROCHE BROTHERS WAY NORTH EASTON, MA (508) DEPOT ST NORTH EASTON, MA (508) DEPOT ST NORTH EASTON, MA (508) NORTH GRAFTON 100 WORCESTER ST NORTH GRAFTON, MA (508) WORCESTER RD NORTH GRAFTON, MA (508) STAT-CARE 198 WORCHESTER ST NORTH GRAFTON, MA (508) NORTH OXFORD 742 MAIN ST NORTH OXFORD, MA (508) NORTH READING 22 MAIN ST NORTH READING, MA (978) MAIN ST NORTH READING, MA (978) NORTHAMPTON BIG Y 136 N KING ST RTE 5 NORTHAMPTON, MA (413) KING ST NORTHAMPTON, MA (413) MAIN ST NORTHAMPTON, MA (413) SERIO'S 63 STATE ST NORTHAMPTON, MA (413) KING ST NORTHAMPTON, MA (413) N KING ST NORTHAMPTON, MA (413) NORTHBOROUGH 14 W MAIN ST NORTHBOROUGH, MA (508) SHATTUCK 17 W MAIN ST NORTHBOROUGH, MA (508) OTIS ST NORTHBOROUGH, MA (508) WEGMANS 9102 SHOPS WAY NORTHBOROUGH, MA (508) NORTON 35 W MAIN ST NORTON, MA (508) HASKINS 4 SCOTT DR NORTON, MA (508) ROCHE BROS 175 MANSFIELD AVE NORTON, MA (508) NORWELL 104 WASHINGTON ST NORWELL, MA (781) WASHINGTON ST NORWELL, MA (781) PROFESSIONAL 75 WASHINGTON ST NORWELL, MA (781) WASHINGTON ST STE 2 NORWELL, MA (781) WASHINGTON ST NORWELL, MA (781) NORWOOD 136 NAHATAN ST NORWOOD, MA (781) MEDI-SON SOLUTIONS 898 WASHINGTON ST NORWOOD, MA (781) WALPOLE ST NORWOOD, MA (781) PROVIDENCE HWY NORWOOD, MA (781) OAK BLUFFS CONROY APOTHECARY OB 82 PENNACOOK AVE OAK BLUFFS, MA (508) ORANGE 555 E MAIN ST ORANGE, MA (978) ORLEANS 110 RTE 6A ORLEANS, MA (508) WEST RD SKAKET CORS ORLEANS, MA (508) ORLEANS S/C, RT 6A ORLEANS, MA (508) RTE 6 A CRANBERRY COVE PLZ ORLEANS, MA (508) OXFORD 302 MAIN ST OXFORD, MA (508) MAIN ST OXFORD, MA (508) PALMER BIG Y 1180 THORNDIKE ST PALMER, MA (413) THORNDYKE ST PALMER, MA (413) THORNDIKE ST PALMER, MA (413) PEABODY 637 LOWELL ST PEABODY, MA (978) LYNNFIELD ST PEABODY, MA (978) LOWELL ST PEABODY, MA (978) MAIN ST PEABODY, MA (978) EATON APOTHECARY 23 CENTENNIAL DR PEABODY, MA (978) HARVARD VANGUARD MED ASSOC 2 ESSEX CENTER DR PEABODY, MA (978) LAHEY CLINIC NORTH 1 ESSEX CENTER DR PEABODY, MA (978) NEIGHBORCARE- BROOKSBY VILLAGE 100 BROOKSBY VILLAGE DR PEABODY, MA (978) HOWLEY ST PEABODY, MA (978) TREMONT COMPANY 86 TREMONT ST PEABODY, MA (978) PEMBROKE 44 MATTAKEESETT ST PEMBROKE, MA (781) CHURCH ST PEMBROKE, MA (781) November 2011

42 PEPPERELL RUTLAND PEPPERELL PEPPERELL FAMILY 74 MAIN ST PEPPERELL, MA (978) GROTON ST PEPPERELL, MA (978) PITTSFIELD BERKSHIRE MEDICAL CENTER 725 NORTH ST PITTSFIELD, MA (413) BIG Y 200 WEST ST PITTSFIELD, MA (413) WEST ST PITTSFIELD, MA (413) FLYNN'S 173 ELM ST PITTSFIELD, MA (413) PRICE CHOPPER 555 HUBBARD AVE PITTSFIELD, MA (413) CHESHIRE RD PITTSFIELD, MA (413) ELM ST PITTSFIELD, MA (413) SOUTH ST PITTSFIELD, MA (413) NORTH ST PITTSFIELD, MA (413) DAN FOX DR PITTSFIELD, MA (413) MERRILL RD PITTSFIELD, MA (413) HUBBARD AVE STE 12 PITTSFIELD, MA (413) PLAINVILLE PLAINVILLE PRESCRIPTION CENTER 122 SOUTH ST PLAINVILLE, MA (508) TAUNTON ST PLAINVILLE, MA (508) TARGET 103 TAUNTON ST PLAINVILLE, MA (508) PLYMOUTH APOTHECARE OF PLYMOUTH CAMELOT DR PLYMOUTH, MA (508) BALBONI'S 289 COURT ST PLYMOUTH, MA (508) PILGRIM HILL RD PLYMOUTH, MA (508) STATE RD PLYMOUTH, MA (508) STATE RD PLYMOUTH, MA (508) HIGH POINT 1233 STATE RD PLYMOUTH, MA (508) COURT ST STE 5 PLYMOUTH, MA (508) SHAWS - OSCO 2260 STATE RD PLYMOUTH, MA (508) SAMOSET ST PLYMOUTH, MA (508) COLONY PLACE PLYMOUTH, MA (508) PROVINCETOWN 56 SHANK PAINTER RD PROVINCETOWN, MA (508) QUINCY BAXTER 464 WASHINGTON ST QUINCY, MA (617) BLACKWOOD 181 PARKING WAY QUINCY, MA (617) QUINCY SHORE DR QUINCY, MA (617) INDEPENDENCE AVE QUINCY, MA (617) SOUTHERN ARTERY QUINCY, MA (617) HARVARD VANGUARD MED ASSOC 1250 HANCOCK ST QUINCY, MA (617) HANCOCK ST QUINCY, MA (617) GRANITE ST QUINCY, MA (617) SOUTHERN ARTERY QUINCY, MA (617) NEWPORT AVE QUINCY, MA (617) FALLS BLVD QUINCY, MA (617) RANDOLPH 171 N MAIN ST RANDOLPH, MA (781) MEMORIAL PKWY RANDOLPH, MA (781) RAYNHAM 266 ROUTE 44 RAYNHAM, MA (508) BROADWAY RAYNHAM, MA (508) NEW STATE HWY RAYNHAM, MA (508) PARAMOUNT DR RAYNHAM, MA (508) READING 650 MAIN ST READING, MA (781) BOLTON ST READING, MA (781) HAVEN ST READING, MA (781) REVERE 61 SQUIRE RD REVERE, MA (781) REVERE HLTH CTR 300 OCEAN AVE REVERE, MA (781) SQUIRE RD REVERE, MA (781) BROADWAY REVERE, MA (781) SQUIRE RD REVERE, MA (781) VFW HWY REVERE, MA (781) TARGET 36 FURLONG DR REVERE, MA (781) ROCKLAND 80 MARKET ST ROCKLAND, MA (781) MARKET ST ROCKLAND, MA (781) ROCKPORT 33 WHISTLESTOP MALL ROCKPORT, MA (978) ROSLINDALE 4600 WASHINGTON ST ROSLINDALE, MA (617) ROSLINDALE 452 HYDE PARK AVE ROSLINDALE, MA (617) SULLIVAN'S HEALTH CARE 30 BELGRADE AVE ROSLINDALE, MA (617) SULLIVAN'S 1 CORINTH ST ROSLINDALE, MA (617) ROWLEY MARKET BASKET CTR RTE 1 ROWLEY, MA (978) ROWLEY 169 MAIN ST ROWLEY, MA (978) ROXBURY DIMOCK CENTER 55 DIMOCK ST ROXBURY, MA (617) ROXBURY CROSSING WHITTIER HEALTH 1123 TREMONT ST ROXBURY CROSSING, MA (617) RUTLAND RUTLAND 18 MAPLE AVE RUTLAND, MA (508) November 2011

43 SALEM SOUTHWICK SALEM 272 HIGHLAND AVE SALEM, MA (978) B ESSEX ST SALEM, MA (978) ESSEX ST SALEM, MA (978) TARGET 227 HIGHLAND AVE SALEM, MA (978) HIGHLAND AVE SALEM, MA (978) SALISBURY 2 LAFAYETTE RD SALISBURY, MA (978) SANDWICH 65 TUPPER RD PURITY PLZ SANDWICH, MA (508) QUAKER MEETING HOUSE RD SANDWICH, MA (508) ROUTE 6A SANDWICH, MA (508) SAUGUS 1075 BROADWAY SAUGUS, MA (781) BROADWAY SAUGUS, MA (781) MAIN ST SAUGUS, MA (781) TARGET 400 LYNN FELLS PKWY SAUGUS, MA (781) SCITUATE HARBOR MALL 100 FRONT ST SCITUATE, MA (781) SCITUATE 384 GANNETT RD SCITUATE, MA (781) SEEKONK 1475 NEWMAN AVE SEEKONK, MA (508) SAM'S CLUB 1110 FALL RIVER AVE SEEKONK, MA (508) HIGHLAND AVE SEEKONK, MA (508) TARGET 79 COMMERCE WAY SEEKONK, MA (508) FALL RIVER AVE SEEKONK, MA (508) SHARON 66 S MAIN ST SHARON, MA (781) S MAIN ST SHARON, MA (781) SHELBURNE FALLS BAKER 52 BRIDGE ST SHELBURNE FALLS, MA (413) SHREWSBURY CRITICAL CARE SYSTEMS 246 BOSTON TPKE SHREWSBURY, MA (508) BOSTON TPKE SHREWSBURY, MA (508) PRICE CHOPPER 731 BOSTON TPKE SHREWSBURY, MA (000) MAIN ST SHREWSBURY, MA (508) SHAWS 50 BOSTON TPKE RD SHREWSBURY, MA (508) BOSTON TPKE # 571 SHREWSBURY, MA (508) SOMERSET 1587 BRAYTON POINT RD SOMERSET, MA (508) COUNTY ST SOMERSET, MA (508) GRAND ARMY HWY SOMERSET, MA (508) SOMERVILLE 532 MEDFORD ST SOMERVILLE, MA (617) DAVIS SQ SOMERVILLE, MA (617) HARVARD VANGUARD MED ASSOC 40 HOLLAND ST SOMERVILLE, MA (617) SOMERVILLE AVE SOMERVILLE, MA (617) MCGRATH HWY SOMERVILLE, MA (617) HIGHLAND AVE SOMERVILLE, MA (617) BROADWAY SOMERVILLE, MA (617) MCGRATH HWY SOMERVILLE, MA (617) TARGET 180 SOMERVILLE AVE SOMERVILLE, MA (617) SOUTH ATTLEBORO 366 WASHINGTON ST SOUTH ATTLEBORO, MA (508) SOUTH BOSTON 423 W BROADWAY SOUTH BOSTON, MA (617) SOUTH DARTMOUTH 548 DARTMOUTH ST SOUTH DARTMOUTH, MA (508) DARTMOUTH ST SOUTH DARTMOUTH, MA (508) SOUTH DEERFIELD DEERFIELD 45 MAIN ST SOUTH DEERFIELD, MA (413) SOUTH DENNIS RTE 134 PATRIOT SQ SC SOUTH DENNIS, MA (508) SOUTH HADLEY BIG Y 44 WILLIMANSETT ST SOUTH HADLEY, MA (413) BIG Y 501 NEWTON ST SOUTH HADLEY, MA (413) SOUTH HAMILTON CONNOLLYS 44 BAY RD SOUTH HAMILTON, MA (978) WALNUT RD SOUTH HAMILTON, MA (978) SOUTH WEYMOUTH PLEASANT ST RTE 18 SOUTH WEYMOUTH, MA (781) OLDENS 101 PLEASANT ST SOUTH WEYMOUTH, MA (781) SOUTH YARMOUTH 976 ROUTE 28 SOUTH YARMOUTH, MA (508) STATION AVE SOUTH YARMOUTH, MA (508) LONG POND DR SOUTH YARMOUTH, MA (508) SOUTHAMPTON 14 COLLEGE HWY SOUTHAMPTON, MA (413) SOUTHBOROUGH EATON APOTHECARY 162 CORDAVILLE RD SOUTHBOROUGH, MA (508) SOUTHBRIDGE 399 MAIN ST SOUTHBRIDGE, MA (508) MAIN ST SOUTHBRIDGE, MA (508) SOUTHWICK BIG Y 195 COLLEGE HWY SOUTHWICK, MA (413) COLLEGE HWY SOUTHWICK, MA (413) COLLEGE HWY SOUTHWICK, MA (413) November 2011

44 SPENCER WAKEFIELD SPENCER BIG Y 62 W MAIN ST SPENCER, MA (508) MAIN ST SPENCER, MA (508) SPRINGFIELD BAYSTATE 3300 MAIN ST SPRINGFIELD, MA (413) BAYSTATE 140 HIGH ST SPRINGFIELD, MA (413) BAYSTATE 380 PLAINFIELD ST SPRINGFIELD, MA (413) BAYSTATE 759 CHESTNUT ST SPRINGFIELD, MA (413) BIG Y 300 COOLEY ST SPRINGFIELD, MA (413) CARING 377 BELMONT AVE SPRINGFIELD, MA (413) COMMUNITY PHCY AT MERCY MED 299 CAREW ST SPRINGFIELD, MA (413) SAINT JAMES AVE SPRINGFIELD, MA (413) BOSTON RD SPRINGFIELD, MA (413) MAIN ST SPRINGFIELD, MA (413) BELMONT AVE STE 621 SPRINGFIELD, MA (413) PARKER ST SPRINGFIELD, MA (413) LOUIS & CLARK 490 PAGE BLVD SPRINGFIELD, MA (413) LOUIS & CLARK 471 BRECKWOOD BLVD SPRINGFIELD, MA (413) LOUIS & CLARK 1295 STATE ST SPRINGFIELD, MA (413) LOUIS AND CLARK 300 BIRNIE AVE SPRINGFIELD, MA (413) ISLAND POND RD SPRINGFIELD, MA (413) COOLEY ST SPRINGFIELD, MA (413) SPRING STREET S 600 STATE ST SPRINGFIELD, MA (413) LIBERTY ST SPRINGFIELD, MA (413) BOSTON RD SPRINGFIELD, MA (413) THE APOTHECARY CENTER 1985 MAIN ST SPRINGFIELD, MA (413) BOSTON RD SPRINGFIELD, MA (413) STONEHAM 107 MAIN ST STONEHAM, MA (781) STOUGHTON 1025 CENTRAL ST STOUGHTON, MA (781) MEDICAL 769 WASHINGTON ST STOUGHTON, MA (781) WASHINGTON ST STOUGHTON, MA (781) WASHINGTON ST STOUGHTON, MA (781) TARGET 1 HAWES WAY STOUGHTON, MA (781) STOW SHAWS/OSCO 155 GREAT RD # 117 STOW, MA (978) STURBRIDGE 182 MAIN ST STURBRIDGE, MA (508) CHARLTON RD STURBRIDGE, MA (508) SUDBURY 501 BOSTON POST RD SUDBURY, MA (978) BOSTON POST RD SUDBURY, MA (978) SUDBURY 447 BOSTON POST RD SUDBURY, MA (978) SWAMPSCOTT 413 PARADISE RD SWAMPSCOTT, MA (781) PARADISE RD SWAMPSCOTT, MA (781) SWANSEA 2340 GAR HWY SWANSEA, MA (508) LIFELINE PRESCRIPTION CENTER 1211 GAR HIGHWAY SWANSEA, MA (508) WILBUR AVE SWANSEA, MA (508) TARGET 579 GAR HWY STE 5 SWANSEA, MA (774) SWANSEA MALL DR SWANSEA, MA (508) TAUNTON 675 COUNTY ST TAUNTON, MA (508) WINTHROP ST TAUNTON, MA (508) WASHINGTON ST TAUNTON, MA (508) JOSEPH E WARREN BLVD TAUNTON, MA (508) DEAN ST TAUNTON, MA (508) TREMONT ST TAUNTON, MA (508) BROADWAY TAUNTON, MA (508) SHAWS 260 WINTHROP ST TAUNTON, MA (508) TARGET 801 TAUNTON DEPOT DR TAUNTON, MA (508) TEATICKET 137 TEATICKET HWY TEATICKET, MA (508) TEWKSBURY 1900 MAIN ST TEWKSBURY, MA (978) MAIN ST STADIUM PLZ TEWKSBURY, MA (978) KMART 10 MAIN ST TEWKSBURY, MA (978) ANDOVER ST TEWKSBURY, MA (978) TEWKSBURY HOSPITAL 365 EAST ST TEWKSBURY, MA (978) MAIN ST TEWKSBURY, MA (978) TOWNSEND MCNABB 233 MAIN ST TOWNSEND, MA (978) MAIN ST TOWNSEND, MA (978) TURNERS FALLS 206 AVENUE A TURNERS FALLS, MA (413) UXBRIDGE 323 N MAIN ST UXBRIDGE, MA (508) N MAIN ST UXBRIDGE, MA (508) VINEYARD HAVEN CONROY APOTHECARY 459 STATE RD VINEYARD HAVEN, MA (508) F E LESLIE GIST 65 MAIN ST VINEYARD HAVEN, MA (508) VINEYARD SCRIPTS 117 BEACH RD VINEYARD HAVEN, MA (508) WAKEFIELD 376 MAIN ST WAKEFIELD, MA (781) November 2011

45 WAKEFIELD WESTBOROUGH NORTH SHORE SERVICES 360 AUDUBON RD WAKEFIELD, MA (800) SMITH 390 MAIN ST WAKEFIELD, MA (781) THE MEDICINE STORE 409 LOWELL ST WAKEFIELD, MA (781) WALPOLE BETRO 965 MAIN ST WALPOLE, MA (508) BIG Y 999 PROVIDENCE HWY WALPOLE, MA (508) MAIN ST WALPOLE, MA (508) MAIN ST WALPOLE, MA (508) PROVIDENCE HWY WALPOLE, MA (508) WALTHAM CLINICAL CARE AMERICA 69 HICKORY DR WALTHAM, MA (781) COSTCO 71 SECOND AVE WALTHAM, MA (781) LEXINGTON ST WALTHAM, MA (781) LINDEN ST WALTHAM, MA (781) HARVARD ST WALTHAM, MA (781) RUSSELL ST WALTHAM, MA (781) JOHNSON COMPOUND AND WELL CTR 577 MAIN ST WALTHAM, MA (781) MASS GENERAL OPD 40 SECOND AVE WALTHAM, MA (781) ONCOMED 150 BEAR HILL RD WALTHAM, MA (516) PELHAM COMMUNITY 196 BEAR HILL RD WALTHAM, MA (617) RIVER ST WALTHAM, MA (781) ROGERS 923 MAIN ST WALTHAM, MA (781) STAR/OSCO 1070 LEXINGTON ST WALTHAM, MA (781) WARE 104 WEST ST WARE, MA (413) WEST ST WARE, MA (413) PALMER RD WARE, MA (413) WAREHAM 419 MAIN ST STE C WAREHAM, MA (508) MARION RD WAREHAM, MA (508) TARGET 2421 CRANBERRY HWY STE 110 WAREHAM, MA (508) WATERTOWN 189 WATERTOWN ST WATERTOWN, MA (617) MAIN ST # 43 WATERTOWN, MA (617) HARVARD VANGUARD MED ASSOC 485 ARSENAL ST WATERTOWN, MA (617) TARGET 550 ARSENAL ST WATERTOWN, MA (617) WAYLAND 325 BOSTON POST RD WAYLAND, MA (508) MAIN ST WAYLAND, MA (508) WEBSTER 112 E MAIN ST WEBSTER, MA (508) PROCARE 344 THOMPSON RD WEBSTER, MA (508) PRICE CHOPPER 118 E MAIN ST STE 1 WEBSTER, MA (508) E MAIN ST WEBSTER, MA (508) ROYAL PALM SPECIALTY 118 MAIN ST WEBSTER, MA (508) WELLESLEY ANDREWS 324 WESTON RD WELLESLEY, MA (781) CENTRAL ST WELLESLEY, MA (781) LINDEN ST WELLESLEY, MA (781) HARVARD VANGUARD MED ASSOC 230 WORCESTER ST WELLESLEY, MA (781) WELLFLEET OUTER CAPE HEALTH SERIVCES 2700 STATE HWY RTE 6 UNIT 3 WELLFLEET, MA (508) WEST BOYLSTON 264 W BOYLSTON ST WEST BOYLSTON, MA (508) W BOYLSTON RD WEST BOYLSTON, MA (508) WEST NEWTON 999 WATERTOWN ST WEST NEWTON, MA (617) WEST PEABODY 637 LOWELL ST WEST PEABODY, MA (978) WEST ROXBURY 1921 CENTER ST # 1943 WEST ROXBURY, MA (617) GREATER BOSTON LONG TERM CARE 1864 CENTRE ST WEST ROXBURY, MA (617) SHAWS/OSCO 75 SPRING ST WEST ROXBURY, MA (617) WEST ROXBURY 1868 CENTRE ST WEST ROXBURY, MA (617) WEST SPRINGFIELD COSTCO 119 DAGGETT DR WEST SPRINGFIELD, MA (413) B MEMORIAL AVE WEST SPRINGFIELD, MA (413) ELM ST WEST SPRINGFIELD, MA (413) RIVERDALE ST WEST SPRINGFIELD, MA (413) INTEGRISCRIPT 95 ASHLEY AVE STE B WEST SPRINGFIELD, MA (413) MCCLELLAND HOME HEALTH PHCY 85 INTERSTATE DR WEST SPRINGFIELD, MA (413) WESTFIELD ST WEST SPRINGFIELD, MA (413) RIVERDALE ST WEST SPRINGFIELD, MA (413) WESTERN MASS COMPOUNDING CNTR 138 MEMORIAL AVE WEST SPRINGFIELD, MA (413) WEST YARMOUTH 438 ROUTE 28 WEST YARMOUTH, MA (508) WESTBOROUGH 74 E MAIN ST WESTBOROUGH, MA (508) PROCARE 106 E MAIN ST WESTBOROUGH, MA (508) November 2011

46 WESTBOROUGH WORCESTER 32 LYMAN ST WESTBOROUGH, MA (508) TARGET 330 TURNPIKE RD WESTBOROUGH, MA (508) WESTFIELD ARROW PRESCRIPTION CENTER 427 N ELM ST WESTFIELD, MA (413) BIG Y 475 E MAIN ST WESTFIELD, MA (413) E MAIN ST WESTFIELD, MA (413) ELM ST WESTFIELD, MA (413) E SILVER ST WESTFIELD, MA (413) MAIN ST WESTFIELD, MA (413) SPRINGFIELD RD WESTFIELD, MA (413) WESTFORD 174 LITTLETON RD WESTFORD, MA (978) CARLISLE RD WESTFORD, MA (978) WESTMINSTER WESTMINSTER 128 MAIN ST WESTMINSTER, MA (978) WESTPORT 599 STATE RD WESTPORT, MA (508) WESTPORT APOTHECARY 784 MAIN RD WESTPORT, MA (508) WESTWOOD 278 WASHINGTON ST WESTWOOD, MA (781) WEYMOUTH 474 WASHINGTON ST WEYMOUTH, MA (781) MAIN ST WEYMOUTH, MA (781) COMMERCIAL ST WEYMOUTH, MA (781) BRIDGE ST WEYMOUTH, MA (781) WASHINGTON ST WEYMOUTH, MA (781) MIDDLE ST WEYMOUTH, MA (781) MIDDLE ST WEYMOUTH, MA (781) WHITINSVILLE 1163 PROVIDENCE RD WHITINSVILLE, MA (508) VALLEY PKWY WHITINSVILLE, MA (508) WHITMAN 351 BEDFORD ST WHITMAN, MA (781) DUVAL'S 571 WASHINGTON ST WHITMAN, MA (781) WILBRAHAM BIG Y 2035 BOSTON RD WILBRAHAM, MA (413) BOSTON RD WILBRAHAM, MA (413) LOUIS & CLARK 459 MAIN ST WILBRAHAM, MA (413) WILLIAMSBURG WILLIAMSBURG 49 MAIN ST WILLIAMSBURG, MA (413) WILLIAMSTOWN 212 MAIN ST WILLIAMSTOWN, MA (413) WILMINGTON 222 MAIN ST WILMINGTON, MA (978) MAIN ST WILMINGTON, MA (978) WINCHENDON 250 CENTRAL ST WINCHENDON, MA (978) WINCHENDON FAMILY 117 CENTRAL ST WINCHENDON, MA (978) WINCHESTER 539 MAIN ST STE 545 WINCHESTER, MA (781) WINCHESTER 568 MAIN ST WINCHESTER, MA (781) WINTHROP BROWN'S REXALL 214 WINTHROP ST WINTHROP, MA (617) WOODSIDE AVE WINTHROP, MA (617) E BOS NEIGHBOR HLTH CTR 26 STURGIS ST WINTHROP, MA (617) SAMUELS 46 WOODSIDE AVE WINTHROP, MA (617) WOBURN 300 MISHAWAM RD WOBURN, MA (781) MAIN ST WOBURN, MA (781) NEIGHBORHOOD 15 COMMONWEALTH AVE WOBURN, MA (781) NEW ENGLAND LIFE CARE 4 CONSTITUTION WAY WOBURN, MA (781) PALLIMED 400 W CUMMINGS PARK WOBURN, MA (781) CAMBRIDGE ST WOBURN, MA (781) ELM ST WOBURN, MA (781) TARGET 101 COMMERCE WAY WOBURN, MA (781) WOLLASTON 42 BEALE ST WOLLASTON, MA (617) WORCESTER BEACON 810 MAIN ST WORCESTER, MA (508) BIG Y 100 MAYFIELD ST WORCESTER, MA (508) CARE PLUS 123 SUMMER ST STE 360 WORCESTER, MA (508) COMPARE QUALITY 664 MAIN ST WORCESTER, MA (508) PARK AVE WORCESTER, MA (508) LINCOLN ST WORCESTER, MA (508) W BOYLSTON ST WORCESTER, MA (508) GRAFTON ST WORCESTER, MA (508) STAFFORD ST WORCESTER, MA (508) CHANDLER ST WORCESTER, MA (508) LINCOLN ST WORCESTER, MA (508) FRONT ST STE 102 WORCESTER, MA (508) SW CUTOFF WORCESTER, MA (508) PROCARE 630 PLANTATION ST WORCESTER, MA (508) PROCARE 135 GOLDSTAR BLVD WORCESTER, MA (508) EDWARD M KENNEDY COMM HLTH CTR 19 TACOMA ST WORCESTER, MA (508) FAMILY HEALTH CENTER 26 QUEEN ST WORCESTER, MA (508) November 2011

47 WORCESTER YARMOUTH PORT HAIG & HAIG 550 W BOYLSTON ST WORCESTER, MA (508) PARK AVENUE 414 PARK AVE WORCESTER, MA (508) PRICE CHOPPER 50 CAMBRIDGE ST WORCESTER, MA (508) PRICE CHOPPER 72 PULLMAN ST WORCESTER, MA (508) GRAFTON ST WORCESTER, MA (508) ABRAMSON LANE WORCESTER, MA (508) CHANDLER ST WORCESTER, MA (508) SHAWS/OSCO 14 W BOYLSTON ST WORCESTER, MA (508) STOP ABD SHOP 949 GRAFTON ST WORCESTER, MA (508) W BOYLSTON ST WORCESTER, MA (508) TARGET 529 LINCOLN ST WORCESTER, MA (508) TRANG 456 PARK AVE WORCESTER, MA (508) UMASS MEMORIAL MED CTR PHCY 55 LAKE AVE N WORCESTER, MA (508) UMASS MEMORIAL MED CTR PHCY 281 LINCOLN ST WORCESTER, MA (508) TOBIAS BOLAND WAY WORCESTER, MA (774) WINTHROP APOTHECARY 10 WINTHROP ST WORCESTER, MA (508) WORCESTER FAMILY 108 GROVE ST STE 12 WORCESTER, MA (508) YARMOUTH PORT 918 MAIN ST YARMOUTH PORT, MA (508) November 2011

48 AMHERST MANCHESTER NEW HAMPSHIRE AMHERST 85 RTE 101-A AMHERST, NH (603) DERRY 48 E BROADWAY DERRY, NH (603) MANCHESTER RD DERRY, NH (603) QOL MEDS 10 TSIENNETO RD DERRY, NH (603) CRYSTAL AVE DERRY, NH (603) ROCKINGHAM ST DERRY, NH (603) SHAWS 55 CRYSTAL AVE DERRY, NH (603) MANCHESTER RD DERRY, NH (603) EPPING 26 CALEF HWY EPPING, NH (603) CALES HWY EPPING, NH (603) GOFFSTOWN HOWE'S 39 MAIN ST GOFFSTOWN, NH (603) MAST RD GOFFSTOWN, NH (603) SHAWS 533 MAST RD GOFFSTOWN, NH (603) HOLLIS HOLLIS 6 ASH ST HOLLIS, NH (603) HUDSON 77 DERRY RD HUDSON, NH (603) LOWELL RD HUDSON, NH (603) LOWELL RD HUDSON, NH (603) SAM'S CLUB 7 BLVD HUDSON, NH (603) LOWELL RD HUDSON, NH (603) LONDONDERRY 117 MAMMOUTH RD LONDONDERRY, NH (603) HAMPTON DR LONDONDERRY, NH (603) NEIGHBORCARE - PEMBROKE 13 COMMERCE AVE LONDONDERRY, NH (603) NASHUA RD LONDONDERRY, NH (603) SHAWS RT 102 OLD ORCHARD VIEW DR LONDONDERRY, NH (603) MERRIMACK 456 DANIEL WEBSTER HWY MERRIMACK, NH (603) DANIEL WEBSTER HWY MERRIMACK, NH (603) SHAWS 7 CONTINENTAL BLVD MERRIMACK, NH (603) SHAWS 570 DANIEL WEBSTER HWY MERRIMACK, NH (603) MILFORD 15 MT VERNON ST MILFORD, NH (603) NASHUA ST MILFORD, NH (603) ELM ST MILFORD, NH (603) NASHUA COSTCO 311 DANIEL WEBSTER HWY NASHUA, NH (603) DANIEL WEBSTER HWY NASHUA, NH (603) MAIN ST # 242 NASHUA, NH (603) MAIN ST NASHUA, NH (603) S NEW HAMPSHIRE MEDICAL CTR 8 PROSPECT ST NASHUA, NH (603) SHAWS 300 MAIN ST NASHUA, NH (603) ST JOSEPH HEALTHCARE RET PHCY 172 KINSELY ST NASHUA, NH (603) TARGET 310 DANIEL WEBSTER HWY NASHUA, NH (603) WINGATE'S 129 MAIN ST NASHUA, NH (603) NASHUA MEDICINE WORLD 262 MAIN DUNSTABLE RD. NASHUA, NH (603) NASHUA 633 AMHERST ST NASHUA, NH (603) COLISEUM AVE NASHUA, NH (603) KMART 375 AMHERST ST BLDG 1 NASHUA, NH (603) AMHERST ST NASHUA, NH (603) TARGET 600 AMHERST ST NASHUA, NH (603) NASHUA RICE'S 59 MAIN ST NASHUA, NH (603) PELHAM 48 ATWOOD RD PELHAM, NH (603) RAYMOND 2 FREETOWN RD RAYMOND, NH (603) FREETOWN RD RAYMOND, NH (603) SALEM 510 S BROADWAY # 512 SALEM, NH (603) S BROADWAY SALEM, NH (603) MAIN ST SALEM, NH (603) TARGET S BROADWAY SALEM, NH (603) N BROADWAY SALEM, NH (603) WINDHAM 1 WALL ST WINDHAM, NH (603) SHAWS 43 INDIAN ROCK RD WINDHAM, NH (603) MANCHESTER 788 S WILLOW ST MANCHESTER, NH (603) KEN'S 36 ELM ST MANCHESTER, NH (603) ELM ST MANCHESTER, NH (603) November 2011

49 MANCHESTER WARNER MANCHESTER 432 S MAIN ST MANCHESTER, NH (603) MAST RD MANCHESTER, NH (603) MCGREGOR ST MANCHESTER, NH (603) MANCHESTER 201 JOHN DEVINE DR MANCHESTER, NH (603) MANCHESTER METRO TREATMENT CTR 5 A DRIVING PARK RD MANCHESTER, NH (603) WILLOW ST MANCHESTER, NH (603) SHAWS 375 S WILLOW ST MANCHESTER, NH (603) KELLER ST MANCHESTER, NH (603) MANCHESTER 271 MAMMOUTH RD MANCHESTER, NH (603) BICENTENNIAL DR MANCHESTER, NH (603) HANOVER ST MANCHESTER, NH (603) HOOKSETT RD MANCHESTER, NH (603) HOOKSETT 10 WHITEHALL RD HOOKSETT, NH (603) HOOKSETT RD HOOKSETT, NH (603) TARGET 100 QUALITY DR HOOKSETT, NH (603) COMMERCE DR HOOKSETT, NH (603) MANCHESTER 270 MAMMOTH RD MANCHESTER, NH (603) BEDFORD BEDFORD 209 ROUTE 101 BEDFORD, NH (603) CRITICAL CARE SYSTEMS 10 COMMERCE PARK NORTH BEDFORD, NH (603) S RIVER RD BEDFORD, NH (603) JENKINS RD BEDFORD, NH (603) COLBY CT BEDFORD, NH (603) SOUTH RIVER RD BEDFORD, NH (603) TARGET 220 S RIVER RD BEDFORD, NH (603) COLBY CT BEDFORD, NH (603) BELMONT 96 DANIEL WEBSTER HWY UNIT 17 BELMONT, NH (603) BRISTOL 360 SUMMER ST BRISTOL, NH (603) CONTOOCOOK COLONIAL VILLAGE 54 PARK AVENUE PLZ CONTOOCOOK, NH (603) EPSOM CARE 1912 DOVER RD EPSOM, NH (603) FRANKLIN 861 CENTRAL ST FRANKLIN, NH (603) CENTRAL ST FRANKLIN, NH (603) CENTRAL ST FRANKLIN, NH (603) HENNIKER HENNIKER 4 BRIDGE ST HENNIKER, NH (603) HILLSBORO OSCO 276 W MAIN ST HILLSBORO, NH (603) W MAIN ST HILLSBORO, NH (603) LACONIA 220 UNION AVE LACONIA, NH (603) UNION AVE LACONIA, NH (603) SHAWS 1400 LAKE SHORE DR LACONIA, NH (603) LAKE SHORE RD LACONIA, NH (603) GILFORD 1371 LAKE SHORE DR GILFORD, NH (603) LINCOLN 50 MAIN ST LINCOLN, NH (603) MEREDITH 38 NH ROUTE 25 STE 4 MEREDITH, NH (603) NEW LONDON COLONIAL 247 NEWPORT RD NEW LONDON, NH (603) NORTHWOOD 174 FIRST NH TPKE NORTHWOOD, NH (603) PITTSFIELD 41 CARROLL ST PITTSFIELD, NH (603) PLYMOUTH RTE 25 HATCH SHOPPING PLAZA PLYMOUTH, NH (603) OLIVER 19 AVERY ST STE 7 PLYMOUTH, NH (603) S MAIN ST PLYMOUTH, NH (603) TENNEY MTN HWY PLYMOUTH, NH (603) ALLENSTOWN EXPRESS 68 SCHOOL ST ALLENSTOWN, NH (603) ALLENSTOWN RD ALLENSTOWN, NH (603) TILTON SHAWS 75 LACONIA RD TILTON, NH (603) E MAIN TILTON, NH (603) WARNER WARNER 11 E MAIN ST WARNER, NH (603) November 2011

50 CONCORD WEST LEBANON CONCORD CONCORD METRO TREATMENT CENTER 8 LOUDON RD CONCORD, NH (603) HALL ST CONCORD, NH (603) N MAIN ST CONCORD, NH (603) FORT EDDY RD CONCORD, NH (603) MODERN 5 CLINTON ST CONCORD, NH (603) NORTHEAST SERVICES 125 N MAIN ST CONCORD, NH (603) PHARMERICA 38 LOCKE RD UNIT 3 CONCORD, NH (603) FORT EDDY RD CONCORD, NH (603) SOUTH ST CONCORD, NH (603) NORTH ST CONCORD, NH (603) SAM'S CLUB 304 SHEEP DAVIS RD CONCORD, NH (603) SHAWS 246 LOUDON RD CONCORD, NH (603) TARGET 80 D'AMANTE DR CONCORD, NH (603) THE PRESCRIPTION CENTER 246 PLEASANT ST STE 100 CONCORD, NH (603) THE PRESCRIPTION CENTER 18 FOUNDRY ST CONCORD, NH (603) THE PRESCRIPTION CENTER 125 N MAIN ST CONCORD, NH (603) LOUDON RD CONCORD, NH (603) CONCORD PENACOOK 305 VILLAGE ST CONCORD, NH (603) PENACOOK FISHERVILLE 219 FISHERVILLE RD PENACOOK, NH (603) KEENE 268 W ST KEENE, NH (603) WEST ST KEENE, NH (603) PRICE CHOPPER 16 ASHBROOK RD KEENE, NH (603) WINCHESTER ST KEENE, NH (603) TARGET 46 ASH BROOK RD KEENE, NH (603) HINSDALE 724 BRATTLEBORO RD HINSDALE, NH (603) JAFFREY 14 PETERBOROUGH ST JAFFREY, NH (603) PETERBOROUGH 125 DUBLIN RD PETERBOROUGH, NH (603) WILTON RD PETERBOROUGH, NH (603) RINDGE 752 US ROUTE 202 RINDGE, NH (603) RT 202 RINDGE, NH (603) WEST SWANZEY KEENE METRO TREATMENT CENTER 1076 OLD SWANZEY RD WEST SWANZEY, NH (603) WINCHESTER 10 W MAIN ST WINCHESTER, NH (603) LITTLETON AMMONOOSUC COMMMUNITY HEALTH 25 MOUNT EUSTIS RD LITTLETON, NH (603) MEADOW ST STE 136 LITTLETON, NH (603) SHAWS 625 MEADOW ST LITTLETON, NH (603) MEADOW ST LITTLETON, NH (603) BERLIN 200 PLEASANT ST BERLIN, NH (603) COLEBROOK 91 MAIN ST COLEBROOK, NH (603) GORHAM 561 MAIN ST GORHAM, NH (603) LANCASTER 177 MAIN ST LANCASTER, NH (603) CLAREMONT BANNON 109 PLEASANT ST CLAREMONT, NH (603) WALL ST CLAREMONT, NH (000) PLEASANT ST CLAREMONT, NH (603) BOWEN ST CLAREMONT, NH (603) ENFIELD FAMILY BROOKSIDE PLZ RTE 4 ENFIELD, NH (603) HANOVER 79 S MAIN ST HANOVER, NH (603) DICK'S HOUSE 5 ROPE FERRY RD HANOVER, NH (603) EASTMAN'S STORE 22 S MAIN ST HANOVER, NH (603) LEBANON DARTMOUTH HITCHCOCK 1 MEDICAL CENTER DR LEBANON, NH (603) LEBANON PRICE CHOPPER 370 MIRACLE MILE RD LEBANON, NH (603) NEWPORT 51 S MAIN ST NEWPORT, NH (603) SUGAR RIVER 46 JOHN STARK HWY NEWPORT, NH (603) Z 239 SUNAPEE ST NEWPORT, NH (603) WEST LEBANON 250 PLAINFIELD RD WEST LEBANON, NH (603) MARKET ST WEST LEBANON, NH (603) November 2011

51 WEST LEBANON EFFINGHAM KMART ROUTE 12 A WEST LEBANON, NH (603) PRICE CHOPPER 285 PLAINFIELD RD WEST LEBANON, NH (877) BENNING ST WEST LEBANON, NH (603) PLAINFIELD RD WEST LEBANON, NH (603) WOODSVILLE 4976 DARTMOUTH COLLEGE HWY WOODSVILLE, NH (603) DARTMOUTH COLLEGE HWY WOODSVILLE, NH (603) NEWINGTON 2200 WOODBURY AVE NEWINGTON, NH (603) PORTSMOUTH 674 ISLINGTON ST PORTSMOUTH, NH (603) MARTIN'S POINT PORTSMOUTH PHCY 161 CORPORATE DR PORTSMOUTH, NH (603) ISLINGTON ST UNIT 1 PORTSMOUTH, NH (603) LAFAYETTE RD STE 3 PORTSMOUTH, NH (603) WOODBURY AVE PORTSMOUTH, NH (603) LAFAYETTE RD PORTSMOUTH, NH (603) ALTON 80 WOLFBORO HWY ALTON, NH (603) CENTER CONWAY SHAWS 1150 EASTMAN RD CENTER CONWAY, NH (603) DOVER CARE 118 CENTRAL AVE DOVER, NH (603) CENTRAL AVE DOVER, NH (603) GRAPEVINE DR DOVER, NH (603) CENTRAL AVE DOVER, NH (603) CENTRAL AVE DOVER, NH (603) DURHAM 5 MILL RD DURHAM, NH (603) EAST HAMPSTEAD 305 SANDOWN RD EAST HAMPSTEAD, NH (603) EXETER 69 PORTSMOUTH AVE EXETER, NH (603) FARMINGTON 829 NH ROUTE 11 FARMINGTON, NH (603) GREENLAND TARGET 1450 GREENLAND RD STE 1 GREENLAND, NH (603) HAMPTON 321 A LAFAYETTE RD HAMPTON, NH (603) LAFAYETTE RD HAMPTON, NH (603) LAFAYETTE RD HAMPTON, NH (603) KINGSTON 53 CHURCH ST KINGSTON, NH (603) NEWMARKET 73 EXETER ST NEWMARKET, NH (603) NORTH CONWAY 1351 WHITE MOUNTAIN HWY NORTH CONWAY, NH (603) ROUTE 16 MTN VALLEY MALL NORTH CONWAY, NH (603) WHITE MOUNTAIN HWY NORTH CONWAY, NH (603) MOUNTAIN VALLEY BLVD NORTH CONWAY, NH (603) LEE 58 CALEF HWY LEE, NH (603) NORTH HAMPTON 72 LAFAYETTE RD NORTH HAMPTON, NH (603) OSSIPEE RTE 16 AMES PLAZA OSSIPEE, NH (603) ROUTE 16 OSSIPEE, NH (603) PLAISTOW 4 PLAISTOW RD PLAISTOW, NH (603) PLAISTOW RD PLAISTOW, NH (603) PLAISTOW RD. PLAISTOW, NH (603) ROCHESTER CARE OF ROCHESTER 161 S MAIN ST ROCHESTER, NH (603) LILAC MALL # 2 ROCHESTER, NH (603) N MAIN ST ROCHESTER, NH (603) WAKEFIELD ST ROCHESTER, NH (603) FARMINGTON RD ROCHESTER, NH (603) ROCHESTER 104 MILTON RD ROCHESTER, NH (603) SEABROOK 628 LAFAYETTE RD SEABROOK, NH (603) SAM'S CLUB 11 BATCHELDER RD SEABROOK, NH (603) LAFAYETTE RD SEABROOK, NH (603) SOMERSWORTH 338 HIGH ST SOMERSWORTH, NH (603) HIGH ST SOMERSWORTH, NH (603) TARGET 11 ANDREWS RD SOMERSWORTH, NH (603) HIGH ST SOMERSWORTH, NH (603) EFFINGHAM LAKEVIEW 244 HIGHWATCH RD EFFINGHAM, NH (603) November 2011

52 STRATHAM WOLFEBORO FALLS STRATHAM 1 WEST RD STRATHAM, NH (603) PORTSMOUTH AVE STRATHAM, NH (603) SHAWS 100 SHAW'S LN STRATHAM, NH (603) WOLFEBORO 50 S MAIN ST WOLFEBORO, NH (603) WOLFEBORO FALLS CARE 36 CENTER ST WOLFEBORO FALLS, NH (603) November 2011

53 BARRINGTON NEWPORT RHODE ISLAND BARRINGTON 180 COUNTY RD BARRINGTON, RI (401) GENOA HEALTHCARE OF RI 2 OLD COUNTY RD BARRINGTON, RI (401) COUNTY RD BARRINGTON, RI (401) BRISTOL 173 STATE ST BRISTOL, RI (401) METACOM AVE BRISTOL, RI (401) METACOM AVE BRISTOL, RI (401) CENTRAL FALLS 309 BROAD ST CENTRAL FALLS, RI (401) BROAD ST CENTRAL FALLS, RI (401) CHARLESTOWN OCEAN HEALTH MART 3986 OLD POST RD CHARLESTOWN, RI (401) CHEPACHET 1068 PUTNAM PIKE CHEPACHET, RI (401) COVENTRY APOTHECARE COMP SOLUTION 85 SANDY BOTTOM RD COVENTRY, RI (401) TIOGUE AVE COVENTRY, RI (401) NEW ENGLAND HOME INFUSION 85 SANDY BOTTOM RD COVENTRY, RI (401) OMNICARE OF RHODE ISLAND 30 CENTER OF NEW ENGLAND COVENTRY, RI (401) TIOGUE AVE COVENTRY, RI (401) TIOGUE AVE COVENTRY, RI (401) CTR OF NEW ENGLAND BLVD COVENTRY, RI (401) CRANSTON 681 RESERVOIR AVE CRANSTON, RI (401) ATWOOD AVE CRANSTON, RI (401) PONTIAC AVE CRANSTON, RI (401) BROAD ST CRANSTON, RI (401) OAKLAWN AVE CRANSTON, RI (401) PHRED'S 1300 OAKLAWN AVE CRANSTON, RI (401) PONTIAC AVE CRANSTON, RI (401) RESERVOIR AVE CRANSTON, RI (401) ATWOOD AVE CRANSTON, RI (401) CRANSTON ST CRANSTON, RI (401) DYER AVE CRANSTON, RI (401) ATWOOD AVE CRANSTON, RI (401) GARFIELD AVE CRANSTON, RI (401) PLAINFIELD PIKE CRANSTON, RI (401) WE CARE RX 678 PARK AVE UNIT 2 CRANSTON, RI (401) CUMBERLAND CHAPEL 2081 DIAMOND HILL RD CUMBERLAND, RI (401) MENDON RD CUMBERLAND, RI (401) DIAMOND HILL RD CUMBERLAND, RI (401) BROAD ST CUMBERLAND, RI (401) MENDON RD CUMBERLAND, RI (401) MENDON RD CUMBERLAND, RI (401) EAST GREENWICH 2250 NEW LONDON TPKE EAST GREENWICH, RI (401) MAIN ST EAST GREENWICH, RI (401) S COUNTY TRL EAST GREENWICH, RI (404) EAST PROVIDENCE CRITICAL CARE SYSTEMS 70 CATAMORE BLVD EAST PROVIDENCE, RI (401) TAUNTON AVE EAST PROVIDENCE, RI (401) WARREN AVE EAST PROVIDENCE, RI (401) WARREN AVE EAST PROVIDENCE, RI (401) PAWTUCKET AVE EAST PROVIDENCE, RI (401) GREENVILLE 445 PUTNAM PIKE GREENVILLE, RI (401) PUTNAM PIKE GREENVILLE, RI (401) JAMESTOWN BAKER'S HEALTH MART 53 NARRAGANSETT AVE JAMESTOWN, RI (401) JOHNSTON ATWOOD PRESCRIPTION CTR 1524 ATWOOD AVE JOHNSTON, RI (401) PLAINFIELD PIKE JOHNSTON, RI (401) HARTFORD AVE JOHNSTON, RI (401) JB HEALTH MART 113 PUTNAM PIKE JOHNSTON, RI (401) ATWOOD AVE JOHNSTON, RI (401) COMMERCE WAY JOHNSTON, RI (401) LINCOLN RHODE ISLAND VILLAGE 1 COMMERCE ST STE B LINCOLN, RI (401) GEORGE WASHINGTON HWY LINCOLN, RI (401) TARGET 620 GEORGE WASHINGTON HWY LINCOLN, RI (401) MIDDLETOWN 99 E MAIN RD MIDDLETOWN, RI (401) W MAIN RD MIDDLETOWN, RI (401) NARRAGANSETT 1123 BOSTON NECK RD NARRAGANSETT, RI (401) WOODRUFF AVE NARRAGANSETT, RI (401) BOSTON NECK RD NARRAGANSETT, RI (401) POINT JUDITH RD STE 24 NARRAGANSETT, RI (401) NEWPORT 181 BELLEVUE AVE NEWPORT, RI (401) NEWPORT PRESCRIPTION CENTER HM 289 BROADWAY NEWPORT, RI (401) December 2011

54 NEWPORT TIVERTON 7 E MAIN RD NEWPORT, RI (401) CONNELL HWY NEWPORT, RI (401) NORTH KINGSTOWN 6495 POST RD NORTH KINGSTOWN, RI (401) POST RD NORTH KINGSTOWN, RI (401) POST RD NORTH KINGSTOWN, RI (401) BROWN ST NORTH KINGSTOWN, RI (401) TEN ROD RD NORTH KINGSTOWN, RI (401) NORTH PROVIDENCE 1510 SMITH ST NORTH PROVIDENCE, RI (401) NORTH SCITUATE 47 VILLAGE PLAZA WAY NORTH SCITUATE, RI (401) NORTH SMITHFIELD 120 EDDIE DOWLING HWY NORTH SMITHFIELD, RI (401) SMITHFIELD RD NORTH SMITHFIELD, RI (401) DOWLING VILLAGE BLVD NORTH SMITHFIELD, RI (401) PASCOAG 20 HIGH ST PASCOAG, RI (401) PAWTUCKET BLACKSTONE HEALTH MART PHCY 465 LONSDALE AVE UNIT B PAWTUCKET, RI (401) NEWPORT AVE PAWTUCKET, RI (401) SMITHFIELD AVE PAWTUCKET, RI (401) E AVE PAWTUCKET, RI (401) HOWELL SMITH GISTS 749 CENTRAL AVE PAWTUCKET, RI (401) QOL MEDS 101 BACON ST PAWTUCKET, RI (401) POWER RD PAWTUCKET, RI (401) MINERAL SPRING AVE PAWTUCKET, RI (401) EAST AVE PAWTUCKET, RI (401) SIMPSON'S 10 NEWPORT AVE PAWTUCKET, RI (401) BROADWAY PAWTUCKET, RI (401) PORTSMOUTH 10 TURNPIKE AVE PORTSMOUTH, RI (401) E MAIN ST PORTSMOUTH, RI (401) E MAIN RD PORTSMOUTH, RI (401) PROVIDENCE ANTHONY'S HM STORE 219 MANTON AVE PROVIDENCE, RI (401) BROWN UNIVERSITY 13 BROWN ST PROVIDENCE, RI (401) HOPE ST PROVIDENCE, RI (401) MANTON AVE PROVIDENCE, RI (401) ADMIRAL ST PROVIDENCE, RI (401) BROAD ST PROVIDENCE, RI (401) WEBSTER AVE PROVIDENCE, RI (401) FRANCIS ST PROVIDENCE, RI (401) MINERAL SPRING AVE PROVIDENCE, RI (401) ANGELL ST PROVIDENCE, RI (401) PROCARE 2 DUDLEY ST STE 170 PROVIDENCE, RI (401) EAST SIDE PRESCRIPTION CENTER 632 HOPE ST PROVIDENCE, RI (401) GENOA HEALTHCARE 530 N MAIN ST STE 124 PROVIDENCE, RI (401) JB 1001 SMITH ST PROVIDENCE, RI (401) N D S 866 BROAD ST PROVIDENCE, RI (401) PROVIDENCE METRO TREATMENT CTR 160 NARRAGANSETT AVE PROVIDENCE, RI (401) PITMAN ST PROVIDENCE, RI (401) MINERAL SPRING RD PROVIDENCE, RI (401) ACADEMY AVE PROVIDENCE, RI (401) BRANCH ST PROVIDENCE, RI (401) N MAIN ST PROVIDENCE, RI (401) BROAD ST PROVIDENCE, RI (401) SHAWS 15 SMITHFIELD RD PROVIDENCE, RI (401) MINERAL SPRING AVE PROVIDENCE, RI (401) MANTON AVE PROVIDENCE, RI (401) VIDASCRIP 500 BROAD ST STE 6 PROVIDENCE, RI (401) SILVER SPRING ST PROVIDENCE, RI (401) WHITE CROSS 1 RANDALL SQ PROVIDENCE, RI (401) RICHMOND 21 KINGSTOWN RD RICHMOND, RI (401) RIVERSIDE 444 WILLETT AVE RIVERSIDE, RI (401) INFUSION RESOURCE 2 HEMINGWAY DR RIVERSIDE, RI (401) WILLETT AVE RIVERSIDE, RI (401) RUMFORD 63 NEWPORT AVE RUMFORD, RI (401) NEWPORT AVE RUMFORD, RI (401) SAUNDERSTOWN BAYVIEW 3045 TOWERHILL RD UNIT 3 SAUNDERSTOWN, RI (401) SLATERSVILLE 900 VICTORY HWY SLATERSVILLE, RI (401) SMITHFIELD MILLENNIUM 33 APPIAN WAY STE B SMITHFIELD, RI (724) PUTNAM PIKE SMITHFIELD, RI (401) TARGET 371 PUTMAN PIKE SMITHFIELD, RI (401) TIVERTON 500 MAIN RD TIVERTON, RI (401) MAIN RD TIVERTON, RI (401) December 2011

55 WAKEFIELD WYOMING WAKEFIELD 11 MAIN ST WAKEFIELD, RI (401) QOL MEDS 55 CHERRY LN WAKEFIELD, RI (401) KINGSTOWN RD WAKEFIELD, RI (401) WAKEFIELD PRESCRIPTION CENTER 580 KINGSTOWN RD WAKEFIELD, RI (401) WARREN 615 METACOM AVE WARREN, RI (401) DELEKTA 496 MAIN ST WARREN, RI (401) WARWICK 2400 WARWICK AVE WARWICK, RI (401) WARWICK AVE WARWICK, RI (401) POST RD WARWICK, RI (401) OXNARD HEALTH MART 198 BUTTONWOOD AVE WARWICK, RI (401) PHARMERICA 83 VERMONT AVE UNIT 2 WARWICK, RI (401) WARWICK AVE WARWICK, RI (401) W SHORE RD WARWICK, RI (401) WARWICK AVE WARWICK, RI (401) BALD HILL RD WARWICK, RI (401) QUAKER LN WARWICK, RI (401) WARWICK AVE WARWICK, RI (401) SUBURBAN 242 PAWTUXET AVE WARWICK, RI (401) TARGET 400 BALD HILL RD STE 200 WARWICK, RI (401) TARGET 1245 BALD HILL RD WARWICK, RI (401) BALD HILL RD WARWICK, RI (401) POST RD WARWICK, RI (401) WEST WARWICK 1734 MAIN ST WEST WARWICK, RI (401) PROVIDENCE ST WEST WARWICK, RI (401) MAIN ST WEST WARWICK, RI (401) MAIN ST WEST WARWICK, RI (401) UROLOGIC SPECIALISTS 207 QUAKER LN WEST WARWICK, RI (401) WESTERLY 151 FRANKLIN ST WESTERLY, RI (401) GRANITE ST WESTERLY, RI (401) MCQUADES MARKETPLACE 106 MAIN ST WESTERLY, RI (401) GRANITE ST WESTERLY, RI (401) POST RD WESTERLY, RI (401) WOONSOCKET 1516 DIAMOND HILL RD WOONSOCKET, RI (401) CASS AVE WOONSOCKET, RI (401) PROCARE 450 CLINTON ST WOONSOCKET, RI (401) SOCIAL ST WOONSOCKET, RI (401) WYOMING 1187 MAIN ST WYOMING, RI (401) December 2011

56 ANSONIA CHESHIRE CONNECTICUT ANSONIA 24 PERSHING DR ANSONIA, CT (203) HANCOCK VI 95 WAKELEE AVE ANSONIA, CT (203) LEAR 198 WAKELEE AVE ANSONIA, CT (203) MAIN ST ANSONIA, CT (203) DIVISION ST ANSONIA, CT (203) TARGET 20 W MAIN ST ANSONIA, CT (203) AVON 358 W MAIN ST AVON, CT (860) RT 44 & DALE RD AVON, CT (860) W MAIN ST AVON, CT (860) BEACON FALLS BEACON FALLS 20 N MAIN ST BEACON FALLS, CT (203) BERLIN 1055 FARMINGTON AVE BERLIN, CT (860) WILBUR CROSS HWY BERLIN, CT (860) PHARMERICA 77 OLD BRICKYARD LN STE 1 BERLIN, CT (860) FARMINGTON AVE BERLIN, CT (860) BETHEL BIG Y 81 STONY HILL RD BETHEL, CT (203) DURANT AVE BETHEL, CT (203) ENGLISH APOTHECARY 140 GREENWOOD AVE BETHEL, CT (860) GREENWOOD AVE BETHEL, CT (203) TARGET 7 STONY HILL RD BETHEL, CT (203) BETHLEHEM TOWNE APOTHECARY 95 MAIN ST S BETHLEHEM, CT (203) BLOOMFIELD 341 COTTAGE GROVE RD BLOOMFIELD, CT (860) PARK AVE BLOOMFIELD, CT (860) RELIANCE 699 COTTAGE GROVE RD BLOOMFIELD, CT (860) PARK AVE BLOOMFIELD, CT (860) BOLTON BOLTON 667 BOSTON TPKE BOLTON, CT (860) BRANFORD 2-6 SHORT BEACH RD BRANFORD, CT (203) LEETES ISLAND RD BRANFORD, CT (203) TOWNE 1012 MAIN ST BRANFORD, CT (203) COMMERCIAL PKWY BRANFORD, CT (203) BRIDGEPORT ARROW PRESCRIPTION CENTER 2660 MAIN ST BRIDGEPORT, CT (203) BRIDGEPORT 978 E MAIN ST BRIDGEPORT, CT (203) MAIN ST BRIDGEPORT, CT (203) E MAIN ST BRIDGEPORT, CT (203) BOSTON AVE BRIDGEPORT, CT (203) HANCOCK 1557 FAIRFIELD AVE BRIDGEPORT, CT (203) HANCOCK 1020 FAIRFIELD AVE BRIDGEPORT, CT (203) HANCOCK IV 500 SYLVAN AVE BRIDGEPORT, CT (203) LUPE'S STORE 3129 MAIN ST BRIDGEPORT, CT (203) MAIN STREET 2117 BOSTON AVE BRIDGEPORT, CT (203) MAIN STREET 1001 MAIN ST STE 7 BRIDGEPORT, CT (203) E MAIN ST BRIDGEPORT, CT (203) MADISON AVE BRIDGEPORT, CT (203) N MAIN ST BRIDGEPORT, CT (203) BRISTOL BEACON MEDICATION SERVICES 25 MELLEN ST BRISTOL, CT (860) BEACON PRESCRIPTION SOUTH ST 57 SOUTH ST BRISTOL, CT (860) BEACON PRESCRIPTIONS 25 COLLINS RD BRISTOL, CT (860) N MAIN ST BRISTOL, CT (860) MIDDLE ST BRISTOL, CT (860) FARMINGTON AVE BRISTOL, CT (860) PRICE CHOPPER 121 FARMINGTON AVE BRISTOL, CT (860) N MAIN ST STE A BRISTOL, CT (860) SHOPRITE 1200 FARMINGTON AVE BRISTOL, CT (860) FARMINGTON AVE BRISTOL, CT (860) PINE ST BRISTOL, CT (860) FARMINGTON AVE BRISTOL, CT (860) BROOKFIELD BROOKFIELD 31 OLD ROUTE 7 BROOKFIELD, CT (203) BROOKFIELD 60 OLD NEW MILFORD RD BROOKFIELD, CT (203) COSTCO 200 FEDERAL RD BROOKFIELD, CT (203) CANDLEWOOD LAKE RD BROOKFIELD, CT (203) FEDERAL RD BROOKFIELD, CT (203) BROOKLYN 542 PROVIDENCE RD BROOKLYN, CT (860) BURLINGTON 292 SPEILMAN HWY BURLINGTON, CT (860) CANAAN CANAAN APOTHECARY 91 MAIN ST CANAAN, CT (860) GEER 99 S CANAAN RD CANAAN, CT (860) MAIN ST CANAAN, CT (860) CANTERBURY 200 WESTMINSTER RD CANTERBURY, CT (860) CHESHIRE 581 HIGHLAND AVE CHESHIRE, CT (203) S MAIN ST CHESHIRE, CT (203) December 2011

57 CHESHIRE ENFIELD 922 S MAIN ST CHESHIRE, CT (203) MAIN ST CHESHIRE, CT (203) HIGHLAND AVE CHESHIRE, CT (203) VALUE HEALTHCARE SERVICES 525 KNOTTER DR CHESHIRE, CT (203) CLINTON 14 E MAIN ST CLINTON, CT (860) SHOPRITE 266 E MAIN ST CLINTON, CT (860) E MAIN ST CLINTON, CT (860) COLCHESTER 119 S MAIN ST COLCHESTER, CT (860) BROADWAY ST COLCHESTER, CT (860) LINWOOD AVE COLCHESTER, CT (860) COS COB 122 E PUTNAM AVE COS COB, CT (203) COVENTRY 3514 MAIN ST COVENTRY, CT (860) CROMWELL 72 BERLIN RD CROMWELL, CT (860) PROFESSIONAL HOME CARE SVCS 104 SEBETHE DR CROMWELL, CT (860) SHUNPIKE RD CROMWELL, CT (860) BERLIN RD CROMWELL, CT (860) XPECT 47 SHUNPIKE RD CROMWELL, CT (860) DANBURY A AND P SUPER FOODMART 35 MAIN ST DANBURY, CT (203) A AND P SUPER FOODMART 1 PANDANARAM RD DANBURY, CT (203) PADANARAM RD DANBURY, CT (203) LAKE AVENUE EXT # 49 DANBURY, CT (203) SOUTH ST DANBURY, CT (203) WHITE ST DANBURY, CT (203) DANBURY 95 LOCUST AVE DANBURY, CT (203) MAIN STREET 151 MAIN ST DANBURY, CT (203) MILL PLAIN RD DANBURY, CT (203) GERMANTOWN RD DANBURY, CT (203) A PADANARUM RD DANBURY, CT (203) NEW TOWN RD DANBURY, CT (203) LAKE AVENUE EXT DANBURY, CT (203) NEWTOWN RD DANBURY, CT (203) DANIELSON BIG Y 70 WAUREGAN RD DANIELSON, CT (860) BONNEVILLE 77 WESTCOTT RD DANIELSON, CT (860) DARIEN 964 POST RD DARIEN, CT (203) GRIEB'S 1021 POST RD DARIEN, CT (203) DAYVILLE GENOA HEALTHCARE 1007 N MAIN ST DAYVILLE, CT (860) N MAIN ST DAYVILLE, CT (860) TARGET 2177 KILLINGLY CMNS DAYVILLE, CT (860) DERBY 656 NEW HAVEN AVE DERBY, CT (203) GRIFFIN AND GIFT 130 DIVISION ST DERBY, CT (203) SHOPRITE 49 PERSHING DR DERBY, CT (203) NEW HAVEN AVE DERBY, CT (203) DURHAM DURHAM 321 MAIN ST DURHAM, CT (860) EAST BERLIN CAP 80 CLARK DR EAST BERLIN, CT (866) EAST HAMPTON 54 E HIGH ST EAST HAMPTON, CT (860) E HIGH ST EAST HAMPTON, CT (860) E HIGH ST EAST HAMPTON, CT (860) EAST HARTFORD 20 BURNSIDE AVE EAST HARTFORD, CT (860) MAIN ST EAST HARTFORD, CT (860) ELLINGTON RD EAST HARTFORD, CT (860) SHOPRITE 31 MAIN ST EAST HARTFORD, CT (860) SILVER LN EAST HARTFORD, CT (860) EAST HAVEN BEACON PRESCRIPTIONS 875 FOXON RD EAST HAVEN, CT (203) MAIN ST EAST HAVEN, CT (203) FOXON RD EAST HAVEN, CT (203) MAIN ST EAST HAVEN, CT (203) HEMINGWAY AVE EAST HAVEN, CT (203) FOXON RD EAST HAVEN, CT (203) HEMINGWAY AVE EAST HAVEN, CT (203) EAST LYME 15 CHESTERFIELD RD EAST LYME, CT (860) FLANDERS AVE EAST LYME, CT (860) FLANDERS RD EAST LYME, CT (860) EAST WINDSOR BIG Y 67 PROSPECT HILL RD EAST WINDSOR, CT (860) BRIDGE ST EAST WINDSOR, CT (860) PROSPECT HILL RD EAST WINDSOR, CT (860) ELLINGTON BIG Y 135 WEST RD ELLINGTON, CT (860) ENFIELD ABLE CARE PHCY AND MED SPPLY 15 PALOMBA DR ENFIELD, CT (860) December 2011

58 ENFIELD JEWETT CITY COSTCO 75 FRESHWATER BLVD ENFIELD, CT (860) HAZARD AVE ENFIELD, CT (860) ENFIELD ST ENFIELD, CT (860) PALOMBA DR ENFIELD, CT (860) SOUTHWOOD 89 RAFFIA RD ENFIELD, CT (860) HAZARD AVE ENFIELD, CT (860) TARGET 90 ELM ST ENFIELD, CT (860) ESSEX 125 WESTBROOK RD ESSEX, CT (860) FAIRFIELD 330 GRASMERE AVE FAIRFIELD, CT (203) BLACK ROCK TPKE FAIRFIELD, CT (203) BLACK ROCK TPKE FAIRFIELD, CT (203) POST RD FAIRFIELD, CT (203) LUPE'S STORE 2035 BLACK ROCK TPKE FAIRFIELD, CT (203) POST RD FAIRFIELD, CT (203) KINGS HIGHWAY CUTOFF FAIRFIELD, CT (203) FARMINGTON ARROW PHARM AND NUTRITION CTR 838 FARMINGTON AVE FARMINGTON, CT (888) MAIN ST RTE 10 FARMINGTON, CT (860) GEORGETOWN REDDING 73 REDDING RD GEORGETOWN, CT (203) GLASTONBURY 766 NEW LONDON TPKE GLASTONBURY, CT (860) MAIN ST GLASTONBURY, CT (860) GLASTONBURY BLVD GLASTONBURY, CT (860) OAK ST GLASTONBURY, CT (860) GRANBY 20 BANK ST GRANBY, CT (860) GRANBY 9 HARTFORD AVE GRANBY, CT (860) SALMON BROOK ST GRANBY, CT (860) GREENWICH 99 GREENWICH AVE GREENWICH, CT (203) FINCH 3 RIVERSVILLE RD GREENWICH, CT (203) GRANNICK'S 277 GREENWICH AVE GREENWICH, CT (203) GREENVIEW 13 N WATER ST GREENWICH, CT (203) GREENWICH 116 GREENWICH AVE GREENWICH, CT (203) HARMONY & HEALTH CTR 84 E PUTNAM AVE GREENWICH, CT (917) NORTH STREET 1043 NORTH ST GREENWICH, CT (203) PALMERS PROFESSIONAL 49 LAKE AVE GREENWICH, CT (203) GROTON BIG Y 995 POQUONNOCK RD GROTON, CT (860) POQUONNOCK RD GROTON, CT (860) FORT HILL 116 FORT HILL RD GROTON, CT (860) ROUTE 12 GROTON, CT (860) GOLD STAR HWY GROTON, CT (860) GUILFORD BIG Y 830 BOSTON POST RD GUILFORD, CT (203) BOSTON POST RD STE 2 GUILFORD, CT (203) HAMDEN ANNEX 2380 A DIXWELL AVE HAMDEN, CT (203) APEX AND HOME CARE 2380 DIXWELL AVE HAMDEN, CT (203) DIXWELL AVE HAMDEN, CT (203) DIXWELL AVE HAMDEN, CT (203) SHOPRITE 2100 DIXWELL AVE HAMDEN, CT (203) DIXWELL AVE HAMDEN, CT (203) DIXWELL AVE HAMDEN, CT (203) DIXWELL AVE HAMDEN, CT (203) HARTFORD ARROW PRESCRIPTION CENTER 100 WOODLAND ST HARTFORD, CT (860) ARROW PRESCRIPTION CENTER 85 SEYMOUR ST HARTFORD, CT (860) ARROW PRESCRIPTION CENTER 500 ALBANY AVE HARTFORD, CT (860) ARROW PRESCRIPTION CENTER 500 FARMINGTON AVE HARTFORD, CT (860) ARROW PRESCRIPTION CENTER 131 COVENTRY ST HARTFORD, CT (860) WETHERSFIELD AVE HARTFORD, CT (860) FARMINGTON AVE HARTFORD, CT (860) MAIN ST HARTFORD, CT (860) BLUE HILLS AVE HARTFORD, CT (860) MAPLE AVE HARTFORD, CT (860) ONCOLOGY ASSOCIATES 85 RETREAT AVE HARTFORD, CT (860) ALBANY AVE HARTFORD, CT (860) FRANKLIN AVE HARTFORD, CT (860) SCHOOL ST HARTFORD, CT (860) NEW PARK AVE HARTFORD, CT (860) FLATBUSH AVE HARTFORD, CT (860) HEBRON HEBRON 117 MAIN ST HEBRON, CT (860) HIGGANUM HIGGANUM 3 CANDLEWOOD HILL RD STE A HIGGANUM, CT (860) JEWETT CITY JEWETT CITY 78 MAIN ST JEWETT CITY, CT (860) December 2011

59 JEWETT CITY NAUGATUCK 27 MAIN ST JEWETT CITY, CT (860) KENSINGTON BEACON PRESCRIPTIONS 59 CHAMBERLAIN HWY KENSINGTON, CT (860) FARMINGTON AVE KENSINGTON, CT (860) KENT KENT APOTHECARY 3 MAPLE ST KENT, CT (860) KILLINGWORTH KILLINGWORTH FAMILY 183 ROUTE 81 STE 3 KILLINGWORTH, CT (860) LISBON TARGET 195 RIVER RD LISBON, CT (860) RIVER RD LISBON, CT (860) LITCHFIELD 266 WEST ST LITCHFIELD, CT (860) MURPHY'S 59 WEST ST LITCHFIELD, CT (860) WEST ST LITCHFIELD, CT (860) MADISON 613 BOSTON POST RD MADISON, CT (203) SAMSON ROCK DR MADISON, CT (203) MANCHESTER BIG Y 234 TOLLAND TPKE MANCHESTER, CT (860) N MAIN ST MANCHESTER, CT (860) MIDDLE TPKE W MANCHESTER, CT (860) GENOA HEALTHCARE 587 MIDDLE TPKE E MANCHESTER, CT (860) LENOX 299 E CENTER ST MANCHESTER, CT (860) MANCHESTER 348 MAIN ST MANCHESTER, CT (860) CENTER ST MANCHESTER, CT (860) SAM'S CLUB 69 PAVILIONS DR MANCHESTER, CT (860) SHOPRITE 214 SPENCER ST MANCHESTER, CT (860) BROAD ST MANCHESTER, CT (860) TARGET 125 BUCKLAND HILLS DR MANCHESTER, CT (860) BUCKLAND HILLS DR MANCHESTER, CT (860) WESTOWN 455 HARTFORD RD MANCHESTER, CT (860) MANSFIELD BIG Y 141 B STORRS RD MANSFIELD, CT (860) MERIDEN BIG Y 533 S BROAD ST MERIDEN, CT (203) W MAIN ST MERIDEN, CT (203) E MAIN ST MERIDEN, CT (203) E MAIN ST MERIDEN, CT (203) GENOA HEALTHCARE 883 PADDOCK AVE MERIDEN, CT (203) GRAEBER'S 172 W MAIN ST MERIDEN, CT (203) HANCOCKS 840 E MAIN ST MERIDEN, CT (203) BROAD ST MERIDEN, CT (203) TARGET 474 CHAMBERLAIN HWY MERIDEN, CT (203) MIDDLETOWN CONNECTICUT ONCOLOGY GROUP 536 SAYBROOK RD MIDDLETOWN, CT (860) MAIN STREET EXT MIDDLETOWN, CT (860) WASHINGTON ST MIDDLETOWN, CT (860) HANCOCK V 644 MAIN ST MIDDLETOWN, CT (860) PRICE CHOPPER 855 WASHINGTON ST MIDDLETOWN, CT (860) MAIN ST MIDDLETOWN, CT (860) MAIN ST MIDDLETOWN, CT (860) MILFORD COSTCO 1718 BOSTON POST RD MILFORD, CT (203) BOSTON POST RD MILFORD, CT (203) BROAD ST MILFORD, CT (203) HOWES 78 BROAD ST MILFORD, CT (203) NEW HAVEN AVE MILFORD, CT (203) BOSTON POST RD MILFORD, CT (203) W TOWN ST MILFORD, CT (203) BRIDGEPORT AVE MILFORD, CT (203) TARGET 1191 BOSTON POST RD MILFORD, CT (203) BOSTON POST RD MILFORD, CT (203) XPECT 480 BOSTON POST RD MILFORD, CT (203) MONROE 535 MONROE TPKE MONROE, CT (203) MONROE TPKE MONROE, CT (203) MAIN ST MONROE, CT (203) MOODUS NATHAN HALE 26 FALLS RD MOODUS, CT (860) MOOSUP 20 PROSPECT ST MOOSUP, CT (860) MYSTIC BIG Y 179 STONINGTON RD MYSTIC, CT (860) BROADWAY AVE MYSTIC, CT (860) MCQUADES 10 CLARA DR MYSTIC, CT (860) MCQUADES SPECIALTY 10 CLARA DR MYSTIC, CT (860) NAUGATUCK BIG Y 85 BRIDGE ST NAUGATUCK, CT (203) BRIDGE ST NAUGATUCK, CT (203) FORD 2 CHURCH ST NAUGATUCK, CT (203) NELSON'S 153 MAPLE ST NAUGATUCK, CT (203) RUBBER AVE NAUGATUCK, CT (203) RUBBER AVE NAUGATUCK, CT (203) December 2011

60 NAUGATUCK NORWALK 1100 NEW HAVEN RD NAUGATUCK, CT (203) NEW BRITAIN BEACON PRESCRIPTIONS 543 W MAIN ST NEW BRITAIN, CT (860) W MAIN ST NEW BRITAIN, CT (860) COLUMBUS BLVD NEW BRITAIN, CT (860) STANLEY ST NEW BRITAIN, CT (860) CORBIN AVE NEW BRITAIN, CT (860) TARGET 475 HARTFORD RD NEW BRITAIN, CT (860) NEW CANAAN 94 PARK ST NEW CANAAN, CT (203) LANGS 136 ELM ST NEW CANAAN, CT (203) VARNUM'S 91 MAIN ST NEW CANAAN, CT (203) NEW FAIRFIELD CANDLEWOOD S 11 STATE ROUTE 37 NEW FAIRFIELD, CT (203) STATE ROUTE 39 NEW FAIRFIELD, CT (203) NEW HAVEN BELLA VISTA HLTH MART PHCY 321 EASTERN ST BLDG A NEW HAVEN, CT (203) BERNEYS 615 HOWARD AVE NEW HAVEN, CT (203) WHALLEY AVE NEW HAVEN, CT (203) WHALLEY AVE NEW HAVEN, CT (203) EAST ROCK 767 ORANGE ST NEW HAVEN, CT (203) HANCOCK 1 LONG WHARF DR STE 116 NEW HAVEN, CT (203) HANCOCK VII 306 GRAND AVE NEW HAVEN, CT (203) HOSP OF ST RAPHAEL APOTHECARY 1450 CHAPEL ST NEW HAVEN, CT (203) MEDICAL CENTER 50 YORK ST NEW HAVEN, CT (203) CHAPEL SQUARE ST NEW HAVEN, CT (203) WHALLEY AVE NEW HAVEN, CT (203) FERRY ST NEW HAVEN, CT (203) AMITY RD NEW HAVEN, CT (203) VISEL'S STORE 714 DIXWELL AVE NEW HAVEN, CT (203) FOXON BLVD NEW HAVEN, CT (203) NEW LONDON 817 BANK ST NEW LONDON, CT (860) GENOA HEALTHCARE 165 STATE ST FLOOR 2 NEW LONDON, CT (860) MEDICINE SHOPPE 613 BROAD ST NEW LONDON, CT (860) BROAD ST NEW LONDON, CT (860) SHOPRITE 351 N FRONTAGE RD NEW LONDON, CT (860) NEW MILFORD BIG Y 2 BANK ST NEW MILFORD, CT (860) EAST ST NEW MILFORD, CT (860) DANBURY RD NEW MILFORD, CT (860) DANBURY RD NEW MILFORD, CT (860) DANBURY RD NEW MILFORD, CT (860) NEWINGTON 1181 MAIN ST NEWINGTON, CT (860) PRICE CHOPPER 2985 BERLIN TPKE NEWINGTON, CT (860) CEDAR ST NEWINGTON, CT (860) SAM'S CLUB 3465 BERLIN TPKE NEWINGTON, CT (860) KITTS LN NEWINGTON, CT (860) FENN RD NEWINGTON, CT (860) TARGET 3265 BERLIN TPKE NEWINGTON, CT (860) BERLIN TPKE NEWINGTON, CT (860) NEWTOWN 6 QUEENS ST NEWTOWN, CT (203) CENTER OF NEWTOWN 61 CHURCH HILL RD NEWTOWN, CT (203) S MAIN ST NEWTOWN, CT (203) NIANTIC 58 PENNSYLVANIA AVE NIANTIC, CT (860) NORTH BRANFORD BIG Y 1289 FOXON RD NORTH BRANFORD, CT (203) BRANFORD RD NORTH BRANFORD, CT (203) NORTH HAVEN 162 WASHINGTON AVE NORTH HAVEN, CT (203) NORTH HAVEN 278 MAPLE AVE NORTH HAVEN, CT (203) EXPRESS 262 STATE ST NORTH HAVEN, CT (203) MIDDLETOWN AVE NORTH HAVEN, CT (203) WASHINGTON AVE NORTH HAVEN, CT (203) TARGET 2 UNIVERSAL DR N NORTH HAVEN, CT (203) NORTH WINDHAM 474 BOSTON POST RD NORTH WINDHAM, CT (860) NORTHFORD 1395 MIDDLETOWN AVE NORTHFORD, CT (203) NORWALK ARCHFOOT CARE 761 MAIN AVE NORWALK, CT (203) COSTCO 779 CONNECTICUT AVE NORWALK, CT (203) WILLARD RD NORWALK, CT (203) WEST AVE NORWALK, CT (203) MAIN AVE NORWALK, CT (203) NORWALK 250 WESTPORT AVE NORWALK, CT (203) EAST AVE NORWALK, CT (203) NEW CANAAN AVE NORWALK, CT (203) SHOPRITE 360 CONNECTICUT AVE NORWALK, CT (203) CONNECTICUT AVE NORWALK, CT (203) December 2011

61 NORWALK SOMERS 380 MAIN ST NORWALK, CT (203) SWC 120 CONNECTICUT AVE NORWALK, CT (203) SWC 24 STEVENS ST NORWALK, CT (203) VITAL CARE OF CONNECTICUT 189 MAIN ST NORWALK, CT (203) MAIN AVE NORWALK, CT (203) CONNECTICUT AVE NORWALK, CT (203) NORWICH BIG Y 224 SALEM TPKE NORWICH, CT (860) W MAIN ST NORWICH, CT (860) GREENVILLE STORE 213 CENTRAL AVE NORWICH, CT (860) W MAIN ST NORWICH, CT (860) TOWN ST NORWICH, CT (860) UMCAS 20 TOWN ST NORWICH, CT (860) UTLEY AND JONES 112 LAFAYETTE ST NORWICH, CT (860) SALEM TPKE NORWICH, CT (860) OLD GREENWICH 225 SOUND BEACH AVE OLD GREENWICH, CT (203) OLD LYME 90 HALLS RD OLD LYME, CT (860) OLD SAYBROOK 519 BOSTON POST RD OLD SAYBROOK, CT (860) ELM ST OLD SAYBROOK, CT (860) BOSTON POST RD OLD SAYBROOK, CT (860) ORANGE 279 BOSTON POST RD ORANGE, CT (203) SAM'S CLUB 2 BOSTON POST RD ORANGE, CT (203) BULL HILL LN ORANGE, CT (203) TARGET 25 BOSTON POST RD ORANGE, CT (203) OXFORD OXFORD 260 OXFORD RD OXFORD, CT (203) PAWCATUCK 37 S BROAD ST PAWCATUCK, CT (860) PLAINFIELD 10 LATHROP RD PLAINFIELD, CT (860) PLAINVILLE 14 FARMINGTON AVE PLAINVILLE, CT (860) DISCOVER RX 25 ROBERT JACKSON WAY PLAINVILLE, CT (860) MEDSTAT 41 NORTHWEST DR PLAINVILLE, CT (860) EAST ST PLAINVILLE, CT (860) PLANTSVILLE PLANTSVILLE 1 W MAIN ST PLANTSVILLE, CT (860) PORTLAND BORDONARO 283 MAIN ST PORTLAND, CT (860) MEDICINE CENTRE- SENIOR CARE 283 MAIN ST PORTLAND, CT (800) MAIN ST PORTLAND, CT (860) PROSPECT 73 WATERBURY RD PROSPECT, CT (203) PUTNAM 57 PROVIDENCE PIKE PUTNAM, CT (860) PRICE CHOPPER 251 KENNEDY DR STE A PUTNAM, CT (860) KENNEDY DR PUTNAM, CT (860) PROVIDENCE PIKE PUTNAM, CT (860) SCHOOL ST PUTNAM, CT (860) RIDGEFIELD BISSELL 23 GOVERNOR ST RIDGEFIELD, CT (203) MAIN ST RIDGEFIELD, CT (203) DANBURY RD RIDGEFIELD, CT (203) DANBURY RD RIDGEFIELD, CT (203) RIVERSIDE 1239 E PUTNAM AVE RIVERSIDE, CT (203) ROCKY HILL BIG Y 1040 ELM ST ROCKY HILL, CT (860) MAIN ST ROCKY HILL, CT (860) CROMWELL AVE ROCKY HILL, CT (860) RX HEALTH 70 INWOOD RD STE 5 ROCKY HILL, CT (860) TOWN LINE RD ROCKY HILL, CT (860) SALISBURY SALISBURY 20 MAIN ST SALISBURY, CT (860) SEYMOUR 215 WEST ST SEYMOUR, CT (203) SEYBRIDGE 37 NEW HAVEN RD SEYMOUR, CT (203) FRANKLIN ST SEYMOUR, CT (203) SHARON SHARON 8 GAY STREET SHARON, CT (860) SHELTON MEDICINE SHOPPE 202 LEAVENWORTH RD SHELTON, CT (203) SHOPRITE 875 BRIDGEPORT AVE SHELTON, CT (203) BRIDGEPORT AVE SHELTON, CT (203) BRIDGEPORT AVE SHELTON, CT (203) SIMSBURY 714 HOPMEADOW ST SIMSBURY PLZ SIMSBURY, CT (860) HOPMEADOW APOTH AND MED EQUIP 1300 HOPMEADOW ST SIMSBURY, CT (860) SIMSBURY 1418 HOPMEADOW ST SIMSBURY, CT (860) BUSHY HILL RD SIMSBURY, CT (860) SOMERS SOMERS 629 MAIN ST SOMERS, CT (860) December 2011

62 SOUTH WINDSOR TRUMBULL SOUTH WINDSOR 525 BUCKLAND RD SOUTH WINDSOR, CT (860) SOUTHBURY 22 DEPOT HILL RD SOUTHBURY, CT (203) ODIN DE LOS REYES DPM 1 POMPERAUG OFFICE PARK SOUTHBURY, CT (203) RELIANT 200 MAIN ST S SOUTHBURY, CT (203) SHOPRITE 775 MAIN ST S SOUTHBURY, CT (203) MAIN ST N SOUTHBURY, CT (203) SOUTHINGTON BEACON PRESCRIPTIONS 609 N MAIN ST SOUTHINGTON, CT (860) MAIN ST SOUTHINGTON, CT (860) QUEENS ST SOUTHINGTON, CT (860) PRICE CHOPPER 410 QUEEN ST SOUTHINGTON, CT (860) QUEEN ST SOUTHINGTON, CT (860) MAIN ST SOUTHINGTON, CT (860) SERAFINO 36 N MAIN ST SOUTHINGTON, CT (860) N MAIN ST SOUTHINGTON, CT (860) TARGET 600 EXECUTIVE BLVD SOUTHINGTON, CT (860) QUEEN ST SOUTHINGTON, CT (860) SOUTHPORT SWITZER 322 PEQUOT AVE SOUTHPORT, CT (203) STAFFORD SPRINGS BIG Y 87 W STAFFORD RD STE C STAFFORD SPRINGS, CT (860) W STAFFORD RD STAFFORD SPRINGS, CT (860) STAMFORD 11 FOREST ST STAMFORD, CT (203) HOPE ST STAMFORD, CT (203) HOPE ST STAMFORD, CT (203) NEWFIELD AVE STAMFORD, CT (203) HIGH RIDGE RD STAMFORD, CT (203) HOPE STREET 221 HOPE ST STAMFORD, CT (203) MAIN STREET 166 W BROAD ST STE G1 STAMFORD, CT (203) MEDICINE SHOPPE 296 BEDFORD ST STAMFORD, CT (203) HEALTHCARE SOLUTIONS 68 ELMCROFT RD STAMFORD, CT (203) PROFESSIONAL 32 STRAWBERRY HILL CT STAMFORD, CT (203) HOYT ST STAMFORD, CT (203) SHOPRITE 1990 W MAIN ST STAMFORD, CT (203) SHOPRITE 200 SHIPPAN AVE STAMFORD, CT (203) SLAVIN'S PROFESSIONAL 922 WASHINGTON BLVD STAMFORD, CT (203) STAMFORD 1055 HIGH RIDGE RD STAMFORD, CT (203) W MAIN ST STAMFORD, CT (203) BEDFORD ST STAMFORD, CT (203) TARGET 21 BROAD ST STAMFORD, CT (203) STORRS 632 MIDDLE TPKE STORRS, CT (860) UCONN STDNT HLTH SVC 234 GLENBROOK RD UNIT 2011 STORRS, CT (860) STORRS MANSFIELD STORRS 1232 STORRS RD STE 6 STORRS MANSFIELD, CT (860) STRATFORD BIG Y 355 HAWLEY LN STRATFORD, CT (203) HAWLEY LN STRATFORD, CT (203) BARNUM AVE STRATFORD, CT (203) ORONOQUE 7365 MAIN ST STRATFORD, CT (203) MAIN ST STRATFORD, CT (203) ROTARY 1030 BARNUM AVE STRATFORD, CT (203) SHOPRITE 250 BARNUM AVENUE CUTOFF STRATFORD, CT (203) E MAIN ST STRATFORD, CT (203) BARNUM AVENUE CUTOFF STRATFORD, CT (203) SUFFIELD 152 MOUNTAIN RD SUFFIELD, CT (860) TERRYVILLE BEACON PRESCRIPTIONS 241 MAIN ST TERRYVILLE, CT (860) MAIN ST VILLAGE PLZ TERRYVILLE, CT (860) S MAIN ST STE A TERRYVILLE, CT (860) THOMASTON PHOENIX INTERNAL MEDICINE 130 S MAIN THOMASTON, CT (860) S MAIN ST THOMASTON, CT (860) TOLLAND BIG Y 33 FIELDSTONE CMNS TOLLAND, CT (860) TORRINGTON BIG Y 504 WINSTED RD TORRINGTON, CT (860) MAIN ST TORRINGTON, CT (860) PRICE CHOPPER 990 TORRINGFORD ST TORRINGTON, CT (860) WILLOW ST TORRINGTON, CT (860) HIGH ST TORRINGTON, CT (860) TARGET 1922 E MAIN ST TORRINGTON, CT (860) TORRINGTON PHCY PETRICONE'S 110 E MAIN ST TORRINGTON, CT (860) TORRINGFORD ST TORRINGTON, CT (860) TRUMBULL MACKENZIE'S 930 WHITE PLAINS RD TRUMBULL, CT (203) QUALITY ST TRUMBULL, CT (203) December 2011

63 TRUMBULL WESTON TARGET 5065 MAIN ST TRUMBULL, CT (203) TARGET 120 HAWLEY LN TRUMBULL, CT (203) UNCASVILLE 2005 NORWICH NEW LNDN TPKE UNCASVILLE, CT (860) ROUTE 32 STE F UNCASVILLE, CT (860) UNIONVILLE 45 S MAIN ST UNIONVILLE, CT (860) THE RYAN 30 MILL ST UNIONVILLE, CT (860) VERNON CRITICAL CARE SYSTEMS 176 BOLTON RD VERNON, CT (866) PIONEER HLTH COMPOUNDING PHCY 520 HARTFORD TPKE STE D VERNON, CT (860) PRICE CHOPPER 35 TALCOTTVILLE RD VERNON, CT (860) WINDSORVILLE RD VERNON, CT (860) VERNON ROCKVILLE BEACON PRESCRIPTIONS 40 W MAIN ST VERNON ROCKVILLE, CT (860) WINDSOR AVE VERNON ROCKVILLE, CT (860) TALCOTTVILLE RD VERNON ROCKVILLE, CT (860) MEDICINE SHOPPE 79 EAST ST VERNON ROCKVILLE, CT (860) PITKIN RD VERNON ROCKVILLE, CT (860) WALLINGFORD MASONIC HEALTHCARE CTR PHCY 22 MASONIC AVE WALLINGFORD, CT (203) N COLONY RD WALLINGFORD, CT (203) SHOPRITE 846 N COLONY RD WALLINGFORD, CT (203) N COLONY RD WALLINGFORD, CT (203) N COLONY RD WALLINGFORD, CT (203) WASHINGTON DEPOT WASHINGTON HLTH CTR AND PHCY 5 BRYAN HALL PLZ WASHINGTON DEPOT, CT (860) WATERBURY BUNKER HILL 256 BUNKER HILL AVE WATERBURY, CT (203) COSTCO 3600 E MAIN ST WATERBURY, CT (203) REIDVILLE DR WATERBURY, CT (203) N MAIN ST WATERBURY, CT (203) MERIDEN RD WATERBURY, CT (203) WATERTOWN AVE WATERBURY, CT (203) W MAIN ST WATERBURY, CT (203) DELLA PIETRA 792 HIGHLAND AVE WATERBURY, CT (203) EAST MAIN 2152 E MAIN ST WATERBURY, CT (203) HEALTH COMPLEX 84 PROGRESS LANE WATERBURY, CT (203) PHOENIX INTERNAL MEDICINE 500 CHASE PKWY DEPT 700 WATERBURY, CT (203) PICKETT 675 N MAIN ST WATERBURY, CT (203) MERIDEN RD WATERBURY, CT (203) FAIRFIELD AVE WATERBURY, CT (203) WOLCOTT ST WATERBURY, CT (203) SHOPRITE 943 WOLCOTT ST WATERBURY, CT (203) STOLL'S 185 GROVE ST WATERBURY, CT (203) READVILLE DR WATERBURY, CT (203) WOLCOTT ST WATERBURY, CT (203) CHASE AVE WATERBURY, CT (203) TARGET 300 CHASE AVE WATERBURY, CT (203) WOLCOTT ST WATERBURY, CT (203) WATERBURY 197 E MAIN ST WATERBURY, CT (203) WATERFORD 106 BOSTON POST RD WATERFORD, CT (860) BOSTON POST RD WATERFORD, CT (860) BOSTON POST RD WATERFORD, CT (860) TARGET 900 HARTFORD TPKE WATERFORD, CT (860) WATERFORD PKWY N WATERFORD, CT (860) WATERTOWN HEALTH COMPLEX 55 DEFOREST ST WATERTOWN, CT (860) MAIN ST WATERTOWN, CT (860) MAIN ST WATERTOWN, CT (860) STRAITS TPKE WATERTOWN, CT (860) WEST HARTFORD BIG Y 772 N MAIN ST WEST HARTFORD, CT (860) FARMINGTON AVE WEST HARTFORD, CT (860) NEW BRITTAIN AVE WEST HARTFORD, CT (860) S MAIN ST WEST HARTFORD, CT (860) BLVD WEST HARTFORD, CT (860) FARMINGTON AVE WEST HARTFORD, CT (860) SHOPRITE 46 KANE ST WEST HARTFORD, CT (860) SUBURBAN 344 N MAIN ST WEST HARTFORD, CT (860) SUBURBAN LTC 344 N MAIN ST WEST HARTFORD, CT (860) WEST HAVEN 252 ORANGE AVE WEST HAVEN, CT (203) JONES HILL RD WEST HAVEN, CT (203) ELM ST WEST HAVEN, CT (203) ELM ST WEST HAVEN, CT (203) SAWMILL RD WEST HAVEN, CT (203) WESTON LANGS 190 WESTON RD WESTON, CT (203) December 2011

64 WESTPORT WOODBURY WESTPORT ACHORN'S 166 MAIN ST WESTPORT, CT (203) COLONIAL GISTS 611 POST RD E WESTPORT, CT (203) POST RD E WESTPORT, CT (203) POST RD E WESTPORT, CT (203) WETHERSFIELD 1078 SILAS DEAN HWY WETHERSFIELD, CT (860) SILAS DEANE HWY WETHERSFIELD, CT (860) SILAS DEANE HWY WETHERSFIELD, CT (860) BERLIN TPKE WETHERSFIELD, CT (860) WILLIMANTIC BEACON PRESCRIPTIONS 972 MAIN ST WILLIMANTIC, CT (860) MAIN ST WILLIMANTIC, CT (860) MEDICAL 1213 MAIN ST WILLIMANTIC, CT (860) MAIN ST WILLIMANTIC, CT (860) WILTON 93 OLD RIDGEFIELD RD WILTON, CT (203) RIVER RD WILTON, CT (203) WINDSOR 219 BROAD ST WINDSOR, CT (860) WINDSOR AVE WINDSOR, CT (860) PRICE CHOPPER 675 POQUONOCK AVE WINDSOR, CT (860) KENNEDY RD WINDSOR, CT (860) TARGET 1075 KENNEDY RD WINDSOR, CT (860) WINDSOR LOCKS 90 MAIN ST WINDSOR LOCKS, CT (860) WINSTED BEACON PRESCRIPTION 294 MAIN ST WINSTED, CT (860) MAIN ST WINSTED, CT (860) NEW HARTFORD RD WINSTED, CT (860) NEW HARTFORD RD WINSTED, CT (860) WOLCOTT 744 WOLCOTT RD WOLCOTT, CT (203) WOODBURY CANFIELD CORNER 2 MAIN ST N WOODBURY, CT (203) WOODBURY 238 MAIN ST S WOODBURY, CT (203) December 2011

65 ALBION BRUNSWICK MAINE ALBION CENTRAL MAINE 18 CHINA RD ALBION, ME (207) AUBURN BEDARD 359 MINOT AVE STE B AUBURN, ME (207) UNION ST AUBURN, ME (207) SPRING ST AUBURN, ME (207) KMART 603 CENTER ST AUBURN, ME (207) MINOT AVE AUBURN, ME (207) UNION ST AUBURN, ME (207) SHAWS/OSCO 600 CENTER ST AUBURN, ME (207) MT AUBURN AVE AUBURN, ME (207) AUGUSTA 2 STONE ST AUGUSTA, ME (207) CAPITOL ST AUGUSTA, ME (207) WHITTEN RD AUGUSTA, ME (207) CONY ST AUGUSTA, ME (207) KENNEBEC PHCY AND HOMECARE 43 LEIGHTON RD AUGUSTA, ME (207) MVH 5 COMMUNITY DR STE 3 AUGUSTA, ME (207) HOSPITAL ST AUGUSTA, ME (207) N BELFAST AVE AUGUSTA, ME (207) SHAWS/OSCO 150 WESTERN AVE AUGUSTA, ME (207) TARGET 119 CROSSING WAY AUGUSTA, ME (207) CIVIC CENTER DR AUGUSTA, ME (207) BANGOR 1133 UNION ST BANGOR, ME (207) BROADWAY BANGOR, ME (207) MILLER LTC 208 STATE ST BANGOR, ME (207) MILLER RIVERSIDE 431 STATE ST BANGOR, ME (207) MILLER STATE STREET 210 STATE ST BANGOR, ME (207) MILLER WESTGATE 915 UNION ST STE 7 BANGOR, ME (207) PENOBSCOT COMM HLTH CTR PHCY 1012 UNION ST STE 3 BANGOR, ME (207) PENOBSCOT CTY METRO TRTMNT CTR 659 HOGAN RD BANGOR, ME (207) UNION ST BANGOR, ME (207) BROADWAY BANGOR, ME (207) UNION ST BANGOR, ME (207) SAM'S CLUB 47 HASKELL RD BANGOR, ME (207) SHAWS/OSCO 353 MAIN ST BANGOR, ME (207) TARGET 60 LONGVIEW DR BANGOR, ME (207) STILLWATER AVE BANGOR, ME (207) BAR HARBOR 86 COTTAGE ST BAR HARBOR, ME (207) COTTAGE ST BAR HARBOR, ME (207) WEST END CO 105 MAIN ST BAR HARBOR, ME (207) BATH 1 CHANDLER DR STE 27 BATH, ME (207) WILSON'S 114 FRONT ST BATH, ME (207) BELFAST 93 LINCOLNVILLE AVE BELFAST, ME (207) MAIN ST BELFAST, ME (207) BERWICK YORK HOSPITAL BERWICK 4 DANA LN BERWICK, ME (207) BETHEL 26 MAYVILLE RD BETHEL, ME (207) BIDDEFORD 384 ELM ST BIDDEFORD, ME (207) ELM ST BIDDEFORD, ME (207) ALFRED ST BIDDEFORD, ME (207) SHAWS/OSCO 510 ALFRED ST BIDDEFORD, ME (207) SOUTHERN MAINE MED CTR PHCY 1 MEDICAL CTR DR BIDDEFORD, ME (207) TARGET 430 MARINER WAY BIDDEFORD, ME (207) ALFRED RD BIDDEFORD, ME (207) BINGHAM E W MOORE AND SON 337 MAIN ST BINGHAM, ME (207) BLUE HILL COMMUNITY BLUE HILL 15 SOUTH ST BLUE HILL, ME (207) SOUTH ST BLUE HILL, ME (207) BOOTHBAY HARBOR 223 TOWNSEND AVE BOOTHBAY HARBOR, ME (207) BREWER AIRLINE 405 N MAIN ST BREWER, ME (207) BREWER MEDICAL CENTER PHCY 735 WILSON ST BREWER, ME (207) WILSON ST BREWER, ME (207) MILLER WHITING HILL 33 WHITING HILL RD STE 4 BREWER, ME (207) WILSON ST BREWER, ME (207) WALTON DR BREWER, ME (207) BRIDGTON 109 PORTLAND RD BRIDGTON, ME (207) PORTLAND RD BRIDGTON, ME (207) BRUNSWICK 147 BATH RD BRUNSWICK, ME (207) December 2011

66 BRUNSWICK GRAY 35 ELM ST BRUNSWICK, ME (207) MEDICAL CENTER 121 MEDICAL CENTER DR BRUNSWICK, ME (207) MEDICAL CENTER 56 BARIBEAU DR BRUNSWICK, ME (207) MEDICAL CENTER 329 MAIN ST BRUNSWICK, ME (207) MAINE ST BRUNSWICK, ME (207) SHAWS/OSCO 147 BATH RD BRUNSWICK, ME (207) BATH RD BRUNSWICK, ME (207) BUCKSPORT COMMUNITY BUCKSPORT 75 MAIN ST BUCKSPORT, ME (207) US ROUTE 1 STE 1 BUCKSPORT, ME (207) BUXTON 24 PORTLAND RD BUXTON, ME (207) PARKER FARM RD BUXTON, ME (207) CALAIS 223 & 233 NORTH ST CALAIS, ME (207) TREWORGY 333 MAIN ST CALAIS, ME (207) SOUTH ST CALAIS, ME (207) CAMDEN 35 ELM ST CAMDEN, ME (207) WALTZ 157 MAIN ST CAMDEN, ME (207) CAPE ELIZABETH 335 OCEAN HOUSE RD CAPE ELIZABETH, ME (207) CARIBOU PARADIS SHOP N SAVE 114 HIGH ST CARIBOU, ME (207) BENNETT DR CARIBOU, ME (207) CHINA 33 HANNAFORD DR CHINA, ME (207) CORINTH COMMUNITY OF CORINTH 689 MAIN ST CORINTH, ME (207) CORNISH COMMUNITY OF CORNISH 200 MAPLE ST STE 3 CORNISH, ME (207) MAPLE ST CORNISH, ME (207) DAMARISCOTTA 469 MAIN ST DAMARISCOTTA, ME (207) MAIN ST DAMARISCOTTA, ME (207) DEXTER COMMUNITY OF DEXTER 37 CHURCH ST DEXTER, ME (207) SPRING ST DEXTER, ME (207) DOVER FOXCROFT 151 E MAIN ST DOVER FOXCROFT, ME (207) SHAWS - OSCO 1073 W MAIN ST STE 9 DOVER FOXCROFT, ME (207) EAST MILLINOCKET DAVIS 59 MAIN ST EAST MILLINOCKET, ME (207) EAST WATERBORO GOOD FOR ALL 10 GOODALL WAY STE 800 EAST WATERBORO, ME (207) SOKOKIS TRL EAST WATERBORO, ME (207) ELLSWORTH 225 HIGH ST STE 1 ELLSWORTH, ME (207) HIGH ST ELLSWORTH, ME (207) SHAWS/OSCO 175 HIGH ST ELLSWORTH, ME (207) HIGH ST ELLSWORTH, ME (207) FAIRFIELD FAIRFIELD 66 WESTERN AVE FAIRFIELD, ME (207) MAIN ST FAIRFIELD, ME (207) FALMOUTH 65 GRAY RD FALMOUTH, ME (207) DEPOT RD FALMOUTH, ME (207) US ROUTE 1 FALMOUTH, ME (207) FARMINGTON 131 HANNAFORD DR FARMINGTON, ME (207) MT BLUE 624 WILTON RD FARMINGTON, ME (207) WILTON RD FARMINGTON, ME (207) WILTON RD FARMINGTON, ME (207) FORT FAIRFIELD I CARE 227 MAIN ST FORT FAIRFIELD, ME (888) MAIN ST FORT FAIRFIELD, ME (207) FORT KENT PARADIS SHOP N SAVE 62 W MAIN ST STE 101 FORT KENT, ME (207) E MAIN ST FORT KENT, ME (207) ST JOHNS VALLEY 182 MARKET ST STE 2 FORT KENT, ME (207) FREEPORT 10 MIDDLE ST FREEPORT, ME (207) SHAWS/OSCO 200 LOWER MAIN ST FREEPORT, ME (207) FRYEBURG 119 BRIDGTON RD STE 302 FRYEBURG, ME (207) GARDINER 100 MAIN ST GARDINER, ME (207) SPRING ST GARDINER, ME (207) GORHAM COMMUNITY OF GORHAM 365 MAIN ST GORHAM, ME (207) MAIN ST GORHAM, ME (207) MAIN ST GORHAM, ME (207) GRAY 130 SHAKER RD GRAY, ME (207) W GRAY RD GRAY, ME (207) December 2011

67 GREENVILLE PITTSFIELD GREENVILLE HARRIS 10 PRITHAM AVE GREENVILLE, ME (207) GUILFORD 3 HUDSON AVE GUILFORD, ME (207) HAMPDEN 77 WESTERN AVE HAMPDEN, ME (207) WESTERN AVE HAMPDEN, ME (207) HOULTON PARADIS SHOP N SAVE 33 LUDLOW ST HOULTON, ME (207) NORTH ST HOULTON, ME (207) RR #3 HOULTON, ME (207) JAY 15 JAY PLAZA LN JAY, ME (207) SPRUCE MOUNTAIN 3 TWEEDIE ST JAY, ME (207) KENNEBUNK 48 PORTLAND RD KENNEBUNK, ME (207) PORTLAND RD STE 9 KENNEBUNK, ME (207) KENNEBUNK GOOD FOR ALL PHCY 2 LIVEWELL DR STE 101 KENNEBUNK, ME (207) KENNEBUNK VILLAGE HM 18 BLUE WAVE PRO CTR KENNEBUNK, ME (207) PORTLAND RD KENNEBUNK, ME (207) KENNEBUNKPORT COLONIAL 40 DOCK SQ KENNEBUNKPORT, ME (207) KINGFIELD WESTERN MAINE 238 MAIN ST KINGFIELD, ME (207) KITTERY 15 SHAPELEIGH RD KITTERY, ME (207) LEWISTON BEDARD 61 COLLEGE ST LEWISTON, ME (207) EAST AVE LEWISTON, ME (207) SABATTUS ST LEWISTON, ME (207) SABATTUS ST LEWISTON, ME (207) MEDICINE SHOPPE 373 SABATTUS ST LEWISTON, ME (207) SABATTUS ST LEWISTON, ME (207) MAIN ST LEWISTON, ME (207) LISBON ST LEWISTON, ME (207) SHAWS/OSCO 27 EAST AVE LEWISTON, ME (207) LINCOLN 22 GODING AVE LINCOLN, ME (207) W BROADWAY LINCOLN, ME (207) OUTER W BROADWAY LINCOLN, ME (207) LISBON FALLS 575 LISBON ST LISBON FALLS, ME (207) LIVERMORE FALLS 81 MAIN ST LIVERMORE FALLS, ME (207) MACHIAS 144 DUBLIN ST MACHIAS, ME (207) MADAWASKA MADAWASKA 104 MAIN ST STE 101 MADAWASKA, ME (207) MAIN ST MADAWASKA, ME (207) MADISON TAYLOR'S STORE 2 OLD POINT AVE MADISON, ME (207) MANCHESTER 943 WESTERN AVE MANCHESTER, ME (207) MARS HILL MARS HILL 106 MAIN ST MARS HILL, ME (207) MARSHFIELD MACHIAS FRIENDLY 8 OLD COUNTY RD MARSHFIELD, ME (207) MEXICO 258 RIVER ED MEXICO, ME (207) MILBRIDGE MILBRIDGE 11 MAIN ST MILBRIDGE, ME (207) MILLINOCKET 843 CENTRAL ST MILLINOCKET, ME (207) CENTRAL ST MILLINOCKET, ME (207) MILO 35 PARK ST MILO, ME (207) NAPLES 665 ROOSEVELT TRL NAPLES, ME (207) NEWPORT COMMUNITY OF NEWPORT 44 MOOSEHEAD TRL NEWPORT, ME (207) MOOSEHEAD TRL NEWPORT, ME (207) OAKLAND OAKLAND 54 MAIN ST OAKLAND, ME (207) MAIN ST OAKLAND, ME (207) OLD ORCHARD BEACH 15 SACO AVE OLD ORCHARD BEACH, ME (207) OLD TOWN 500 STILLWATER AVE OLD TOWN, ME (207) HELEN HUNT HEALTH CTR PHCY 242 BRUNSWICK ST OLD TOWN, ME (207) MAIN ST OLD TOWN, ME (207) ORONO ORONO 16 MILL ST ORONO, ME (207) OXFORD 1603 MAIN ST OXFORD, ME (207) MAIN ST/RT 26 OXFORD, ME (207) PALMYRA 1573 MAIN ST PALMYRA, ME (207) PATTEN PATTEN 20 MAIN ST PATTEN, ME (207) PITTSFIELD COMMUNITY PITTSFIELD 101 SOMERSET PLZ PITTSFIELD, ME (207) December 2011

68 PITTSFIELD STANDISH 108 SOMERSET AVE PITTSFIELD, ME (207) PORTLAND APOTHECARY BY DESIGN 84 MARGINAL WAY STE 100 PORTLAND, ME (207) BRIGHTON AVE PORTLAND, ME (207) CONGRESS ST PORTLAND, ME (207) AUBURN ST PORTLAND, ME (207) CONGRESS ST PORTLAND, ME (207) FOREST AVE PORTLAND, ME (207) FOREST AVE PORTLAND, ME (207) RIVERSIDE ST PORTLAND, ME (207) NEW ENGLAND LIFE CARE 108A INDUSTRIAL WAY PORTLAND, ME (207) PHARMERICA 97 MCALISTER FARM RD PORTLAND, ME (207) PORTLAND I 331 VERANDA ST PORTLAND, ME (888) PORTLAND II 901 WASHINGTON AVE PORTLAND, ME (800) CONGRESS ST W PORTLAND, ME (207) FOREST AVE PORTLAND, ME (207) CONGRESS ST PORTLAND, ME (207) ALLEN AVE PORTLAND, ME (207) SHAWS/OSCO 91 AUBURN ST PORTLAND, ME (207) PRESQUE ISLE CITY STORE 172 ACADEMY ST PRESQUE ISLE, ME (207) PRESQUE ISLE 797 MAIN ST PRESQUE ISLE, ME (207) MAIN ST PRESQUE ISLE, ME (207) MAIN ST. PRESQUE ISLE, ME (207) RANDOLPH COMMUNITY OF RANDOLPH 268 WATER ST RANDOLPH, ME (207) ROCKLAND GOOD NOW'S 58 PARK ST ROCKLAND, ME (207) MAVERICK ST ROCKLAND, ME (207) JENSEN'S 91 CAMDEN ST STE 105 ROCKLAND, ME (207) PARK ST ROCKLAND, ME (207) SHAWS/OSCO 235 CAMDEN ST ROCKLAND, ME (207) CAMDEN ST ROCKLAND, ME (207) ROCKPORT KENNEBEC AND HOMECARE 839 COMMERCIAL ST ROCKPORT, ME (207) PENOBSCOT BAY MED CTR PHCY 6 GLEN COVE DR ROCKPORT, ME (207) RUMFORD 520 WALDO ST RUMFORD, ME (207) PORTLAND ST RUMFORD, ME (207) SACO COMMUNITY OF SACO 244 MAIN ST SACO, ME (207) MAIN ST SACO, ME (207) MAIN ST SACO, ME (207) SHAWS/OSCO 4 SCAMMON ST STE 12 SACO, ME (207) SANFORD 797 MAIN ST STE D SANFORD, ME (207) MAIN ST SANFORD, ME (207) JUNE STREET 25A JUNE ST STE 13 SANFORD, ME (207) SHAWS/OSCO 1364 MAIN ST SANFORD, ME (207) MAIN ST SANFORD, ME (207) SCARBOROUGH 31 HANNAFORD DR SCARBOROUGH, ME (207) MAINE CENTER FOR CANCER MED 100 CAMPUS DR UNIT 108 SCARBOROUGH, ME (207) US ROUTE 1 SCARBOROUGH, ME (207) SAM'S CLUB 440 PAYNE RD SCARBOROUGH, ME (207) SHAWS 417 PAYNE RD SCARBOROUGH, ME (207) GALLERY RD SCARBOROUGH, ME (207) SKOWHEGAN 100 FAIRGROUND MKT PL SKOWHEGAN, ME (207) MADISON AVE SKOWHEGAN, ME (207) VARIETY 78 WATER ST SKOWHEGAN, ME (207) FAIRGROUNDS MARKET PLACE SKOWHEGAN, ME (207) SOUTH BERWICK SOUTH BERWICK 289 MAIN ST SOUTH BERWICK, ME (207) SOUTH PARIS 259 MAIN ST SOUTH PARIS, ME (207) SOUTH PORTLAND CRITICAL CARE SYSTEMS 10 DONALD B DEAN DR SOUTH PORTLAND, ME (207) OCEAN ST SOUTH PORTLAND, ME (207) COTTAGE RD SOUTH PORTLAND, ME (207) PHILBROOK AVE SOUTH PORTLAND, ME (207) MOBY RX 225 WATERMAN DR SOUTH PORTLAND, ME (207) MAIN ST SOUTH PORTLAND, ME (207) TARGET 200 RUNNING HILL RD SOUTH PORTLAND, ME (207) SOUTHWEST HARBOR CARROLL STORE 3 VILLAGE GREEN WAY SOUTHWEST HARBOR, ME (207) SPRINGVALE 464 MAIN ST SPRINGVALE, ME (207) STANDISH 71 COLONIAL DR STANDISH, ME (207) December 2011

69 STONINGTON YORK STONINGTON V AND S 3 BURNT COVE RD STONINGTON, ME (207) TOPSHAM 49 TOPSHAM FAIR MALL RD TOPSHAM, ME (207) MALLETT DR TOPSHAM, ME (207) TARGET 125 TOPSHAM FAIR MALL RD TOPSHAM, ME (207) WALTZ LTC 605 LEWISTON RD TOPSHAM, ME (207) UNITY UNITY 33 PLAZA DR UNITY, ME (207) VAN BUREN HERBERT REXALL 74 MAIN ST VAN BUREN, ME (207) MAIN ST VAN BUREN, ME (207) WALDOBORO WALTZ 5 FRIENDSHIP ST WALDOBORO, ME (207) WATERVILLE 1 KENNEDY MEMORIAL DR WATERVILLE, ME (207) ELM PLZ WATERVILLE, ME (207) JFK PLZ KENNEDY DR WATERVILLE, ME (207) MAIN ST WATERVILLE, ME (207) SHAWS/OSCO 251 KENNEDY MEMORIAL DR WATERVILLE, ME (207) WATERVILLE COMMONS DR WATERVILLE, ME (207) WELLS 11 STEEPLE WAY WELLS, ME (207) WELLS PLZ WELLS, ME (207) POST RD WELLS, ME (207) WESTBROOK 870 MAIN ST WESTBROOK, ME (207) HANNAFORD DR WESTBROOK, ME (207) OMNICARE OF ME WESTBROOK 39 EISENHOWER DR WESTBROOK, ME (207) MAIN ST WESTBROOK, ME (207) SHAWS 47 MAIN ST WESTBROOK, ME (207) WINDHAM 770 ROOSEVELT TRL WINDHAM, ME (207) ROOSEVELT TRL WINDHAM, ME (207) LANDING RD WINDHAM, ME (207) WINSLOW 2 CHINA RD WINSLOW, ME (207) WINSLOW 20 GARLAND RD WINSLOW, ME (207) WINTHROP 399 MAIN ST WINTHROP, ME (207) PECK FARM RD WINTHROP, ME (207) YARMOUTH 756 ROUTE 1 YARMOUTH, ME (207) ROUTE 1 YARMOUTH, ME (207) YORK 440 US ROUTE 1 YORK, ME (207) US ROUTE 1 YORK, ME (207) YORK HOSPITAL APOTHECARY 15 HOSPITAL DR YORK, ME (207) December 2011

70 BARRE LUDLOW VERMONT BARRE 456 S BARRE RD BARRE, VT (802) HARRY'S DISCOUNT 921 US ROUTE 302 STE 1 BARRE, VT (802) KINNEY S 800 US ROUTE 302 BARRE, VT (802) MEDICINE SHOPPE 20 S MAIN ST BARRE, VT (802) N MAIN ST BARRE, VT (802) BARTON KINNEY S 16 CHURCH ST BARTON, VT (802) BELLOWS FALLS GREATER FALLS 78 ATKINSON ST BELLOWS FALLS, VT (802) ROCKINGHAM ST BELLOWS FALLS, VT (802) BENNINGTON 8 KOCHER DR BENNINGTON, VT (802) EXTENDED CARE 207 NORTH ST BENNINGTON, VT (802) HANNAFORD SQ BENNINGTON, VT (802) PRICE CHOPPER 214 NORTHSIDE DR BENNINGTON, VT (802) NORTH ST BENNINGTON, VT (802) THE 205 NORTH ST BENNINGTON, VT (802) NORTHSIDE DR BENNINGTON, VT (802) BERLIN OSCO 160 PAINE TPKE N BERLIN, VT (802) BERLIN MALL RD STE 1 BERLIN, VT (802) BETHEL 1823 VERMONT ROUTE 107 BETHEL, VT (802) BOMOSEEN CASTLETON HEALTH CENTER PHCY 275 ROUTE 30 N BOMOSEEN, VT (802) KINNEY S ROUTE 30 BOMOSEEN, VT (802) BRADFORD KINNEY S 901 LOWER PLN BRADFORD, VT (802) BRANDON BRANDON COMMUNITY 420 GROVE ST BRANDON, VT (802) CARVER ST BRANDON, VT (802) BRATTLEBORO BRATTLEBORO 413 CANAL ST BRATTLEBORO, VT (802) PUTNEY RD UNIT 6 BRATTLEBORO, VT (802) CANAL ST BRATTLEBORO, VT (802) THE HOTEL 20 ELLIOT ST STE 1 BRATTLEBORO, VT (802) BRISTOL 1 PRINCE LN BRISTOL, VT (802) BURLINGTON FLETCHER ALLEN OP 111 COLCHESTER AVE BURLINGTON, VT (802) FLETCHER ALLEN OP 1 S PROSPECT ST BURLINGTON, VT (802) NORTH AVE STE 11 BURLINGTON, VT (802) KINNEY S 789 PINE ST BURLINGTON, VT (802) LAKESIDE 242 PEARL ST BURLINGTON, VT (802) PRICE CHOPPER 595 SHELBURNE RD BURLINGTON, VT (802) NORTH AVE STE 33 BURLINGTON, VT (802) NORTH AVE BURLINGTON, VT (802) CHERRY ST BURLINGTON, VT (802) VERMONT FAMILY 1219 NORTH AVE BURLINGTON, VT (802) CAMBRIDGE KINNEY S 155 S MAIN ST CAMBRIDGE, VT (802) COLCHESTER COMMUNITY HEALTH 158 BRENTWOOD DR COLCHESTER, VT (802) COSTCO 50 MOUNTAIN VIEW DR COLCHESTER, VT (802) FLETCHER ALLEN OP 792 COLLEGE PKWY COLCHESTER, VT (802) PRIM RD STE 2 COLCHESTER, VT (802) SHAWS 66 MOUNTAIN VIEW DR COLCHESTER, VT (802) DERBY 4408 US RTE 5 DERBY, VT (802) DERBY LINE BROWNS STORE 40 MAIN ST DERBY LINE, VT (802) ENOSBURG FALLS ENOSBURG HM 366 MAIN ST SOUTH ENOSBURG FALLS, VT (802) MAIN ST ENOSBURG FALLS, VT (802) ESSEX JUNCTION 7 ESSEX WAY ESSEX JUNCTION, VT (802) A ESSEX WAY ESSEX JUNCTION, VT (802) KINNEY S 82 PEARL ST ESSEX JUNCTION, VT (802) PRICE CHOPPER 90 CENTER RD ESSEX JUNCTION, VT (802) SUSIE WILSON RD ESSEX JUNCTION, VT (802) PEARL ST ESSEX JUNCTION, VT (802) FAIR HAVEN 62 WASHINGTON ST FAIR HAVEN, VT (802) HARDWICK 82 ROUTE 15 WEST HARDWICK, VT (802) HINESBURG KINNEY S ROUTE 116 HINESBURG, VT (802) LONDONDERRY GREEN MOUNTAIN 5700 RTE 100 UNIT C-10 LONDONDERRY, VT (802) LUDLOW LUDLOW 57 POND ST STE 3 LUDLOW, VT (802) MAIN ST LUDLOW, VT (802) December 2011

71 LYNDONVILLE WHITE RIVER JCT LYNDONVILLE KINNEY S RTE 5 MEMORIAL DR LYNDONVILLE, VT (802) BROAD ST LYNDONVILLE, VT (802) MANCHESTER EQUINOX COMPOUNDING 34 WAYS LN MANCHESTER, VT (802) MANCHESTER CENTER MANCHESTER 1009 DEPOT ST MANCHESTER CENTER, VT (802) MAIN ST STE A MANCHESTER CENTER, VT (802) MIDDLEBURY 260 COURT ST UNIT 6 MIDDLEBURY, VT (802) KINNEY S 40 COURT ST MIDDLEBURY, VT (802) MARBLE WORKS 99 MAPLE ST STE 19 MIDDLEBURY, VT (802) COURT ST MIDDLEBURY, VT (802) MILTON KINNEY S 3 CENTRE DR MILTON, VT (802) ROUTE 7 S MILTON, VT (802) MONTPELIER MONTPELIER 69 MAIN ST MONTPELIER, VT (802) MAIN ST MONTPELIER, VT (802) MORRISVILLE 80 FAIRGROUNDS PLZ MORRISVILLE, VT (802) KINNEY S 97 MORRISVILLE PLZ MORRISVILLE, VT (802) CONGRESS ST MORRISVILLE, VT (802) NEWPORT KINNEY S 55 SHATTUCK HILL RD NEWPORT, VT (802) WATERFRONT PLZ STE 2 NEWPORT, VT (802) NORTHFIELD NORTHFIELD 14 DEPOT SQ NORTHFIELD, VT (802) RANDOLPH KINNEY S 151 VERMONT ROUTE 12 S RANDOLPH, VT (802) N MAIN ST RANDOLPH, VT (802) RICHFORD NOTCH 44 MAIN ST STE 201 RICHFORD, VT (802) RUTLAND BEAUCHAMP AND O'ROURKE PHCY 62 WOODSTOCK AVE RUTLAND, VT (802) MAIN ST RUTLAND, VT (802) S MAIN ST RUTLAND, VT (802) PRICE CHOPPER 38 RUTLAND SHOPPING PLZ RUTLAND, VT (802) WEST ST RUTLAND, VT (802) RUTLAND 75 ALLEN ST RUTLAND, VT (802) RUTLAND PLZ RUTLAND, VT (802) WILCOX HOME INFUSION 250 STRATTON RD RUTLAND, VT (802) WILCOX 252 STRATTON RD RUTLAND, VT (802) WILCOX LTC 252 STRATTON RD RUTLAND, VT (802) SAINT ALBANS 277 SWANTON RD SAINT ALBANS, VT (802) JACK RIXON 40 N MAIN ST SAINT ALBANS, VT (802) KINNEY S 164 SWANTON RD SAINT ALBANS, VT (802) PRICE CHOPPER 170 SWANTON RD SAINT ALBANS, VT (802) N MAIN ST SAINT ALBANS, VT (802) SAINT JOHNSBURY KINNEY S 957 MEMORIAL DR SAINT JOHNSBURY, VT (802) RAILROAD ST SAINT JOHNSBURY, VT (802) SHELBURNE 30 SHELBURNE SHOPPING PARK SHELBURNE, VT (802) SOUTH BURLINGTON 217 DORSET ST SOUTH BURLINGTON, VT (802) HANNAFORD DR SOUTH BURLINGTON, VT (802) KINNEY S 1653 WILLISTON RD SOUTH BURLINGTON, VT (802) HINESBURG RD SOUTH BURLINGTON, VT (802) SHAWS 570 SHELBURNE RD SOUTH BURLINGTON, VT (802) SOUTH HERO MCGREGORS SOUTH HERO 334 ROUTE 2 SOUTH HERO, VT (802) SPRINGFIELD PETE'S 242 RIVER ST STE 9 SPRINGFIELD, VT (802) CHESTER RD STE 2 SPRINGFIELD, VT (802) SPRINGFIELD 264 RIVER ST SPRINGFIELD, VT (802) SWANTON SWANTON REXALL S 44 MERCHANTS ROW SWANTON, VT (802) TOWNSHEND MESSENGER VALLEY 170 GRAFTON RD TOWNSHEND, VT (802) VERGENNES KINNEY S 115B MONKTON RD VERGENNES, VT (802) MARBLE WORKS 187 MAIN ST VERGENNES, VT (802) WAITSFIELD THE STORE 7 VILLAGE SQ WAITSFIELD, VT (802) WATERBURY KINNEY S 80 S MAIN ST WATERBURY, VT (802) SHAWS/OSCO 820 WATERBURY STOWE RD WATERBURY, VT (802) WELLS RIVER WELLS RIVER 41 MAIN ST N WELLS RIVER, VT (802) WEST RUTLAND 294 MAIN ST WEST RUTLAND, VT (802) WHITE RIVER JCT CORNER STORE 213 MAPLE ST WHITE RIVER JCT, VT (802) December 2011

72 WILLISTON WOODSTOCK WILLISTON 78 MARSHALL AVE WILLISTON, VT (802) KINNEY S 600 BLAIR PARK RD STE 195 WILLISTON, VT (802) CORNERSTONE DR WILLISTON, VT (802) SHAWS 71 BOXWOOD ST WILLISTON, VT (802) HARVEST LN WILLISTON, VT (802) WILMINGTON 1 E MAIN ST WILMINGTON, VT (802) WINDSOR 52 MAIN ST WINDSOR, VT (802) WINOOSKI MCGREGORS MEDICINE ON TIME 321 MAIN ST STE B WINOOSKI, VT (802) MAIN ST WINOOSKI, VT (802) WOODSTOCK SHIRE APOTHECARY 13 ELM ST WOODSTOCK, VT (802) WOODSTOCK 19 CENTRAL ST WOODSTOCK, VT (802) December 2011