Name 4D Pharmacy Mangement Systems, Inc. 4D Pharmacy Mangement Systems, Inc. 4D Pharmacy Mangement Systems, Inc. 4D Pharmacy Mangement Systems, Inc. 4D Pharmacy Mangement Systems, Inc. or Preferred-Choice Pharmacy Discount Drug Card Traditional Pharmacy Managed Choice Pharmacy Managed Pharmacy PCN:1990000 PCN: 1990000 PCN: 1990000 PCN: 1990000 PCN:1990000 866-849-4196 866-849-4196 866-849-4196 866-849-4196 866-849-4196 Agelity, Inc. Pre Scripts BIN: 004682 800-847-7147 Agelity, Inc. Agelity, Inc. Agelity Prescription Benefit Plan Agelity Prescription Drug Savings BIN: 009265 800-847-7147 BIN: 009265 800-847-7147 Agelity, Inc. My Prescription Card BIN: 600426 800-847-7147 Agelity, Inc. Goldline BIN: 600426 800-847-7147 Agelity, Inc. SMCRx BIN: 610550 800-847-7147 Agelity, Inc. Agelity Affinity Cash Discount Card BIN: 600426 PCN: 3A Agelity, Inc. Scripts BIN: 004682 800-847-7147 Agelity, Inc. American Health Care Administrative Services, Inc. American Health Care Administrative Services, Inc. American Health Care Administrative Services, Inc. American Health Care Administrative Services, Inc. Americhoice NJ Americhoice NJ AmeriHealth Mercy Health Plan, Inc. AmeriHealth Mercy Health Plan, Inc. PPSC Cash Cash Discount Card BIN: 004682 PCN: SG BIN: 610118 AHC Citizens Health BIN: 610118 Citizens Choice HealthPlan Rx Medicare Medicaid Keystone Mercy Health Plan Retail BIN: 610118 BIN: 610118 PCN: AHC BIN: 610097 PCN: 9999 AMCNJ BIN: 610494 PCN: 2300 PCN: 01940000 800-768-7272 MAPD: 877-889-6510 All s: 800-788-7871 Name AmeriHealth Mercy Health Plan, Inc. or OTC Medications and Supplies AmeriScript, Inc. Retail Applied Underwriters, Inc. Applied Workers' Compensation Applied Underwriters, Inc. The Applied ANA - 60 90 day at Retail ANA - 92 Open BIN: 610640 PCN: AMER9999 BIN: 013329 PCN: APP BIN: 013329 PCN: APP 800-681-6912 877-234-4420 Option 5 877-234-4420 Option 5 90 days Retail 800-522-7487 800-522-7487 LTC 800-522-7487 ANA - 91 Priority Health 800-522-7487 Argus Home Infusion ANA - Nursing Home, Long Term Care And Assisted Living 800-522-7487 ANA - Hospice 800-522-7487 ANA - 5 800-522-7487 ANA - 4 800-522-7487 ANA - 3 800-522-7487 Vrx: Deseret Mutual Administration MedicisRx ANA - 54 Discount Card ANA - 22 Health Partners of PA BIN: 610245. PCN: 05490000 PCN: 05080000 GRP: 05770131 PCN: 03020000 888-635-8315 855-479-7283 800-522-7487 800-522-7487 Retail BIN: 610649 800-522-7487 Gateway Health Plan ANA - 101 Uninsured Member s ANA - 69 Medicare Part D Commercial PCN: 02710000 Medicare BIN: 012353 PCN: 03740000 Med Part D: 800-221-9537 Medicaid: 800-220-4532 800-522-7487 800-522-7487
Name Atlantic Prescription Services Atlantic Prescription Services BC/BS of Alabama BC/BS of Alabama BC/BS of Arizona BC/BS of Arizona or ANA - 98 Part D ANA - 87 Comp-Med ANA - 98 Medicare Part D Managed Care Discount Rx Card BCBSAL Retail Specialty Pharmacy Medication BCBSAL Medicare Products Pharmacy BCBSAZ In Arizona BCBSAZ Out of Arizona BIN: 610649 800-522-7487 Now handles all BSCA as Well 800-522-7487 BIN: 004915 BIN: 004915 BIN: 603017 PCN: BAZ, TQC BIN: 603017 PCN: BAZ, TQC 800-522-7487 Medicare: 888-878-8668 Commercial : 800-216-9920 Benescript Benescript Retail BIN: 003452 800-345-3189 Beyond Rx Beyond Rx Beyond Rx Beyond Rx Beyond Rx Bio Scrip Bio Scrip Bio Scrip Beyond Rx Beyond Rx BRX Choice Beyond Rx VPN Beyond Rx Select II Beyond Rx Select BioScrip Medicaid BioScrip Affinity BioScrip Open Pharmacy Bio Scrip Medicaid Total Care LTC BIN: 610641 PCN: PB BIN: 610641 PCN: PB BIN: 610641 PCN: PB BIN: 610641 PCN: PB BIN: 610641 PCN: PB 866-247-9996 866-247-9996 866-247-9996 866-247-9996 866-247-9996 BIN: 900020 800-230-8187 BIN: 900020 800-230-8187 BIN: 900020 800-230-8187 BIN: 900020 PCN: CLAIMNE 315-634-5555 Name or RxAmerica Zenith Insurance Company CareComp State of TN Extended Day Supply CareValue3a CareValue3b Retail 1 Retail 2 Horizon BCBSNJ RxClusive Consumer Card Savings PatientChoice 90 PreferredChoice Retail Extended Days Supply BCBS RI Influenza Administration Medicaid NY Presbyterian System SelectHealth Medicaid MetroPlus Health Plan KY BIN: 610029 PCN: STNRX 800-421-2342 BIN: 610415 800-364-6331 BIN: 610468 800-777-1023 Medicaid Fidelis Care Medicaid CDPHP Medicaid Affinity Health Plan BIN: 004336 Group: RX8579 BIN: 004336 Group: RXMPHP BIN: 0046366 Groups: RX6460, RX6461, RX6462, RX6465, RX6466 BIN: 0046336 Group: RXCDPHP BIN: 0046336 Group: RX4212 866-469-7774 800-303-9626 800-345-5413 800-388-2994 866-247-5678
Name or Medicaid Amerigroup FEP Administration Administration Coventry GHP Plans Retail Maintenance Provider 2 Molina Healthcare of Ohio Coventry GHP Plans Retail Maintenance Provider 1 BIN: 0046336 Group: RX4293 BIN: 610239, 610415 Carrier-Group: 65006500 BIN: 002286 PCN: 6000 BIN: 610473 PCN: N/A Group: N/A Medicaid BIN: 002286 PCN:6000 800-454-3730 800-844-9636 Eligibility and Prior Authorization Rrequests: 800-642-4168 Non-clinical or technical: 800-364-6331 800-844-9636 CarePremier BIN: 006350 800-364-6331 Managed Cash Orange Count MSI Retail 90 A Retail 90 B BCBS Association Provider AMERIGROUP Corporate - Florida Plan CareSelect MetroPlus Health Plan (PCS Health Systems) (PCS Health Systems) (PCS Health Systems) PCS RECAP PCS Plan Sponsor FL BIN: 004816, 610029 PCN: CRMPT BIN: 004336 GRP: RXMPHP FEP 800-364-6331 Medicaid: 800-364-6331 PCS BIN: 610502 800-364-6331 Retail Name or Medicaid WellCare Health Plans IPA Managed Care Organizations Sound Health & Wellness Retiree Trust Group: 856257, 788257 800-288-5441 BIN: 005947 888-869-4600 Health Alliance BIN: 005947 WellCare of Kentucky Medicaid Standard Upper Peninsula Health Plan Plus HMO SNP KY WellCare of New York Sound Health & Wellness Trust WellCare of Ohio Wellcare 90 Day at Retail GRP: 476257 Part D - BIN: 005947 PCN: CLAIMCR GRP: UPHPMEDD Part B - Call 877-349-9324 Group: 856257 Family Health Plus, Healthy Choice Group: 716257 CIGNA CIGNA Specialty CIGNA CIGNA Pharmaceutical Services CIGNA CIGNA Med Part D CIGNA CIGNA LTC, DER Requests: 877-389-9457 Part D: 877-464-0073 Part B: 877-349-9324 DER Requests: 800-288-5441 Remittance Questions: DME Supply Questions: 800-288-5441 DER: 800-951-7719 Remittance: Community Care Rx-MTM MemberHealth LTC Community Care Rx-MTM CMTM Level 1 CPT Code 0115T Community Care Rx-MTM CMTM Services Declined
Name or Community Care Rx-MTM CMTM WMR Tasks Community Care Rx-MTM MemberHealth al A Community Care Rx-MTM MemberHealth B Community Care Rx-MTM CMTM Level 2 Community Plus Pharmacy - BCBSMS - Advanced Health Systems Cypress Care (Healthcare ) Community Plus Healthcare Workers Comp DataRx DataRx Open Emdeon Emdeon Emdeon Emdeon MedE Workers Compensation MedE Therapy First Plus MedE Preferred MedE Patient Choice BIN for NDC: 004583 BIN for Envoy: 004084 BIN: 004682 PCN: CC BIN: 610568, 610219, 014252, or 14236 PCN: DRX CPT Code 0115T + 0117T 800-551-5258 or 601-932-9788 877-823-1273 BIN: 009265 Emdeon MedE Self-Pay Emdeon MedE Therapy First Emdeon MedE Employee Health Ins Mgmt - EHIM Employee Health Ins Mgmt - EHIM EHIM LTC Pharmacy BIN: 004682 PCN: CN BIN: 600426 PCN: 54 BIN: 004682 PCN: CN BIN: 600426, 004682 PCN: 3A, CAT, 96 BIN: 004682 PCN: CN BIN: 600426 PCN: 54 BIN: 005285 EHIM Retail BIN: 005285 Envision Elderplan Envision Fringe Benefit Management Company Ohio's Best Rx IL,, NE, NH, ME, KY, BIN: 012312 PCN: PARTD BIN: 009893 PCN: ROIRX BIN: 009893 PCN: ROIRX Name or Envision Managed HealthCare Services Company Quality Health Plans Envision LA Rx Presciption Savings Card Envision 2011-2012 Flu & Pneumonia Envision Preferred HI Envision Preferred LTC Envision HPP Private Label Savings Card Envision LTC Envision Preferred BIN: 009893 PCN: ROIRX BIN: 015012 PCN: PARTD BIN: 009893 PCN: ROIRX Express Scripts, Inc. EN40 Express Scripts, Inc. Express Scripts, Inc. Express Scripts, Inc. Express Scripts, Inc. ESI Med Part D Administration ESI Retail TRICARE Vaccination ESI Administration Express Scripts, Inc. BCBSLA Vaccination Express Scripts, Inc. ExpressComp Express Scripts, Inc. EN50 Express Scripts, Inc. Medicaid Amida Care BIN: 012312 PCN: PARTD BIN: 012312 PCN: PARTD BIN: 009893 PCN: ROIRX BIN: 012312 PCN: PARTD BIN: 012312 PCN: PARTD PCN: A4, SC (only Med D) PCN: MD, SC (only Med D) PCN: MD, SC (only Med D) OCBL A4, SC (Med D only), PCN: A4, SC (only Med D) PCN: A4, SC (only Med D) PCN: A4 Group: KJFA 800-824-0898 646-786-1800
Name or Express Scripts, Inc. Medicaid Healthfirst Express Scripts, Inc. Express Scripts, Inc. Medicaid HIP Health Plan of New York Emblem Health Medicaid Neighborhood Health Providers PCN: A4 Group: HEFA BIN: 015748 PCN: 20111001 PCN: A4 Group: KJBA First Health PRIMExtra BIN: 610468 First Health EPIC American Indian Health BIN: 610468 First Health ALTA Rx BIN: 610468 First Health First Health FLRx FLRx FLRx FutureScripts FutureScripts General Prescription Medicare Drug Discount Card EPIC NY State Senior Prescription Plan FLRx Simply Prescriptions Medicare Part D Pharmacy FLRx Simply Prescriptions Medicare Retail for Specialty Drugs FLRx Pharmacy FutureScripts Medicare Part D FutureScripts Commercial GPP s MI, MO, NY, PA BIN: 610468 BIN: 610475 BIN: 610475 866-463-6743 800-447-8255 877-782-8655 800-826-6240 BIN: 610475 585-327-7530 800-950-9120 Worker's Compensation Rx Discount 90 Day - FUNDED Business BIN: 009992 800-950-9120 Name or 90 Day Supply - 100% Cash Business s RURAL RURAL 90 Day Supply Prescription Discount Card Pharmacy must reside at least 10 miles from a major metropolitan city. Pharmacy must reside at least ten miles from a major metropolitan city. LTC 800-950-9120 UNA Cash Discount Kaiser Permenente BIN: 009992 PCN: Gr HTAWEST01, HTAPORT01, USPG0023 BIN: 011172, 011842, 011230, 011859, 011248, 011214, 011222, 011255 PCN: NWCMS 100% Cash BIN: 010553 HIP HIP LTC BIN: 400023, 010033 HIP HIP Medicare BIN: 400023, 010033 HIP HIP Medicare Extended Day Supply BIN: 400023, 010033 866-257-1419 HIP HIP Vaccination BIN: 400023, 010033 Part B and Part D HIP HIP Commercial IdealScripts IdealScripts Retail BIN: 011289 IdealScripts IdealScripts 90 Day at Retail BIN: 011289 Independent Health Maintenance Drugs BIN: 004626 716-631-2927 Independent Health Compounding BIN: 004626 Independent Health Medicaid Independent Health BIN: 004626 800-993-9898 Independent Health Retail BIN: 004626 716-631-2927 Innoviant Innoviant Part D 84- Days or Greater Supply Retail BIN: 610127 PCN: 02330000 800-794-1086
Innoviant Name or 90-Day at Retail Innoviant Open Innoviant Innoviant Innoviant Innoviant Part D 1-83 Days Supply Retail Innoviant Home Infusion Cash Discount 877-559-2955 Innoviant Innoviant LTC BIN: 610127 PCN: 02330000, 01960416 Wausau BIN: 610127 PCN: 02330000 BIN: 610127 PCN: 02330000 BIN: 610127 PCN: 02570000 BIN: 610127 PCN: 02330000 877-559-2955 800-794-1086 800-794-1086 800-794-1086 IPM IPM Retail BIN: 014658 877-860-8846 IPM IPM GAP High Deductible BIN: 014658 Keystone Mercy Health Plan KMHP Retail Keystone Mercy Health Plan KMHP OTC Maxor Plus MaxorPlus Select Maxor Plus Maxor Prime Maxor Plus Maxor Maxor Plus Maxor Plus Maxor Plus Medicaid Hudson Health Plan MaxorPlus MaxorPlus Preferred BIN: 005377 PCN: 10000019 BIN: 005377, Medicaid Group: MDC, Family Health Plus Group: FHP. PCN: 10000019 BIN: 005377 PCN: 10000019 BIN: 005377 PCN: 10000019 Maxor Plus Maxor FirstCare Medical Security Card ScriptSave Medical Security Card RxA s BIN: 006053 PCN: MSC, HDN BIN: 006053 PCN: RXA Admin LTC Excellus Retail Excellus LTC 17 Retail 800-687-0707 800-339-4557 800-687-0707 800-687-0707 Name or Excellus Home Infusion Choice 90 800-788-2949 Home Infusion CRX 2009 Health Alliance IL PCN: 14100 Choice 90 w MAC 800-788-2949 Cash Discount CRX Cash Discount Card Medicaid HealthPlus, Medicaid Group: HCP9198, Family Health Plus Group: FHP9198 PCN: 58080 800-300-8181 (HNY03-Health Plus NYS Medicaid) Excellus Extended Supply Retail Medicare Part D Excellus Commercial Employee Group KPS Health Plan Physicians of Douglas County Carolina Care - MedWest Hospital Apex Affinity Big Path AME Benefits Cash Discount Card LA Care Health Plan Health Plan Select Flu Influenza FirstCarolinaCare Influenza Vaccination Excellus Managed Medicaid Premier Health Plan (610475) PCN: 74000 (FLRX), (Group: EXC) PCN: 49100 800-788-2949 800-788-2949 PCN 34106 BIN: 015441 PCN: 11330 GRP: B033000000 PCN: 11200 PCN: 34400 PCN: 74000 Family Health Plus 888-942-7670 800-788-2949 800-724-5033
Name or Name or Medicaid Univera Community Health PCN: 74000 800-724-5033 AM-2 BIN: 008324, 012304 PCN: MH 866-684-5395 HEB Kingsville Independent School District NY Medical and Surgical Supply Pharmacy Medicaid Health Plus of NY Family Health Plus TX HEB Hidalgo County TX Medtrak Services Group Health HealthPartners of Minnesota Vaccination Medtrak BIN: 014988 PCNL: B22942 Group: KGVL1 (not required) PCN: 58110, 58080 PCN: 58110, 58080 BIN: 014988 PCN: B22942 PCN: 24002 BIN: 800004 (NDC), 001659 (Envoy) PCN: 008126 (NDC), Call Envoy Health Plus of New York: 800-788-2949 800-300-8181 800-788-2949 800-788-2949 800-771-4648 Medtrak Services MedTrak 90 BIN: 800004 800-771-4648 Medtrak Services Medtrak Services Performance 90 Pharmacy Open Pharmacy MH-5 Sponsored Discount s MH-4 Discount MemberHealth 800-771-4648 MemberHealth LTC MemberHealth Part B and Part D BIN: 800004 (NDC), 001659 (Envoy) PCN: 008126 (NDC), Call Envoy BIN: 008324 PCN: MH BIN: 008324, 012304 PCN: MH 800-771-4648 888-868-5854 Community Care Rx, Golden Buckeye Medicare, and Criterion Advantage: 866-684-5395 Enter "1" in the DUR/PPS Code Counter field and "MA" into the Professional Service Code field Mirixa MemberHealth Rural MemberHealth Fidelis MemberHealth MTM Services Community CCRx Welcome Mirixa CCRx MTM Mirixa Mirixa Navitus Navitus Navitus Medco SOCRxATES ESI 1:1 Pharmacy Outreach Navitus Part D Vaccination Navitus Medicare Part D Retail Retail IL Navitus 90 Day Retail Navitus Long-Term Care Navitus Retail (31-90 Day Supply) CPT Code: 99605+99607 (Face to Face new patient), 99606+99607 (Face to Face repeat Patient), 98968 (MTM via Phone), 99080 (Decline) Pharmacy will be paid $40.00 for each completed session with a patient. Pharmacy will be paid $60.00 for each completed session with a patient, subject to adjustment for geographical region. Initial session: $30 per care gap, follow up sessions: $15 per care gap per session, decline for patient refusal: $10 per patient, initial only Service Code: Face to Face - 99606, Phone (5-10 min): 98966, Phone (15 min) 98967 BIN: 610602 PCN: D1004 BIN: 610602 PCN: D1004 866-333-2757 or 800-279-1301
Name or Name or Navitus Navitus Compound Drugs - Home Infusion Retail (1-30 Day Supply) Navitus TX Medicaid TX Contact DeanCare RX, 1-888-422-3326 for processing assistance in connection with compounds with ingredient costs exceeding $100.00. BIN: 610602 866-333-2757 or 800-279-1301 Navitus BadgerRx Gold BIN: 610602 866-333-2757 Net Card Systems - Welldyne Florida Medicaid Workers Comp Preferred Select FL Retail C&O Railroad Employees Hospital Association Retail Neighborhood Health Providers 100% Discount Card Child Health Plus PCN: NMHC PCN: NMHC PCN: NMHC PCN: NMHC NPS Processing NPS Medicare Retail NPS Processing NPS Medicare LTC NPS Processing NPS Retail PCN: PCN Group: NHPLAN PCN: NMHC PCN: PCN Group: NHPLAN BIN: 004758 PCN: DNPS BIN: 004758 PCN: DNPS BIN: 004758 PCN: NPS NRx NRx Retail BIN: 001917 Ohio Best Rx Ohio's Best Rx OH Opus OPUS Retail BIN: 601341 PCN: OHS for Phy Claims, OHCP for Coupon s 800-546-5677 800-546-5677 800-546-5677 800-364-4767 Option 1 Paramount Rx Paramount Rx MTM Pharmacists Mutual Employee Prescription Plan MTM CarePro Health Services MTM ChecKmeds NC MTM City of Ames, Iowa Employee Prescription Plan MTM Freedom Health Plan MTM Health Plan of San Mateo CareAdvantage Plan MTM Medica Health Plan Medicare Part D Plan MTM Medi-CareFirst BCBS Medicare Part D Plan MTM Personal Pharmacist MTM Partnership HealthPlan of CA Plan MTM Alameda Alliance for Health MTM UAHC Health Plan of Tennesee Plan MTM Optima Health Plan MTM Senior Whole Health Medicare Part D Plan Paramount Prescription Benefit Plan Paramount Prescription Drug Savings Partially Funded PharmaCare Preferred Card PCN: HWJ, HPSM, TQC PCN: AAH, TQC KY PCN: 01730001 BIN: 610210 BIN: 610210 BIN: 610468 800-777-1023 BIN: 610468, 610474 PCN: RI, TDI-PA 800-777-1023
Name or Independent - Oakland Pharmacy 800-777-1023 Non-Funded 800-777-1023 State of Connecticut Employees CT BIN: 610468, 610449 800-777-1023 Indemnity BIN: 610468 800-777-1023 CLAIMSPRO Managed Care BIN: 004245 800-777-1023 GOLD/PN2 BIN: 610468 800-777-1023 Medicare Prescription Drug Discount Card and Transitional Assistance 800-777-1023 Specialty BIN: 610468 800-777-1023 Pharmacy CLAIMSPRO Preferred PharmaCare Benefit Plan Wooster Comm Hosp and Schnucks Plans Funded s/ Vouchers/Patient Assistance ADULTCARE MED D PDM Discount Card s - 100% member copay, Workers' Comp PNPS TRUE RX BIN: 610449 PCN: MD2U. BIN: 004245 PCN: MD2C, BIN: 610468 PCN: MD2 610449: 800-519-8374 004245: 800-837-9600 610468: 800-777-1023 BIN: 004245 800-777-1023 800-777-1023 BIN: 610020 PCN: PBD09 GRP: 99990572 or 99990606 BIN: 610020, 006012, 013535 BIN: 610020 PCN: MEDDPDM GRP: 99990435 BIN: 610020, 006012, 013535 BIN: 610020 PCN: PNPS BIN: 014955 PCN: PDMI 800-800-7364 800-767-4226 800-800-7364 800-767-4226 800-800-7364 800-800-7364 ABC Managed Care BIN: 006012 800-800-7364 Name Preferred Care Preferred Care Preferred Care or City of Toledo Preferred Care 90 Days at Retail Preferred Care Retail Pharmacy Preferred Care Retail Specialty PrimeStandard BCBS of TX HMO Blue BIN: 610020 PCN: TLDRX GRP: 99990569 800-800-7364 BIN: 004915 800-519-8378 BIN: 004915 800-519-8378 BIN: 004915 800-519-8378 TX PrimeExtended BCBS of FL Medicare FL, CC Prime IL HMO 90-Day at Retail Prime 90-Day at Retail Extended Supply IL Prime Limited OK, NM BIN: 011552 PCN: BCTX Prime Limited BCBS TX BCBSTX - Pilgrim Pride Prime Limited Blue Select**** BCBS of FL HMO & PPO Prime BCBS TX HMO Blue FL, CC Prime TX BIN: 610455 PCN: PDPOK Prime Limited IL BCBS IL Non-HMO Prime Advantage PrimeStandard Rates PrimeStandard LTC 888-229-2978 Prime Plus BIN: 610455 800-693-6619 Prime Commercial Prime Select
Name or Name or Pro Care Rx Managed Care Select BIN: 018878, 010918 800-699-3542 1-83 Day Supply - Exclusive Retail Pro Care Rx Services Pro Care Rx Extended Day Supply BIN: 018878 800-699-3542 Pro Care Rx Hospice BIN: 009430 Pro Care Rx Westmoreland Coal Company Quantities for Hospice patients are generally limited to a 15 day supply. BIN: 009430 800-352-8542 Pro Care Rx Preferred BIN: 018878, 010918 800-699-3542 Ramsell Public Health Plan - Independent Ramsell Public Health Plan - Independent Regence Rx California ADAP Immunization and OTC Medications BIN: 004519 PCN: ADP VPC 888-311-7632 Regence Rx Regence Retail BIN: 610622 888-437-1508 Open Choice Plus HAS/Member Pay Prime Workers Compensation Medicare Prescription Drug Benefit for Leon Medical Center Rx dba Prescription Rx dba Prescription Rx dba Prescription Rx dba Prescription Rx dba Prescription Rx dba Prescription Unison Affiliated Health Plans 84 Day Supply or Greater Retail Medicare Long Term Care Molina Healthcare of California Ucare Medicare Advantage Peoples Health BIN: 012189 PCN: 5010, MISS-5025, AR-5024, TN5013, AR5024, MS5025, OH5026 BIN: 012189 PCN: 5001, 5031 BIN: 012189 PCN: 5029, 5030 BIN: 012189 PCN: Medicaid- 5050, 5051, 5052, Medicare: 500 N1-P and N-1 BIN: 610097 /Immunization Injection Vaccination Quality Health Plans BIN: 011875 and 014848 N1 BIN: 610097 OPTIMA BIN: 610494 PCN: 9999 FFS 800-770-8014 877-279-0372 800-790-1698 877-279-0372 Medicaid - 866-783-7041 Medicare - 877-279-0372 MAPD: 877-889-6510 All others: 800-788-7871 Central Illinois Medicare Prescription Drug Benefit for Union Pacific Railroad Caresource Medicaid Plan Medicare Retail 1-83 Day Supply - Select Plus Retail BIN: 610473 PCN: 0797, 0798 BIN: 012189 PCN: 5000 866-669-0321 Rx dba Prescription Rx dba Prescription Rx dba Prescription Rx dba Prescription Sav-Rx Southern California Drug Fund Employers Benefit Plan Medicaid UnitedHealthcare RxS Discount RxS Narrow BIN: 610494 PCN: 9999 GRP: RXS BIN: 610494 PCN: 9999 Group: ACUNY BIN: 610494 PCN: 9999 GRP: RXS 800-493-4647
Name or Sav-Rx B - Premier BIN: 006558 402-753-2800 Sav-Rx Script Care Script Care Script Care Script Save Script Save Advantage Pharmacy 2011-2012 Pneumonia Vaccination SCL Prescription Drug 2011-2012 Flu Vaccination RxA ScriptSave BIN: 008563 402-753-2800 800-880-9988 Script Save Immunization ScriptNet ScriptNet Retail Serve You Custom Rx Mgmt Serve You Custom Rx Mgmt Serve You Custom Rx Mgmt Serve You Custom Rx Mgmt Sierra Rx Stone River Workman's Comp Serve You 90 Day Retail Serve You Discount Card Serve You Workers Compensation Serve You Stone River W/C TennCare Ambulatory informedrx Consumer Card Retail BIN: 004410 PCN: SCI, NDC 800-880-9988 800-880-9988 BIN: 00631 PCN: RXA, HDN BIN: 006053 PCN: MSC. GRP: 904 BIN: 610621 PCN: SNT PCN: SERVU PCN: SERVU BIN: 610548 PCN: 3WC GRP: UHS PCN: SERVU BIN: 005567, 003573 PCN: TPS PCN: TENNCARE 800-347-5985 888-880-8562 800-759-3203 800-759-3203 800-759-3203 800-759-3203 866-200-8393 866-434-5520 BIN: See card 800-282-3232 SXC Premier BIN: See Card 800-282-3232 informedrx Retail 90 Chain BIN: See card Chains with more than 50 pharmacies: 800-282-3232 Name or informedrx Retail 90 Independent and Small Chain TennCare LTC informedrx Choice 100 UFCW Local 655 informedrx Select informedrx Rural Pharmacy TennCare Compounding Health Xcellence Benefits Preferred Pharmacy IL BIN: See card PCN: TENNCARE Chains with less than 50 pharmacies and PSAOs: 800-282-3232 866-434-5520 BIN: See card 800-282-3232 BIN: See card 800-282-3232 BIN: See card 800-282-3232 TennCare Specialty TDI Managed Care Svc Inc TDI Managed Care Svc Inc TDI Managed Care Svc Inc Health Plan of San Mateo Medi-Cal, Healthy Kids, Health Workers, and Healthy Family Health Plan of San Mateo Medicare Part D Retail Health Plan of San Mateo LTC informedrx Choice Plus 100 ChoiceAccess PreferredAccess Discount Card s Tmesys Plan # 2066.2 PCN: TENNCARE 866-434-5520 800-282-3232 800-282-3232 PCN: TENNCARE 866-434-5520 BIN: 005947 800-282-3232 BIN: 005947 800-282-3232 BIN: 005947 800-282-3232 BIN: See card 800-282-3232
Name or Name or Tmesys Plan # 1009 Tmesys Plan # 1055 Tmesys Plan # 2044 Tmesys Plan #1005 Tmesys Plan #1007 Universal Care US Script US Script US Script US Script Retail US Script Open and Medicare Part D HD-Rx Flu Immunization Kentucky Spirit Health Plan Medicaid Well Care Health Plans Ohio Medicaid WHI 90 Day WHI Performance B KY PCN: 50110 BIN: 008019 PCN: 10 A/N BIN: 008019 PCN: 10 A/N BIN: 008019 PCN: 10 A/N Only applicable to Group Number 716257 800-748-6277 Tmesys Plan # 2066 Tmesys Plan # 1015 Tmesys Plan # 1021 Tmesys Plan # 1029 Total Script Nationwide BIN: 006524 PCN: TSCRIPT 800-752-2211 WHI WHI WHI Value (Discount Card) County of Volusia & Daytona Beach Plan Sheet WHI Plus WHI Palm Group IL WHI Performance A FL BIN: 610652 PCN: 82266461 GRP: 586461 Group: 612081, 619218 Wise Rx Retail BIN: 610020 800-800-7364