effective 07.27.2015 subject to change bin type … confirmed plan... · pcn group : type network:...

EFFECTIVE 07.27.2015 Subject to Change

Page 1

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk Number

AlphaScrip Inc Alpha Scrip 610600 AS Commercial 1-877-274-3244

AmWins Rx Commercial

AmWINS Rx AmWINS Rx011289; 013492; N/A Commercial 1-800-717-6614

AmWINS Rx 1.1.2015 AmWINS Rx 015185 Commercial National 1-800-717-6614AmWINS Rx 1.1.2015 AmWINS Rx 013527 Commercial National 1-800-717-6614AmWINS Rx 1.1.2015 AmWINS Rx 016341 9743 see card Commercial National 1-800-717-6614

AmWins Rx Medicare Prt DAmWINS Rx AmWINS Rx Prt D 015178 HRTPARTD Prt D NY 1-700-717-6614AmWINS Rx AmWINS Rx Prt D 015178 CMSPARTD see card Prt D NY 1-700-717-6614AmWINS Rx AnWINS Rx Prt D 014848 MEDD Prt D NY 1-800-717-6614

Applied Underwriters, Inc. Applied Underwriters 013329 APP Commercial National 1-877-234-4420 opt 5APPRO RX 1.1.2015ApproRx ApproRx Dscnt Card 610568 DRX Commercial 1-800-571-4757

ARGUS 1.1.2015 0600CashPay DSCNT Card 600428 06000001 Commercial national 1-866-921-7284ARGUS 1.1.2015 ADJ Marketing Prgm DSCNT Card 600428 05080000 Commercial national 1-866-921-7284

ARGUS 1.1.2015AmeriHealth Caritas Healthy PA Healthy PA Keystone 600428 07220000 Medicaid PA

1-855-332-0729 1-855-332-0434

ARGUS 1.1.2015 Araya AWPRX 610237 AWPRX Commercial NY 1-888-700-0922ARGUS 1.1.2015 Araya NYM 610208 NYM Commercial NY 1-866-352-5171ARGUS 1.1.2015 Argus Pharma Prgrms 0723 600428 07230000 Commercial national 1-866-921-7284

ARGUS 1.1.2015 Argus Pharmacy Voucher / Mkting Programs 600428 05090000 Commercial national 1-866-921-7284ARGUS 1.1.2015 Argus Drug Discount Programs 600428 05100000 Commercial national 1-866-921-7286ARGUS 1.1.2015 BLUE SHIELD CA EXCHANGE 600428 06650000 Exchange CA 1-888-210-3808

ARGUS 1.1.2015 BS of CA Commercial 60042801910000 '02960000 Commercial CA 1-888-635-8224

ARGUS 1.1.2015 CalOptima CalWrap 600428 05760000 Medicaid CA 1-888-962-3100ARGUS 1.1.2015 CalOptima Medi-Cal 600428 05720000 Medicaid CA 1-888-962-3100ARGUS 7.1.2015 Centura Health 600428 06860000 Commercial CO KS 1-855-816-6389

Citizens RxEmployers and Labor Local 100 & 397Health Strategic InitiativesIBEW-NECASEIUPRAM

ARGUS 1.1.2015 ClearScript 600428 06810000 Commercial MN 1-855-816-6389ARGUS 1.1.2015 Connect Health Solutions 600428 05830000 Commercial national 1-800-309-1603ARGUS 1.1.2015 DDC Group Valore Rx CC Program 016961 06770001 Commercial 1-866-921-7289ARGUS 1.1.2015 DDC-RXDC1 Program 017655 06770003 Commercial 1-866-921-7289ARGUS 1.1.2015 Gateway Health Plan / ALL 600428 02710000 Commercial KY OH NC PA 1-800-220-4532ARGUS 1.1.2015 GeneRx 808413 RUN Commercial 1-866-921-7284ARGUS 1.1.2015 Gunderson Health Plan 600428 06820000 Commercial WI 1-855-816-6401ARGUS 1.1.2015 HEALTH PARTNERS 600428 02530000 Medicaid PA 1-800-522-7487

06059999 Commercial MO IL 1-888-445-5519ARGUS 1.1.2015

Argus Commercial / Medicaid / Exchange 6.1.2015

ALPHASCRIP INC 1.1.2015

AmWINS Rx 1.1.2015

ARGUS 7.21.2015

Applied Underwriters, Inc. 1.1.2015

016607


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ARGUS 1.1.2015HealthCare Corp of America /Prescription Corp of America HCA-PCA 340 Basics 600428 06730000 Medicaid National 1-800-309-1603

ARGUS 1.1.2015 Health Network Dscnt Card 600428 1HEALTH Commercial National 1-866-921-7286ARGUS 1.1.2015 Health Options 600428 07130000 Commercial 1-844-848-4312

ARGUS 1.1.2015 Health Plan of San Mateo Medi-Cal / BHRS 600428 05860000 Medicaid CA 1-888-635-8362

ARGUS 1.1.2015Health Plan of San Mateo (HK, HF, HW, ACE, Healthy Kids, HealthWorx, ACE 600428 05860000 Medicaid CA 1-888-635-8362

ARGUS 1.1.2015 Health Republic Insurance 600428 06690000 Commercial NY 1-866-511-6017ARGUS 1.1.2015 Help All Drug Discnt Card Prgrm 600428 HELPALL Commercial National 1-866-921-7286ARGUS 1.1.2015 Humana 610649 03190000 Commercial National 1-800-865-8715ARGUS 1.1.2015 INLAND EMPIRE (IEHP) 600428 02550000 Medicaid CA 1-800-522-7487ARGUS 1.1.2015 DRFIRSTARGUS 1.1.2015 ASCRIPTSARGUS 1.1.2015 NEXTGENARGUS 1.1.2015 NEWCROPARGUS 1.1.2015 ATHENAARGUS 1.1.2015 EXWORKSARGUS 1.1.2015 EPICARGUS 1.1.2015 PFUSIONARGUS 1.1.2015 Kern Health Systems 600428 04970000 Commercial CA 1-800-522-7487ARGUS 1.1.2015 Lovelace Global PCN 600428 02490000 Commercial TX 1-800-522-7487ARGUS 1.1.2015 Lovelace Medicare MA Only Part B 600428 02493205 Commercial TX 1-800-522-7487ARGUS 1.1.2015 Lovelace Health Plan Comm HMO 600428 02490205 Commercial TX 1-800-522-7487ARGUS 1.1.2015 Lovelace Salud (Medicaid) 600428 02492205 Medicaid TX 1-800-522-7487ARGUS 1.1.2015 Lovelace Diabetic - LL 600428 02492225 Commercial TX 1-800-522-7487ARGUS 1.1.2015 Lovelace Small Group and Individual 600428 06630000 Commercial TX 1-800-522-7487ARGUS 1.1.2015 MagnaCare Rx 600428 05880000 Commercial NJ NY 1-888-445-5328ARGUS 1.1.2015 New Benefits (NBRX) 610225 05591000 Commercial National 1-866-520-5985

ARGUS 1.1.2015New Benefits Marketing Partners Dscnt Card Program 610225 '05594444 Commercial National 1-866-520-5985

ARGUS 1.1.2015 123ARGUS 1.1.2015 FINDARGUS 1.1.2015 VETARGUS 1.1.2015 GETARGUS 1.1.2015 Physicians Plus Insurance (PPIC) 600428 00710000 Commercial WI 1-800-522-7487ARGUS 1.1.2015 Physicians Plus TPA 600428 07120000 Commercial WI 1-800-545-5015ARGUS 1.1.2015 Physician Plus PPIC WI HIX 600428 06620000 Exchange WI 1-800-522-7487ARGUS 1.1.2015 Preferred One 600428 06840000 Commercial MN 1-855-816-6402ARGUS 1.1.2015 Priority Health 600428 00750000 Commercial MI 1-800-466-6642

ARGUS 1.1.2015ProAct Prescription Drug Dscnt Card Sussex County Dscnt Card 017878 7878

see card or SSX Commercial National NJ 1-866-921-7286

ARGUS 1.1.2015 Providence Health 600428 01420000 Commercial OR WA 1-888-445-5518ARGUS 1.1.2015 Providence Health 600428 06680000 Commercial OR WA 1-888-445-5518

ARGUS 1.1.2015 Providence Health Pharmacy Bridge Program 600428 05230000 Commercial OR WA 1-888-445-5518ARGUS 1.1.2015 RxEDO No Copay or COB Copay Only 610220 03980000 Commercial 1-800-522-7487ARGUS 1.1.2015 San Francisco Health Plan 600428 06300000 Commercial CA 1-888-989-0091ARGUS 1.1.2015 Scott & White Commercial 610141 06740000 Commercial TX 1-800-728-7947ARGUS 1.1.2015 Scott & White Health Plan HMO 610141 03270000 Commercial TX 1-800-522-7487ARGUS 1.1.2015 SCOTT & WHITE HMO 610141 02500000 Commercial TX 1-800-522-7487ARGUS 1.1.2015 SCOTT & WHITE PBM 610141 02510000 Commercial 1-800-522-7487ARGUS 1.1.2015 Scott & White Exchange 610141 06570000 Exchange TX 1-800-728-7947

1-866-921-7284

1-866-921-7286InteliScript Point of Care Price Compare 016978 Commercial

Pharma Save 017267 Commercial


Page 3

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberARGUS 1.1.2015 Scott & White RightCare Medicaid 610141 05800000 Medicaid TX 1-866-934-7573ARGUS 1.1.2015 Scott & White Valley Baptist ASO 610141 05580000 Commercial TX 1-800-522-7487ARGUS 1.1.2015 Scott & White Valley Baptist HMO 610141 05570000 Commercial TX 1-800-522-7487

ARGUS 1.1.2015Security Health Plan HMO Family Health Center 017317 06960400 Commercial WI 1-877-873-5611

ARGUS 1.1.2015 Security Health Plan Exchange 017317 06960505 Exchange WI 1-877-873-5611

ARGUS 1.1.2015Security Health Plan SHP HMO & Security Admin Services 017317 06960000 Commercial WI 1-877-873-5611

ARGUS 1.1.2015 TrialCard Prgm ANA-101 600428 06780000 Commercial National 1-855-816-4762

ARGUS 1.1.2015Upper Peninsula Health Plan (UPHP) Medicaid 017480 01990000 Medicaid MI 1- 866-849-4196

ARGUS 1.1.2015 Valore Rx CCT 015954 VALORE Commercial 1-866-921-7286ARGUS 1.1.2015 Vantage Health Plan 600428 06880000 Commercial LA 1-888-823-1910ARGUS 1.1.2015 VRX 610245 05490000 Commercial UT 1-888-635-8315ARGUS 1.1.2015 VRX 610245 05780000 Commercial UT 1-888-635-8315ARGUS 7.1.2015 SearchRX Program 610367 COMPARE Commercial National 1-866-921-7286Argus / 4D 1.1.2015 4-D Pharmacy 600428 01990000 Commercial MI 1-866-846-4196Argus / 4D 1.1.2015 Comsumers Mutual INS of MI MktPlace 600428 06640312 Commercial MI 1-866-849-4196Argus / 4D 1.1.2015 McLaren Marketplace 600428 06640316 Exchange MI 1-866-849-4196Argus / 4D 1.1.2015 4D Meijer 600428 06800001 Commercial National 1-866-921-7286

Argus / 4D 1.1.20154D DBA Meditipster Dscnt Care a McLaren Health Plan 610209 05460000 Commercial MI 1-800-307-6147

Argus / Caremark 1.1.2015 Valley Baptist Health Plans 004336 ADV

RX6054 RX6076 RX6077 RX6078 RX6079 RX6112 RX6113

Commercial TX 1-800-364-6331

ARGUS / FutureScripts Catamaran 1.1.2015 FutureScripts 600428 04820000 Commercial PA 1-888-678-7012

ARGUS / FutureScripts Catamaran 1.1.2015 FutureScripts IBC _Independence Blue Cross 600428 03820000 Commercial PA 1-888-678-7012

ARGUS / FutureScripts Catamaran 1.1.2015 FutureScripts - AHA 600428 03840000 Commercial NJ PA 1-888-678-7012

ARGUS / FutureScripts Catamaran 1.1.2015 FutureScripts-Wise Foods 600428 03825100 Commercial PA 1-888-678-7012

ARGUS / FutureScripts Catamaran 1.1.2015 FutureScripts - UFCW 600428 03825000 Commercial PA 1-888-678-7012

ARGUS / FutureScripts Catamaran 1.1.2015 IBC 015814 06090000 Commercial National 1-855-390-2604

ARGUS / FutureScripts Catamaran 1.1.2015 IBC NJ Exchange 015814 06440000 Exchange NJ 1-855-390-2604

ARGUS / FutureScripts Catamaran 1.1.2015 IBC PA Exchange 015814 06430000 Exchange PA 1-855-390-2604

ARGUS / FutureScripts Catamaran 1.1.2015 IBC National Alliance 015814 06080000 Commercial PA 1-855-390-2604Argus / Gateway West Virginia Family Health Plan 600428 06330000 Medicaid WV 1-800-220-4532Argus / PerformRx 1.1.2015 Alamdeda Alliance Commercial 600428 06360000 Commercial CA 1-855-508-1713Argus / PerformRx 1.1.2015 Alameda Alliance Hlth Medicaid 600428 06320000 Medicaid CA 1-855-508-1713Argus / PerformRx 1.1.2015 Alameda Exchange 600428 06370000 Exchange CA 1-855-508-1717Argus / PerformRx 5.4.2015 Amerihealth DC 600428 06280000 Medicaid DC 1-888-602-3741Argus / PerformRx 1.1.2015 AmeriHealth Caritas Louisiana 600428 06030000 Medicaid LA 1-800-684-5502Argus / PerformRx 1.1.2015 AmeriHealth Northeast 600428 06200000 Medicaid PA 1-888-208-1020


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PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberArgus / PerformRx 1.1.2015 Ascella Health Plan 600428 07250000 Commercial PA 1-855-843-0833Argus / PerformRx 1.1.2015 Blue Cross Complete 600428 06210000 Commercial MI? 1-888-288-3231Argus / PerformRx 1.1.2015 Contra Costa Health Plan 600428 03970000 Commercial CA 1-866-907-7088Argus / PerformRx 1.1.2015 Contra Costa Exchange 600428 06460000 Exchange CA 1-855-662-0927Argus / PerformRx 1.1.2015 Indiana University Health

Argus / PerformRx 1.1.2015Indiana University La Porte, Ball Memorial, Clarian 600428 05510000 Commercial IN 1-888-765-9575

Argus / PerformRx 1.1.2015 Indiana University Health Plans Prt B 600428 05270000 Commercial IN 1-866-907-7088Argus / PerformRx 1.1.2015 Keystone First 600428 01940000 Medicaid PA 1-800-588-6767Argus / PerformRx 1.1.2015 MDWise Exchange 600428 06590000 Exchange IN 1-855-491-0633

Argus / PerformRx 1.1.2015 Neighborhood Health Plan of Rhode Island 600428 05280000 Commercial RI 1-866-910-7654Argus / PerformRx 1.1.2015 NHPRI Exchange 600428 06600000 Exchange RI 1-866-910-7654Argus / PerformRx 1.1.2015 Select Health 600428 02180000 Commercial ID UT 1-866-610-2773

Argus / PerformRx 1.1.2015South Country Health Alliance Medicaid (SCHA) 600428 06180000 Medicaid MN 1-866-935-8874

Argus / PerformRx 1.1.2015State of California PBM: CDRC, DAPO & CDCR DJJPO 600428 05440000 Commercial CA 1-866-765-6382

Argus / PerformRx 1.1.2015 True Blue 600428 06040000 Commercial 1-888-365-0702

Argus / US Script 1.1.2015Buckey Community Health Plan - My Care Ohio (Opt Out) 600428 06240000 Commercial OH 1-877-935-8021

ARGUS /Catamaran 1.1.2015See CIGNA/Argus - they are the PROCESSOR for this BIN 015764 Commercial

ARGUS 1.1.2015 Blue Shield of California MA-PD 012353 01920000 Prt D CA 1-800-494-1862ARGUS 1.1.2015 Blue Shield of California PDP 012353 03510000 Prt D CA 1-800-494-1862ARGUS 7.1.2015 Cal Medi Connect 012353 06450000 Prt D CA 1-888-609-0004ARGUS 1.1.2015 CalOptima One Care 012353 05730000 Prt D CA 1-888-609-0004ARGUS 1.1.2015 CalOptima Pace 012353 06580000 Prt D CA 1-888-587-8088ARGUS 1.1.2015 CarePlus MA-PD 015581 03200008 Prt D national 1-800-865-4034ARGUS 1.1.2015 Contra Costa Select Care MA-PD 012353 04740000 Prt D 1-877-234-4269ARGUS 1.1.2015 Gateway Health Plan MA-PD 012353 03740000 Prt DARGUS 1.1.2015 Gunderson Health Plan Prt D 012353 06830000 Prt D MN 1-855-816-6403

ARGUS 1.1.2015HAP Midwest Health Plan MI Health Link MMP HMO 012353 07197191 Prt D MI 1-800-577-7487

ARGUS 1.1.2015 Health Partners Medicare 012353 05650000 Prt D MN 1-800-522-7487ARGUS 1.1.2015 Health Plan of San Mateo 012353 05850000 Prt D CA 1-888-635-8362

ARGUS 1.1.2015Health Plan of San Mateo Medicare Part D Retail 012353 06850000 Prt D CA 1-888-635-8362

ARGUS 1.1.2015 Humana PDP (Careplus) 015581 03200000 Prt D national 1-800-865-4034ARGUS 1.1.2015 Humana / MA PFFS 610649 03200004 Prt D 1-800-522-7487ARGUS 1.1.2015 Inland Empire Dual Choice 012353 04110000 Prt D CA 1-888-635-8361

ARGUS 1.1.2015 Lovelace Health Plan, Inc. MA-PD 012353NM=03733251 OK=03736801 Prt D OK

NM= 1-800-522-7487 ok = 1-855-816-6460

ARGUS 1.1.2015 Medi-CareFirst 012353 03030000 Prt D 1-800-522-7487

ARGUS 1.1.2015Medicare's Limited Income NET Prog- Administered Humana 015599 05440000 Prt D national 1-800-783-1307

ARGUS 1.1.2015 MercyCare Advantage 012353 05630000 Prt D AZ 1-800-522-7487

ARGUS 1.1.2015Midwest Advantage Medicare Part D HMO SNP 012353 06171000 Prt D MI 1-800-522-7487

ARGUS 1.1.2015 Premara Blue Cross Prt D 012353 06670000 Prt D OR 1-888-445-5518ARGUS 1.1.2015 Priority Medicare Rx 012353 03700000 Prt D MI 1-800-522-7487ARGUS 1.1.2015 Priority Medicare, Value, and Select 012353 03690000 Prt D MI 1-800-522-7487

Argus Medicare Prt D 6.1.2015


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PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberARGUS 1.1.2015 Providence Health Plans MA-PD 012353 03300000 Prt D OR WA 1-888-445-5518

ARGUS 1.1.2015Scott & White Senior Care RxMA-PD 012353 03710000 Prt D TX 1-800-816-6405

ARGUS 1.1.2015Scott & White Medicare Prt D MAPD (Vital Trad HMO/MAPD) 012353 06750000 Prt D Dalla/Ft Worth 1-800-816-6405

ARGUS 1.1.2015Select Health of South Carolina Advantage HMO SNP 012353 06120000 Prt D SC 1-866-828-0092

ARGUS 1.1.2015 Security Health Plan HMO AdvocareARGUS 1.1.2015 SHP HMO Advocare 017309 06970000 Prt D WI 1 -877-873-5611ARGUS 1.1.2015 SHP HMO Advocare NO DRUG 017309 06971212 Prt D WI 1 -877-873-5611ARGUS 7.1.2015 SHP Medicare PART B 017307 06971515 Prt D WI 1 -877-873-5611

ARGUS 1.1.2015Upper Peninsula Health Plan Advntg HMO MAPD 012353 07187182 Prt D MI 1-800-522-7487

ARGUS 1.1.2015Upper Peninsula Health Plan MMP HMO Michigan Hlth Link 012353 06766761 Prt D MI 1-800-522-7487

ARGUS 1.1.2015 Upper Peninsula Hlth Plan HMO SNP MAPD 012353 07187181 Prt D MI 1-800-522-7487

ARGUS 1.1.2015Vista Advantage: Keystone VIP Choice & AmeriHealth VIP 012353 06110000 Prt D PA

Keystone-1-866-828-0023 AmeriHealth-1-866-543-2657

Argus / 4D 1.1.2015 4D McLaren Prt D Advantage HMO SNP 012353 06702000 Prt D MI 1-888-863-9281Argus / 4D 1.1.2015 4D McLaren Prt D HMO 012353 06702001 Prt D MI 1-888-863-9281Argus / 4D 1.1.2015 McLaren Advantage Diamond 012353 06706701 Prt D MI 1-888-863-9281Argus / 4D 1.1.2015 McLaren Advantage Sapphire 012353 06706702 Prt D MI 1-888-863-9281

ARGUS / FutureScripts Catamaran 1.1.2015 FutureScripts Secure (PDP) 012353 03820000 Prt D NJ PA 1-888-678-7015Argus / PerformRx 1.1.2015 Alameda Prt D 012353 06310000 Prt D CA 1-855-251-0966Argus / PerformRx 1.1.2015 AmeriHealth Advantage 012353 03660000 Prt D PAArgus / PerformRx 1.1.2015 Amerihealth DC Prt D 012353 06560000 Prt D DC 1-888-987-6396Argus / PerformRx 1.1.2015 Amerihealth LA Prt D 012353 06540000 Prt D LA 1-866-560-6052Argus / PerformRx 1.1.2015/4.1.2015 AmeriHealth VIP Care Plus 012353 06500000 Prt D MI 1-855-327-0510Argus / PerformRx 1.1.2015 Essence Health Plan 012353 02750000 Prt D MO 1-800-578-0898Argus / PerformRx 1.1.2015 First Choice VIP Care Plus 012353 06510000 Prt D SC 1-800-792-7487 x 52231Argus / PerformRx 1.1.2015 Indiana University Health Plans MAPD 012353 05270000 Prt D IN 1-866-907-7088Argus / PerformRx 7.1.2015 NHPRI Integrity 012353 06470000 Prt D RI 1-855-327-0514Argus / PerformRx 7.1.2015 Partners Health Plan 012353 06480000 Prt D 1-855-508-1719Argus / PerformRx 1.1.2015 Prominence Health Plan Prt D 012353 07080000 Prt D NV 1-800-792-7487 x 52231

Argus / PerformRx 1.1.2015South Carolina Health Alliance Medicare (SCHA) (South Country) 012353 06190000 Prt D SC 1-866-935-6681

Argus / PerformRx 1.1.2015 Vantage Hlth Plan Prt D 012353 06870000 Prt D LA 1-866-524-5144Argus / US Script 1.1.2015 Superior Health Plan 012353 06244500 Prt D TX 1-888-210-3879Argus / US Script 1.1.2015 Bridgeway Health Solutions Prt D 012353 06240300 Prt D AZ 1-800-309-0179Argus / US Script 1.1.2015 Buckeye Health Plan Prt D 012353 06243600 Prt D OH 1-866-611-8700Argus / US Script 1.1.2015 Peach State Health Plan Prt D 012353 06241100 Prt D GA 1-866-582-6582Argus / US Script 1.1.2015 Sunshine Health Prt D 012353 06241000 Prt D FL 1-888-445-5602Argus / US Script 1.1.2015 Managed Health Services Prt D 012353 06245100 Prt D WI 1-888-445-5532Argus / US Script 1.1.2015 IlliniCare Health Prt D 012353 06241400 Prt D IL 1-855-854-0270

Argus / US Script 1.1.2015Buckeye Community Health Plan - My Ohio Care Prt D 012353 06243601 Prt D OH 1-855-421-0272

Argus / US Script 1.1.2015 Absolute Total Care Prt D 012353 06244200 Prt D SC 1-844-857-4347Argus / US Script 1.1.2015 Superior STAR+PLUS Prt D 012353 06244501 Prt D TX 1-844-857-4375


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Benecard Commercial

Benecard BeneCard PBF 014179 9743

10010, 10011, 10018, 10020, 10021, 2145, see card

Commercial 1-888-907-0050

BeneCard 12.1.2014 Teamsters Local 830 014179 9743 10047 Commercial PA 1-888-907-0050BeneCard 12.1.2014 Puerto Rico Carpenters 014179 9743 10044 Commercial PR 1-888-907-0050

Benecard National - Retail Participating Network 014179 9743 Commercial 1-888-907-0050Benecard 1.1.15 Precise RxCareBenecard 1.1.15 Borough of Fort Lee EGWP 016341 9743 1138 Commercial NJ 1-800-717-6614Benecard 1.1.15 City of Ocean City EGWP 016341 9743 2828 Commercial NJ 1-800-717-6614Benecard 1.1.15 City of Union City EGWP 016341 9743 2102 Commercial NJ 1-800-717-6614Benecard 1.1.15 Metro Bank 014179 9743 10046 Commercial PA 1-888-907-0050Benecard 1.1.15 Iron Workers Local Welfare Fund 014179 9743 10039 Commercial PA 1-888-907-0050Benecard 1.1.15 Hanover Foods 014179 9743 10048 Commercial PA 1-888-907-0050Benecard 1.1.15 Horst Insurance 014179 9743 10050 Commercial PA 1-888-907-0050Benecard 1.1.15 Good's Store 014179 9743 10051 Commercial PA 1-888-907-0050Benecard 1.1.15 Neward Public Schools Loc 3 & 617 014179 9743 3132 Commercial NJ 1-888-907-0050

Benecard 1.1.15 Neward PublixSchools Senior Management 014179 9743 3133 Commercial NJ 1-888-907-0050Benecard 1.1.15 County Of Sussex Retirees 014179 9743 2619 Commercial NJ 1-888-907-0050Benecard 1.1.15 Township of Springfield 014179 9743 1132 Commercial NJ 1-888-907-0050Benecard 1.1.15 Ewing BOE 014179 9743 1840 Commercial NJ 1-888-907-0050Benecard 2.1.2015 Winslow Twp Board of Education 014179 9743 2132 Commercial NJ 1-888-907-0050Benecard 2.1.2015 The City of North Wildwood 014179 9743 3231 Commercial NJ 1-888-907-0050Benecard 3.1.2015 Borough of Seaside Heights 014179 9743 1113 Commercial NJ 1-888-907-0050

BeneCardEmpiRx Health Corrections Officers Benevolent Assoc. (COBA) 017688 9743 190001 Commercial PA 1-888-904-0050

BeneCard 3.1.2015 Philadelphia Fire Fighters IAFF Local 22 014179 9743 10052 Commercial PA 1-888-907-0050BeneCard 7.1.2015 Central Regional Board of Education 014179 9743 4149 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Berkeley, Township of 014179 9743 2315 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Bridgeton Board of Education 014179 9743 4230 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Buena Regional School District 014179 9743 3234 Commercial NJ 1-888-907-0050

BeneCard 7.1.2015 Commercial Township Board of Education 014179 9743 2247 Commercial NJ 1-888-907-0050

BeneCard 7.1.2015Cumberland County Technical Education Center 014179 9743 2112 Commercial NJ 1-888-907-0050

BeneCard 7.1.2015 Cumberland Regional Board of Education 014179 9743 4203 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Florence Board of Education 014179 9743 2309 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Gloucester City, City of 014179 9743 3110 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Hopewell Township Board of Education 014179 9743 1331 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Medford Township Board of Education 014179 9743 2848 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Millville Board of Education 014179 9743 1205 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Tabernacle Board of Education 014179 9743 1219 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Middle, Township of 014179 9743 3239 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Quinton Board of Education 014179 9743 1333 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Vineland Board of Education 014179 9743 4245 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Vineland, City of 014179 9743 3117 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Dallastown 014179 9743 10055 Commercial PA 1-888-907-0050BeneCard 7.1.2015 Greater Egg Harbor Regional High School Distr 014179 9743 3348 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Berkeley Twp. BOE 014179 9743 1203 Commercial NJ 1-888-907-0050

BENECARD 7.21.2015


Page 7

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberBeneCard 7.1.2015 Pennsauken BOE 014179 9743 1339 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Burlington City BOE 014179 9743 2849 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Roseland BOE 014179 9743 2248 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 North Caldwell BOE 014179 9743 2103 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Belmar BOE 014179 9743 3102 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Plumstead Twp. BOE 014179 9743 1146 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Mount Olive BOE 014179 9743 1318 Commercial NJ 1-888-907-0050BeneCard 7.1.2015 Somerdale BOE 014179 9743 3649 Commercial NJ 1-888-907-0050

BeneCard Medicare EGWP 016341 see card see card Prt D 1-877-870-8560Benecard Smart D Rx/Medicare 016333 see card see card Prt D 1-855-850-6333

BioScrip 12.23.2014 ApotheCard 010439 DRX see card Commercial 1-800-230-8187 Opt #3BioScrip 12.23.2014 BioScrip Discount Card 017670 WTVNRX see card Commercial 1-800-230-8187 Opt #3BioScrip 12.23.2014 BioScrip Discount Card 017614 BIOUSRX see card Commercial 1-800-230-8187 Opt #3BioScrip 9.10.2014 BioScrip Discount Card 017614 BIOSNBBI see card Commercial 1-800-230-8187 Opt #3BioScrip 9.10.2014 BioScrip Discount Card 017647 PDCWMT see card Commercial 1-800-230-8187 Opt #3BioScrip 9.10.2014 Jai Medical 610084 CLAIMNE Q9016 CommercialBioScrip 7.01.2011 MATRIX 610208 Various Commercial 1-800-230-8187 Opt #3BioScrip 7.01.2011 AWPRX (Matrix) 610237 Various Commercial 1-800-230-8187 Opt #3BioScrip 7.01.2011 Lucinia Health/Scrip Discount Card 610679 LHDC Commercial 1-800-230-8187 Opt #3

BioScrip 12.23.2014 BioScrip Discount Card 900014CLAIMNE, CLAIMRX, CLAIMWT

Commercial National 1-800-230-8187 Opt #3

BioScrip 12.23.2014 ApotheCard Discount Card 900020 CLAIMNE Commercial 1-800-230-8187 Opt #3BioScrip 12.23.2014 Avanti Health Systems 900020 CLAIMNE AVANTI Commercial CA 1-800-230-8187 Opt #3BioScrip 12.23.2014 Indiana ADAP 900020 CLAIMNE 52255 Medicaid IN 1-800-230-8187 Opt #3BioScrip 1.1.2015 Indiana HIAP COB 900020 CLAIMNE 51115 Medicaid IN 1-800-230-8187 Opt #3BioScrip 11.1.2014 LTC Hospice of Chattanooga 900020 CLAIMNE HOC Commercial TN 1-800-230-8187 Opt #3

BioScrip 11.1.2014 Hospice of Chattanooga 3day emergency 900020 CLAIMNE EM3HOC Commercial TN 1-800-230-8187 Opt #3BioScrip 11.1.2014 Hearth Hospice 900020 CLAIMNE HEARTH Commercial TN GA 1-800-230-8187 Opt #3BioScrip 12.23.2014 PSG 900020 CLAIMNE BPSG*** Commercial 1-800-230-8187 Opt #3BioScrip 12.23.2014 Prescription Services 900020 CLAIMNE MCP Commercial 1-800-230-8187 Opt #3BioScrip 12.23.2014 BioScrip Commercial 900020 CLAIMNE CommercialBioScrip 1.1.2015 Indiana MDAP 900020 INMDAP 52256 Prt D IN 1-800-230-8187 Opt #3

Caremark Legacy PHC 004245 see card see card Commercial 1-800-777-1023Caremark 6.10.2015 AAA Auto Discount Card 004336 AAA Commercial National 1866-222-7283

Caremark 10.31.2014 Adidas 004336 ADV

RX6620, RX6621, RX6622, RX6623 Commercial National 1-800-364-6331

Caremark 10.31.2014 Aero Contractors 004336 ADVRX2134, RX2144 Commercial National 1-800-364-6331

Caremark 1.1.2015 Aetna BetterHealth Louisiana 004336 ADV RX8834 Medicaid LA 1-855-364-2977Caremark 1.1.2015 Aetna BetterHealth New Jersey 004336 ADV RX8829 Medicaid NJ 1-855-319-6286

BIOSCRIP 6.25.2015

CAREMARK 7.21.2015Caremark Commercial / Medicaid / Exchange 7.21.2015

Benedcare Medicare Prt D


Page 8


Caremark 1.1.2015 /6.1.2015Aetna BetterHlth PA Medicaid Coventry Care (Restricting to Promise ID Providers) 004336 ADV RX8813 Medicaid PA 1-800-364-2970

Caremark 10.31.2014 AFL Fujikura 004336 ADV RX6474 Commercial National 1-800-364-6331Caremark Affinity Essential Exchange 004336 ADV RX4267 Exchange NY 1-800-364-6331Caremark 10.31.2014 AK Public Employees 71 004336Caremark 10.31.2014 ANTHC (Alaskan Tribal Health) 004336Caremark 10.31.2014 ASEA State of Alaska 004336Caremark 1.1.2015 Aleris 004336 ADV RX1621 Commercial National 1-800-364-6331Caremark 1.1.2015 Allegheny Technologies Inc, Health Plan 004336 ADV RX1852 Commercial NC SC WA WI 1-800-364-6331

Caremark 1.1.2015 Allegheny Technologies Inc, Health Plan HDHP 004336 ADV

RX5822 RX5823 Commercial PA 1-800-364-6331

Caremark 1.1.2015 Allegian Health Plans, Inc 004336 ADVRX1419 RX1029 Exchange TX 1-800-364-6331

Caremark 10.31.2014 ALSAC St. Jude 004336 ADV RX1737 Commercial IL 1-800-364-6331

Caremark 10.31.2014 Alstom 004336 ADVRX5141, RX5241, RX5341

Commercial National 1-800-364-6331

Caremark 10.31.2014 AM General 004336 ADV RX4801 Commercial IN, Ml, OH 1-800-364-6331Caremark 1.1.2015 AMN Healthcare 004336 ADV RX4117 Commercial National 1-800-364-6331Caremark 1.1.2015 Amerigas 004336 ADV RX1052 Commercial National 1-800-364-6331Caremark 3.1.2012 (3.16.2015) Amerigroup of Texas 004336 ADV RX4289 Medicaid TXCaremark 10.31.2014 American Capital 004336 ADV RX2175 Commercial MD, MA, IL, TX, NY 1-800-364-6331Caremark 10.31.2014 American Seafoods 004336 ADV RX6832 Commercial TX, OR, RI, LA, MD 1-800-364-6331

Caremark 10.31.2014 Americold 004336 ADVRX6074, RX6075 Commercial National 1-800-364-6331

Caremark 2.19.2015Amy's Kitchen Super Store Industries 004336 ADV RX1840 Commercial CA OR 1-800-364-6331

Caremark 4.1.2015 Apria Health Care 004336 ADV RX1570 Commercial National 1-800-364-6331Caremark 10.31.2014 Archdiocese of Boston 004336 ADV RX4647 Commercial MA 1-800-364-6331

Caremark 1.1.2015 Arkansas BCBS Federal MarketPlace / State Private Options 004336 ADV RX3956 Exchange AR 1-800-364-6331

Caremark 1.1.2015 Armstrong 004336 ADV RX1635 Commercial PA 1-800-364-6331Caremark 10.31.2014 Arrow Tank and Engineering 004336 ADV RX2134 Commercial MN 1-800-364-6331

Caremark 10.31.2014 Asurion 004336 ADVRX6018, RX6019 Commercial National 1-800-364-6331

Caremark 1.1.2015 Athletico 004336 ADV RX1043 Commercial IL 1-800-364-6331

Caremark 10.31.2014 Atlas Capital Services 004336 ADVRX6747, RX6749 Commercial NY 1-800-364-6331

Caremark 1.1.2015 Avantor Materials 004336 ADV RX1635 Commercial KY PA 1-800-364-6331Caremark 1.1.2015 AVMed Commercial 004336 ADV RX1548 Commercial FL 1-800-364-6331Caremark 10.31.2014 Badger Welding Supplies 004336 ADV RX2134 Commercial WI 1-800-364-6331Caremark 1.1.2015 Baker Hugher 004336 ADV RX1424 Commercial National 1-800-364-6331Caremark 1.1.2015 Baptist Memorial Health Care 004336 ADV RX1733 Commercial TN 1-800-364-6331Caremark 8.1.2015 Barnes and Noble, Inc 004336 ADV RX1587 Commercial NY 1-800-364-6331Caremark 8.1.2015 Barnes and Noble, Education Inc 004336 ADV see card Commercial NY 1-800-364-6331Caremark 7.1.2015 Baxalta 004336 ADV RX1027 Commercial National 1-800-364-6331Caremark 1.1.2015 Bayer 004336 ADV RX1359 Commercial National 1-800-364-6331

Caremark 1.1.2015 BCBS of S Carolina 004336 ADVSCB14 SCB15 Commercial National 1-800-364-6331

Caremark 3.11.15BCBS of S Carolina (PAI) Planned Administrators, Inc 004336 BCBSSC PAIALP Commercial National 1-800-364-6331

AK 1-800-364-6331WISRX RX2078 Commercial


Page 9


Caremark 1.1.2015 BCBS S Carolina Thomas Cooper Health Plan 004336 ADV RX4222 RX2105 TCCXW

Commercial SC 1-800-364-6331

Caremark 10.31.2014 BCTGM Local 6 004336 ADV RX5701 Commercial PA 1-800-364-6331Caremark 10.31.2014 Bealka Casting 004336 ADV RX2144 Commercial WI 1-800-364-6331

Caremark 1.1.2015 Becton Dickinson 004336 ADVRX1059 PR-RX1039 Commercial National / PR 1-800-364-6331

Caremark 1.1.2015 Bell Partners 004336 ADV RX3606 Commercial NC 1-800-364-6331Caremark 10.31.2014 Benefits Plan Administrators of Roanoke 004336 ADV RX2552 Commercial VA 1-800-364-6331Caremark 4.1.15 Blue Choice 004336 ADV RX7501 Commercial SC 1-800-364-6331Caremark 4.1.15 Providence Hospitals of SC 004336 ADV RX1639 Commercial SC 1-800-364-6331Caremark 10.31.2014 Bone & Joint Clinic 004336 ADV RX2144 Commercial TX 1-800-364-6331Caremark 1.1.2015 Bowling Green State University 004336 ADV RX1439 Commercial OH 1-800-364-6331Caremark 10.31.2014 Burrtec Waste 004336 ADV RX6618 Commercial CA 1-800-364-6331Caremark 10.31.2014 Business Administrators & Consultants 004336 ADV RX1476 Commercial TX, OH 1-800-364-6331Caremark 1.1.2015 Cardinal Health (new group) 004336 ADV RX6071 Commercial National 1-800-364-6331Caremark 1.1.2015 Career Education Corportation 004336 ADV RX1163 Commercial National 1-800-364-6331

Caremark 1.1.2015 CareFirst Administrators 004336 ADVMost used RXGRP or RX7580


Caremark 7. CareFirst Group BCBS + BlueChoice 004336 ADV RX7546 Commercial MD DC VA 1-800-364-6331Caremark 1.1.2015 CareSource IN 004336 ADV RX3159 Exchange IN 1-866-286-9949Caremark 1.1.2015 CareSource KY Exchange 004336 ADV RX3158 Exchange KY 1-855-852-5558Caremark 3.30.2015 CareSource KY Medicaid 004336 ADV RX5046 Medicaid KY 1-800-364-6331Caremark 10.31.2014 Carolina Therapy Services, Inc 004336 ADV RX2694 Commercial NC 1-800-364-6331

Caremark 10.31.2014 Cascade Drilling 004336 ADVRX6832, RX6833 Commercial National 1-800-364-6331

Caremark 10.31.2014 Catholic Diocese of Jackson 004336 ADV RX2013 Commercial MI 1-800-364-6331Caremark 1.1.2015 Catholic Health Initiatives 004336 ADV RX1751 Commercial National 1-800-364-6331Caremark 1.1.2015 CBS Corporation 004336 ADV RX1433 Commercial National 1-800-364-6331

Caremark 10.31.2014 Central Wisconsin Community Action Council 004336 ADV RX2144 Commercial WI 1-800-364-6331Caremark 1.1.2015 Cenveo, Inc 004336 ADV RX1856 Commercial National 1-800-364-6331

Caremark 1.1.2015C. H. Robinson Worlwide, Inc (United Heatlhcare Card) 004336 ADV RX1058 Commercial National 1-800-364-6331

Caremark 3.1.2015 Christus Health Plan 004336 ADV RX6415 Medicaid TX 1-800-364-6331Caremark 1.1.2015 Cincom Systems 004336 ADV RX1041 Commercial National 1-800-364-6331

Caremark 10.31.2014 Cintas 004336 ADVRX6362, RX6363 Commercial National 1-800-364-6331

Caremark 10.31.2014 Citv of Hartford 004336 ADV RX3170 Commercial CT 1-800-364-6331Caremark 10.31.2014 City of Mesa 004336 ADV RX1119 Commercial AZ 1-800-364-6331Caremark 10.31.2014 City of Peoria 004336 ADV RX7462 Commercial AZ 1-800-364-6331Caremark 1.1.2015 Clondalkin 004336 ADV RX1626 Commercial FL NJ IN NC CT PR 1-800-364-6331Caremark 10.31.2014 Colorado Employer Benefit Trust 004336 ADV CEBT0001 Commercial CO 1-800-364-6331

Caremark 7.1.2015

Commonwealth of Massachusetts Grp Insurance Commission UniCare State Indemntiy 004336 ADV RX7351 Commercial MA 1-800-364-6331

Caremark 10.31.2014 Community Action Opportunity 004336 ADV RX2634 Commercial NC 1-800-364-6331

Caremark 10.31.2014Community Care Alliance of Illinois (limited to ages 19+) 004336 ADV RX1128 Medicaid IL 1-800-364-6331

Caremark 1.1.2015 Compass Group Support Services 004336 ADVRX3175 RX3176 Commercial National 1-800-364-6331

Caremark 1.1.2015 Conoco Phillips mostly OK TX 004336 ADV RX1441 Commercial National 1-800-364-6331Caremark 10.31.2014 Conrad Weiser Area School District 004336 ADV RX2637 Commercial PA 1-800-364-6331


Page 10

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark 7.1.2015 Construction Worker's Trust Fund 004336 ADV RX1589 Commercial National 1-800-364-6331Caremark 1.1.2015 Crossmark PPO & H.SA 004336 ADV RX1443 Commercial National 1-800-364-6331Caremark 1.1.2015 CSX Corporation 004336 ADV RX1444 Commercial National 1-800-364-6331

Caremark Deutsche Bank 004336 ADVRX6048, RX6049, RX6544


Caremark 7.1.2015 DH Pace Company, Inc 004336 ADV RX1588 CommercialAZ CO FL GE IL KS

MO NE 1-800-364-6331Caremark 1.1.2015 Domino's Pizza 004336 ADV RX4118 Commercial National 1-800-364-6331

Caremark 10.31.2014 DRS Technologies 004336 ADVRX6066, RX6099, RX6065


Caremark 10.31.2014 Eagle Aviation Resource Group 004336 ADV RX2134 Commercial GA 1-800-364-6331Caremark 1.1.2015 Eastman Chemical Company 004336 ADV RX1477 Commercial TN 1-800-364-6331Caremark 1.1.2015 E.C. Styberg Engineering 004336 ADV RX1633 Commercial WI 1-800-364-6331Caremark 10.31.2014 Electrolock 004336 ADV RX6749 Commercial OH, SC 1-800-364-6331Caremark 1.1.2015 EMD Millipore 004336 ADV RX5198 Commercial MA 1-800-364-6331Caremark 1.1.2015 EMD Serono 004336 ADV RX5197 Commercial MA NH 1-800-364-6331Caremark 1.1.2015 Emory University 004336 ADV RX1051 Commercial GA 1-800-364-6331Caremark 10.31.2014 Energen Corporation 004336 ADV RX6526 Commercial AL, NM, TX 1-800-364-6331Caremark 10.31.2014 Enterprise Group Planninq 004336 ADV RX7468 Commercial OH 1-800-364-6331Caremark 10.31.2014 Excavators Union Local 731 004336 ADV RX0048 Commercial NY 1-800-364-6331Caremark 1.1.2015 EZCORP, Inc 004336 ADV RX1854 Commercial National 1-800-364-6331

Caremark 10.31.2014 Family Health Network (limited to ages 19+) 004336 ADV RX1078 Medicaid IL 1-800-364-6331

Caremark 10.31.2014 Ferguson Enterprises 004336 ADVRX6380, RX6381 Commercial National 1-800-364-6331

Caremark 5.25.2015 Fidelis Care 004336 ADV / MEDDADV

RX6460, RX6461, RX6462 RX6463 Prt D -RX8652

Commercial/ Prt D

NY 1-800-364-6331

Caremark 1.1.2015 Fidelity Investments 004336 ADV RX1434 Commercial National 1-800-364-6331Caremark 1.1.2015 First American Financial Corp 004336 ADV RX1053 Commercial National 1-800-364-6331Caremark 10.31.2014 First in Flight 004336 ADV RX2134 Commercial National 1-800-364-6331Caremark 10.31.2014 Flodraulic 004336 ADV RX2300 Commercial IN 1-800-364-6331Caremark 10.31.2014 Florida Cancer 004336 ADV RX2169 Commercial FL 1-800-364-6331Caremark Florida Medicaid Molina 004336 ADV RX0794 Medicaid FL 1-800-364-6331

Caremark Foster Poultry Farms 004336 ADVRX6139, RX6028 Commercial National 1-800-364-6331

Caremark 1.1.2015 FTI Consulting 004336 ADV RX1044 Commercial MD 1-800-364-6331Caremark 1.1.2015 GEHA 004336 ADV RX1412 Commercial National 1-800-364-6331Caremark 10.31.2014 GENCORP 004336 ADV RX7445 Commercial CA 1-800-364-6331Caremark 1.1.2015 Global Aerospace 004336 ADV RX3604 Commercial NJ NY 1-800-364-6331Caremark 10.31.2014 Grassland Dairy Products 004336 ADV RX2134 Commercial WI 1-800-364-6331Caremark 10.31.2014 Greatbatch 004336 ADV RX3508 Commercial National 1-800-364-6331Caremark 1.1.2015 Greenberg Traurig 004336 ADV RX1624 Commercial National 1-800-364-6331Caremark 10.31.2014 GREIF 004336 ADV RX1784 Commercial National 1-800-364-6331Caremark 10.31.2014 Group Insurance Service Centers 004336 ADV RX2826 Commercial MA 1-800-364-6331Caremark 1.1.2015 H.J. Heinz Company (Aetna Card also) 004336 ADV RX1855 Commercial National 1-800-364-6331Caremark 1.1.2015 Harley Davidson Financial Services 004336 ADV RX1038 Commercial IL TX NY 1-800-364-6331

Caremark 1.1.2015Heating, Piping and Refrigeration Medical Fund 004336 ADV RX1612 Commercial National 1-800-364-6331

Caremark Health Action Council 004336 ADV RX1253 Commercial OH 1-800-364-6331


Page 11

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark 1.1.2015 Health First Medicaid 004336 ADV RX1113 Medicaid NY 1-800-364-6331Caremark 1.1.2015 hibu, Inc 004336 ADV RX1164 Commercial National 1-800-364-6331Caremark 10.31.2014 Hirschvogel 004336 ADV RX6749 Commercial OH 1-800-364-6331Caremark 10.31.2014 House of Heating 004336 ADV RX2134 Commercial WI 1-800-364-6331Caremark 1.1.2015 Hudson Advisors 004336 ADV RX1625 Commercial NY TX 1-800-364-6331Caremark 10.31.2014 Hull & Associates 004336 ADV RX1476 Commercial TX 1-800-364-6331Caremark HUMANA CARESOURCE 004336 ADV RX5046 Medicaid KY

Caremark 10.31.2014 Ingram Industries 004336 ADVRX4745, RX4841 Commercial National 1-800-364-6331

Caremark 10.31.2014 Inman Mills 004336 ADV RX7486 Commercial SC 1-800-364-6331Caremark 10.31.2014 lnterceramic 004336 ADV RX2187 Commercial National 1-800-364-6331Caremark 10.31.2014 Ironwood Plastics 004336 ADV RX1763 Commercial MI 1-800-364-6331Caremark 1.1.2015 Jet Blu 004336 ADV RX1056 Commercial National 1-800-364-6331Caremark 10.31.2014 JM Hutton 004336 ADV RX2300 Commercial IN 1-800-364-6331Caremark 1.1.2015 KY Employees Health Plan (KEHP) 004336 ADV RX1054 Commercial KY 1-866-488-4708

Caremark 1.1.2015KY Managed Medicaid for Humana/CareSource 004336 ADV RX5046 Medicaid KY 1-855-853-7005

Caremark 1.1.2015Keystone Health Plan Central, SecureChoice (Capital BlueCross) 004336 ADV RXCAP Medicaid PA 1-800-364-6331

Caremark 1.1.2015 Kforce 004336 ADV RX1615 Commercial FL 1-866-488-4708Caremark 1.1.2015 KGS 004336 ADV RX1618 Commercial FL 1-800-364-6331Caremark 10.31.2014 Knoll, Inc 004336 ADV RX7364 Commercial PA 1-800-364-6331

Caremark 10.31.2014 Knowles Corp 004336 ADVRX1096, RX1097, RX1198

Commercial IL, NH, NY, CA 1-800-364-6331

Caremark 1.1.2015 Koch Industries, Inc 004336 ADV RX1616 Commercial National 1-800-364-6331

Caremark 10.31.2014 Kocourek Auto Group 004336 ADVRX2144, RX2134 Commercial WI 1-800-364-6331

Caremark 10.31.2014 KS Industries 004336 ADV RX6618 Commercial CA, TX, ND, CO, WY 1-800-364-6331Caremark 10.31.2014 Lafayette Parish School System 004336 ADV RX4579 Commercial LA 1-800-364-6331

Caremark 7.1.2015Lake County Schools Council Health Benefits Plan 004336 ADV RX1465 Commercial OH 1-800-364-6331

Caremark 1.1.2015 Little River Casino 004336 ADV RX1634 Commercial MI 1-800-364-6331Caremark 1.1.2015 LRG HealthCare 004336 ADV RX5155 Commercial NH 1-800-364-6331Caremark 1.1.2015 M&T Bank 004336 ADV RX1414 Commercial NY 1-800-364-6331Caremark 10.31.2014 Magellan Midstream Holdings 004336 ADV RX7369 Commercial National 1-800-364-6331Caremark 7.1.2015 Martin Sprocket and Gear 004336 ADV RX3616 Commercial National 1-8003646331Caremark 10.31.2014 Masonite Corporation 004336 ADV RX1472 Commercial National 1-800-364-6331

Caremark 10.31.2014 McDonough Manufacturing 004336 ADVRX2144, RX2134 Commercial WI 1-800-364-6331

Caremark Medicaid Amerigroup 004336 ADV see card MedicaidFL, LA, MD, NJ, NM,

NY, OH, WA 1-800-364-6331Caremark Medicaid CDPHP 004336 ADV RXCDPHP Medicaid NY 1-800-364-6331

Caremark Medicaid MetroPlus Health Plan 004336 ADV RX7541 RX7543 RX7544 RX7545

Medicaid NY 1-800-342-9871

Caremark MedStar Medicaid 004336 ADV RX4303 Medicaid DC, MD 1-800-364-6331Caremark 10.31.2014 Merco Group 004336 ADV RX4910 Commercial National 1-800-364-6331Caremark 7.10.2015 Mercy Maricopa Integrated Care 004336 ADV RX8822 Medicaid AZ 1-855-319-6295


Page 12


Caremark 1.1.2015 Meritus Exchange 004336 ADV

RX1264 RX1265 RX1266 RX1267

Exchange AZ 1-800-364-6331

Caremark MetroPlus Exchange 004336 ADV RX7539 RX7540 Exchange 05 NY/NJ/PA 1-800-510-4836Caremark 7.1.2015 MetroPlus Managed LTC 004336 ADV RX1325 Medicaid NY 1-800-364-6331Caremark 7.10.2015 Midwest Operating Engineers 004336 ADV RX7617 Commercial IL IN 1-800-364-6331

Caremark 3.1.2012 (3.16.2015) Molina Medicaid Independent 004336 ADV

RX0824, RX0825, RX0826, RX0833, see card

Medicaid TX OH 1-800-364-6331

Caremark 1.1.2015 Molina Healthcare of CA 004336 ADV RX0016 Medicaid CA 1-800-364-6331

Caremark (4.1.15 )/ 7.1.2015Molina Healthcare of IL, restricted to active Medicaid Providers

004336 ADVRX0817 RX0823 RX0829

Medicaid IL 1-800-364-6331

Caremark 1.1.2015 Molina Healthcare of MI 004336 ADV

RX0506 RX0811 RX0843 RX0868

Medicaid MI 1-800-364-6331

Caremark (4.1.15 ) Molina Healthcare of S Carolina 004336 ADV RX0860 Medicaid SC 1-800-364-6331Caremark 10.31.2014 Moline Machinery 004336 ADV RX2144 Commercial MN 1-800-364-6331Caremark 1.1.2015 Mondi North America 004336 ADV RX1631 Commercial National 1-800-364-6331Caremark 1.1.2015 Moody's 004336 ADV RX1797 Commercial National 1-800-364-6331Caremark 1.1.2015 Mondelez Internatioanl 004336 ADV RX1559 Commercial IL MI 1-800-364-6331Caremark 1.1.2015 Mutual of America 004336 ADV RX1046 Commercial National 1-800-364-6331Caremark 1.1.2015 MVP = Hudson Health Plan 004336 ADV MVP625 Medicaid NY 1-800-364-6331Caremark 1.1.2015 MVP Health Care 004336 ADV MVPCOMM Commercial NH NY VT 1-800-364-6331Caremark 1.1.2015 MVP Health Care 004336 ADV MVPMRKT Exchange NH NY VT 1-800-364-6331

Caremark MWH 004336 ADVRX5238, RX5138 Commercial National 1-800-364-6331

Caremark 10.31.2014 NCI Building Systems 004336 ADV RX5184 Commercial National 1-800-364-6331Caremark 10.31.2014 New Mexico Pipe Line Trades 004336 ADV RX0605 Commercial NM 1-800-364-6331Caremark 1.1.2015 Nevada Energy 004336 ADV RX2412 Commercial NV 1-800-364-6331Caremark 1.1.2015 NOITU Insurance Trust Fund 004336 ADV RX1637 Commercial NY 1-800-364-6331

Caremark 10.31.2014 Norfolk Southern 004336 ADV

RX6581, RX6582, RX6583, RX6584


Caremark 10.31.2014 Northrop Grumman 004336 ADVRX1079, RX1127 Commercial VA, MD, CA 1-800-364-6331

Caremark 1.1.2015 NVIDIA Corp 004336 ADV RX1613 Commercial CA 1-800-364-6331Caremark 10.31.2014 Ohio Operating Engineers Local 18 004336 ADV RX7271 Commercial OH 1-800-364-6331Caremark 10.31.2014 OMNOVA Solutions 004336 ADV RX7512 Commercial National 1-800-364-6331Caremark 1.1.2015 Oncor 004336 ADV RX1785 Commercial National 1-800-364-6331Caremark 1.1.2015 Oregon Clinic 004336 ADV RX1717 Commercial OR 1-800-364-6331Caremark 1.1.2015 Oscar Health Care 004336 ADV RX1555 Commercial NJ 1-800-364-6331Caremark 10.31.2014 Oscar Healthcare 004336 ADV RX1093 Commercial NY 1-800-364-6331

Caremark 10.31.2014 Palmer Holland, Inc. 004336 ADVRX6747, RX6749 Commercial OH 1-800-364-6331

Caremark 1.1.2015 Panera Bread 004336 ADV RX4116 Commercial National 1-800-364-6331Caremark 1.1.2015 Paramount Commercial 004336 ADV RX6166 Commercial MI OH 1-800-364-6331Caremark 1.1.2015 Paramount Health Exchange 004336 ADV RX6166 Exchange MI OH 1-800-364-6331


Page 13

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark 10.31.2014 Park View Home 004336 ADV RX2144 Commercial IL 1-800-364-6331Caremark 1.1.2015 Partners HealthCare 004336 ADV RX1438 Commercial MA 1-800-364-6331

Caremark 10.31.2014 Patient Advocates 004336 ADVRX2651, RX2523 Commercial ME 1-800-364-6331

Caremark 6.1.2015 PayPal 004336 ADV RX1166 Commercial National 1-800-364-6331

Caremark 10.31.2014 Pember Companies 004336 ADVRX2144, RX2134 Commercial WI 1-800-364-6331

Caremark 1.1.2015 Phillips 66 mostly OK / TX 004336 ADV RX1048 Commercial National 1-800-364-6331Caremark 1.1.2015 Phoenix Health Plan 004336 ADV RX6052 Medicaid AZ 1-800-364-6331

Caremark 1.1.2015 Phoenix Marketplace/Phoenix Choice 004336 ADVRX1036 RX1431 Exchange

AZ CA CO NV NM UT 1-800-364-6331

Caremark 10.31.2014 Poarch Creek Indian Employees 004336 ADV RX2169 Commercial AL 1-800-364-6331Caremark 10.31.2014 Power Engineers 004336 ADV RX6364 Commercial National 1-800-364-6331Caremark 1.1.2015 PRA Health Sciences 004336 ADV RX1617 Commercial National 1-800-364-6331

Caremark 1.1.2015Putnam / Northern Westchester Health Benefits Consortium 004336 ADV RX1442 Commercial NY 1-800-364-6331

Caremark 1.1.2015 Reed Elsevier Inc 004336 ADV RX1432 Commercial National 1-800-364-6331Caremark 1.1.2015 Regal Beloit Corporation 004336 ADV RX1607 Commercial WI 1-800-364-6331Caremark 1.1.2015 RSI Home Products 004336 ADV RX1622 Commercial CA 1-800-364-6331Caremark 1.1.2015 Ross Stores 004336 ADV RX5148 Commercial CA 1-800-364-6331Caremark 10.31.2014 RUIZ Foods 004336 ADV RX6618 Commercial National 1-800-364-6331Caremark 1.1.2015 Salem Clinic 004336 ADV RX1717 Commercial OR 1-800-364-6331Caremark 10.31.2014 Samson Resources 004336 ADV RX1327 Commercial OK, CO, TX 1-800-364-6331

Caremark 10.31.2014 School District of Spring Valley 004336 ADVRX2144, RX2134 Commercial WI 1-800-364-6331

Caremark 1.1.2015 Scientific Games Corporation (SGC) 004336 ADV RX1857 Commercial National 1-800-364-6331Caremark 1.1.2015 Shred-It 004336 ADV RX1164 Commercial National 1-800-364-6331

Caremark 7.1.2015 SEIU Healthcare of PA Health and Welfare 004336 ADV RX1554 Commercial PA 1-800-364-6331Caremark 10.31.2014 Smith Implements 004336 ADV RX7521 Commercial PA, MD 1-800-364-6331

Caremark 1.1.2015Southeastern IN Health Organization Insurance Market Place 004336 ADV RX2468 Exchange IN 1-800-364-6331

Caremark 10.31.2014 Southern Minnesota Region Legal Service 004336 ADVRX2144, RX2134 Commercial MN 1-800-364-6331

Caremark 1.1.2015 Southern UTE Tribal Plan COB 004336 ADV RX6916 Commercial NM 1-888-779-6638Caremark 10.31.2014 Spartan Light Metal Products 004336 ADV RX2839 Commercial IL, MI, MO 1-800-364-6331Caremark 10.31.2014 Stanislaus County 004336 ADV RX1930 Commercial CA 1-800-364-6331

Caremark 1.1.2015 State of Florida Prescription Drug Plan 004336 ADVRX1557 RX1558 Commercial FL 1-800-364-6331

Caremark 7.1.2015 State of Illinois 004336 ADV RX1017 Commercial Il 1-800-364-6331Caremark 10.31.2014 State of New York 004336 ADV RX6027 Commercial NY 1-800-364-6331Caremark 10.31.2014 State of Tennessee 004336 ADV RX7529 Commercial TN 1-800-364-6331Caremark 10.31.2014 Steel Dynamics 004336 ADV RX7665 Commercial National 1-800-364-6331Caremark 1.1.2015 Stock Building Supply 004336 ADV RX1632 Commercial National 1-800-364-6331Caremark 10.31.2014 Teacher Retirement Svstem 004336 ADV RX1296 Commercial TX 1-800-364-6331Caremark 10.31.2014 Teamsters 28 004336 ADV RX6037 Commercial NY 1-800-364-6331Caremark 10.31.2014 Tenet 004336 ADV Varies Commercial National 1-800-364-6331Caremark 10.31.2014 Terrebonne General Medical Center 004336 ADV RX2160 Commercial LA 1-800-364-6331Caremark 1.1.2015 ThyssenKrupp 004336 ADV RX5742 Commercial National 1-800-364-6331Caremark 10.31.2014 The Righter Company 004336 ADV RX1476 Commercial OH 1-800-364-6331Caremark 1.1.2015 The World Bank 004336 ADV RX1623 Commercial DC 1-800-364-6331Caremark 10.31.2014 Theoris Group 004336 ADV RX6749 Commercial IN 1-800-364-6331Caremark 10.31.2014 Thomas 5 004336 ADV Rx6749 Commercial National 1-800-364-6331Caremark 1.1.2015 TIIA-CREF 004336 ADV RX1057 Commercial NY TX 1-800-364-6331


Page 14

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark 1.1.2015 Time, Inc (Aetna Card also) 004336 ADV RX1860 Commercial National 1-800-364-6331Caremark 1.1.2015 TMX Finance 004336 ADV RX1160 Commercial National 1-800-364-6331Caremark 1.1.2015 Trinity Health 004336 ADV RX2454 Commercial Natn'l 1-800-364-6331Caremark 1.1.2015 Tufts Health Plan 004336 ADV RXTHP Commercial MA 1-800-364-6331

Caremark 9.15.14 Tufts Health Plan -Network Health 004336 ADVRX1143 RX1144 Commercial MA 1-800-364-6331

Caremark 10.31.2014 Tulalip Tribes 004336 ADV RX6832 Commercial WA 1-800-364-6331Caremark 10.31.2014 Tyco International 004336 ADV RX7493 Commercial National 1-800-364-6331Caremark 1.1.2015 US Bank 004336 ADV RX1437 Commercial National 1-800-364-6331

Caremark 10.31.2014 United Rentals 004336 ADVRX8106, RX3536 Commercial National 1-800-364-6331

Caremark 1.1.2015 United Technologies 004336 ADV

RX6483 RX6484 RX6485 RX6486 RX6487

Commercial CT + 1-800-364-6331

Caremark 10.31.2014 University of Akron 004336 ADV RX6088 Commercial OH 1-800-364-6331Caremark 1.1.2015 University of Georgia 004336 ADV RX1428 Commercial GA 1-800-364-6331Caremark 10.31.2014 University System of New Hampshire 004336 ADV RX7593 Commercial NH 1-800-364-6331Caremark 7.1.2015 University of Pennsylvania 004336 ADV RX1580 Commercial PA 1-800-364-6331

Caremark 10.31.2014 Vail Resorts 004336 ADV RX1233 CommercialCO, CA, ID, WY, UT,

WI 1-800-364-6331

Caremark (Scott White) Valley Baptist Health Plans 004336 ADV

RX6054 RX6076 RX6077 RX6078 RX6079 RX6112 RX6113

Commercial TX 1-800-364-6331

Caremark 10.31.2014 VIVA Health 004336 CRK / MEDDADVC: VIVAH M: RX7816

Commercial / Prt D AL 1-800-364-6331

Caremark 10.31.2014 WAICU Benefits Consortium 004336 ADV RX3722 Commercial WI 1-800-364-6331Caremark 1.1.2015 Ward Transport 004336 ADV RX1008 Commercial Natn'l 1-800-364-6331Caremark 10.31.2014 Wells Enterprises, Inc 004336 ADV RX5140 Commercial IA 1-800-364-6331

Caremark 10.31.2014 Westgate Animal Hospital 004336 ADVRX2144 RX2134 Commercial WI 1-800-364-6331

Caremark 1.1.2015 Western Reserve Hospital 004336 ADV RX1636 Commercial OH 1-800-364-6331Caremark 1.1.2015 White Oak Healthcare 004336 ADV RX1033 Commercial Natn'l 1-800-364-6331Caremark 1.1.2015 WISRX-ISAS Trust 004336 ADV RX7833 Commercial TX 1-800-364-6331

Caremark 10.31.2014 Xerox 004336 ADV

RX4112 RX4113 RX4114 RX4005


Caremark 1.1.2015 YRC Worldwide 004336 ADV RX1049 Commercial KS 1-800-364-6331Caremark 1.1.2015 Zale Corporation 004336 ADV RX1629 Commercial National 1-800-364-6331Caremark 10.31.2014 Zimmerman Transfer 004336 ADV RX2144 Commercial WI 1-800-364-6331Caremark 4.1.2015 Starwood Hotels & Resorts 004336 ADV RX1574 Commercial National 1-800-364-6331Caremark 1.1.2015 BCBS S Carolina BlueChoice 004336 CHC CHC Commercial National 1-800-364-6331Caremark 1.1.2015 HealthNet Commericial 004336 HNET HNET Medicaid CA OR WA 1-800-364-6331Caremark HealthNet 7.1.2015 Medi-Cal and CalViva 004336 HNMC see card Medicaid CA 1-800-600-0180Caremark 1.1.2015/1.3.2015 CareSource OH 004336 ADV RX3292 Medicaid 1-800-364-6331Caremark 7.1.2015 CareSource OH 004336 MCAIDOH RX0797 Medicaid OH 1-800-364-6331


Page 15


Caremark 7.1.2015

Molina Healthcare of OH 004336 MCAIDOH

RX0714, RX0718, RX0759, RX0761, RX0867, RX0854, RX0855

Medicaid

OH

1-800-364-6331

Caremark 1.1.2015 /7.1.2015 Paramount ADV 004336 MCAIDOH

RX6407, RX6408, RX6409, RX6410, RX6411

Medicaid OH 1-800-364-6331

Caremark Legacy AmeRx 012189 see card Commercial 1-866-668-6681

Caremark Caremark Legacy PCS Commercial COB 013089

COMSEGPCS COMSEGADV COMSEGCRK AMGSEGADV


Caremark 1.1.2015 Legacy PHC Commercial 004245, ' VARIES Commercial 1-800-777-1023Caremark 1.1.2015 Legacy PHC Commercial 006144 AI Commercial 1-800-777-1023

Caremark 1.1.2015 Legacy PHC Commercial 610474TDI, SSP, CAP, EBMS Commercial 1-800-777-1023

Caremark 1.1.2015 Legacy PHC Commercial 603604 CAP Commercial 1-800-777-1023Caremark 1.1.2015 Legacy PHC Commercial 610449 U07, U12 Commercial 1-800-777-1023

Caremark 1.1.2015 Legacy PHC Commercial 610468PC2, MDP, HP, FCHP, COMHP, AHP, PC3, PC5, HPI, FALLON


Caremark Caremark Legacy CRK 610029 CRK see card Commercial National 1-800-421-2342Caremark 10.31.2014 ADT 610029 CRK ADTCO Commercial National 1-800-421-2342Caremark 10.31.2014 Charles Schwab 610029 CRK CSCRX Commercial National 1-800-421-2342Caremark 10.31.2014 Town of West Hartford 610029 CRK WHART Commercial CT 1-800-421-2342Caremark 11.1.2014 / 1.1.2015 Amerigroup 610084 ADV RX4296 Medicaid MD 1-866-488-4708Caremark Maryland Physicians Care 610084 ADV RX8809 Medicaid MD 1-866-488-4708Caremark MedStar Family Choice 610084 PCS T2400001 Medicaid MD 1-866-488-4708Caremark Priority Partners MCO 610084 PCS W7579999 Medicaid MD 1-866-488-4708Caremark Riverside Health 610084 ADV RX4209 Medicaid MD 1-866-488-4708Caremark Blue Cross Blue Shield Federal Employee 610239 FEPRX 65006500 Commercial 1-800-364-6331

CaremarkLegacy PCS Commercial ADV National League of Cities 610415 ADV see card Commercial 1-800-345-5413

CaremarkLegacy PCS Commercial National Association of Counties 610415 PCS see card Commercial 1-800-345-5413

Caremark 10.31.2014 Commonwealth of Virginia 610502 0670000 Varies Commercial VA 1-800-364-6331Caremark Caremark Commercial 610591 ADV per card Commercial per card

Caremark 1.1.2015 Aetna Better Health of PA Healthy Pennsylvania Private Cov Option 610591 ADV RX8832 Medicaid PA 1-855-364-2970

Caremark 3.1.2012 (3.16.2015) Aetna Better Health of Texas 610591 ADV RX8801 Medicaid TXCaremark Mercy Care Plan 610591 ADV RX8805 Commercial AZ 1-855-548-5646Caremark Mercy Healthcare Group 610591 ADV RX8807 Commercial AZ 1-855-548-5565

Caremark/Aetna

CVS Caremark Medicaid, Aetna Better Health, CHRISTUS Health Plan, Mercy Maricopa 610591 ADV per card Medicaid 1-877-874-3317


Page 16


Caremark 1.1.2015 Aetna Better Health of IL Dual 3.1.2014 610591 MEDDADV RX8815 Prt D IL 1-800-364-6331

Caremark 1.1.2015 Aetna Better Health of Ohio Dual 6.1.2014 610591 MEDDADV RX8812 Prt D OH 1-800-364-6331Caremark 1.1.2015 Aetna Better Health Dual 1.1.2015 610591 MEDDADV RX8823 Prt D NY 1-800-364-6331

Caremark 1.1.2015 (12.10.14)Aetna Better Health of Pennsyslvania Private Coverage Option 610591 MEDDADV RX8832 Prt D Pa 1-855-364-2970

Caremark 3.1.2015 Aetna Better Health of Michigan Dual 610591 MEDDADV RX8827 Prt D MI 1-855-319-6287Caremark 1.1.2015 ArchCare Dual 1.1.2015 004336 MEDDADV RX8571 Prt D NY 1-800-364-6331Caremark 1.1.2015 CareSource Dual 1.1.2015 004336 MEDDADV RX5045 Prt D OH 1-800-364-6331Caremark 1.1.2015 Fallon Total Care Dual 10.1.2013 004336 MEDDADV RX7609 Prt D MA 1-800-364-6331Caremark 1.1.2015 Fidelis Care Dual 1.1.2015 004336 MEDDADV RX8671 Prt D NY 1-800-364-6331Caremark 1.1.2015 HealthFirst Dual 1.1.2015 004336 MEDDADV RX1110 Prt D NY 1-800-364-6331Caremark 1.1.2015 Health Net Dual 4.1.2014 004336 MEDDADV RX6270 Prt D CA 1-800-364-6331Caremark 1.1.2015 Metroplus Dual 1.1.2015 004336 MEDDADV RX8542 Prt D NY 1-800-364-6331Caremark 1.1.2015 Molina Dual 4.1.2014 004336 MEDDADV RX5062 Prt D CA 1-800-364-6331Caremark 1.1.2015 Molina Illinois Dual 3.1.2014 004336 MEDDADV RX5058 Prt D IL 1-800-364-6331Caremark 1.1.2015 Molina Ohio Dual 6.1.2014 004336 MEDDADV RX5060 Prt D OH 1-800-364-6331Caremark 3.1.15 Molina Texas 004336 MEDDADV RX5008 Prt D TX 1-800-364-6331Caremark 1.1.2015 Montefiore Dual 1.1.2015 004336 MEDDADV RX8521 Prt D NY 1-800-364-6331Caremark 1.1.2015 Network Health Unify Dual 1.1.2014 004336 MEDDADV RX8519 Prt D MA 1-800-364-6331Caremark 1.1.2015 North Shore Dual 1.1.2015 004336 MEDDADV RX8523 Prt D NY 1-800-364-6331

Caremark 1.1.2015 Affinity Health Plan 004336 MEDDADV RX8539 Prt D NY 1-800-364-6331Caremark 1.1.2015 AvMEd 004336 MEDDADV RX8551 Prt D FL 1-800-364-6331

Caremark 1.1.2015 BlueCross BlueShield of Arizona Blue Medicare 004336 MEDDADV RX8635 Prt D AZ 1-800-364-6331

Caremark 1.1.2015 Blue Cross of Idaho 004336 MEDDADVRX8527 RX8528 Prt D ID 1-800-364-6331

Caremark 1.1.2015 Capital Blue Cross

Caremark 1.1.2015 MAPD's SeniorBlue Hmo SeniorBlue PPO

Caremark 1.1.2015 PDP's Avalon Insurance Co SecureRX PDP

Caremark 1.1.2015 Capital District Physician' Health Plan (CDPDP)

Caremark 1.1.2015 CDPDP Universal Benefits, IncCaremark 1.1.2015 CDPHP Medicare ChoicesCaremark 1.1.2015 HMO BasicCaremark 1.1.2015 Care Point Guardian (PPO SNP) 004336 MEDDADV RX8556 Prt D NJ 1-800-364-6331

Caremark 1.1.2015 Catholic Special Needs Plan, LLC Archcare Advantage 004336 MEDDADV

RX8572 RX8593 Prt D NY 1-800-364-6331

Caremark 1.1.2015 Community Care Alliance of Illinois 004336 MEDDADV RX8547 Prt D IL 1-800-364-6331Caremark 1.1.2015 Fallon Community Health Plan - Caremark 1.1.2015 Navicare HMO SNP 004336 MEDDADV RX7603 Prt D MA 1-800-364-6331Caremark 1.1.2015 Fallon Community Health Plan -

Caremark 1.1.2015 Fallon Senior Plan Summitt Elder Care

004336 MEDDADVRX7601, RX7602, Rx7603

Prt D MA 1-800-364-6331

Caremark 1.1.2015 Fallon Health Weinberg 004336 MEDDADV RX8549 Prt D MA 1-800-364-6331

Caremark 1.1.2015 FamilyCare Health Plans 004336 MEDDADVRX5006 RX5016 Prt D MA 1-800-364-6331

Caremark 1.1.2015 First United American Life Insurance CO 004336 MEDDADV RX8595 Prt D NY 1-800-364-6331

Caremark Medicare Prt D 7.21.2015 DUAL / DEMO 7.21.2015

Prt D PA 1-800-364-6331

004336 MEDDADV RX8662 RX8663

Prt D NY 1-800-364-6331

004336 RXCAP

Caremark MAPD/PDP 1.1.2015

MEDDADV


Page 17

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark 1.1.2015 Global Health 004336 MEDDADV HMOMAPD Prt D OR 1-800-364-6331Caremark 1.1.2015 Health First 004336 MEDDADV RX1110 Prt D NY 1-800-364-6331Caremark 1.1.2015 Health Net Pharmaceutical Services Prt D Natn'lCaremark 1.1.2015 Health Net MAPD, PPO 004336 MEDDADV RX6270 Prt D NY 1-800-364-6331Caremark 1.1.2015 HMSA BCBS of Hawaii 004336 MEDDADV RX3982, Prt D HI 1-800-364-6331Caremark 1.1.2015 Itsaca Medical Care-IM Classic 004336 MEDDADV RX8653 Prt D AZ, CA, OR, CT 1-800-364-6331Caremark 1.1.2015 Martin's Point Generations, LLC Prt D HI

Caremark 1.1.2015 Martin's Point Generations Advantage 004336 MEDDADVRX8576 RX8577 Prt D MN 1-800-364-6331

Caremark 1.1.2015 Mercy Care Advantage 610591 MEDDADV RX8803 Prt D 1-800-364-6331Caremark 1.1.2015 Mercy Maricopa Advantage 610591 MEDDADV RX8804 Prt D ME 1-800-364-6331Caremark 1.1.2015 Metro Plus Health Plan 004336 MEDDADV RX8541 Prt D AZ 1-800-364-6331Caremark 1.1.2015 MMM 004336 MEDDADV RX8553 Prt D AZ 1-800-364-6331Caremark 1.1.2015 Molina Medicare Prt D NYCaremark 1.1.2015 Molina CA 004336 MEDDADV RX5001 PRCaremark 1.1.2015 Molina FL 004336 MEDDADV RX5056 FLCaremark 1.1.2015 Molina IL 004336 MEDDADV RX5061 CACaremark 1.1.2015 Molina MI 004336 MEDDADV RX5004 FLCaremark 1.1.2015 Molina NM 004336 MEDDADV RX5021 ILCaremark 1.1.2015 Molina OH 004336 MEDDADV RX5041 MICaremark 1.1.2015 Molina TX 004336 MEDDADV RX5022 NMCaremark 1.1.2015 Molina UT 004336 MEDDADV RX5002 OHCaremark 1.1.2015 Molina WA 004336 MEDDADV RX5003 TXCaremark 1.1.2015 Molina WI 004336 MEDDADV RX5059 UTCaremark 1.1.2015 Mount Carmel Health Plan -- WA

Caremark 1.1.2015 MediGold 004336 MEDDADVRX1307 RX1310 Prt D OH 1-800-364-6331

Caremark 1.1.2015 MVP Health Care 004336 MEDDADV MVPMEDD Prt D NY VT 1-800-364-6331Caremark 1.1.2015 New England Joint Enterprise Caremark 1.1.2015 Blue MedicareRX 004336 MEDDADV NEJERX Prt D MA, CT, RI, VT 1-800-364-6331

Caremark 1.1.2015 New York State Catholic Health Plan / Fidelis Care NY

Caremark 1.1.2015 Fidelis Medicare AdvantageCaremark 1.1.2015 Fidelis Medicare Advantage FlexCaremark 1.1.2015 Fidelis Dual AdvantageCaremark 1.1.2015 Fidelis Dual Advantage FlexCaremark 1.1.2015 Fidelis Advantage Part B ReductionCaremark 1.1.2015 Northern Plains Alliance

Caremark 1.1.2015 MedicareBlue Rx 004336 MEDDADVRX8633 RX8634 Prt D

IA MN MT NE ND SD 1-800-364-6331

Caremark 1.1.2015 PacificSource

Caremark 1.1.2015 PDP 004336 MEDDADV RX8630-RX8631 OR/ID

Caremark 1.1.2015 MAPD 004336 MEDDADV

RX8632 RX6157, RX6158 OR/ID

Caremark 1.1.2015 Paramount /includes EGWP & Elite 004336 MEDDADV

RX8640 RX8641 RX8642 Prt D OH 1-800-364-6331

Caremark 1.1.2015 Peoples Health 004336 MEDDADV RX5050 Prt D LA 1-800-364-6331Caremark 1.1.2015 Phoenix Health Plan 004336 MEDDADV RX8548 Prt D AZ 1-800-364-6331Caremark 1.1.2015 Piedmont Community HealthCareCaremark 1.1.2015 Piedmont Medicare AdvantageCaremark 1.1.2015 Piedmont Select Medicare Option 1

Prt D

1-800-364-6331

1-800-364-6331

VA 1-800-364-6331

1-800-364-6331

NY

Prt D

004336 MEDDADV RX8555 Prt D

004336 MEDDADV RX8652 Prt D


Page 18

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark 1.1.2015 Piedmont Select Medicare Option 2Caremark 1.1.2015 SilverScriptCaremark 1.1.2015 SilverScript Plus (PDP)Caremark 1.1.2015 SilverScript Choice (PDP)Caremark 1.1.2015 Tufts Health Plan

Caremark 1.1.2015 /4.1.2015 Tufts Health Plan Medicare Preferred004336 MEDDADV

RX8657 / RX8658 '/ RX8519

Prt D MA 1-800-364-6331

Caremark 1.1.2015 Tribute Health Plan of Arkansas 004336 MEDDADV RX8544 Prt D AR 1-800-364-6331Caremark 1.1.2015 United American Insurance Company 004336 MEDDADV RX8595 Prt D Natn'l except NY 1-800-364-6331Caremark 1.1.2015 Universal AmericanCaremark 1.1.2015 Today's Option Advantage Caremark 1.1.2015 Today's Option Advantage PlusCaremark 1.1.2015 Today's Option Advantage PremierCaremark 1.1.2015 Generations Healthcare ValueCaremark 1.1.2015 Generations Healthcare PremierCaremark 1.1.2015 Texan Plus ClassicCaremark 1.1.2015 Texan Plus ValueCaremark 1.1.2015 Texan Plus SelectCaremark 1.1.2015 VIVA Health - Caremark 1.1.2015 VIVA Medicare Plus 004336 MEDDADV RX7816 Prt D AL 1-800-364-6331

Caremark SilverScript 1.1.2015 Abbvie 004336 MEDDADV RXCVSD Prt D IL 1-866-693-4620Caremark SilverScript 1.1.2015 Altria 004336 MEDDADV RXCVSD Prt D VA 1-866-693-4620Caremark SilverScript 1.1.2015 Anne Arundel County Government 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 Anne Arundel County Public Schools 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 Armstrong 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 AT&T 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 BASF 004336 MEDDADV RXCVSD Prt D NY, NJ 1-866-693-4620Caremark SilverScript 1.1.2015 California Value Trust 004336 MEDDADV RXCVSD Prt D CA 1-866-693-4620Caremark SilverScript 1.1.2015 Calpers Anthem 004336 MEDDADV RXCVSD Prt D CA 1-866-693-4620Caremark SilverScript 1.1.2015 Calpers Sharp 004336 MEDDADV RXCVSD Prt D CA 1-866-693-4620Caremark SilverScript 1.1.2015 CF&I Retirees VEBA 004336 MEDDADV RXCVSD Prt D CO 1-866-693-4620Caremark SilverScript 1.1.2015 Chrysler 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Cleveland Clinic 004336 MEDDADV RXCVSD Prt D OH 1-866-693-4620Caremark SilverScript 1.1.2015 Coca-Cola 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 ConAgra Foods, Inc. 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Consolidated Edison 004336 MEDDADV RXCVSD Prt D NY, NJ 1-866-693-4620Caremark SilverScript 1.1.2015 Consol Energy 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620Caremark SilverScript 1.1.2015 Dartmouth College 004336 MEDDADV RXCVSD Prt D NH 1-866-693-4620Caremark SilverScript 1.1.2015 Energy Future Holdings 004336 MEDDADV RXCVSD Prt D TX 1-866-693-4620

Caremark SilverScript 1.1.2015 ERS Employee Retirement System Health Select Medicare Rx 004336 MEDDADV RXCVSD Prt D TX 1-866-693-4620

Caremark SilverScript 1.1.2015 Franklin Essex Hamilton School Districts Health Insurance Consortium 004336 MEDDADV RXCVSD Prt D NY 1-866-693-4620

Caremark SilverScript 1.1.2015 Frederick County Public Schools 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 Gannett, Inc. 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Goodyear 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 General Electric 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Health Net 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620

Caremark SilverScript 1.1.2015 Heating, Piping and Refrigeration Medical Fund 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620

Caremark SilverScript 1.1.2015 Hubbell 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Ingersoll Rand 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620

***NOTE Plans listed in SilverScript Section

National

National 1-800-364-6331

1-800-364-6331

MEDDADV RXCVSD

HMOMAPD PFFMAPD PPOMAPD

CAREMARK SILVERSCRIPT 1.1.2015

Prt D004336 MEDDADV

004336 Prt D


Page 19

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark SilverScript 1.1.2015 IUOE Local 37 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 JFK Health Systems 004336 MEDDADV RXCVSD Prt D NJ 1-866-693-4620Caremark SilverScript 1.1.2015 John Hancock 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Kellogg Company 004336 MEDDADV RXCVSD Prt D MI 1-866-693-4620Caremark SilverScript 1.1.2015 LS Starrett 004336 MEDDADV RXCVSD Prt D MA 1-866-693-4620Caremark SilverScript 1.1.2015 Martin Marietta Materials 004336 MEDDADV RXCVSD Prt D NC 1-866-693-4620

Caremark SilverScript 1.1.2015 The Maryland National Capital Parks and Planning Commission 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620

Caremark SilverScript 1.1.2015 McCormick and Co. 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 McKesson EGWP 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620

Caremark SilverScript 1.1.2015 Metropolitan Washington Airports Authority 004336 MEDDADV RXCVSD Prt D DC, MD, VA 1-866-693-4620Caremark SilverScript 1.1.2015 Montgomery College 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 Montgomery County Government 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 Montgomery County Public Schools 004336 MEDDADV RXCVSD Prt D MD 1-866-693-4620Caremark SilverScript 1.1.2015 Murray Energy 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620Caremark SilverScript 1.1.2015 Navistar 004336 MEDDADV RXCVSD Prt D IL 1-866-693-4620Caremark SilverScript 1.1.2015 National Grid 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Nestle 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 New York Medical College 004336 MEDDADV RXCVSD Prt D NY 1-866-693-4620

Caremark SilverScript 1.1.2015 New York State Health Insurance Program (NYSHIP) 004336 MEDDADV RXCVSD Prt D NY 1-866-693-4620

Caremark SilverScript 1.1.2015 New York Times 004336 MEDDADV RXCVSD Prt D NY 1-866-693-4620Caremark SilverScript 1.1.2015 Northern Trust 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Oncor 004336 MEDDADV RXCVSD Prt D TX 1-866-693-4620Caremark SilverScript 1.1.2015 Operating Engineers 428 004336 MEDDADV RXCVSD Prt D AZ 1-866-693-4620Caremark SilverScript 1.1.2015 Operating Engineers Local 139 004336 MEDDADV RXCVSD Prt D WI 1-866-693-4620Caremark SilverScript 1.1.2015 Patriot Coal 004336 MEDDADV RXCVSD Prt D MO 1-866-693-4620Caremark SilverScript 1.1.2015 Peabody Energy 004336 MEDDADV RXCVSD Prt D MO 1-866-693-4620

Caremark SilverScript 1.1.2015 Pennsylvania Employee Benefits Trust Fund 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620Caremark SilverScript 1.1.2015 Philadelphia Gas Works 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620Caremark SilverScript 1.1.2015 PPG Industries 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620Caremark SilverScript 1.1.2015 Praxair 004336 MEDDADV RXCVSD Prt D NJ 1-866-693-4620

Caremark SilverScript 1.1.2015 Putnam / Northern Westchester Health Benefits Consortium 004336 MEDDADV RXCVSD Prt D NY 1-866-693-4620

Caremark SilverScript 1.1.2015 Retired Construction Workers 004336 MEDDADV RXCVSD Prt D WV 1-866-693-4620

Caremark SilverScript 1.1.2015 Retired Firefighters Security Benefit Fund of the Uniformed Firefighters Association 004336 MEDDADV RXCVSD Prt D NY 1-866-693-4620

Caremark SilverScript 1.1.2015 RR Donnelly 004336 MEDDADV RXCVSD Prt D IL 1-866-693-4620Caremark SilverScript 1.1.2015 Schneider Electric USA, Inc. 004336 MEDDADV RXCVSD Prt D IL 1-866-693-4620Caremark SilverScript 1.1.2015 Seattle Fire Fighters 004336 MEDDADV RXCVSD Prt D WA 1-866-693-4620Caremark SilverScript 1.1.2015 Shell 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 State of Connecticut 004336 MEDDADV RXCVSD Prt D CT 1-866-693-4620Caremark SilverScript 1.1.2015 State of Connecticut Partnership 004336 MEDDADV RXCVSD Prt D CT 1-866-693-4620Caremark SilverScript 1.1.2015 State of Hawaii EUTF & HSTAVB 004336 MEDDADV RXCVSD Prt D HI 1-866-693-4620Caremark SilverScript 1.1.2015 Southern California Edison 004336 MEDDADV RXCVSD Prt D CA 1-866-693-4620Caremark SilverScript 1.1.2015 Temple University 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620Caremark SilverScript 1.1.2015 Textron 004336 MEDDADV RXCVSD Prt D RI 1-866-693-4620Caremark SilverScript 1.1.2015 The Queens Health Systems 004336 MEDDADV RXCVSD Prt D HI 1-866-693-4620Caremark SilverScript 1.1.2015 Thomson Reuters 004336 MEDDADV RXCVSD Prt D NY 1-866-693-4620Caremark SilverScript 1.1.2015 ThyssenKrupp Budd 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Town of Greenwich 004336 MEDDADV RXCVSD Prt D CT 1-866-693-4620


Page 20

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberCaremark SilverScript 1.1.2015 UBS 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 University of Idaho 004336 MEDDADV RXCVSD Prt D ID 1-866-693-4620Caremark SilverScript 1.1.2015 University of Pennsylvania 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620

Caremark SilverScript 1.1.2015 University System of GA Board of Regents 004336 MEDDADV RXCVSD Prt D GA 1-866-693-4620Caremark SilverScript 1.1.2015 Victualic 004336 MEDDADV RXCVSD Prt D PA 1-866-693-4620Caremark SilverScript 1.1.2015 Walter Energy 004336 MEDDADV RXCVSD Prt D AL, WV 1-866-693-4620Caremark SilverScript 1.1.2015 Western & Southern 004336 MEDDADV RXCVSD Prt D NATn'l 1-866-693-4620Caremark SilverScript 1.1.2015 Wolters Kluwer 004336 MEDDADV RXCVSD Prt D IL 1-866-693-4620

Caremark / Aetna 1.1.2015 Aetna Commercial 610502 00670000 see card Commercial National 1-800-238-6279Caremark / Aetna 1.1.2015 Adecco 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279Caremark / Aetna 1.1.2015 AstraZeneca Pharmaceuticals 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 Athena Health 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 Austin Independent School District 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279Caremark / Aetna 1.1.2015 BJ's Restaurants, Inc 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279Caremark / Aetna 1.1.2015 California Institute of Technology 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279Caremark / Aetna 1.1.2015 Carroll County Public Schools 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279Caremark / Aetna 1.1.2015 Cement Mason Local 780 610502 00670000 see card Commercial Natn'l 1-800-238-6279Caremark / Aetna 1.1.2015 Cenveo Corporation 610502 00670000 see card Commercial Natn'l 1-800-238-6279Caremark / Aetna 1.1.2015 City of Abilene 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279Caremark / Aetna 1.1.2015 City of New Rochelle 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 City of San Bernadino 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279Caremark / Aetna 1.1.2015 Comprehensive Health Management Inc 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279Caremark / Aetna 1.1.2015 Envision Healthcare Corp 610502 00670000 see card Commercial Natn'l 1-800-238-6279Caremark / Aetna 1.1.2015 EZCorp, Inc 610502 00670000 see card Commercial Natn'l 1-800-238-6279Caremark / Aetna 1.1.2015 F.N.B. Corporation 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 GENCO Distribution System, Inc 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 Golden Corral Corp 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279

Caremark / Aetna 1.1.2015 Gwinnett County Board of Commissioners 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279Caremark / Aetna 1.1.2015 H.J. Heinz Company (CVS Card Also) 610502 00670000 see card Commercial Natn'l 1-800-238-6279Caremark / Aetna 1.1.2015 IAC 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 Mary Washington Healthcare 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279Caremark / Aetna 1.1.2015 New Castle County 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279Caremark / Aetna 1.1.2015 Orlando Utilities Commission 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279

Caremark / Aetna 1.1.2015 Pentecostal Assemblies of the World 610502 00670000 see card CommercialNatn'l / Mid

Atlantic 1-800-238-6279Caremark / Aetna 1.1.2015 Port Authority of Allegheny County 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 Ranstad North America 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279Caremark / Aetna 1.1.2015 Ruby Tuesday 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279

Caremark / Aetna 1.1.2015The Sheet Metal Workers Local 27 Health and Welfare fund 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279

Caremark / Aetna 1.1.2015 St. Joseph's Healthcare System 610502 00670000 see card Commercial Natn'l / N East 1-800-238-6279Caremark / Aetna 1.1.2015 Summit Restaurant Group 610502 00670000 see card Commercial Natn'l / S East 1-800-238-6279Caremark / Aetna 1.1.2015 Time, Inc (CVS care Also) 610502 00670000 see card Commercial Natn'l 1-800-238-6279Caremark / Aetna 1.1.2015 Valleycrest Companies 610502 00670000 see card Commercial Natn'l / West 1-800-238-6279Caremark / Aetna 1.1.2015 Aetna Better Health 610591 see card see card Medicaid by State 1-877-874-3317

Aetna / Caremark MAPD Aetna Medicare Value Plan 610502 MEDDAET 354163 Prt D AZ 1-800-282-5366Aetna Medicare Select Plan Prt DAetna Medicare Prime Plan Prt D

Aetna / Caremark MAPD Aetna Medicare Standard Plan 610502 MEDDAET 354020 Prt D DC 1-800-282-5366

CA 1-800-282-5366

CARMARK AETNA Commercial 1.1.2015

Aetna / Caremark MAPD

Aetna / Caremark MAPD

CAREMARK AETNA Medicare Prt D 1.1.2015

354170,466267,

610502 MEDDAET


Page 21

PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk NumberAetna / Caremark MAPD Aetna Medicare Select Plan 610502 MEDDAET 354160 Prt D GA 1-800-282-5366Aetna / Caremark MAPD Aetna Medicare Value Plan 610502 MEDDAET 354236 Prt D IL 1-800-282-5366Aetna / Caremark MAPD Aetna Medicare Standard Plan 610502 MEDDAET 354020 Prt D MD 1-800-282-5366

Aetna Medicare NNJ Prime Plan Aetna Medicare Standard Plan Aetna Medicare Premier PlanAetna Medicare Value PlanAetna Medicare Value Plan Prt DAetna Medicare Select Plan Prt DAetna Medicare Standard Plan Prt DAetna Medicare Value Plan Prt DAetna Medicare Select Plan Prt DAetna Medicare Value PlanAetna Medicare Select PlanAetna Medicare Prime Plan Aetna Medicare Standard Plan Aetna Medicare Premier Plan Aetna Medicare Value Plan Aetna Medicare Select Plus Plan Aetna Medicare Select Plan

Aetna Medicare Pinnacle Health Prime PlanAetna Medicare Premier Plan Aetna Medicare Select Plan Aetna Medicare Prime Plan

Aetna / Caremark MAPD 1.1.2015 Aetna Medicare Innovation Prime Plan 610502 MEDDAET 354020 Prt D VA 1-800-282-5366Aetna Medicare Value Plan Aetna Medicare Premier Plan Aetna Medicare Select PlanAetna Medicare Select Plus PlanAetna Medicare Standard Plan Aetna Medicare Premier Plan Aetna Medicare Select PlanAetna Medicare Innovation Choice Plan Aetna Medicare Select Plus PlanAetna Medicare Choice PlanAetna Medicare Prime PlanAetna Medicare Essential PlanAetna Medicare Syracuse Prime Plan Aetna Medicare Value PlanAetna Medicare Standard Plan Aetna Medicare Value PlanAetna Medicare Elite Plan

Aetna / Caremark MAPD 1.1.2015 Aetna Medicare Standard Plan Aetna / Caremark MAPD 1.1.2015 Aetna Medicare Premier PlanAetna / Caremark MAPD 1.1.2015 Aetna Medicare Value Plan 610502 MEDDAET 466261 Prt D OK 1-800-282-5366Aetna / Caremark MAPD 1.1.2015 Aetna Medicare Select Plus PlanAetna / Caremark MAPD 1.1.2015 Aetna Medicare Select PlanAetna / Caremark MAPD 1.1.2015 Aetna Medicare Select PlanAetna / Caremark MAPD 1.1.2015 Aetna Medicare Prime PlanAetna / Caremark MAPD 1.1.2015 Aetna Medicare Select Plan 610502 MEDDAET 354163 Prt D NV 1-800-282-5366

Prt D NJ

610502

Prt D

Aetna / Caremark MAPD 1.1.2015


MEDDAET 354055

Aetna / Caremark MAPD 1.1.2015 610502 MEDDAET

Prt D

610502 MEDDAET 354020, 354055

Aetna / Caremark MAPD 1.1.2015 610502

Prt D

Aetna / Caremark MAPD 1.1.2015 610502 MEDDAET 354158 Prt D

Prt D


354642, 354635, 466256, 354650, 365647, 365673, 354646, 354440, 354807, 466259

PA KY NC 1-800-282-5366

TX 1-800-282-5366

VA 1-800-282-5366MEDDAET 354020




466258, 354020, 354158, 354269

610502 MEDDAET 354054

MEDDAET

Prt D

Prt D

AL, CA, CO, CT, DC, DE, FL, GA, IL, KY,

ME, NC, NJ, NV, NY, OH, PA, TX, VA

610502 MEDDAET

Prt D

610502 MEDDAET 354020, 466260

1-800-282-5366

610502 ME

610502

354269

DE 1-800-282-5366

CT

354269 Prt D

1-800-282-5366

FL 1-800-282-5366

354055

1-800-282-5366

NY 1-800-282-5366

1-800-282-5366

OH 1-800-282-5366

CO 1-800-282-5366

MEDDAET 354055


Page 22


Aetna Medicare Rx SaverAetna Medicare Rx Premier

Caremark / Aetna 1.1.2015*All Aetna Medicare Rx Essentials*All Aetna Medicare Part D 610502 MEDDAET see card Prt D National 1-800-238-6279

Catamaran/SXC-informed Rx 5.24.2013 Indiana Medicaid 001553 INM Medicaid IN 1-855-577-6317Catamaran 9.20.2013 Georgia Medicaid 001553 GAM Medicaid GACatamaran 1.1.2012 Nevada Medicaid 001553 NVM Medicaid NV 1-866-244-8554Catamaran /Ramsell Corp Health Trans 1.1.2013 California ADAP Program 004519 ADP VPC Commercial CA/WA/AZ/NV 1-888-311-7632Catamaran/HealthTrans/SXC CCPN-Consulcare Rx Network 004781 HT Commercial National 1-417-841-4820Catamaran Health Trans RXCLUB 005491 HT Commercial national 1-800-311-3446 Catamaran 1.1.15 Ascension / EMI 005757 ASCWC Workers' Comp 1-800-774-2002Catamaran 1.1.2015 State of Iowa Sec COB to Caremark Prt D 005947 WELLRX Commercial IA 1-800-788-2949

Catamaran 1.1.2015BigApple Integrated w/IDNYC Municipal Dscnt Card 005947 CLAIMCR 8214THF

Commercial/ Discount NY 1-877-459-8474

Catamaran 1.1.2015 Barnabas Health 005947 CLAIMCR BARNABAS Commercial NJ 1-855-209-1294Catamaran 1.1.2015 Core Molding Technologies 005947 CLAIMCR CMDTECH Commercial OH MN SC TX 1-844-265-1742Catamaran 1.1.2015 Gerland's 005947 CLAIMCR GERLANDRX Commercial TX 1-844-265-1742Catamaran 1.1.2015 MGM Resorts International 005947 CLAIMCR MGMRI Commercial NV 1-855-209-1297Catamaran 1.1.2015 Regeneron Pharmaceuticals 005947 CLAIMCR RGNRN Commercial NY 1-844-265-1742Catamaran 1.1.2015 Rudolph Libbe Group 005947 CLAIMCR RDPHLBGP Commercial OH MI 1-844-265-1742Catamaran 1.1.2015 Scrip World (ASBAIT) 005947 CLAIMCR SCW Commercial AZ 1-855-312-6103Catamaran/SXC-informed Rx Simply/Clear Health Alliance 005947 CLAIMCR SIMPLY Commercial FL 1-855-380-1231Catamaran/SXC-informed Rx Simply/Better Health Alliance 005947 CLAIMCR Better Commercial FL 1-855-380-1231Catamaran 7.1.2015 Spirit AeroSystems 005947 CLAIMCR SPIRIT Commercial KS OK NC 1-855-312-6097Catamaran 4.1.2015 Voestalpine Nortrak Inc 005947 CLAIMCR CTRVOESTRA Commercial National 1-844-265-1774Catamaran/SXC-informed Rx Wellmark 005947 CLAIMCR WELLRX Commercial 1-800-600-8065Catamaran/SXC-informed Rx Catalyst Catamaran No PCN 005947 Commercial 05 NY/NJ/PA 1-888-869-4600Catamaran/Catalyst Total Script 006524 TSCRIPT Commercial 1-800-880-1188

Catamaran/NetCard Systems 1.1.2015 Prestige Health Choice 008878PRS### (see card) Commercial FL 1-866-473-5254

Catamaran/NetCard Systems 1.1.2015 Delta County Memorial Hospital 008878 RXW00275 Commercial CO 1-800-479-2000Catamaran/NetCard Systems 1.1.2015 Maine Sense 008878 per card Commercial ME 1-800-479-2000Catamaran/NetCard Systems 1.1.2015 Valley View Hospital 008878 RXW00278 Commercial CO 1-800-479-2000Catamaran/NetCard Systems 1.1.2015 NetCard Welldyne / Strategy Corp 008878 11330 Commercial 1-800-479-2000Catamaran/NetCard Systems 1.1.2015 NetCard Welldyne / RxWest 008878 CB8 Commercial 1-888-479-2000Catamaran/NetCard Systems 1.1.2015 Colorado HealthOP 008878 NETCARD per card Commercial CO 1-888-479-2000Catamaran/NetCard Systems 5.1.2015 WellDyneRx Dscnt Card 018034 WDF per card Commercial National 1-888-886-5822

Catamaran/HealthTrans/SXC

RWDSU=Duane Reade / MtSinai World Trade Center / COHO CTSI / East Side School District / Hartman Cash Dscnt Card / Oakwood

009117 HT Commercial NJ NY PA 1-877-459-8474

Catamaran/HealthTrans/SXCCatamaran Commercial Medicaid including: Physicians Rx Care, Family Freedom Rx, Colorado Indigent Program

010553 HTCommercial /

MedicaidNational 1-800-880-1188

Catamaran / Cyrpess Care 3.28.2015 Texas Mutual 010876 CC CC3778 Workers' Comp National 1-888-220-2805Catamaran/HealthTrans/SXC Kaiser Commercial Northwest 011230 HT Commercial OR WA 1-800-813-2000Catamaran/HealthTrans/SXC New Benefits Discount Card - NBRx 011677 HT Commercial 1-800-880-1188Catamaran/HealthTrans/SXC Outlook Discnt Prescription Card 011792 HT Commercial 1-877-448-6183

AETNA/CAREMARK PDP

Catamaran Commercial / Medicaid / Exchange / Workers' Compensation

AETNA/CAREMARK PDP 1.1.2015

CATAMARAN 7.21.2015

610502 MEDDAET352041, 352044, 352049

Prt DNATIONWIDE, AND

DC1-877-238-6211


Page 23


Catamaran/HealthTrans/SXC 1.28.2015Wholesale Benefits Club, United Networks of America (UNA) 011867 HT Commercial 1-877-459-8474

Catamaran/SXC-informed Rx TeamsterRx 011883 Varies Commercial National 1-800-880-1188Catamaran 1.1.15 Hospiscript Services 011891 N/A see card Commercial 1-800-427-4893Catamaran/SXC-informed Rx Kroger Prescription Plan 012882 KKP KPP or Blank Commercial National 1-800-880-1188

Catamaran/Catalyst AmeriScript 012957 PCN starts with AMS Commercial 1-800-662-0210Catamaran/HealthTrans/SXC AmeriPlan Cash Dscnt Card 013907 HT Commercial 1-877-459-8474Catamaran/HealthTrans/SXC TelaRx 014681 HT or Blank fill Commercial 1-800-880-1188Catamaran/NetCard Systems 1.1.2015 NetCard / Pharmastrategies 014856 Commercial 1-800-479-2000Catamaran/Catalyst 1.1.2015 Dynamic Enrollment Card Dscnt 015383 01410000 587022B Commercial 1-800-479-2000Catamaran/Catalyst 1.1.2015 Sun Association RX Value Card 015383 01410000 see card Commercial 1-800-207-2568

Catamaran/HealthTrans/SXC Discount Drug Network Puerto Rico 015558 HTDDN6255 DDN6253 Commercial PR 1-877-459-8474

Catamaran/Catalyst Script Relief 015756 RXRELIEF Commercial National 1-800-207-2568Catamaran / FutureScript IBC PA HIX /NJ HIX SEE ARGUS 015814Catamaran / Cigna 9.1.2015 Cigna Commercial 017010 02150000 see card Commercial National 1-800-244-6224

CIGNA Groups See Appendix for Groups Migrating

Catamaran / Cigna 9.1.2015 Cigna International 017010 02160000see card '09999A001 Commercial National 1-800-244-6224

Catamaran / Cigna 9.1.2015 Cigna Great West 017010 05180000 see card Commercial National 1-800-244-6224Catamaran / Cigna 9.1.2015 Cigna Payer Solutions 017010 05190000 see card Commercial National 1-800-244-6224Catamaran / Cigna 9.1.2015 Cigna Hlth Spring / Medicaid 017010 CIHSCAID Medicaid National 1-888-625-5686Catamaran 1.1.15 MDIPASS 017399 HT MDAL980 Commercial 1-877-459-8474Catamaran / Cigna 9.1.2015 Ascension BCBS MI 600428 02150000 Commercial MI 1-855-281-8312Catamaran FutureScripts See ARGUS 600428Catamaran BCBS of Arizona 603017 BAZ, TQC Commercial National 1-800-880-1188

Catamaran 1.1.15CC Metals and Alloys, Commercial and retiree 603286 014

effective 07.27.2015 subject to change bin type … confirmed plan... · pcn group : type network:...

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