Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -1)

General Appendix 13

TPL/PBM Resource Code Directory

The Pharmacy Benefit Manager (PBM) codes consist of a five digit numeric resource code. The first three digits identify the company and the last two digits identify the office where the claim is to be sent for processing. Please enter the five digit PBM code as applicable in the Other Payer ID field in the COB/Other Payment segment in the NCPDP version 5.1 (340-7C). An alphabetical listing of insuring organizations and the PBM code assigned to each is provided on the following pages. It is followed by a numerical listing, by PBM code, of the same insuring organizations PBM CODE Insuring Organization Name & Address

(Alphabetic Order)

80100 Acordia Senior Benefits P.O. Box 942 Fair Lawn, NJ 07410

81600 ACS 145 Technology Lane Henderson, NC 27536

74900 Administrative Service Consult 215 Stanford Pkwy. Box 928 Findlay, OH 45839

50100 Aetna Pharmacy Management P.O. Box 14024, Attn: Claims PR Lexington, KY 40512

50101 Aetna Pharmacy Management P.O. Box 14024, Attn: Claims PR Lexington, KY 40512

50102 Aetna Pharmacy Management P.O. Box 14024, Attn: Claims PR Lexington, KY 40512

50103 Aetna Pharmacy Management P.O. Box 14024, Attn: Claims PR Lexington, KY 40512

50104 Aetna Pharmacy Management P.O. Box 14024, Attn: Claims PR Lexington, KY 40512

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -2)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

50105 Aetna Pharmacy Management P.O. Box 14024, Attn: Claims PR Lexington, KY 40512

57700 Affordable Network P.O. Box 11518 Scottsdale, AZ 88271

53300 All Scripts Networks P.O. Box 519 Lincoln, RI 02865

53301 All Scripts Networks P.O. Box 18014 Columbus, OH 43218

74700 Allied Benefit System P.O. Box 909786 Chicago, IL 60690

74000 Alternative Risk Management 111 W. Campbell, 4th Floor Arlington Heights, IL 60005

77900 American Diversified Pharmacy P.O. Box 340940 Sacramento, CA 95834

57600 American Drug Stores 3030 Cullerton Franklin Park, IL 60131

73800 American Freightways P.O. Box 840 Harison, AR 72602

71800 American Medical Security P.O. Box 19032 Green Bay, WI 54307

70300 American National Insurance P.O. Box 1520 Galveston, TX 77553

80300 American Republic Insurance Co. P.O. Box 10 Des Moines, IA 50301

72500 American Trust Administrators P.O. Box 87 Shawnee Mission, KS 66201

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -3)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

50300

Ameriscript 4301 Darrow Road Stow, OH 44224

59703 Anthem P.O. Box 37010 Louisville, KY 40233

50611 Anthem Blue Cross Blue Shield P. O. Box 37010 Louisville, KY 40233

59701 Anthem Home Life (AHL) P.O. Box 7000 Coraopolis, PA 15108

59700 Anthem RX P.O. Box 145433 Cincinnati, OH 45250

59702 Anthem RX P.O. Box 746000 Cincinnati, OH 45274

58800 APM (Community RX) P.O. Box 145433 Cincinnati, OH 45250

73500 Argus Health Systems P.O. Box 4190919 Kansas City, MO 64141

73502 Argus Health Systems P.O. Box 4190919, Dept. 191 Kansas City, MO 64141

76200 Associated Third Party Admin. P.O. Box 4912 Chicago, IL 60680

82000 AVIA Partners 20427 N. 27th Avenue Phoenix, AZ 85027

77800 Bankers Life & Casualty 222 Merchandise Mart Plaza Chicago, IL 60654

50500 Barnes-Jewish Pharmacy 216 South Kingshighway St. Louis, MO 63110

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -4)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

81400 BCI Administrators P.O. Box 251568 W. Bloomfield, MI 48325

75100 Benckmark-Drug Claims P.O. Box 4666 Rockford, IL 61110

77600 Benefit Consultants Inc. 13515 Barrett Pkwy., Suite 265 Ballwin, MO 63021

75800 Benefit Systems and Services 760 Pasquinelli Dr., Suite 320 Westmont, IL 60559

50700 Benescript P.O. Box 921229 Norcross, GA 30010

50701 Benescript P.O. Box 921229 Norcross, GA 30010

51720 Best Buy Inc. 7601 Penn Ave. South Richfield, MN 55423

83000 Beyond RX P. O. Box 26456 Attn: Claims Shawnee Mission, KS 66225

78500 Bio Scrip P. O. Box 1778 Columbus, OH 43216

50620 Blue Cross Blue Shield Alliance P.O. Box 14882 St. Louis, MO 63178

50622 Blue Cross Blue Shield Anthem P.O. Box 37010 Louisville, KY 40233

50628 Blue Cross Blue Shield Care Fi 550 12th St., SW Washington, D.C. 20065

50621 Blue Cross Blue Shield Maxor P 320 S. Polk, Suite 200 Amarillo, TX 79101

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -5)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

50602 Blue Cross Blue Shield of Alabama P.O. Box 995 Birmingham, AL 35298

50612 Blue Cross Blue Shield of CA P.O. Box 9271 Van Nuys, CA 91409

50615 Blue Cross Blue Shield of CT P.O. Box 533 North Haven, CT 06473

50626 Blue Cross Blue Shield of GA P.O. Box 9907 Columbus, GA 31908

50613 Blue Cross Blue Shield of IA 636 Grand Ave. Des Moines, IA 50309

50604 Blue Cross Blue Shield of IL P.O. Box 805107 Chicago, IL 60680

50606 Blue Cross Blue Shield of IL P.O. Box 786 Chicago, IL 60610

50631 Blue Cross Blue Shield of MA P.O. Box 9204 North Quincy, MA 02171

50632 Blue Cross Blue Shield of MD P.O. Box 1725 Cumberland, MD 21501

50605 Blue Cross Blue Shield of MI P.O. Box 1618 Detroit, MI 48231

50630 Blue Cross Blue Shield of MO P.O. Box 412735 Kansas City, MO 64141

50617 Blue Cross Blue Shield of ND 4510 13th Ave. SW Fargo, ND 58121

50624 Blue Cross Blue Shield of NE P.O. Box 3248 Omaha, NE 68180

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -6)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

50609 Blue Cross Blue Shield of NY 165 Court Street Rochester, NY 14647

50616 Blue Cross Blue Shield of OR P.O. Box 1271 Portland, OR 97207

50603 Blue Cross Blue Shield of PA 5th Avenue Place Pittsburgh, PA 15222

50623 Blue Cross Blue Shield of PA 70 N. Main St. Wilkes-Barre, PA 18711

50619 Blue Cross Blue Shield of RI 444 Westminster St. Providence, RI 02903

50627 Blue Cross Blue Shield of SD 800 Stevensport Drive, #721D Dakota, SD 57049

50629 Blue Cross Blue Shield of TN P.O. Box 180150 Chattanooga, TN 37402

50614 Blue Cross Blue Shield of TX P.O. Box 660044 Dallas, TX 75266

50618 Blue Cross Blue Shield-Empire P.O. Box 1407 New York, NY 10008

50600 Blue Cross Blue Shield Pro Service P.O. Box 9082 Oxnard, CA 93031

50601 Blue Cross Blue Shield Pro Service P.O. Box 9081 Oxnard, CA 93031

50607 Blue Cross Blue Shield Pro Service P.O. Box 9081 Oxnard, CA 93031

50625 Blues Shield RX Services P.O. Box 7168 San Francisco, CA 94120

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -7)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

51727 Boilermakers 754 Minnesota Avenue, Suite 5 Kansas City, KS 66101

51724 Boise Cascade 1111 Jefferson St Boise, ID 83728

74400 Burns and Company P.O. Box 9708 Springfield, IL 62704

78300 Butler Benefit Services P.O. Box 3310 Davenport, IA 52808

50800 Butler Manufacturing Company 1020 S. Henderson St. Galesburg, IL 61401

51732 Cadbury Schweppes America 5301 Legacy Drive Plano, TX 75024

57800 Cannon Cochran Management Services P.O. Box 1430 Danville, IL 61834

79500 Cannon Precision Manufacturing 4th & Washington Keithsburg, IL 61442

73501 Care First P.O. Box 419019 Dept. 300 Kansas City, MO 64141

50900 Caremark P.O. Box 52196 Phoenix, AZ 85072

50901 Caremark P.O. Box 52196 Phoenix, AZ 85072

50902 Caremark P.O. Box 52196 Phoenix, AZ 85072

50903 Caremark P.O. Box 52196 Phoenix, AZ 85072

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -8)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

50904 Caremark P.O. Box 52196 Phoenix, AZ 85072

50905 Caremark P.O. Box 52196 Phoenix, AZ 85072

50906 Caremark P.O. Box 52196 Phoenix, AZ 85072

50907 Caremark P.O. Box 52196 Phoenix, AZ 85072

50908 Caremark P.O. Box 52196 Phoenix, AZ 85072

50909 Caremark P.O. Box 52196 Phoenix, AZ 85072

53500 Caremark P.O. Box 52197 Phoenix, AZ 85072

53501 Caremark P.O. Box 52197 Phoenix, AZ 85072

53502 Caremark P.O. Box 52197 Phoenix, AZ 85072

53503 Caremark P.O. Box 52197 Phoenix, AZ 85072

53504 Caremark P.O. Box 52197 Phoenix, AZ 85072

53505 Caremark P.O. Box 52197 Phoenix, AZ 85072

53507 Caremark P.O. Box 52197 Phoenix, AZ 85072

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -9)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

53508 Caremark P.O. Box 52197 Phoenix, AZ 85072

53510 Caremark P.O. Box 52197 Phoenix, AZ 85072

57500 Caremark/Advance Recap Claims P.O. Box 686004 San Antonio, TX 78268

57501 Caremark/Advance Recap Claims P.O. Box 686004 San Antonio, TX 78268

57502 Caremark/Advance Recap Claims P.O. Box 686004 San Antonio, TX 78268

51000 Caremark/Pharmacare 30200 Telegraph Road, #401 Bingham Farms, MI 48025

51001 Caremark/Pharmacare 30200 Telegraph Road, #401 Bingham Farms, MI 48025

51002 Caremark/Pharmacare 30200 Telegraph Road, #401 Bingham Farms, MI 48025

51003 Caremark/Pharmacare P.O. Box 18910 Fairfield, OH 45018

59800 Carpenters Health Welfare 1419 Hampton Ave. St. Louis, MO 63139

59600 Catalyst RX 9525 Hillwood Dr., #100 Las Vegas, NV 89134

59601 Catalyst RX P.O. Box 1069 Rockville, MD 20849

80200 CBCA RX 675 Foxhorn Road, Suite 204 East Haven, CT 06513

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -10)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

72100 Central Laborers P.O. Box 1267 Jacksonville, IL 62651

75400 Centrus Pharmacy Solutions 23 British American Blvd. Latham, NY 12110

72800 Century Planners 9201 Watson Rd., Suite 305 St. Louis, MO 63126

55900 Cigna Pharmacy Services P.O. Box 3598 Scranton, PA 18505

55902 Cigna Pharmacy Service Center P.O. Box 3598 Scranton, PA 18505

76300 Conseco P.O. Box 1250 Rockford, IL 61105

51726 Consociate 111 E. Decatur St Decatur, IL 62525

57900 Consultec 9040 Roswell Rd., Suite 700 Atlanta, GA 30350

50400 Continental Pharmacy P.O. Box 1778 Columbus, OH 43216

51100 Coram Prescription Service 10801 Q St., Suite 102 Omaha, NE 68137

74100 Coresource 18401 Maple Creek Drive Tinley Park, IL 60477

74500 Cornerstone Benefits P.O. Box 1007 Elkhart, IN 46515

76800 Corporate Benefit Service of A P.O. Box 738 Hopkins, MN 55343

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -11)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

75300 Country Companies P.O. Box 2000 Bloomington, IL 61702

51200 Curaflex Prescription Service P.O. Box 356 Boystown, NE 68010

51101 Curascript Coram P.O. Box 628212 Orlando, FL 32862

72600 District 9 Health & Welfare Attn: Nancy Heim 12365 St. Charles Rock Rd. Bridgeton, MO 63044

51302 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51303 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51304 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51305 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51306 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51307 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51308 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51300 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

51301 Diversified-Express Scripts P.O. Box 390873 Bloomington, MN 55439

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -12)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

51400 Drug Card RX America 55 Shurman Blvd., Suite 700 Naperville, IL 60563

51500 Drug Source P.O. Box 490 Mt. Prospect, IL 60056

77100 EBX Incorporated 2045 Midway Dr. Twinsburg, OH 44087

59200 Eckerd Health Services-TDI P.O. Box 2860 Pittsburgh, PA 15230

82200 EHIM 26711 North Western HWY #400 Southfield, MI 48034

51601 Empire Express P.O. Box 5099 Middletown, NY 10941

51600 Empire Prescription Plan P.O. Box 1180 Troy, NY 12181

58600 Employer Benefits Corp. 4815 N. Prospect Peoria, IL 61614

80500 Envision/RX Options 2181 East Aurora Road Twinsburg, OH 44087

73600 Epoch 10795 Watson St. Louis, MO 63127

58500 Ethix-ProAmerica Midwest P.O. Box 90603 Arlington, TX 76006

50633 Excellus BC/BS P.O. Box 22999 Rochester, NY 14692

51700 Express Scripts P.O. Box 390873 Bloomington, MN 55439

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -13)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

51701 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51702 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51703 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51704 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51706 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51708 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51709 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51710 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51711 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51712 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51713 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51714 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51715 Express Scripts P.O. Box 390873 Bloomington, MN 55439

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -14)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

51716 Express Scripts, Inc. 6625 W. 78th St. Bloomington, MN 55439

51717 Express Scripts P.O. Box 390873 Bloomington, MN 55439

51718 Express Scripts Tricare P.O. Box 66518 St. Louis, MO 63166

51719 Express Scripts P.O. Box 390873 Bloomington, MN 55439

52500 Express Scripts P.O. Box 390873 Bloomington, MN 55439

52600 Express Scripts (NPA) P.O. Box 390873 Bloomington, MN 55439

53000 Express Scripts (NPA) P.O. Box 390873 Bloomington, MN 55439

53100 Express Scripts (NPA) P.O. Box 390873 Bloomington, MN 55439

53101 Express Scripts (NPA) P.O. Box 390873 Bloomington, MN 55439

55800 Express Value RX Net P.O. Box 390873 Bloomington, MN 55439

51723 Federal Warehouse Company 200 National Road East Peoria, IL 61611

50200 First Health RX P.O. Box 8408 London, KY 40742

50201 First Health RX P.O. Box 8408 London, KY 40742

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -15)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

50202 First Health RX P.O. Box 8408 London, KY 40742

50203 First Health RX P.O. Box 8408 London, KY 40742

75700 Gallagher Benefit Administration P.O. Box 93670 Lubbock, TX 79493

51900 General Prescription Program 305 Madison Ave., Suite 1166 B New York, NY 10165

51901 General Prescription Program 305 Madison Ave., Suite 1166 B New York, NY 10165

51902 General Prescription Program 61 Freeman Street Newark, NJ 07105

77500 Golden Rule Insurance Co. 712 11th Street Lawrenceville, IL 62439

76600 Group Management Services P.O. Box 24708 Omaha, NE 68124

55500 HCH Admin.-Attn: Keppcard P.O. Box 1986 Peoria, IL 61656

52000 Health Source RX P.O. Box 180141 Chattanooga, TN 39401

76500 HealthExtras and Catalyst RX 800 King Farm Blvd., Suite 400 Rockville, MD 20850

52100 Healthlink P.O. Box 419104 St. Louis, MO 63141

82700 Healthspring P.O. Box 20000 Nashville, TN 37202

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -16)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

52200 Healthstar Drug Program P.O. Box 66930 Chicago, IL 60666

81300 Healthtrans 8300 East Maplewood Avenue Greenwood Villa, CO 80111

52303 Humana Inc. P.O. Box 740021 Attn: Pharmacy Louisville, KY 40201

52301 Humana Pharmacy Department P.O. Box 14601 Lexington, KY 40512

52302 Humana Pharmacy Department 1100 Employers Blvd. Green Bay, WI 54344

52300 Humana Pharmacy Reimbursement P.O. Box 14601 Lexington, KY 40512

76900 IBEW Local 309 2000A Mall Street Collinsville, IL 62234

79000 Illinois Valley Community Hospital 925 West Street Peru, IL 61354

52400 Immediate Pharmacy Service P.O. Box 166 Avon Lake, OH 44012

79300 Indiana State Council Roofers P.O. Box 5769 Lafayette, IN 47903

80400 Innoviant P.O. Box 8082 Wausau, WI 54402

71600 Inteq 5445 La Sierra, Suite 400 Dallas, TX 75231

70400 International Pharmacy Mgt. 110 12th Street North Birmingham, AL 35203

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -17)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

80000 Iowa Health Solutions 2550 Middle Road #405 Bettendorf, IA 52722

79400 Iron Workers Stl District 2160 S. Foster Avenue Wheeling, IL 60090

75900 LDI 680 Craig Road, Suite 200 Creve Coeur, MO 63141

51721 LINECO 2000 Springer Drive Lombard, IL 60148

74200 Local 743 2160 S. Foster Wheeling, IL 60090

50204 Mailhandlers Benefit Fund P.O. Box 8404 London, KY 40742

77200 MAPA P.O. Box 2850 Rockford, IL 61132

51731 Masonry Institute 2340 South River road Des Plaines, IL 60018

77000 McAughlin Body Co. 2430 River Dr. Moline, IL 61265

79100 McDermott, Will and Emory 227 W Monroe Street Chicago, IL 60606

76700 McElroy Metal P.O. Box 1148 Shreveport, LA 71163

77400 Med Script 13185 Lakeshore Drive Earth City, MO 63045

52700 Medco P.O. Box 14711 Lexington, KY 40512

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -18)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

52701 Medco P.O. Box 14711 Lexington, KY 40512

52702 Medco P.O. Box 14711 Lexington, KY 40512

52703 Medco P.O. Box 14711 Lexington, KY 40512

52704 Medco P.O. Box 14711 Lexington, KY 40512

52705 Medco P.O. Box 14711 Lexington, KY 40512

52706 Medco P.O. Box 14711 Lexington, KY 40512

52707 Medco P.O. Box 14711 Lexington, KY 40512

52708 Medco P.O. Box 14711 Lexington, KY 40512

52709 Medco P.O. Box 14711 Lexington, KY 40512

52710 Medco P.O. Box 14711 Lexington, KY 40512

52711 Medco P.O. Box 14711 Lexington, KY 40512

52712 Medco P.O. Box 14711 Lexington, KY 40512

52713 Medco P.O. Box 14711 Lexington, KY 40512

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -19)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

52714 Medco P.O. Box 14711 Lexington, KY 40512

52720 Medco P.O. Box 14711 Lexington, KY 40512

52800 Medco P.O. Box 14711 Lexington, KY 40512

54801 Medco P.O. Box 14711 Lexington, KY 40512

54802 Medco P.O. Box 14711 Lexington, KY 40512

54803 Medco P.O. Box 14711 Lexington, KY 40512

54804 Medco P.O. Box 14711 Lexington, KY 40512

54805 Medco P.O. Box 14711 Lexington, KY 40512

71900 Medimpact Attn: Claims 10680 Treena St. San Diego, CA 92131

71000 Medtrack Pharmacy Claims 6310 Lamar, Suite 230 Overland Park, KS 66212

70800 Meijer Inc. P.O. Box 1747 Grand Rapids, MI 49501

80600 Member Health P. O. Box 391180 Cleveland, OH 44139

56600 Meritain Health P. O. Box 853921 Richardson, TX 75085

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -20)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

79800 Midwest Central Operating Engineers P. O. Box 1445 Terre Haute, IN 47808

71400 MIM Health Plans 33 North Road Wakefield, RI 02879

82400 Mutual Medical Plans P. O. Box 689 Peoria, IL 61652

73900 Mutual of Omaha SM Group Claims Mutual of Omaha Plaza Omaha, NE 68175

73901 Mutual of Omaha 14000 River Port Drive St. Louis, MO 63043

70600 National Community Pharmacy P.O. Box 18109 West Palm Beach, FL 33416

73100 National Medical Health Card Services 26 Harbor Park Dr. Port Washington, NY 11050

53200 National RX Services P.O. Box 182050 Columbus, OH 43218

74300 NECA Local 145 1700 52nd Ave. Moline, IL 61265

75500 Neighbor Care Card 7 East Lee St. Baltimore, MD 21202

78600 Nestle USA-Attn: J. Donahue 800 N. Brand Blvd., 7th Fl. Glendale, CA 91203

54600 NMHCRX 320 Executive Court, Suite 20 Little Rock, AR 72205

51725 North American Administrators 300 Corporate Parkway Amherst, NY 14226

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -21)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

53700 NPS National Pharmacy Services P.O. Box 407 Boystown, NE 68010

75200 Nyhart Co. P.O. Box 1090 Evansville, IN 47706

73400 OBA Midwest 1000 Burr Ridge Pkwy., #200 Burr Ridge, IL 60527

51729 Olin Corporation 88 Danbury Road, Suite 2C Wilton, CT 06897

73200 One Health Plan P.O. Box 11111 Ft. Scott, KS 66701

58000 Osco Drugs-3rd Party Dept. 3030 Cullerton Dr. Franklin Park, IL 60131

76400 Painters Welfare Plan #2 2501 59th St. St. Louis, MO 63110

78400 Partners RX Management P.O. Box 12119 Phoenix, AZ 85267

76000 PBM Plus 300 Techne Center Drive, #B Milford, OH 45150

53600 Perform-Express Scripts P.O. Box 390873 Bloomington, MN 55439

53601 Perform-Express Scripts P.O. Box 390873 Bloomington, MN 55439

59500 Pharma Care All Scripts Network P.O. Box 519 Lincoln, RI 02865

78900 Pharmaceutical Care Network 9343 Tech Center Drive Sacramento, CA 95826

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -22)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

59300 Pharmaceutical Prescription 40 Adamson St. Easton, PA 18042

53800 Pharmacists Care Card 21 Corporate Woods Overland Park, KS 66210

53900 Pharmacy Access, J.H. Financial P.O. Box 3010 Andover, MA 01810

72200 Pharmacy Advantage Systems P.O. Box 95527 Atlanta, GA 30347

71700 Pharmacy Associates Inc. P.O. Box 23007 Little Rock, AR 72221

54000 Pharmacy Benefits Association P.O. Box 34343 Kansas City, MO 64120

54001 Pharmacy Benefits Association 1575 N. Universal Ave., Suite 100 Kansas City, MO 64120

82900 Pharmacy Data Management P. O. Box 5300 Poland, OH 44514

70000 Pharmacy Network 4020 Wake Forest Rd., Suite 102 Raleigh, NC 27609

70900 Pharmacy Network National Corp. 4020 Wake Forest Rd., Suite 102 Raleigh, NC 27609

72700 Pharmacy Services Group P. O. Box 100759 Ft. Lauderdale, FL 33310

54300 Pharmalink P.O. Box 412735 Kansas City, MO 64141

54301 Pharmalink P.O. Box 412735 Kansas City, MO 64141

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -23)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

54302 Pharmalink 6330 LMARR, Suite 200 Overland Park, KS 66201

58700 Phoenix Group Services P.O. Box 150809 Arlington, TX 76015

80800 Physicians Plus Ins. Corp. P. O. Box 2078 Madison, WI 53701

54400 PII Benefit Trust 70 E. Lake St. Chicago, IL 60601

53801 Power Group (PCS) 10800 Farley St., #165 Overland Park, KS 62210

82300 PRAM Insurance Services 711 E. Imperial Hwy, Suit 100 Brea, CA 92821

54500 Premier Pharmacy Plan P.O. Box 5824 Spartanburg, SC 29304

72000 Prescription Network of Kansas 1020 SW Fairlawn Rd. Topeka, KS 66604

71200 Prescription Solutions P.O. Box 6037, Stop LC07-192 Cypress, CA 90630

59900 Prescript-Med America 125 Venture Blvd. Spartenburg, SC 29306

54100 Prime Therapeutics BCBS/IL P.O. Box 64812 St. Paul, MN 55164

55600 Prime Therapeutics BCBS/IL P.O. Box 64812 St. Paul, MN 55164

55601 Prime Therapeutics/RX Gold P.O. Box 64812 St. Paul, MN 55164

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -24)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

54700 Priority RX Pharmacy P.O. Box 621107 Cincinnati, OH 45262

79200 Pro Care RX 3090 Premier Parkway, Suite 100 Duluth, GA 30097

54800 PRO Vantage MEDCO P. O. Box 247 Lee’s Summit, MO 64063

54900 Professional Benefits 10835 Rockley Rd. Houston, TX 77099

59400 Professional Benefits Adm. P.O. Box 4687 Oakbrook, IL 60522

78100 Providence Administrative Services P.O. Box 700570 San Antonio, TX 78270

73000 Prudential Pharmacy Management P.O. Box 390864 Edina, MN 55439

71100 Regence Life & Health Ins. Co. P.O. Box 1071 Portland, OR 97207

55100 Relistar 146 Industrial Park Jackson, MN 56143

55200 Restat P.O. Box 758 West Bend, WI 53058

55202 Restat Group P. O. Box 758 West Bend, WI 53095

55000 RHC/Spacemaster Corp. 1400 N. 25th Ave. Melrose Park, IL 60160

72400 Rightchoice P.O. Box 14882 St. Louis, MO 63178

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -25)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

78800 Rockford Construction Ind. Fund 929 South Alpine Road, Suite 408 Rockford, IL 61108

58100 Rollins Inc. P.O. Box 14499 Atlanta GA 30324

55300 RPX (UFCW) 1300 Higgins Rd., Suite 300 Park Ridge, IL 60068

55301 RPX (UFCW) P.O. Box 1043 Park Ridge, IL 60068

55400 RX America P.O. Box 22390 Salt Lake City, UT 84122

55401 RX America 221 Charles Lindbergh Dr. Salt Lake City, UT 84116

55402 RX America 221 Charles Lindbergh Dr. Salt Lake City, UT 84116

55404 RX America Benefit Plan Admin. 608 E. Poplar Harrisburg, IL 62946

55403 RX America Drug Card 55 Shuman Blvd., #700 Naperville, IL 60563

55700 RX Management P.O. Box 36185 Minneapolis, MN 55435

55801 RX Net Express Scripts P.O. Box 390873 Bloomington, MN 55439

81800 RX Options, Inc. 2181 E. Aurora Road, Suite 201 Twinsburg, OH 44087

81100 RX Pharmacy Solutions 1600 W Broadway Road, Suite 300 Tempe, AZ 85282

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -26)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

55901 RX Prime-Cigna P.O. Box 3598 Scranton, PA 18505

59100 RX West P.O. Box 4517 Englewood, CO 80155

56000 Samscript Rte. 4320, Box 169052 Duluth, MN 55816

56100 Sav-RX 224 N. Park Ave. Freemont, NE 68026

81700 Schnuck Markets Inc. 11420 Lackland Dr St Louis, MO 63146

80900 Scrip Solutions 2787 Charter Columbus, OH 43228

58900 Script Care 6380 Folsom Dr Beaumont, TX 77706

82100 Scriptguide P. O. Box 14399 Detroit, MI 48214

82600 Scriptrax P. O. Box 24039 Winston-Salem, NC 27114

73300 Self Insured Services Co. P.O. Box 389 Dubuque, IA 52004

56300 Serv U Prescription P.O. Box 240034 Milwaukee, WI 53224

56301 Serv U Prescription 9051 Heather Ave. Milwaukee, WI 53224

79600 Sheet Metal Workers Local 1 P. O. Box 1986 Peru, IL 61556

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -27)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

56400 Sherrick Drug & Medical Main Street Carthage, IL 62321

81900 SISCO P. O. Box 389 Dubuque, IA 52004

72101 Southern Illinois Laborers 2035 Washington Ave. Cairo, IL 62914

79700 Southwestern Indiana Health P. O. Box 1787 Columbus, IN 47202

51722 St. Paul Companies 385 Washington St. St. Paul, MN 55102

71300 Starbridge P.O. Box 55270 Phoenix, AZ 85078

56500 Starmark RX Drug Program 400 Field Dr. Lake Forest, IL 60045

81500 SUNRX 6 Executive Campus, Suite 400 Cherry Hill, NJ 08034

81000 SXC Health Solutions Inc 2441 Warrenville Road Lisle, IL 60532

76100 TBG Inc. 11550 I Street, Suite 201 Omaha, NE 68137

56700 TDI Eckerd Managed Care 620 Epsilon Drive Pittsburgh, PA 15238

56701 TDI-Eckerd Pharmacare P.O. Box 2860 Pittsburgh, PA 15238

72900 Teamsters Local 682 5730 Elizabeth Avenue St. Louis, MO 63110

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -28)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

72901 Teamsters Local 722 2160 South Foster Avenue Wheeling, IL 60090

72903 Teamsters Local 744 300 S Ashland Chicago, IL 60607

72902 Teamsters Welfare Trust 2873 N. Dirksen Pkwy, Suite 200 Springfield, IL 62702

56800 Thrift Drug Inc. P.O. Box 419096 Kansas City, MO 64179

79900 Total Script 10901 W 120th Ave., Suite 175 Broomfield, CO 80021

80700 TRI Scripts/TRI Cast 10200 Innovation Dr. #300 Milwaukee, WI 53226

75000 Trustmark P.O. Box 2942 Clinton, IA 52733

51730 U S Steel 600 Grant Street, Room 2684 Pittsburgh, PA 15219

58200 UFCW 1300 W. Higgins Rd., #300 Park Ridge, IL 60068

58201 UFCW 1300 W. Higgins Rd., #300 Park Ridge, IL 60068

58202 UFCW Local 655 13537 Barrett Pkwy Dr Manchester, MO 63021

73700 Unicare P.O. Box 4458 Chicago, IL 60680

50610 Unicare Pharmacy 220 Remington Blvd. % C. Riley Bolingbrook, IL 60440

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -29)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

70100 Unified Group Investment P.O. Box 10 Pendleton, IN 46064

56900 Union Plaza Pharmacy 680 Craig Road, Suite 200 Creve Coeur, MO 63141

81200 United Drug Program 333 S Ashland Avenue Chicago, IL 60607

58301 United Healthcare P.O. Box 30555 Salt Lake City, UT 84130

58303 United Healthcare P.O. Box 659759 San Antonio, TX 78265

58304 United Healthcare P.O. Box 55967 Birmingham, AL 35255

58305 United Healthcare P.O. Box 740800 Atlanta, GA 30374

58306 United Healthcare P.O. Box 909714 Chicago, IL 60690

51800 United Healthcare River City 3800 23rd Avenue, Suite 200 Moline, IL 61265

71500 United Medical Resources P.O. Box 145804 Cincinnati, OH 45250

70500 United Provider Services P.O. Box 820277 Ft. Worth, TX 76182

51728 United Teachers Association P. O. Box 26580 Austin, TX 78755

59000 USA Health 111 Massachusetts Ave. North Washington, D.C. 20001

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -30)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

58400 Valspar Human Resources P.O. Box 1461 Minneapolis, MN 55440

57000 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57001 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57002 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57003 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57004 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57005 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57006 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57007 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57008 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57009 Value RX-Express Scripts P.O. Box 390873 Bloomington, MN 55439

57107 Walgreens Health Initiatives 1417 Lake Cook Rd., #MS-L360 Deerfield, IL 60015

57103 Walgreens Health Services P. O. Box 545 Deerfield, IL 60015

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -31)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

57102 Walgreens Health Services P. O. Box 545 Deerfield, IL 60015

57106 Walgreens Health Services P. O. Box 545 Deerfield, IL 60015

57100 Walgreens Health Services P. O. Box 545 Deerfield, IL 60015

57105 Walgreens Health Services P. O. Box 545 Deerfield, IL 60015

57200 Walmart Pharmacy 702 Southwest 8th St. Bentonville, AR 72716

57201 Walmart RX Claims Adm. 922 W. Walnut, Suite A Rogers, AR 72756

74600 Wausau Pharmacy Benefits P.O. Box 8046 Wausau, WI 54402

82500 Welldyne RX West 7472 South Tucson Way Centennial, CO 80112

82800 Wellpoint Next RX P. O. box 145433 Cincinnati, OH 45240

57300 Wellpoint Pharmacy P.O. Box 9080 Oxnard, CA 93031

77300 Wellpoint Pharmacy Management P.O. Box 4496 Woodland Hills, CA 91362

57302 Wellpoint-Unicare-Pro Serv P.O. Box 9085 Oxnard, CA 93031

57301 Wellpoint-Unicare-Pro Serv P.O. Box 9085 Oxnard, CA 93031

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (alpha -32)

PBM CODE Insuring Organization Name & Address (Alphabetic Order)

72300 Westport Benefits P.O. Box 766 Buffalo, NY 14226

57400 WHP Health Initiative 2275 Halfday Rd., Suite 250 Bannockburn, IL 60015

78000 Willis Corroon P.O. Box 305154 Nashville, TN 37230

75600 Woodward Healthcare P.O. Box 9 Woodward, OK 73802

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -1)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 50100 Aetna Pharmacy Management

50101 Aetna Pharmacy Management

50102 Aetna Pharmacy Management

50103 Aetna Pharmacy Management

50104 Aetna Pharmacy Management

50105 Aetna Pharmacy Management

50200 First Health RX

50201 First Health RX

50202 First Health RX

50203 First Health RX

50204 Mailhandlers Benefit Fund

50300 Ameriscript

50400 Continental Pharmacy

50500 Barnes-Jewish Pharmacy

50600 Blue Cross Blue Shield Pro Service

50601 Blue Cross Blue Shield Pro Service

50602 Blue Cross Blue Shield of AL

50603 Blue Cross Blue Shield of PA

50604 Blue Cross Blue Shield of IL

50605 Blue Cross Blue Shield of MI

50606 Blue Cross Blue Shield of IL

50607 Blue Cross Blue Shield Pro Service

50609 Blue Cross Blue Shield of NY

50610 Unicare Pharmacy

50611 Anthem Blue Cross Blue Shield

50612 Blue Cross Blue Shield of CA

50613 Blue Cross Blue Shield of IA

50614 Blue Cross Blue Shield of TX

50615 Blue Cross Blue Shield of CT

50616 Blue Cross Blue Shield of OR

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -2)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 50617 Blue Cross Blue Shield of ND

50618 Blue Cross Blue Shield-Empire

50619 Blue Cross Blue Shield of RI

50620 Blue Cross Blue Shield Alliance

50621 Blue Cross Blue Shield Maxor P

50622 Blue Cross Blue Shield Anthem

50623 Blue Cross Blue Shield of PA

50624 Blue Cross Blue Shield of NE

50625 Blues Shield RX Services

50626 Blue Cross Blue Shield of GA

50627 Blue Cross Blue Shield of SD

50628 Blue Cross Blue Shield Care Fi

50629 Blue Cross Blue Shield of TN

50630 Blue Cross Blue Shield of MO

50631 Blue Cross Blue Shield of MA

50632 Blue Cross Blue Shield of Maryland

50633 Excellus BC/BS

50700 Benescript

50701 Benescript

50800 Butler Manufacturing Company

50900 Caremark (Baxter)

50901 Caremark

50902 Caremark

50903 Caremark

50904 Caremark

50905 Caremark

50906 Caremark

50907 Caremark

50908 Caremark

50909 Caremark

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -3)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 51000 Caremark/Pharmacare

51001 Caremark/Pharmacare

51002 Caremark/Pharmacare

51003 Caremark/Pharmacare

51100 Coram Prescription Service

51101 Curascript Coram

51200 Curaflex Prescription Service

51300 Diversified-Express Scripts

51301 Diversified-Express Scripts

51302 Diversified-Express Scripts

51303 Diversified-Express Scripts

51304 Diversified-Express Scripts

51305 Diversified-Express Scripts

51306 Diversified-Express Scripts

51307 Diversified-Express Scripts

51308 Diversified-Express Scripts

51400 Drug Card RX America

51500 Drug Source

51600 Empire Prescription Plan

51601 Empire Express

51700 Express Scripts

51701 Express Scripts

51702 Express Scripts

51703 Express Scripts

51704 Express Scripts

51706 Express Scripts

51708 Express Scripts

51709 Express Scripts

51710 Express Scripts

51711 Express Scripts

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -4)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 51712 Express Scripts

51713 Express Scripts

51714 Express Scripts

51715 Express Scripts

51716 Express Scripts, Inc.

51717 Express Scripts

51718 Express Scripts Tricare

51719 Express Scripts

51720 Best Buy Inc.

51721 LINECO

51722 St. Paul Companies

51723 Federal Warehouse Company

51724 Boise Cascade

51725 North American Administrators

51726 Consociate

51727 Boilermakers

51728 United Teachers Association

51729 Olin Corporation

51730 U S Steel

51731 Masonry Institute

51732 Cadbury Schweppes America

51800 United Healthcare River City

51900 General Prescription Program

51901 General Prescription Program

51902 General Prescription Program

52000 Health Source RX

52100 Healthlink

52200 Healthstar Drug Program

52300 Humana Pharmacy Reimbursement

52301 Humana Pharmacy Department

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -5)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 52302 Humana Pharmacy Department

52303 Humana Inc.

52400 Immediate Pharmacy Service

52500 Express Scripts

52600 Express Scripts (NPA)

52700 Medco

52701 Medco

52702 Medco

52703 Medco

52704 Medco

52705 Medco

52706 Medco

52707 Medco

52708 Medco

52709 Medco

52710 Medco

52711 Medco

52712 Medco

52713 Medco

52714 Medco

52720 Medco

52800 Medco

53000 Express Scripts (NPA)

53100 Express Scripts (NPA)

53101 Express Scripts (NPA)

53200 National RX Services

53300 All Scripts Networks

53301 All Scripts Networks

53401 Drug Coverage Thru PBM

53402 Drug Coverage No Web Info

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -6)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 53500 Caremark

53501 Caremark

53502 Caremark

53503 Caremark

53504 Caremark

53505 Caremark

53507 Caremark

53508 Caremark

53510 Caremark

53600 Perform-Express Scripts

53601 Perform-Express Scripts

53700 NPS National Pharmacy Services

53800 Pharmacists Care Card

53801 Power Group (PCS)

53900 Pharmacy Access, J.H. Financial

54000 Pharmacy Benefits Association

54001 Pharmacy Benefits Association

54100 Prime Therapeutics BCBS/IL

54300 Pharmalink

54301 Pharmalink

54302 Pharmalink

54400 PII Benefit Trust

54500 Premier Pharmacy Plan

54600 NMHCRX

54700 Priority RX Pharmacy

54800 PRO Vantage MEDCO

54801 Medco

54802 Medco

54803 Medco

54804 Medco

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -7)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 54805 Medco

54900 Professional Benefits

55000 RHC/Spacemaster Corp.

55100 Relistar

55200 Restat

55202 Restat Group

55300 RPX (UFCW)

55301 RPX (UFCW)

55400 RX America

55401 RX America

55402 RX America

55403 RX America Drug Card

55404 RX America Benefit Plan Admin.

55500 HCH Admin.-Attn: Keppcard

55600 Prime Therapeutics BCBS/IL

55601 Prime Therapeutics/RX Gold

55700 RX Management

55800 Express Value RX Net

55801 RX Net Express Scripts

55900 Cigna Pharmacy Services

55901 RX Prime-Cigna

55902 Cigna Pharmacy Service Center

56000 Samscript

56100 Sav-RX

56300 Serv U Prescription

56301 Serv U Prescription

56400 Sherrick Drug & Medical

56500 Starmark RX Drug Program

56600 Meritain Health

56700 TDI Eckerd Managed Care

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -8)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 56701 TDI-Eckerd Pharmacare

56800 Thrift Drug Inc.

56900 Union Plaza Pharmacy

57000 Value RX-Express Scripts

57001 Value RX-Express Scripts

57002 Value RX-Express Scripts

57003 Value RX-Express Scripts

57004 Value RX-Express Scripts

57005 Value RX-Express Scripts

57006 Value RX-Express Scripts

57007 Value RX-Express Scripts

57008 Value RX-Express Scripts

57009 Value RX-Express Scripts

57100 Walgreens Health Services

57102 Walgreens Health Services

57103 Walgreens Health Services

57105 Walgreens Health Services

57106 Walgreens Health Services

57107 Walgreens Health Initiatives

57200 Walmart Pharmacy

57201 Walmart RX Claims Adm.

57300 Wellpoint Pharmacy

57301 Wellpoint-Unicare-Pro Serv

57302 Wellpoint-Unicare-Pro Serv

57400 WHP Health Initiative

57500 Caremark/Advance Recap Claims

57501 Caremark/Advance Recap Claims

57502 Caremark/Advance Recap Claims

57600 American Drug Stores

57700 Affordable Network

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -9)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 57800 Cannon Cochran Management Services

57900 Consultec

58000 Osco Drugs-3rd Party Dept.

58100 Rollins Inc.

58200 UFCW

58201 UFCW

58202 UFCW Local 655

58301 United Healthcare

58303 United Healthcare

58304 United Healthcare

58305 United Healthcare

58306 United Healthcare

58400 Valspar Human Resources

58500 Ethix-ProAmerica Midwest

58600 Employer Benefits Corp.

58700 Phoenix Group Services

58800 APM (Community RX)

58900 Script Care

59000 USA Health

59100 RX West

59200 Eckerd Health Services-TDI

59300 Pharmaceutical Prescription

59400 Professional Benefits Adm.

59500 Pharma Care All Scripts Network

59600 Catalyst RX

59601 Catalyst RX

59700 Anthem RX

59701 Anthem Home Life (AHL)

59702 Anthem RX

59703 Anthem

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -10)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 59800 Carpenters Health Welfare

59900 Prescript-Med America

70000 Pharmacy Network

70100 Unified Group Investment

70300 American National Insurance

70400 International Pharmacy Mgt.

70500 United Provider Services

70600 National Community Pharmacy

70800 Meijer Inc.

70900 Pharmacy Network National Corp.

71000 Medtrack Pharmacy Claims

71100 Regence Life & Health Ins. Co.

71200 Prescription Solutions

71300 Starbridge

71400 MIM Health Plans

71500 United Medical Resources

71600 Inteq

71700 Pharmacy Associates Inc.

71800 American Medical Security

71900 Medimpact Attn: Claims

72000 Prescription Network of Kansas

72100 Central Laborers

72101 Southern Illinois Laborers

72200 Pharmacy Advantage Systems

72300 Westport Benefits

72400 Rightchoice

72500 American Trust Administrators

72600 District 9 Health & Welfare Attn: Nancy Heim

72700 Pharmacy Services Group

72800 Century Planners

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -11)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 72900 Teamsters Local 682

72901 Teamsters Local 722

72902 Teamsters Welfare Trust

72903 Teamsters Local 744

73000 Prudential Pharmacy Management

73100 National Medical Health Card Services

73200 One Health Plan

73300 Self Insured Services Co.

73400 OBA Midwest

73500 Argus Health Systems

73501 Care First

73502 Argus Health Systems

73600 Epoch

73700 Unicare

73800 American Freightways

73900 Mutual of Omaha SM Group Claims

73901 Mutual of Omaha

74000 Alternative Risk Management

74100 Coresource

74200 Local 743

74300 NECA Local 145

74400 Burns and Company

74500 Cornerstone Benefits

74600 Wausau Pharmacy Benefits

74700 Allied Benefit System

74900 Administrative Service Consult

75000 Trustmark

75100 Benckmark-Drug Claims

75200 Nyhart Co.

75300 Country Companies

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -12)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 75400 Centrus Pharmacy Solutions

75500 Neighbor Care Card

75600 Woodward Healthcare

75700 Gallagher Benefit Administration

75800 Benefit Systems and Services

75900 LDI

76000 PBM Plus

76100 TBG Inc.

76200 Associated Third Party Admin.

76300 Conseco

76400 Painters Welfare Plan #2

76500 HealthExtras and Catalyst RX

76600 Group Management Services

76700 McElroy Metal

76800 Corporate Benefit Service of A

76900 IBEW Local 309

77000 McAughlin Body Co.

77100 EBX Incorporated

77200 MAPA

77300 Wellpoint Pharmacy Management

77400 Med Script

77500 Golden Rule Insurance Co.

77600 Benefit Consultants Inc.

77800 Bankers Life & Casualty

77900 American Diversified Pharmacy

78000 Willis Corroon

78100 Providence Administrative Services

78300 Butler Benefit Services

78400 Partners RX Management

78500 Bio Scrip

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -13)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 78600 Nestle USA-Attn: J. Donahue

78800 Rockford Construction Ind. Fund

78900 Pharmaceutical Care Network

79000 Illinois Valley Community Hospital

79100 McDermott, Will and Emory

79200 Pro Care RX

79300 Indiana State Council Roofers

79400 Iron Workers Stl District

79500 Cannon Precision Manufacturing

79600 Sheet Metal Workers Local 1

79700 Southwestern Indiana Health

79800 Midwest Central Operating Engineers

79900 Total Script

80000 Iowa Health Solutions

80100 Acordia Senior Benefits

80200 CBCA RX

80300 American Republic Insurance Co.

80400 Innoviant

80500 Envision/RX Options

80600 Member Health

80700 TRI Scripts/TRI Cast

80800 Physicians Plus Ins. Corp.

80900 Scrip Solutions

81000 SXC Health Solutions Inc

81100 RX Pharmacy Solutions

81200 United Drug Program

81300 Healthtrans

81400 BCI Administrators

81500 SUNRX

81600 ACS

Handbook for Providers Chapter 100 - General Appendices

HFS General Appendix 13 (numeric -14)

INSURING ORGANIZATION LISTED NUMERICALLY BY PBM CODE 81700 Schnuck Markets Inc.

81800 RX Options, Inc.

81900 SISCO

82000 AVIA Partners

82100 Scriptguide

82200 EHIM

82300 PRAM Insurance Services

82400 Mutual Medical Plans

82500 Welldyne RX West

82600 Scriptrax

82700 Healthspring

82800 Wellpoint Next RX

82900 Pharmacy Data Management

83000 Beyond RX