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10970 Shadow Creek Pkwy, Suite 110.1 Pearland, TX 77584 Phone: (832) 284-4933 Fax: (888) 383-2140 08/15/2019 PA Approved o Members or their providers may call 1-866-387-2573 to submit a prescription to CVS Specialty Pharmacy o CVS Specialty can deliver medications to location of the members choice: • Home • Work • Pharmacy o CVS Specialty Pharmacy Care Team is available for members with questions such as order status, billing questions and medication side ... New York State residents may call the CSP toll-free referral line, 1-866-442-CANCER (2262), 24 hours a day, seven days a week, to be connected to the CSP in their area. Questions? Contact the Division of Program Development and Management at …Prescription. Services. CVS Caremark Specialty Pharmacy now provides. convenient access of medication through CVS/pharmacy ®. Refer your patients today. Find a …

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106-37207A 031824 Plan member privacy is important to us. Our employees are trained regarding the appropriate way to handle members’ private health information.

Questions? You can contact the IAM Benefit Trust Fund Office directly to get more information about the plan. Phone: 800-457-3481 or 202-785-8148.Our phones are open Monday through Friday, 8:30 a.m. to 4:00 p.m. Eastern Time. Specialty Pharmacy at 1-866-387-2573. For most specialty drugs, the contracted specialty drug mail-order pharmacy is required. • These drugs must be filled via the CVS Specialty Pharmacy. Call 1-866-387-2573. • Specialty drugs that are essential health benefits and obtained from in-network retail and mail order locations CVS Specialty Pharmacy (1-800-237-2767 OR 1-866-387-2573) YES Provider Network: 866-560-4042 (Options in order 5, 7) OR Pharmacy Customer Service 602-778-1800 (Options in order 5, 5) CHP All See Mercy Care YES See Mercy Care MOLINA HEALTHCARE Central Any contracted pharmacy YES Molina Contact Center: • Call 800-424-5891 Home | Department of General Services

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10970 Shadow Creek Pkwy, Suite 110.1 Pearland, TX 77584 Phone: (832) 284-4933 Fax: (888) 383-2140 04/08/2020 PA Approved Prescriber: Greg Pearson Patient: Charles Wilson

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SPECIALTY DRUG: MBR CALL 866-387-2573 Lotgl: Dispense InfiYmation - F5 4.000 Qty Written: De ys Supply: Re fills Auth: 4.000 Qty Dispensed: INJECT Two SYRINGES (600 MG) UNDER THE SKIN ON DAY ONE. 14 Units Per Dose: D Doses Per Day: 1.000 FiUsOwed: Accumula ted Dedu ctible: Remaining Deductible: Benefits Remaining:

• To transfer your prescription, call CVS at 866-387-2573 • For a new prescription, your doctor can send the order to CVS one of three ways: • Electronically through e-prescribe • Fax: 866-329-2779 • Phone: 866-782-2779, option 2 …

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