CREDENTIALED PHARMACIES LISTING

1 173 Total CREDENTIALED PHARMACIES as of 2/1/2022 2022 NCCP Network Compound Credentialing Program CREDENTIALED PHARMACIES LISTING Please Note: You may not see a pharmacy near you (or even in your state of residence) listed, however the NCCP PHARMACIES listed for each state are licensed to dispense and ship compound medications to that state. Not all NCCP PHARMACIES participate in all networks. Please verify the compound CREDENTIALED pharmacy participates in your Plan s network. 2/1/2022 Introduction This user guide will assist members with the selection of a pharmacy which has been CREDENTIALED with the OptumRx Network Compound Credentialing Program (NCCP). Using the guide This guide is in alphabetical order by state.

2 Each page provides a list of the PHARMACIES CREDENTIALED and licensed to dispense within that state. Symbols next to the PHARMACIES are also provided for reference for some of the more routine types of compounded products. If your type of product is not listed, or if you are unsure of the type of compounded product you are filling; the PHARMACIES listed should be able to answer your questions based on the prescriptions and direct you appropriately as to their ability to compound the product. Also, please be aware that not ALL compounded medications require a pharmacy that is listed within this guide . Some of the more simple compounds which do not require a rigorous credentialing review may be made available to you from any of the network pharmacy providers that you use for your routine medications.

3 How to find a pharmacy that dispenses a specific type of compound medication The abbreviations below represent routine types of compounds. Not all PHARMACIES are CREDENTIALED to dispense all types of compounds. The charts on each page will let you know which pharmacy may be able to compound the medication you need. (For example, if the prescription appears to be for a topical product look for the TOP symbol after the PHARMACIES within your state.) TOP: denotes topical products ( pain ointments/gels and topical hormone creams) HRT: denotes hormone replacement therapy and fertility medications ( estriol) PED: denotes pediatric (children) custom products ( liquid g-tube preparations) NAS: denotes nasal or oral inhaled therapies ( antibiotic or steroid nasal compounds) STR: denotes sterile Preparations ( IV, IM, SC and Epidural injections, Ophthalmic preparations, and fortified antibiotic/antifungal drops) SUP: denotes Supplements ( Enzymes, EFA s, Vitamin A/C/D and Calcium) PTD: denotes Medicare Part D (.)

4 A compound claim for a Medicare Part D beneficiary) Please Note: You may not see a pharmacy near you (or even in your state of residence) listed, however the NCCP PHARMACIES listed for each state are licensed to dispense and ship compound medications to that state. Not all NCCP PHARMACIES participate in all networks. Please verify the compound CREDENTIALED pharmacy participates in your Plan s network. 2/1/2022 St ate Menu: ALABAMA(AL) ALASKA (AK) ARIZONA (AZ) ARKANSAS (AR) CALIFORNIA (CA) COLORADO (CO) CONNECTICUT (CT) DISTRICT OF COLUMBIA (DC) DELAWARE (DE) FLORIDA (FL) FLORIDA (FL) Continued GEORGIA (GA) HAWAII (HI) IDAHO (ID) ILLINOIS (IL) INDIANA (IN) IOWA (IA) KANSAS (KS) KENTUCKY (KY) LOUISIANA (LA) MAINE (ME) MARYLAND (MD) MASSACHUSETTS (MA) MICHIGAN (MI) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MONTANA (MT) NEBRASKA (NE) NEVADA (NV) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NEW YORK (NY) Continued NORTH CAROLINA (NC) NORTH DAKOTA (ND) OHIO (OH) OKLAHOMA (OK) OREGON (OR) PENNSYLVANIA (PA) RHODE ISLAND (RI) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) TENNESSEE (TN) TEXAS (TX) UTAH (UT)

5 VERMONT (VT) VIRGINIA (VA) WASHINGTON (WA) WEST VIRGINIA (WV) WISCONSIN (WI) WYOMING (WY) Please Note: You may not see a pharmacy near you (or even in your state of residence) listed, however the NCCP PHARMACIES listed for each state are licensed to dispense and ship compound medications to that state. Not all NCCP PHARMACIES participate in all networks. Please verify the compound CREDENTIALED pharmacy participates in your Plan s network. 2/1/2022 ALABAMA(AL) ALASKA (AK) Return to Instructions * Return to Menu Pharmac y NameAddressCityStateZip CodePhoneFaxTOP HRTPEDNAS STRSUPPTDA dvanced Infusion Solutions623 Highland Colony Parkway Suite 100 RidgelandMS39157(601)988-1700(888)298-22 20 XXBoothwyn Pharmacy221 Gale LaneKennett SquarePA19346(800)476-7496(610)497-4371 XXXXXB roadway Apothecary1515 Oak StreetEugeneOR97401(541)684-9352(888)963 -7563 XXXXXXC ascade Specialty Pharmacy325 NE Hostmark StPoulsboWA98370(360)779-2737(866)749-57 28 XXXXXXXC hemistry Rx829 Spruce Street Suite 100 PhiladelphiaPA19107(855)790-0100(267)861 -0862 XConversio Health720 Aerovista Place Suite DSan Luis ObispoCA93401(866)239-3784(800)

6 977-9255 XXCreams N Caps Michigan31035 Schoolcraft RoadLivoniaMI48150(800) (800)537-5193 XXXXE lements Compounding Pharmacy2110 E Baseline RdMe s aAZ85204(480)625-4750(480)625-3054 XXXXF oundation Care, LLC4010 Wedgeway CourtEarth CityMO63045(877)291-1122(877)291-1155 XXXXXXXHoye's Pharmacy4330 South Manhattan AvenueTa mpaFL33611(813)839-8861(813)839-8941 XXXXXXI nfinity Care Solutions1204 SE 28th Street Suite 2 BentonvilleAR72712(888)414-5805(855)422- 2400 XXXXXM alanda, Inc dba Mandell's Clinical pharmacy 7 Cedar Grove Lane. Ste 24 Somerset NJ088763(732)907-6780(732)412-7091 XXXMega Aid pharmacy II, Inc140 58th St Suite 8 GBrooklynNY11220(212)920-4500(718)744-27 24 XXPacifica Pharmacy23560 S. Madison St #112 TorranceCA90505(310)530-0831(310)530-821 8 XXXP atient Care America3890 Park Central Blvd.

7 N Pompano BeachFL33351866-348-0441888-503-6982 XXXP harmacy Solutions5204 Jackson Road Suite CAnn ArborMI48103(734)821-8000(734)821-8001 XXXXXXP harmco Inc381 Van Ness Av #1506 TorranceCA90501(310) 783-7450(310) 783-7459 XXXXPro Compounding Pharmacy527 N State Of Franklin Rd Suite 2 Johnson CityTN37604(423)975-0597(423)975-0597 XXXXXS andsRx4 Regency DriveWylieTX75098(972)535-2020(855)385-9 990 XXXXXS mart Workers Pharmacy3740 St. Johns Bluff Road S Suite 21 JacksonvilleFL32224(904)575-3571(844)904 -2667 XXSoleo Health Inc 6190 Shamrock Court Suite 100 DublinOH43016(844)467-8200(614)467-8300 XXXS oleo Health Inc 10210 Werch Drive Suite 202 WoodridgeIL60517(630)478-8240(630)333-97 71 XXXS oleo Health S 48th Street, Suite 101Te mpeAZ85281(480)296-0222(480)264-0495 XXXS outh River Compounding Pharmacy3656 Mayland CourtRichmondVA23233(804)897-6447(804)96 7-6449 XXXXXX Please Note: You may not see a pharmacy near you (or even in your state of residence) listed, however the NCCP PHARMACIES listed for each state are licensed to dispense and ship compound medications to that state.

8 Not all NCCP PHARMACIES participate in all networks. Please verify the compound CREDENTIALED pharmacy participates in your Plan s network. 2/1/2022 ARIZONA (AZ) Return to Instructions * Return to Menu Pharmac y NameAddressCityStateZip CodePhoneFaxTOP HRTPEDNAS STRSUPPTDA dvanced Infusion Solutions623 Highland Colony Parkway Suite 100 RidgelandMS39157(601)988-1700(888)298-22 20 XXAnderson Compounding Pharmacy310 Bluff City HighwayBristolTN37620(423)764-4136(423)7 64-5167 XXXXXXA ristacare Health Inc1056 W Golf RoadHoffma n Es ta te sIL60169(847)790-3995(847)490-3793 XXAventus Pharmacy10323 Cross Creek BlvdTa mpaFL33647(813)-991-8731(888)843-3886 XXXXXA ventus Pharmacy1977 Alafaya Trail Suite 1121 Ovi e doFL32765(407)593-2844(888)-843-3886 XXXXXXB oothwyn Pharmacy221 Gale LaneKennett SquarePA19346(800)476-7496(610)

9 497-4371 XXXXXB uderer Drug Company26611 N. Dixie Highway Suite 119 PerrysburgOH43551(419)873-2800(419)873-0 494 XXXXXXXCareFirst Specialty Pharmacy2200 Garry Rd Ste 1 CinnaminsonNJ8077(844)822-7379(844)922-7 379 XXCarefree Compounding Wellness2525 W. Carefree Hwy Bld 1 Suite 100 PeoriaAZ85383(623)806-1300(623)806-1304 XXXXXXC ascade Specialty Pharmacy325 NE Hostmark StPoulsboWA98370(360)779-2737(866)749-57 28 XXXXXXXC hartwell Pennsylvania LP1001 Oakdale RdOakdalePA15071(412) 920-7500(412) 920-2830 XChemistry Rx829 Spruce Street Suite 100 PhiladelphiaPA19107(855)790-0100(267)861 -0862 XCompounding Docs Inc1000 Clint Moore Rd. BLDG B #201 Boca RatonFL33487(561)826-0711(888)400-9810 XXXXXXXC onversio Health720 Aerovista Place Suite DSan Luis ObispoCA93401(866)239-3784(800)977-9255 XXCreams N Caps Michigan31035 Schoolcraft RoadLivoniaMI48150(800) (800)537-5193 XXXXCureRx Compounding Pharmacy5060 W.

10 Sunset Blvd Suite CLos AngelesCA90027(323)667-1111(323)667-1131 XXCustom Rx pharmacy & Wellness Concepts3510 N Ridge Road Suite 900 WichitaKS67205(316)721-2626(316)721-4823 XXXXXXXD elco Drugs 3833 Richmond AveStaten IslandNY10312(718)984-6600(718)984-6601 XXXXDoug's Compounding Pharmacy137 N. Market StreetPaxtonIL60957(217)379-3684(217)379 -6115 XXXXE lements Compounding Pharmacy2110 E Baseline RdMe s aAZ85204(480)625-4750(480)625-3054 XXXXFort Worth Pharmacy7833 Oakmont Blvd. Ste 120 Fort WorthTX76132(817)361-9960(817)361-9970 XXXXF oundation Care, LLC4010 Wedgeway CourtEarth CityMO63045(877)291-1122(877)291-1155 XXXXXXXHan Sam Corporation dba River's Edge Pharmacy36919 Cook Street Suite 102 Palm DesertCA92211(760) 340-3248(855)862-0446 XXHealth Dimensions Compounding Pharmacy39303 Country Club DrFarmington HillsMI48331(248)489-1573(248)489-1586 XXXXXXXH ealthSmart Pharmacy2001 S Main StWake ForestNC27587(919)569-0500(919)556-4288 XXXXXHoye 's Pha rma c y4330 South Manhattan AvenueTa mpaFL33611(813)839-8861(813)839-8941 XXXXXXI nfinity Care Solutions1204 SE 28th Street Suite 2 BentonvilleAR72712(888)414-5805(855)422- 2400 XXXXXI nnovative Pharmacy312-B Marion AveMc CombMS39648(601)