CREDENTIALED PHARMACIES LISTING

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2021NCCP – Network Compound Credentialing ProgramCREDENTIALEDPHARMACIES LISTING208 Total Credentialed Pharmacies as of 3-19-2021

IntroductionThis user guide will assist members with the selection of a pharmacy which has been credentialed with theOptumRx Network Compound Credentialing Program (NCCP).Using the GuideThis guide is in alphabetical order by state. Each page provides a list of the pharmacies credentialed andlicensed to dispense within that state.Symbols next to the pharmacies are also provided for reference for some of the more routine types ofcompounded products. If your type of product is not listed, or if you are unsure of the type of compoundedproduct you are filling; the pharmacies listed should be able to answer your questions based on theprescriptions 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 thisGuide. Some of the more ‘simple’ compounds which do not require a rigorous credentialing review may bemade available to you from any of the network pharmacy providers that you use for your routine medications.How to find a pharmacy that dispenses a specific type of compound medicationThe abbreviations below represent routine types of compounds. Not all pharmacies are credentialed todispense 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 thepharmacies within your state.) TOP:HRT:PED:NAS:STR:denotes topical products (e.g. pain ointments/gels and topical hormone creams)denotes hormone replacement therapy and fertility medications (e.g. estriol)denotes pediatric (children) custom products (e.g. liquid g-tube preparations)denotes nasal or oral inhaled therapies (e.g. antibiotic or steroid nasal compounds)denotes sterile Preparations (e.g. IV, IM, SC and Epidural injections, Ophthalmic preparations andfortified antibiotic/antifungal drops)SUP: denotes Supplements (e.g. Enzymes, EFA’s, Vitamin A/C/D and Calcium)PTD: denotes Medicare Part D (e.g. 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 theNCCP 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.\3-19-2021

STATESMENU: Please click your specific state to navigate through the Pharmacy Locator Guide.ALAL nt.MACont. 1MA-Cont.2MACont. WI-Cont.WYWY-Cont.Please Note: You may not see a pharmacy near you (or even in your state of residence) listed, however theNCCP 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.\3-19-2021

ALABAMA(AL)Pharmacy NameAddressCityState Zip Code PhoneFaxAdvanced Infusion Solutions623 Highland Colony Parkway Suite n Compounding Pharmacy310 Bluff City Aventus Pharmacy10323 Cross Creek irst Specialty Pharmacy2200 Garry Rd Ste x Pharmacy 7255547 Normandy BlvdJacksonvilleFL32205(904) 374-2692 (866) 725-5332XCompound Pharmaceutical Technologies1048 Stanton Road Suite BDaphneAL36526251-626-2820XConversio Health720 Aerovista Place Suite DSan Luis ObispoCA93401(866) 239-3784 (800) 977-9255DermaTran Health Solutions85 Technology Pkwy NWRomeGA30165855-675-5240844-265-1995XXXXDiabetes Corporation of America233 Bedford well Specialty Pharmacy6506 N. Davis XFoundation Care, LLC4010 Wedgeway CourtEarth CityMO63045314-291-1122314-291-1133XInfinity Care Solutions1204 SE 28th Street Suite ation Compounding Inc6095 Pine Mountain Road NW suite ess Apothecary Trinity24333 Gordon Terry Parkway Suite BTrinityAL35673256-260-3350256-260-3351XKeystone Pharmacy, LLC118 Weisenberger #400MadisonMS39110855-739-9948855-221-0918XLee Silsby Compounding Pharmacy3216 Silsby RdCleveland y Compounding Inc.2422 Danville Rd SW Suite HDecaturAL35603(256) 353-1123 (256) 280-3551XXXXXXXMack Bayou Pharmacy82 Mack Bayou LoopSanta Rosa BeachFL32459850-622-0730850-622-0730XXXXMillers Compounding Pharmacy678 Wyckoff XOptum Pharmacy 801, Inc23620 N 20th Drive Suite nt Care America3890 Park Central Blvd. NPompano BeachFL33351954-473-4717954-473-9519XPentec Health, Inc.4 Creek rmacy Solutions5204 Jackson Road Suite CAnn ArborMI48103(734) 821-8000 (734) 821-8001XXXXXXPro Compounding Pharmacy527 N State Of Franklin Rd Suite 2Johnson nal Arts Pharmacy128 Curran sRx4 Regency DriveWylieTX75094972-535-2020855-385-9990XXXSP2, LLC.3740 St. Johns Bluff Road mart Workers Pharmacy3740 St. Johns Bluff Road S Suite 19JacksonvilleFL32224(904) 575-3571 (844) 904-2667Soleo Health Inc.721 S. Glasgow Ave., Suite CInglewoodCA90301(310) 665-1121 (310) 665-1141XXSoleo Health Inc.3100 Medlock Bridge Road, Suite 200NorcrossGA30071(470) 226-2300 (770) 545-6583XXSoleo Health Inc.5 Shawmut Road, Suite 103CantonMA02021(781) 298-3427 (339) 368-7716XXSoleo Health Inc.26800 Meadowbrook Road, Suite 119NoviMI48377(248) 513-8687 (248) 939-5288XXSoleo Health Inc.4 Skyline DrHawthorneNY10532(800) 395-6143 (800) 395-6149XXSoleo Health Inc.8275 El Rio, Suite 180HoustonTX77054(832) 981-1000 (713) 574-9676XXSoleo Health Inc.2912 W 6th St Suite 120Fort WorthTX76107(817) 916-1206 (817) 381-4419XXSoleo Health Inc.100 Riverchase Center, Suite 308HooverAL35244(205) 994-7103 (205) 588-0255XXSoleo Health Inc.1324 W. Winton Ave.HaywardCA94545(510) 362-7360 (510) 460-1389XXSoleo Health Inc.415 S 48th Street, Suite 101TempeAZ85281(480) 296-0222 (602) 910-4801XXSoleo Health Inc.2866 Dauphin Street, Suite HMobileAL36606(251) 234-6075 (251) 272-3298XXSoleo Health Inc.655 W. Grand Ave., Unit 240ElmhurstIL60124(630) 478-8240 (630) 782-4889XXSoleo Health Inc.6185 Shamrock Ct, Suite ADublinOH43016(614) 467-8200 (614) 467-8300XXSoleo Health Inc.474 Northlake Blvd, Suite 1016Altamonte SpringsFL32701(407) 670-1230 (407) 605-5853XXSoleo Health Inc.6801 South Yosemite Street Suite B1CentennialCO80112(303) 968-1915 (720) 266-4926XXSoleo Health Inc.950 Calcon Hook Road, Suite 19Sharon HillPA19079(610) 200-6502 (610) 726-1882XXSoleo Health Inc.204 Three Springs Dr Suite 3WeirtonWV26062(603) 324-2978 (603) 718-3824XXTopical Solutions Pharmacy20612 N. Cave Creek Rd. #150PhoenixAZ85024(480) 351-8278 (480) 351-8277XXTPS3524 Decatur Highway Suite sdermal Therapeutics, Inc.211 Summit Pkwy Suite 124HomewoodAL35209877-581-5445877-495-5445XVasco Rx Specialty Pharmacy4045 E Bell Rd Suite 163PhoenixAZ85032(602) 971-6950 (602) 404-2504XXXXVillage Compounding Pharmacy975 Corbindale RdHoustonTX77024713-464-5069XXXXVital Care of Meridian1501 23rd AveMeridianMS39301800-652-6157XXXXReturn to Instructions251-626-2850713-464-5099TOPHRT PED NAS STR SUP PTDXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX* Return to MenuPlease Note: You may not see a pharmacy near you (or even in your state of residence) listed, however theNCCP 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.\3-19-2021

ALASKA (AK)Pharmacy NameAddressState Zip Code PhoneFaxAdvanced Infusion Solutions623 Highland Colony Parkway Suite 100 RidgelandCityMS39157877-443-4006888-298-2220TOP HRT PED NAS STR SUP PTDAnderson Compounding Pharmacy310 Bluff City etech Rx Specialty Pharmacy85-48 118th streetKew GardensNY11415(718) 441-5474 (718) 441-5469XBoothwyn Pharmacy221 Gale LaneKennett SquarePA19061610-485-1130Broadway Apothecary1515 Oak StreetEugeneOR97401Cascade Specialty Pharmacy325 NE Hostmark StPoulsboWA98370Chemistry Rx829 Spruce Street Suite 100PhiladelphiaPA19107855-790-0100Conversio Health720 Aerovista Place Suite DSan Luis ObispoCA93401(866) 239-3784 (800) 977-9255DermaTran Health Solutions85 Technology Pkwy NWRomeGA30165855-675-5240844-265-1995XXXXEverwell Specialty Pharmacy6506 N. Davis XFusion Specialty Pharmacy1100 Canyon View Drive Suite CSanta ClaraUT84765435-703-9680435-703-9681XXXXInfinity Care Solutions1204 SE 28th Street Suite vation Compounding Inc6095 Pine Mountain Road NW suite 108 KennesawGA30152770-421-1399770-426-1965XXInverness Apothecary Trinity24333 Gordon Terry Parkway Suite BTrinityAL35673256-260-3350256-260-3351XLee Silsby Compounding Pharmacy3216 Silsby RdCleveland Heights OH44118216-321-4300216-321-4303XXMillers Compounding Pharmacy678 Wyckoff ent Care America3890 Park Central Blvd. NPompano BeachFL33351954-473-4717Pentec Health, Inc.4 Creek ParkwayBoothwynPA19061Pharmacy Specilaties & Clinic2333 W 57TH STSioux FallsSDProfessional Arts Pharmacy128 Curran LnLafayetteSP2, LLC.3740 St. Johns Bluff Road #19Soleo Health Inc.415 S 48th Street, Suite 101University Compounding PharmacyVasco Rx Specialty PharmacyXXXXXXXX(541) 684-9352 (541) 684-0858XXXX(360) 779-2737 (360) 361-3861904-361-3866XXXTempeAZ85281(480) 296-0222 (602) 910-48011875 3rd AveSan DiegoCA92101(619) 683-2005 (619) 683-2008XXXXX4045 E Bell Rd Suite 163PhoenixAZ85032(602) 971-6950 (602) 404-2504XXXXXReturn to InstructionsXXXXXXXXXXXX* Return to MenuPlease Note: You may not see a pharmacy near you (or even in your state of residence) listed, however theNCCP 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.\3-19-2021

ARIZONA (AZ)Pharmacy NameAddressState Zip CodePhoneAdvanced Infusion Solutions623 Highland Colony Parkway Suite 100 RidgelandCityMS39157877-443-4006 888-298-2220FaxTOP HRT PED NAS STR SUP PTDAnderson Compounding Pharmacy310 Bluff City HighwayBristolTN37620423-764-4136 423-764-5167XApothetech Rx Specialty Pharmacy85-48 118th streetKew GardensNY11415(718) 441-5474 (718) 441-5469XAventus Pharmacy10323 Cross Creek BlvdTampaFL33647321-356-1454 888-843-3886Boothwyn Pharmacy221 Gale LaneKennett SquarePA19061Buderer Drug Company26611 N. Dixie Highway Suite 119PerrysburgOH43551CareFirst Specialty Pharmacy2200 Garry Rd Ste 1CinnaminsonNJCarefree Compounding Wellness2525 W. Carefree Hwy Bld 1 Suite 100PeoriaCascade Specialty Pharmacy325 NE Hostmark StPoulsboChemistry Rx829 Spruce Street Suite 100Compounding Docs IncConversio HealthXXXXXXXXXX610-485-1130 610-485-9223XXXXXXX419-873-2800 419-873-0494XXXXXXX8077856-267-0528 856-267-0529XXAZ85383623-806-1300 623-806-1304XXXXXXWA98370(360) 779-2737 (360) 779-4905XXXXXPhiladelphiaPA19107855-790-0100 267-861-08621000 Clint Moore Rd. BLDG B #201Boca RatonFL33487561-826-0711 561-826-0717XX720 Aerovista Place Suite DSan Luis ObispoCA93401(866) 239-3784 (800) 977-9255Creams N Caps Michigan25875 Novi Road Suite 130NoviMI48375(248) 530-5769 (248) 308-2635XCureRx Compounding Pharmacy5060 W. Sunset Blvd Suite CLos AngelesCA90027323-667-1111 323-667-1131XCustom Rx Pharmacy & Wellness Concepts 3510 N Ridge Road Suite 900WichitaKS67205316-721-2626 316-721-4823XXXXDermaTran Health Solutions85 Technology Pkwy NWRomeGA30165855-675-5240 844-265-1995XXXXDiabetes Corporation of America233 Bedford WayFranklinTN37064877-730-5770 877-327-9174XXXXElements Compounding Pharmacy2110 E Baseline RdMesaAZ85204480-625-4750 480-625-3054XXXXEverwell Specialty Pharmacy6506 N. Davis HighwayPensacolaFL32504850-473-9190 850-473-9935XXXXFoundation Care, LLC4010 Wedgeway CourtEarth CityMO63045314-291-1122 314-291-1133XFountain Plaza Pharmacy2825 W. Andrew Johnson HwyMorristownTN37814(423) 307-5757 (423) 307-5241XXXXFusion Specialty Pharmacy1100 Canyon View Drive Suite CSanta ClaraUT84765435-703-9680 435-703-9681XXXXHealth First Infusion1959 W 9th StreetWest Palm BeachFL33404561-842-2828 561842-1617Infinity Care Solutions1204 SE 28th Street Suite 2BentonvilleAR72712888-414-5805 855-422-2400XXInnovation Compounding Inc6095 Pine Mountain Road NW suite 108 KennesawGA30152770-421-1399 770-426-1965XXInverness Apothecary Trinity24333 Gordon Terry Parkway Suite BTrinityAL35673256-260-3350 256-260-3351XJersey Shore Pharmacy580 N Main StreetBarnegatNJ08005609-660-1111 609-660-0101XXXXKare Pharmacy411 Park AveDanvilleVA24541434-792-8281 434-792-3235XXXXKing's Pharmacy and Compounding Center 16205 Sand Canyon Ave #105IrvineCA92618(949) 387-0780 (949) 387-0784XXXXLa Vita Compounding Pharmacy3978 Sorrento Valley Blvd #300San DiegoCA92121858-453-2500 858-453-2501XXXXXLee Silsby Compounding Pharmacy3216 Silsby RdCleveland HeightsOH44118216-321-4300 216-321-4303XXXXXXXMillers Compounding Pharmacy678 Wyckoff AvenueWyckoffNJ07481888-891-3334 866-891-3334XXXXXXXOptum Pharmacy 801, Inc.23620 N 20th Drive Suite 12PhoenixAZ85085877-546-5779 877-546-5780XXXXXPatient Care America3890 Park Central Blvd. NPompano BeachFL33351954-473-4717 954-473-9519XPentec Health, Inc.4 Creek ParkwayBoothwynPA19061800-223-4376 610-494-7328XPerforMix Specialty Pharmacy25 Pelham RdSalemNH03079603-870-9618 603-870-9621XXXXPharmacy Solutions5204 Jackson Road Suite CAnn ArborMI48103(734) 821-8000 (734) 821-8001XXXXPharmacy Specilaties & Clinic2333 W 57TH STSioux FallsSD57108605-334-1672 605-331-3243XXXXPine Pharmacy5110 Main StWilliamsvilleNY14221716-332-2288 716-332-2287XXXPotter's House Apothecary21585 N 77th Ave. Suite 1500PeoriaAZ85382623-362-9322 623-362-9001XXPrecision Scripts Pharmacy1977 Alafaya Trail Suite 1121OviedoFL32765407-593-2844 407-593-2845XXProcare Pharmacy1084 Lee Rd, Suite 4OrlandoFL32810(407) 730-2770 (407) 730-2764XProfessional Arts Pharmacy128 Curran LnLafayetteLA70506337-991-0101 337-991-0151XXRaintree Apothecary9260 E Raintree Dr Suite 150ScottsdaleAZ85260(480) 912-5959 (480) 912-1950XXRock Valley Compounding Pharmacy811 S. Perryville Rd Unit 109RockfordIL61108(779) 423-0542 (815) 977-3077XXReturn to XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX* Return to MenuPlease Note: You may not see a pharmacy near you (or even in your state of residence) listed, however theNCCP 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.\3-19-2021

ARIZONA (AZ) – ContinuedPharmacy NameAddressCityState Zip CodePhoneSan Ysidro Pharmacy1498 East Valley RdSanta BarbaraCA93108805-969-2284 805-565-3174XXXSandsRx4 Regency DriveWylieTX75094972-535-2020 855-385-9990XXXSP2, LLC.3740 St. Johns Bluff Road #19JacksonvilleFL32224904-361-3861 904-361-3866XXXSmart Workers Pharmacy3740 St. Johns Bluff Road S Suite 19JacksonvilleFL32224(904) 575-3571 (844) 904-2667XSoleo Health Inc.721 S. Glasgow Ave., Suite CInglewoodCA90301(310) 665-1121 (310) 665-1141XXSoleo Health Inc.3100 Medlock Bridge Road, Suite 200NorcrossGA30071(470) 226-2300 (770) 545-6583XXSoleo Health Inc.5 Shawmut Road, Suite 103CantonMA02021(781) 298-3427 (339) 368-7716XXSoleo Health Inc.26800 Meadowbrook Road, Suite 119NoviMI48377(248) 513-8687 (248) 939-5288XXSoleo Health Inc.4 Skyline DrHawthorneNY10532(800) 395-6143 (800) 395-6149XXSoleo Health Inc.8275 El Rio, Suite 180HoustonTX77054(832) 981-1000 (713) 574-9676XXSoleo Health Inc.2912 W 6th St Suite 120Fort WorthTX76107(817) 916-1206 (817) 381-4419XXSoleo Health Inc.100 Riverchase Center, Suite 308HooverAL35244(205) 994-7103 (205) 588-0255XXSoleo Health Inc.1324 W. Winton Ave.HaywardCA94545(510) 362-7360 (510) 460-1389XXSoleo Health Inc.415 S 48th Street, Suite 101TempeAZ85281(480) 296-0222 (602) 910-4801XXSoleo Health Inc.2866 Dauphin Street, Suite HMobileAL36606(251) 234-6075 (251) 272-3298XXSoleo Health Inc.655 W. Grand Ave., Unit 240ElmhurstIL60124(630) 478-8240 (630) 782-4889XXSoleo Health Inc.6185 Shamrock Ct, Suite ADublinOH43016(614) 467-8200 (614) 467-8300XXSoleo Health Inc.474 Northlake Blvd, Suite 1016Altamonte SpringsFL32701(407) 670-1230 (407) 605-5853XXSoleo Health Inc.6801 South Yosemite Street Suite B1CentennialCO80112(303) 968-1915 (720) 266-4926XXSoleo Health Inc.950 Calcon Hook Road, Suite 19Sharon HillPA19079(610) 200-6502 (610) 726-1882XXSoleo Health Inc.204 Three Springs Dr Suite 3WeirtonWV26062(603) 324-2978 (603) 718-3824XSureCare Specialty Pharmacy4005 N. MesaEl PasoTX79902915-532-2400 855-821-7058XTopical Solutions Pharmacy20612 N. Cave Creek Rd. #150PhoenixAZ85024(480) 351-8278 (480) 351-8277XTransdermal Therapeutics, Inc.211 Summit Pkwy Suite 124HomewoodAL35209877-581-5445 877-495-5445XUniversity Compounding Pharmacy1875 3rd AveSan DiegoCA92101(619) 683-2005 (619) 683-2008XXXXXV.L.S. Pharmacy, Inc.4402 5th AvenueBrooklynNY11220(718) 854-1384 (718) 854-4313XXXXXXVasco Rx Specialty Pharmacy4045 E Bell Rd Suite 163PhoenixAZ85032(602) 971-6950 (602) 404-2504XXXXXXVillage Compounding Pharmacy975 Corbindale RdHoustonTX77024713-464-5069 713-464-5099XXXXReturn to InstructionsFaxTOP HRT PED NAS STR SUP PTDXXXXXXXXXXXXXXXX* Return to MenuPlease Note: You may not see a pharmacy near you (or even in your state of residence) listed, however theNCCP 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.\3-19-2021

ARKANSAS (AR)Pharmacy NameAddressCityState Zip Code PhoneFaxAdvanced Infusion Solutions623 Highland Colony Parkway Suite n Compounding Pharmacy310 Bluff City Aventus Pharmacy10323 Cross Creek irst Specialty Pharmacy2200 Garry Rd Ste try Rx829 Spruce Street Suite ersio Health720 Aerovista Place Suite DSan Luis ObispoCA93401(866) 239-3784 (800) 977-9255Custom Rx Pharmacy & Wellness Concepts3510 N Ridge Road Suite Tran Health Solutions85 Technology Pkwy NWRomeGA30165855-675-5240844-265-1995XXXXDiabetes Corporation of America233 Bedford WayFra

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 . RI RI-Cont. SC SC-Cont. SD SD-Cont. TN TN-Cont. TX TX-Cont. UT VT VT-Cont VA VA-C

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