Pharmacy
Directory
Addendum
For more recent information or other questions, please
contact KelseyCare Advantage at 1-866-589-5222 or
for TTY users 1-888-206-8041, 24 hours a day, 7 days
a week or visit www.kelseycareadvantage.com.
2017
Through 1/11/2017
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KelseyCare Advantage
2017 Pharmacy Directory Addendum
Introduction
This addendum provides updates about changes to KelseyCare Advantage’s list of network pharmacies.
These updates are current as of 1/11/2017. Pharmacies may have been added or removed from our network
after this addendum was created. This means the pharmacies listed here may no longer be in our network, or
there may be newer pharmacies in our network that are not listed. For the most current list, please see the
first cover page of this addendum for information on how to contact us.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please
review the Evidence of Coverage and KelseyCare Advantage’s formulary.
KelseyCare Advantage is offered by KS Plan Administrators LLC, a Medicare Advantage HMO plan with a
Medicare contract. Enrollment in KelseyCare Advantage depends on contract renewal. Benefits, deductibles
and/or copayments and coinsurance may change on January 1 of each year.
The pharmacy network may change at any time. You will receive notice when necessary.
KelseyCare Advantage’s pharmacy network offers limited access to pharmacies with preferred cost sharing
in urban and suburban areas within Texas. The lower costs advertised in our plan materials for these
pharmacies may not be available at the pharmacy you use. For up-to-date information about our network
pharmacies, including pharmacies with preferred cost sharing, please see the first cover page of this
addendum for information on how to contact us.
This information is available for free in other languages. KelseyCare Advantage can give you information in
Braille, in large print or other alternate formats upon request. For alternative formats, please see the first
cover page of this addendum for information on how to contact us.
KelseyCare Advantage es ofrecido por KS Plan Administrators LLC, un plan Medicare Advantage HMO que
tiene un contrato con Medicare. La inscripción en KelseyCare Advantage depende de la renovación del
contrato. Los beneficios, el deducible y/o los copagos y el coseguro pueden cambiar el 1 de enero de cada
año.
La red de farmacias puede cambiar en cualquier momento. Usted recibirá una notificación cuando sea
necesaria.
La red de farmacias de KelseyCare Advantage ofrece acceso limitado a farmacias con costo compartido
preferido en áreas urbanas y suburbanas dentro de Texas. Es posible que los costos menores publicados en
los materiales de nuestro plan para estas farmacias no estén disponibles para la farmacia que usted usa. Para
información actualizada sobre nuestra red de farmacias, incluyendo farmacias con costo compartido
preferido, por favor vea las portadas anterior de este apéndice para saber cómo contactarse con nosotros.
Esta información está disponible gratis en otros idiomas. KelseyCare Advantage puede brindarle información
en braille, en tamaño de letra grande o en otros formatos alternativos, si lo solicita. Para información alterna,
por favor vea las portadas anterior de este apéndice para saber cómo contactarse con nosotros.
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KelseyCare Advantage complies with applicable Federal civil rights laws and does not discriminate on the
basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than
English, language assistance services, free of charge, are available to you. Call 1-866-535-8343 (TTY: 1866-302-9936).
KelseyCare Advantage cumple con las leyes federales de derechos civiles aplicables y no discrimina por
motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: si habla español, tiene a su
disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-535-8343 (TTY: 1-866-302-9936).
KelseyCare Advantage tuân thủ luật dân quyền hiện hành của Liên bang và không phân biệt đối xử dựa trên
chủng tộc, màu da, nguồn gốc quốc gia, độ tuổi, khuyết tật, hoặc giới tính. CHÚ Ý: Nếu bạn nói Tiếng Việt,
có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-866-535-8343 (TTY: 1-866-302-9936).
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TERMINATIONS
to KelseyCare Advantage Pharmacy Network
The following pharmacies are no longer part of the KelseyCare Advantage pharmacy network. If you need
help finding a network pharmacy, please call 1-866-589-5222 or for TTY users 1-888-206-8041, or visit
www.kelseycareadvantage.com to access our online searchable directory.
PHARMACY NAME
Altus Pharmacy
BGC Pharmacy LLC
Express Family
Pharmacy LLC
Fort Bend Rx Pharmacy
Healthscripts Specialty
Pharmacy LLC
Hope Pharmacy
J & J Pharmacy
Kroger Pharmacy
Lifechek Drug
Madonna Pharmacy Inc
Omni-One-Med
Pharmacy Services LLC
Pharmserv Inc
Precious Place's
Pharmacy
Primary Care Pharmacy
LLC
Prize Pharmacy
Pro Med Rx
The Woodlands
Apothecary
United Rx Inc
Village Pharmacy
ADDRESS
1535 W Loop S Building,
Houston, TX, 77027
12101 Grant Rd, Cypress,
TX, 77429
10101 Fondren Rd Ste 106,
Houston, TX, 77096
1100 FM 1092 Rd Ste D,
Missouri City, TX, 77459
13020 Dairy Ashford Ste
301, Sugar Land, TX, 77478
1919 N Loop W, Houston,
TX, 77008
13415 Woodforest Blvd,
Houston, TX, 77015
19611 Eastex Fwy, Humble,
TX, 77338
1100 Jackson St, Richmond,
TX, 77469
10333 Harwin Dr Ste 450,
Houston, TX, 77036
17310 W Grand Pkwy S Ste
E, Sugar Land, TX, 77479
6828 Ranchester Dr,
Houston, TX, 77036
11336 Beechnut St Ste A8,
Houston, TX, 77072
6612 Hornwood Ste C H,
Houston, TX, 77074
9761 FM 1960 Bypass Rd
W, Humble, TX, 77338
13134 Dairy Ashford Rd Ste
# 900, Sugar Land, TX,
77478
9303 Pinecroft Dr Ste 300,
Spring, TX, 77380
6121 Hillcroft, Houston, TX,
77081
1490 Research Forest Dr,
Shenandoah, TX, 77381
*Pharmacy type includes one or more of the following:
Retail, Long-Term Care (LTC), and Home Infusion (HI)
PHONE
EFFECTIVE
DATE
TYPE
(972) 432-6550
1/1/2017
Retail
(281) 257-4299
11/15/2016
Retail
(713) 636-9177
11/15/2016
Retail
(281) 969-7611
11/15/2016
Retail LTC
(855) 777-1772
1/1/2017
Retail LTC
(713) 864-0100
1/1/2017
Retail
(713) 330-4400
1/1/2017
Retail
(281) 446-2620
1/1/2017
Retail
(281) 232-3529
11/15/2016
Retail LTC
(832) 831-8114
11/15/2016
Retail
(832) 554-5008
1/1/2017
Retail
(713) 988-0883
1/1/2017
Retail
(281) 760-3660
11/15/2016
Retail LTC
(832) 433-7346
12/27/2016
Retail
(281) 973-8683
11/15/2016
Retail
(281) 313-0730
1/1/2017
Retail HI
(281) 962-7006
1/1/2017
Retail
(713) 496-1328
11/15/2016
Retail
(832) 948-1012
11/15/2016
Retail
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TERMINATIONS
to KelseyCare Advantage Pharmacy Network
The following pharmacies are no longer part of the KelseyCare Advantage pharmacy network. If you need
help finding a network pharmacy, please call 1-866-589-5222 or for TTY users 1-888-206-8041, or visit
www.kelseycareadvantage.com to access our online searchable directory.
PHARMACY NAME
Walgreens
Walgreens
Xpress Pharmacy
ADDRESS
1315 St Joseph Pkwy,
Houston, TX, 77002
3833 FM 1960 W, Houston,
TX, 77068
7555 Bellaire Blvd Ste B,
Houston, TX, 77036
*Pharmacy type includes one or more of the following:
Retail, Long-Term Care (LTC), and Home Infusion (HI)
PHONE
EFFECTIVE
DATE
TYPE
(713) 658-0022
11/15/2016
Retail
(281) 866-9674
11/15/2016
Retail
(713) 541-3300
11/15/2016
Retail
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REINSTATEMENTS/ADDITIONS
to KelseyCare Advantage Pharmacy Network
PHARMACY NAME
ADDRESS
*Pharmacy type includes one or more of the following:
Retail, Long-Term Care (LTC), and Home Infusion (HI)
PHONE
EFFECTIVE
DATE
TYPE
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