Prescription Coverage & Pharmacy Directories
💡 Tip: Press Ctrl + F to search these documents for a medication, or find a pharmacy by city or zip code.
Formulary (Covered Drug List Effective starting 01-01-26) – Find out which medications are covered, their tier levels, and any prior authorization requirements.
Nationwide Pharmacy Directory (Effective starting 01-01-26) – A complete list of network pharmacies across the U.S., including major chains like Costco, CVS, Good Neighbor Pharmacy, Kroger, Meijer, Sam’s Club, Walgreens, and Walmart.
Note: While you have access to a convenient nationwide network of participating pharmacies, keep in mind that you’ll always pay the lowest out-of-pocket cost when you use our in-house Four Rivers Community Health Care Pharmacy.
Reimbursement Form
Prescription Reimbursement Form – Submit this form with receipts to request reimbursement for
covered medications you paid for out of pocket.
Member Rights & Privacy Forms
Patient Rights & Responsibilities – Learn about your rights and protections as a member.
Protected Health Information (PHI) Disclosure Form – Authorize the sharing of your private health information with a designated person or organization.
Appointment of Representative Form – Grant permission for another person to act on your behalf in benefit-related matters.
Grievance Form – Submit a formal complaint if you need an issue addressed.
Get More From Your Benefits
Get a glucometer with $0 copay – If you have diabetes and need to track your blood sugar levels, take a copy of this to the pharmacy when you fill your next glucometer prescription.
Member Portal Registration Guide – Access the Member Portal using this step-by-step guide.
Member Portal Overview – Easy sneak peek inside the Member Portal.
Once you become a member, you’ll gain access to the Member Portal, where you can:
✅ Check your drug formulary
✅ Track claims and reimbursement requests
✅ Locate network pharmacies
✅ Compare medication costs at different pharmacies
…and more
📞 Need Assistance? Contact your human resources team for help navigating your benefits.
