Over-the-Counter Catalog€¦ · RiverSpring Star (HMO SNP) For more information, call us . 1-877-715-9398 (TTY 711) 9:30 a.m. to 11:00 p.m. EST. – 7 days a week. RiverSpringStar.org

2019 Over-the-Counter Catalog

RiverSpring Star (HMO SNP)

For more information, call us 1-877-715-9398 (TTY 711) 9:30 a.m. to 11:00 p.m. EST. – 7 days a week.

RiverSpringStar.org

H6776_2019OTCCatalog001_M_File & Use 11/09/2018

RiverSpring Star(HMO SNP)

2019 Over-the-Counter Product Catalog

With RiverSpring Star (HMO SNP), one of your key benefits is coverage for many over-the-counter (OTC) products. Each month, you are able to purchase products and their cost is covered by the Plan. There is no out-of-pocket cost to you, up to the maximum benefit amount.

This packet contains important information about how you will use this benefit. Please save this information in a convenient place, so you can refer to it when you need to purchase additional products each month. This packet includes the following information: maximum benefit amount, how to order your OTC products and a list of products that is covered by RiverSpring Star (HMO SNP).

What is an OTC Benefit?

You are able to purchase certain health products, and the cost is covered by our Plan. Some examples are first aid products, ointments, dental products, and pain relievers. There is no out-of-pocket cost to you, up to the maximum benefit amount. For a complete list of approved OTC products, please see the list in our Over-the-Counter Products Catalog, or call Member Services at 1-800-580-7000 (TTY 711).

How Much Is My Monthly Benefit?

RiverSpring Star (HMO SNP) will pay for up to $25 a month for over-the-counter products. OTC products may only be purchased for the member.

On the first of every month, your OTC benefit will automatically replenish with $25 for you to use towards OTC products. At the end of the month, any remaining balance rolls over to the following month. Please note, at the end of every calendar year, your benefits will expire, and they may not be carried over to future years.

H6776_2019OTCCatalog001_M_File & Use 11/09/2018

How Do I Use My Benefit?

There are two ways for you to take advantage of your OTC Benefit.

You can call OTC Member Services at 1-877-715-9398, 9:30 a.m. to 11 p.m., EST. TTY Users can call 711. Have your Participant ID Card ready, and the names of the products you wish to order, and any other information about the product you are ordering (for example, whether you prefer tablets or capsules). Your products will be delivered to your door. You do not have to pay for shipping.

You can also order your OTC products online by visiting https://shopping.drugsourceinc.com/riverspringstar/. Have your member number and birth date ready so you can sign in and start buying the products you need to stay healthy and well. Your products will be delivered to your door. You do not have to pay for shipping.

Please note that orders can only be placed once a month. You do not have to use your full benefit amount at one time, but remember that any unused benefit amount will carry over to the next month.

Requesting Reimbursement for Products Purchased On Your Own

You can also purchase OTC products that are available through this benefit at any local store, and ask RiverSpring Star to reimburse you for the costs. You are still limited to the total amount available in your benefit. To request reimbursement, please follow the steps below.

• Submit an original itemized receipt showing the products you purchased. The receipt must show: store where purchase was made, date of purchase, the specific name of the product(s) that were purchased, and the price paid.

• Your request must also include information about you. Please include in your request: Member’s name and ID number, the complete mailing address where your reimbursement should be sent, and your phone number so we can contact you if we have any questions.

All requests should be sent to:

RiverSpring Star Attn: OTC Card Services 80 West 225th Street Bronx, New York 10463

All requests must be submitted within 30 days of purchase. Please allow up to 30 days to process your request and mail you a check.

https://shopping.drugsourceinc.com/riverspringstar/

ACNE TREATMENT

Generic SKU Price

Benzoyl Peroxide Gel 10% 45gm 540-8570 3.61

Brand SKU Price

Clean & Clear Advantage Acne Spot Treatment .75oz 148-2967 9.65

Clean & Clear Essential Foam Facial Cleanser 8oz 410-6050 6.16

Neutrogena Clear Pore Oil-Eliminating Astringent 8oz 113-3560 6.94

ANTI-ARTHRITIC

Generic SKU Price

Glucosamine Chondroitin 500/400mg 60 Capsules 1043399 12.36

ANTI-FUNGAL

Generic SKU Price

Athletes Antifungal Foot Cream 0.5oz 221-5952 12.11

Clotrimazole 1% Cream 1oz 148-1258 7.21

Clotrimazole 1% Cream 0.5oz 904-1955 5.67

Miconazole Nitrate Cream 2% 30gm 099-1265 6.70

Tolnaftate 1% Cream 1oz 105-4352 5.98

Tolnaftate 1% Cream 0.5oz 354-0051 4.12

Tolnaftate 1% Powder 1.5oz 536-3387 4.64

Brand SKU Price

Fungi Nail Tincture 30ml 316-0017 19.50

Lamisil At Athletes Foot Cream 12gm 102-3407 12.36

Lotrimin AF Cream 0.5oz 550-3818 11.58

Lotrimin AF Cream 30gm 19150 18.70

ANTI-ITCH

Generic SKU Price

Calamine Lotion 6oz 359-1146 4.12

Diphenhydramine Cream 2% 1oz 150-6468 5.00

Hydrocortisone 1% Anti-Itch Cream 1oz 099-0994 5.15

Hydrocortisone 1% Ointment 1oz 099-0978 5.67

Brand SKU Price

After Bite Extra Gel 0.5oz 376-1616 4.45

Benadryl Extra Strength Itch Stopping 2% Cream 1oz 735-7791 6.43

Benadryl Regular Strength Itch Relief 1% Cream 1oz 735-7783 6.02

Cortizone 10 Creme 1oz 455-5561 6.70

Cortizone 10 Ointment 1oz 455-5587 6.94

Cortizone-10 Intensive Healing Formula Anti-Itch Creme 1oz 211-7380 6.98

Gold Bond Medicated Body Powder 10oz 799-0955 8.84

Gold Bond Medicated Maximum Strength Cream 1oz 799-0930 5.15

Psoriasin Ointment 4oz 572-1857 12.69

ANTI-INFECTIVE

Generic SKU Price

Triple Antibiotic Ointment 1oz 155-2405 7.73

Brand SKU Price

Bactine Liquid 4oz 472-0132 5.67

Neosporin Original Antibiotic Ointment 1oz 735-6389 10.55

Neosporin Plus Maximum Strength Ointment 0.5oz 735-6405 7.79

Neosporin Plus Ointment Max/Strength 1oz 735-6413 12.65

BATH SAFETY

Brand SKU Price

Adjustable Transfer Bench 147-9856 98.99

Bath Seat 121-4162 50.85

Bath Seat with Back 170-1622 49.00

Bath Seat with Back, Aluminum 350-0873 42.07

Bathroom Safety Shower Tub Bench Chair 618-2356 41.57

Bathtub Mat, 28’ x 16’ 149-1760 15.95

Economy Elevated Toilet Seat 7000404 16.99

Raised Toilet Seat with Arms and Lock, 5 Inches 7000101 33.99

Safety Treads 356-3277 5.00

Suction Cup Grab Bar with 180 Swivel Action, 19 Inch 261-0822 39.99

Suction Tub and Shower Bar 16 Inch 261-0814 17.95

Toilet Safety Frame 618-2943 35.00

Toilet Seat Raised Lock 500lbs 232-5348 52.99

COLD & ALLERGY

Generic SKU Price

Cetirizine 10mg Tablets 30ct 221-2652 11.85

Cough Drops Black Cherry Sugar Free 25ct 133-8839 2.06

Cough Drops Cherry 30ct 133-8805 2.06

Cough Drops Honey Lemon 30ct 133-8813 2.06

Diphenhydramine 25mg Capsules 100ct 904-0981 4.64

Diphenhydramine 25mg Tablet 24ct 155-2694 4.12

Effervescent Cold Relief Tablets 20ct 565-5683 7.50

Loratadine 10mg Tablet 30ct 149-7379 4.12

Loratadine 10mg Tablets 100ct 234-1964 12.36

Medicated Chest Rub 3.53oz 162-4311 4.12

Mucus Relief Tablets 60ct 244-3901 5.15

Nasal Spray 1oz 163-1522 6.70

Saline Nasal Spray 1.5oz 904-1468 3.61

Sudogest PE Tab 10mg 36ct 172-4897 6.18

Tussin Dm Sugar Free Liquid Clear 4oz 565-5501 4.12

Tussin Form CF 8oz 565-5519 5.15

Tussin Form DM 8oz 565-5527 6.11

Brand SKU Price

Afrin Nasal Spray Original 0.5oz 525-4941 8.13

Afrin Nasal Spray Sinus 0.5oz 525-6821 8.13

Airborne Immune Support Chewable Tablets Berry 32ct 566-4149 10.90

Airborne Immune Support Chewable Tablets Citrus 32ct 566-4156 10.90

Alka-Seltzer Plus Cold 20ct Effervescent Tablet Original 567-2217 7.70

Alka-Seltzer Plus Cold Formula Effervescent Tablets Original 36ct

567-2225 11.12

Allegra OTC 180mg Tablets 24 Hour 15ct 563-7806 20.73



Benadryl Allergy Softgels Dye Free 24ct 362-5738 7.17

Breathe Right Nasal Strips Clear Large 30ct 146-8883 16.48

Breathe Right Nasal Strips Tan Small/Medium 30ct 814-0097 17.78

Cepacol Maximum Strength Lozenge Honey Lemon 16ct 361-6034 4.37

COLD & ALLERGY, continued

Chloraseptic Sore Throat Spray Menthol 6oz Sugar Free 532-4892 7.30

Claritin Allergy 24 Hour 10mg 30ct 145-5054 33.14

Claritin Allergy 24 Hour 10mg 20ct 135-5098 27.19

Contac Cold/Flu Day/Night Caplet 28ct 355-8814 9.27

Coricidin HBP Chest Congestion & Cough Liqui-Gels 20ct 134-2476 8.44

Coricidin HBP Cough & Cold Tablets 16ct 525-7134 8.44

Coricidin HBP Maximum Strength Flu Tablets 20ct 115-5324 8.44

Halls Cough Drop Honey Lemon 30ct 735-7346 3.09

Halls Defense Strawberry 30ct 103-8751 3.09

Halls Defense Vit C Drops Sugar Free Assorted Citrus 25ct 230-4830 3.09

Halls Mentho-Lyptus Drops Cherry 30ct 735-7338 3.09

Mucinex DM Extended Release Tablets 20ct 158-9670 16.75

Mucinex DM Maximum Strength Tablets 14ct 206-5191 17.94

Mucinex DM Maximum Strength Tablets 28ct 208-3053 33.57

Mucinex Extended Release Tablets 20ct 143-8928 15.31

Nasacort Allergy 24 Hour Spray 0.5oz 367-7085 27.74

Robitussin DM Peak Cold Cough/Congestion 4oz 248-6637 7.97

Robitussin DM Sugar Free Peak Cold Cough/Congestion 4oz 248-6686 7.97

Sucrets Regular Lozenges Wild Cherry 18ct 464-6022 4.12

Vicks Dayquil Liquid Capsules 24ct 249-1736 13.03

Vicks Nyquil Liquid 8oz 249-1645 11.08

Vicks Nyquil Liquid Capsules 24ct 249-1769 13.03

Vicks Vaporub 1.76oz 532-5816 6.61

Vicks Vaporub 6oz 532-5832 17.24

Vicks Vaporub 3.53oz 532-5824 11.55

Vicks Vaporub Lemon Scent 1.76oz 217-7335 6.61

Zyrtec Allergy 10mg Tablets 30ct 210-6755 29.58

Zyrtec OTC Adult 10mg 24 Hour Tab 5ct 210-6722 9.81

DIABETIC Brand SKU Price

Dex4 Glucose Tablets Raspberry 50ct 823-0153 8.38

Diabetic Foot Care Cream 4oz 548-6139 11.99

DIAGNOSTICS

Brand SKU Price

Blood Pressure Monitor Digital, Talking 860214 55.55

Heating Pad Econo Dry 12 X 15 110-0445 20.91

Heating Pad Moist/Dry With Select Temp 549-0313 34.65

Homedics Blood Pressure Monitor Automatic 220-6886 64.19

Omron Blood Pressure Cuff Large - Cuff Only 898-0997 22.95

Omron Blood Pressure Monitor Manual 145-2739 38.38

Smartheart Blood Pressure Monitor 564-1469 42.10

Smartheart Blood Pressure Monitor Automatic 2 Cuffs 01-554 37.99

Smartheart Digital Blood Pressure Monitor, Automatic Wrist Monitor

5219999 25.99

EAR CARE

Brand SKU Price

Debrox Drops Earwax Removal Aid 0.5oz 464-5313 8.10

Macks Wax Away Earwax Removal System 554-2592 6.61

Murine Ear Wax Removal System 0.5oz 479-0283 8.47

Murine Earwax Removal Drops 0.5oz 479-0317 7.73

EYE CARE

Generic SKU Price

Artificial Tears 0.5oz Polyvinyl 1.4% 133-7120 8.24

Eye Drops 0.5oz 565-685 3.09

Brand SKU Price

Bausch & Lomb Soothe Hydration Lubricant Eye Drops 15ml 250-6624 13.43

Blink Contacts Lubricant Eye Drops 10ml 175-7509 8.62

Clear Eyes Itchy Eye Relief Drops 0.5oz 222-0937 5.35

Clear Eyes Maximum Redness Relief Drops 0.5oz 210-5542 5.51

Opti-Free No-Rub Express Solution 4oz 030-4246 7.30

Opti-Free Replenish Multi-Purpose Solution 10oz 547-4713 15.00

Opti-Free Rewetting Drops 10ml 030-3529 9.69

Refresh Liquigel 0.5oz 122-3809 14.62

Systane Lubricant Eye Drops 15ml 144-3415 16.19

Thera Tears Sterilid Lid Scrub 1.62oz 201-8265 20.03

Visine A Drops 0.5oz 571-2393 9.16

Visine Ac Eye Drops 0.5oz 455-4531 6.18

Visine Original Eye Drops 0.5oz 455-1073 6.18

FIBER SUPPLEMENTS

Generic SKU Price

Fiber Laxative Caplets 100ct 565-6616 10.82

Fiberlax Tablets 90ct 141-0224 7.32

Natural Fiber Powder 13oz 110-8646 9.79

Natural Fiber Powder Orange 13oz 130-2637 9.27

Brand SKU Price

Fibercon Tablet 90ct 193-3647 17.33

FIRST AID SUPPLIES

Generic SKU Price

Adhesive Fabric Strips Assorted 30ct 133-8110 3.60

Adhesive Pads Non-Stick Large 3x4in 10ct 565-7093 3.61

Adhesive Sheer Strips Assorted 60ct 565-7119 3.50

Adhesive Tape 1/2 X 5yd 565-7283 2.58

Adhesive Waterproof Tape 1/2 X 10yd 259-6922 3.09

Alcohol Prep Pads 100ct 354-0663 3.09

Bacitracin Ointment 1oz 103-3448 6.18

Basic Thermometer Digital 8350 5.15

Cotton Balls 300ct 133-7716 4.12

Epsom Salt 16oz 18752700 4.64

Hot And Cold Micro Therapy Gel Pack 230-9557 4.64

Hydrogen Peroxide 3% 16oz 142779 3.61

Rubbing Alcohol 70% 16oz 219-9305 4.50

Sterile Pads 3x3in 25ct 565-7242 4.12

Thermometer Digital Flexible Tip 133-8060 8.24

FIRST AID SUPPLIES, continued

Brand SKU Price

Ace Bandage Velcro 2 Inch 287-8056 5.44

Ace Bandage Velcro 3 Inch 287-8064 8.24

Ace Cold Compress Reusable 287-6639 7.48

Ace Elastic Bandage 3 Inch 287-5417 8.24

Ace Self-Adhering Bandage 2 Inch 287-6530 5.15

Band-aid Comfort-Flex Plastic All One Size 60ct 427-6143 2.87

Band-aid Flex Fabric 3/4 30ct 427-7497 4.26

Band-aid Flexible Fabric Assorted Sizes 30ct 427-7505 4.28

BD Home Sharps Container 124-1462 4.12

Ice Bag 9inch 549-0339 10.39

Johnson & Johnson First Aid Kit 140 Pieces 563-8606 20.08

Mederma Gel 50gm 852-0066 40.76

New-Skin Liquid Bandage 1oz 608-0410 7.21

Purell Hand Sanitizer 8oz 518-0021 5.06

Thermometer Forehead Strip 564-0156 5.10

Vaseline Petroleum Jelly 13 Oz 651-0267 6.49

FOOT CARE Brand SKU Price

Dr Scholl’s Corn Remover Pads 9ct 1863653 3.85

Dr Scholl’s Corn Cushion Regular 9ct 550-0129 3.61

Mycocide Ns Antimicrobial Sol 1oz 820-1295 22.15

GASTROINTESTINALS Generic SKU Price

Antacid Assorted Tablet 150ct 433-6400 4.12

Antacid Chewable Extra Strength 96ct 547-9993 3.61

Antacid Liquid Ds 12oz 904-3829 4.64

Antacid Regular Strength Liquid 12oz 904-3811 5.85

Antacid Ultra Strength Tablets 72ct 133-3434 7.21

Anti-Diarrheal Caplet 24ct 904-3639 5.67

Anti-Diarrheal Caplet 2mg 12ct 107-4129 3.61

Anti-gas 80mg Tablets 100ct 107-3998 4.50

Bisacodyl 5mg Tablet 100ct 553-2650 7.21

Clearlax Powder 4.1 Oz 228-9783 6.18

Clearlax Powder 8.3oz 228-9791 13.91

Effervescent Pain Relief Tablets 36ct 565-6400 6.47

Enema Adult 4.5oz 369-2209 3.50

Famotidine 10mg Tablets 60ct 155-4260 11.33

Famotidine Tablet 10mg 30ct 155-4278 6.18

Gas Relief Softgel Extra Strength 30ct 564-0750 6.18

Magnesium Citrate Cherry 10oz 565-6574 3.09

Magnesium Citrate Lemon 10oz 565-6582 3.09

Milk Of Magnesia 12oz 150-6682 4.12

Milk Of Magnesia Suspension 16oz 155-6323 5.67

Omeprazole 20mg Tablets 42ct 221-2660 30.83

Pink Bismuth Liquid 8oz 150-6260 3.61

Pink Bismuth Tablet - Chewable 30ct 155-2736 5.03

Ranitidine 75mg Tablet 30ct 371-1934 5.15

Senna Tablet 100ct 115-1208 6.70

Stool Softener Softgels 100ct 553-6867 5.00

Brand SKU Price

Alka-Seltzer Original 24ct 564-5536 6.05

Beano Tablets 30ct 308-3466 6.72

Dulcolax Tablets 5mg 100ct 201-9198 26.98

Dulcolax Tablets 5mg 25ct 201-9172 9.18

Ex-Lax Pieces Regular Strength 24ct 213-4773 6.52

Ex-Lax Tablets Regular Strength 30ct 224-0851 7.73

Fleet Glycerin Suppository 24ct 371-0530 4.12

Gas-X Extra Strength Cherry Creme 18ct 224-1354 6.18

Gas-X Extra Strength Softgels 10ct 224-1586 5.67

Imodium A-D Liquid Cool Mint 4oz 172-2016 8.15

Kaopectate Liquid Regular Flavor 8oz 241-0280 6.63

Lactaid Caplets 120ct 554-2790 20.08

Lactaid Fast Act Caplets 32ct 172-2073 12.09

Metamucil Capsules 100ct 135-2343 21.17

Miralax Powder 17.9oz 209-3177 28.99

Miralax Powder 8.3oz 202-4701 16.77

Miralax Powder 7 Doses 4.1oz 202-4693 9.67

Nexium 24hr Heartburn Relief 42ct 372-4903 39.84

Nexium 24hr Heartburn Relief 20mg 14ct 372-4929 16.57

Nexium 24hr Heartburn Relief 20mg 28ct 372-4580 29.17

Pepcid Ac Tablets Original Strength 30ct 161-6093 14.58

Pepcid Complete Chewable Tablet Berry 50ct 134-5149 27.40

Pepto-Bismol Caplets Original 40ct 532-8208 10.57

Pepto-Bismol Liquid Original 8oz Sugar Free 532-1237 6.55

Pepto-Bismol Liquid Original 16 Oz Sugar Free 532-1211 9.75

Prilosec OTC 20mg Tab 14ct 145-6714 18.11

Prilosec OTC Tablets 28ct 145-7050 29.86

Prilosec OTC Tablets 42ct 145-7068 39.58

Rolaids Extra Strength Chewable Tablets Fruit 96ct 390-8423 6.83

Rolaids Extra Strength Chewable Tablets Mint 96ct 379-9525 6.83

Rolaids Regular Strength Chewable Tablets Mint 150ct 379-9517 6.83

Senokot-S Tablet 30ct 184-2707 22.79

Tagamet HB OTC 200mg Tablets 6ct 567-6812 3.61

Tums Extra Strength Smoothies Tab Assorted Fruit 60ct 191-8531 7.30

Tums Extra Strength Tablets Assorted 96ct 464-3664 6.97

Zantac 150mg Maximum Strength 24ct 170-8890 14.47

Zantac 75mg Tablets 10ct Sugar Free 735-7254 7.16

Zantac 75mg Tablets 30ct 735-7700 14.47

HEMORRHOID Generic SKU Price

Antiseptic Cleansing Pads 100ct 244-4529 6.18

Hemorrhoidal Cream 1.8oz 133-4036 5.87

Brand SKU Price

Preparation H Cream Maximum Strength 0.9oz 170-2489 9.79

Preparation H Ointment 2oz 193-3910 19.10

Preparation H Suppositories 24ct 193-5113 20.91

Tucks Medicated Pads 40ct 564-5197 6.60

HOME CARE KITS Ear Eye And Nose Combo 999244 12.36

First Aid Essentials 999826 15.45

Hemorrhoid Care Combo 999027 12.47

Oral Care Combo 999115 7.73

Pain Relief Combo 999053 12.36

INCONTINENCE Generic SKU Price

A & D Ointment 4oz 103-3364 6.31

Brand SKU Price

Balmex Clear Protection Ointment 3.5oz 148-2942 6.45

Balmex Diaper Rash Cream With Zinc Oxide 2oz 308-3052 5.15

Balmex Diaper Rash Cream With Zinc Oxide 4oz 308-3326 6.23

Depends Poise Pads Regular Light 30ct 571-8432 10.30

Desitin Ointment 2oz 455-0380 5.76

Desitin Original Ointment 4oz 455-0398 8.69

Fitted Brief Large 18ct Diapers **Tabs** 193-3761 15.45

Fitted Briefs Extra Large 15ct Diapers **Tabs** 146-2316 15.45

Fitted Briefs Medium 16ct Diapers **Tabs** 193-3720 15.45

Perfit Protective Underwear 14ct Extra Large **Pull-Up** 175-7400 15.45

Perfit Protective Underwear 18ct Large **Pull-Up** 175-7392 15.45

Perfit Protective Underwear 20ct Medium **Pull-Up** 175-7376 15.45

Perineum Wash 8oz 521-4850 7.21

Prevail Bladder Control Pads, Moderate 20ct 146-2571 15.00

Prevail Underpad 30x36 10ct 146-2621 10.30

Surecare Protective Underwear 14ct Extra Large 187-4866 22.30

Surecare Protective Underwear 18ct Large 187-4841 23.60

Surecare Protective Underwear 20ct Medium 187-4858 20.60

LICE TREATMENT Brand SKU Price

Nix Control Spray Pump 5oz 103-3182 9.27

Nix Lice Treatment Creme Rinse 2oz Single 735-6421 14.96

Nix Lice Treatment Creme Rinse 2 X 2oz 735-6447 23.46

MEDICATED LIP PRODUCTS Brand SKU Price

Blistex Lip Ointment Medicated 0.21oz 296-0557 2.58

Carmex Jar 0.25 Oz 790-0046 2.06

Carmex Easy-On Applicator 0.35oz 211-5715 2.06

Herpecin L Lip Protectant SPF 30 0.1oz 571-0595 6.58

MISCELLANEOUS Brand SKU Price

Optichamber Diamond Valved Holding Chamber

356-5462 18.85

MOTION SICKNESS Generic SKU Price

Motion Sickness Tab 12ct 126-3037 2.58

Brand SKU Price

Bonine Tablets 8ct 455-4762 4.64

Dramamine 50mg 12ct 241-0843 5.84

ORAL CARE Generic SKU Price

Dental Floss 100yd 359-2920 2.64

Dental Floss Mint Waxed 100yd 133-8987 2.58

Denture Cleaner Tablet 90ct 235-7697 7.79

Toothbrush Full Head Soft 560-5142 1.55

Brand SKU Price

Act Anti-cavity Fluoride Rinse Mint 18oz 513-7542 5.67

Act Total Care Anti-cavity Fluoride Rinse Fresh Mint 18oz 224-7161 6.85

Aim Anti-Tartar Gel Toothpaste 5.5oz 102-5105 1.61

Anbesol Gel Regular Strength Cool Mint 0.33oz 109-0166 7.41

Anbesol Liquid Regular Strength Cool Mint 0.41oz 109-0141 7.41

Biotene Dry Mouth Fluoride Toothpaste Fresh Mint 4.3 Oz 711-0026 8.25

Biotene Moisturizing Mouth Spray W/ Xylitol 1.5oz 214-3865 7.63

Biotene Mouthwash Antibacterial W/ Calcium 16oz 711-0034 8.45

Colgate Cavity Protection Toothpaste 1oz 557-9446 1.55

Colgate Plus Adult Toothbrush Soft 553-4961 3.09

Dental Flossers Mint 60ct 5845410 2.50

Efferdent Denture Cleanser Tablets 102ct 735-8021 7.79

Efferdent Denture Cleanser Tablets 44ct 735-7957 3.99

Efferdent Plus Mint Tablet 90ct 735-8286 7.79

Fixodent Control Denture Adhesive Cream 2oz 162-8718 7.66

Fixodent Control Denture Adhesive Cream Plus Scope Flavor 2oz

186-3695 7.66

Fixodent Denture Adhesive Cream Original 2.5oz 532-5170 7.63

Fixodent Fresh 2.5oz 532-7762 7.66

G-U-M EEZ-Thru X-Treme Fresh 75ct 554-2642 2.65

Orajel Maximum Strength Gel 0.25oz 435-0492 7.39

Orajel Maximum Strength Gel 0.42oz 363-3187 8.35

Orajel Mouth Sore Gel 0.18oz 558-1525 7.21

Orajel Mouth Sore Gel 0.42oz 565-4470 8.43

Oral Denture Brush 091-0950 4.00

Polident 3 Minute Tablets 120ct 257-3228 11.02

Polident Overnight Cleanser 120ct 552-5837 11.26

Sea-Bond Denture Adhesive Lowers Original 15ea 358-0800 4.50

Sea-Bond Denture Adhesive Uppers Original 15ea 358-0792 4.50

Sensodyne Cool Gel Fresh Flavor 4oz 308-2633 8.25

Super Poligrip Denture Adhesive Cream Zinc Free Formula 2.4oz

308-0397 8.24

Toothpaste Colgate Regular 8oz 557-9438 5.15

Toothpaste Crest Large 4.6oz 532-0080 3.61

PAIN RELIEVERS Generic SKU Price

Acetaminophen 325mg Tablet 100ct 218-8928 4.64

Acetaminophen Extra Strength 500mg Tablet 100ct 115-2438 5.15

Acetaminophen Extra Strength Rapid Release Gels 500mg 100ct

213-2603 7.73

Arthritis Pain Relief Caplet 650mg 50ct 188-3362 7.73

Aspirin 325mg Tablet 100ct 540-8596 3.61

Aspirin 325mg Tablets Enteric Coated 100ct 189-2132 3.61

Aspirin Adult Enteric Coated 81mg 120ct 205-4898 3.61

PAIN RELIEVERS, continued Aspirin Child Chew 81mg 36ct 904-0148 2.06

Headache Relief Added Strength Tablet 100ct 904-0486 5.67

Ibuprofen 200mg Caplet 100ct 904-1674 6.18

Ibuprofen 200mg Caplet 50ct 150-6583 3.09

Ibuprofen 200mg Tablet 100ct 115-2594 6.18

Migraine Formula Caplet 24ct 133-1149 4.12

Naproxen Sodium 220mg Caplet 100ct 565-5048 9.22

Brand SKU Price

Advil 200mg Caplet 100ct 193-2979 16.08

Advil 200mg Caplets 50ct 193-2961 9.85

Advil 200mg Caplets 200ct 192-3127 24.55

Advil 200mg Gel Caplets 24ct 193-3043 5.73

Advil 200mg Liqui-Gel 80ct 193-5030 16.86




Advil 200mg Migraine Liqui-Gel 20ct 107-5308 6.22

Advil 200mg Tablets 24ct 193-3100 5.73



Advil Child Suspension Fruit 4oz 193-4363 7.93

Aleve 220mg Arthritis Gelcaps 40ct Easy Open 162-4501 10.75

Aleve 220mg Arthritis Liqui-Gel 80ct Easy Open 229-0971 22.04

Aleve 220mg Caplet 100ct 472-4456 18.02

Aleve 220mg Caplets 50ct 472-4449 10.75

Aleve 220mg Caplets 24ct 472-4530 6.38

Aleve 220mg Tablets 24ct 472-4472 6.38

Aleve 220mg Tablets 100ct 472-4498 18.02

Anacin Tablets 100ct 193-1914 12.59

Azo Standard Tablet 95mg 30ct 443-0054 11.33

Bayer 325 Tablets 100ct 472-3433 11.02

Bayer 325 Tablets 200ct 472-3441 16.21

Bayer Adult 81mg Enteric Coated Low Dose Aspirin 120ct 472-3375 11.76

Bayer Child Chew Aspirin Low Dose 36ct 472-3367 3.79

BC Arthritis Powders 24 Packets 112-7307 6.09

BC Headache Powder 24 Packets 308-2351 5.80

Ecotrin 325mg Regular Strength Tablets 125ct 145-9890 10.05

Midol Maximum Strength Menstrual Form Caplet 24ct 472-4670 7.70

Midol Maximum Strength Menstrual Form Gelcap 24ct 472-4696 7.70

Motrin IB 200mg Caplet 100ct 161-6739 14.69

Pamprin Multi-Symptom Caplets 20ct 570-7435 5.65

St Joseph Adult Aspirin 81mg Chew Tab 36ct 248-0614 3.61

Tylenol Extra Strength 500mg Caplet 100ct 161-3629 16.73

Tylenol Extra Strength 500mg Caplet 24ct 161-3603 5.69

Tylenol Regular Strength 325mg Tablets 100ct 161-0872 12.05

PILL BOXES Brand SKU Price

Medi-chest With 7 Day Planner 564-0115 9.79

Pill Organizer 7 Day XXL 108-9739 5.67

SLEEP AIDS Generic SKU Price

Melatonin Chewable Gummies 5mg 60ct 370-7569 11.85

Melatonin Maximum Strength 10mg Tablets 60ct 483-2424 11.67

Melatonin Maximum Strength Fast Dissolve Tablets 10mg 60ct

547-5868 11.33

Melatonin Maximum Strength Tablets 5mg 120ct 223-6727 8.82

Melatonin Quick Dissolve Berry Tablets 5mg 60ct 359-6061 11.33

Melatonin Tablets 1mg 100ct 209-7558 7.21

Melatonin Tablets 3mg 60ct 150-6625 6.18

Sleep Aid Tablets 24ct 565-5113 5.40

SMOKING CESSATION Generic SKU Price

Nicotine Gum 2mg Sugar Free 50ct 170-8007 26.01

Nicotine Gum 4mg Sugar Free 50ct 172-3758 26.01

Nicotine Patch Step 1 21mg 14ct 214-3261 43.37



Brand SKU Price

Nicoderm CQ Clear 1 14ct 106-4716 73.78

SUNBURN RELIEF Brand SKU Price

Afterburn Gel Tube 2oz 254-5614 7.00

Aloe Vera 100% Gel *Fruit Of The Earth* 6oz 423-0256 5.67

Fruit Of Earth Aloe Vera Gel 20oz Pump 220-3321 8.08

Sunscreen Lotion / Generic SPF 30 8oz 222-6058 8.73

SUPPORT PRODUCTS Brand SKU Price

Futuro Ankle Support Wrap Around Medium 259-0305 11.71

Futuro Ankle Support Wrap Around Large 259-0313 11.71

Futuro Knee Support Stabilizing Large 152-9635 17.11

Futuro Knee Support Stabilizing Medium 152-9627 17.11

Futuro Wrist Stabilizer Deluxe Left Large/X-Large 222-5324 29.15

Futuro Wrist Stabilizer Deluxe Left Small/Medium 135-5783 29.15

Futuro Wrist Stabilizer Deluxe Right Large/X-Large 242-7607 29.15

Futuro Wrist Stabilizer Deluxe Right Small/Medium 135-5791 29.15

Jobst Mens Dress Knee High 8-15mmhg Black Large 2ct 061-0915 18.61

Jobst Mens Dress Knee High 8-15mmhg Black Medium 2ct 061-0907 18.61

Jobst Mens Dress Knee High 8-15mmhg Brown Large 2ct 061-0972 17.70

Jobst Mens Dress Knee High 8-15mmhg Brown Medium 2ct 124-4235 17.70

Jobst Mens Knee High 8-15mmhg White Large 2ct 124-4334 18.55

Jobst Mens Knee High 8-15mmhg White Medium 2ct 061-1939 18.55

Jobst Womens Sheer Knee High 8-15mmhg Large Silky Beige

061-0741 14.29

Jobst Womens Sheer Knee High 8-15mmhg Medium Silky Beige

061-0733 14.62

TOPICALS Generic SKU Price

Cold Hot Medicated Patch 5ct 565-3449 5.99

TOPICALS, continued Brand SKU Price

Abreva Cold Sore Cream 2gm 116-6586 26.20

Aspercreme Heat Pain Relieving Gel 2.5oz 212-5664 7.23

Aspercreme Pain Relieving Rub 3oz 584-0129 7.61

Bengay Pain Relieving Cream Ultra Strength 2oz 455-5389 7.57

Bengay Pain Relieving Cream Ultra Strength 4oz 455-5397 11.04

Bengay Ultra Strength Pain Relieving Patch Reg Size 5ct 162-5128 10.16

Bengay Vanishing Scent Rub 2oz 568-1374 7.73

Capzasin Topical Analgesic Liquid No-Mess Applicator 1oz 203-3793 10.99

Compound W Fast-Acting Liquid 0.31oz 608-0477 10.90

Compound W Gel 0.25oz 608-0485 10.90

Flexall Gel Maximum Strength 3oz 799-0633 7.86

Icy Hot Balm 3.5oz 799-0534 7.57

Icy Hot Cream 1.25oz 799-0542 5.15

Icy Hot Medicated Patches Extra Strength Large Back 5ct 145-1285 9.27

Icy Hot Patches Arm/Neck/Leg 5ct 121-4733 7.21

Icy Hot Sleeve Large Knee Ankle Elbow 3ct 147-8890 8.47

Thermacare Heatwraps 8hr Lower Back & Hip 2ct 223-6974 9.79

Thermacare Heatwraps 8hr Neck Shoulder Wrist 3ct 223-6966 9.79

Thermacare Heatwraps Menstrual 3ct 227-0569 9.79

Tiger Balm Extra Strength Ointment 0.63oz 112-8248 7.21

Zostrix High Potency Arthritis Pain Relief Cream 2oz 326-0577 22.95

Zostrix Original Strength Arthritis Pain Relief Cream 2oz 326-0569 18.87

VAGINAL Generic SKU Price

Miconazole 7 Vaginal Cream 45gm 099-1190 10.82

Brand SKU Price

Monistat 7 Cream With Disposable Applicator 1.59oz 513-7278 14.82

Monistat-3 Cream Prefilled Applicator 3ct 113-9690 19.89

VITAMINS & SUPPLEMENTS Generic SKU Price

Calcium Carbonate 600mg + D Tablet 60ct 904-1385 6.18

Cerovite Senior Tablet 60ct 536-2835 5.67

Ferrous Sulfate Tablets 325mg 100ct 236-4917 6.18

Fish Oil 1000mg Softgels 100ct 904-1542 7.73

Krill Oil 300mg, Omega-3 Softgels 60ct 236-9247 22.12

Oyst-Cal + D 500mg 60ct 218-8969 3.61

Prosight Tablet 60ct 127-0248 8.76

Vitamin B-12 500mcg Tablets 100ct 207-2569 5.67

Vitamin C 500mg Tablets 100ct 110-9131 6.70

Vitamin D Tab 400iu 100ct 211-0211 5.15

Vitamin D3 2000iu Softgels 100ct 220-2893 6.70

Vitamin E 400iu Softgel 100ct 904-3886 11.85

Brand SKU Price

Caltrate 600mg + D Tablet 60ct 193-3316 11.15

Centrum Silver 50+ Mens 100ct 223-0415 16.73

Centrum Silver 50+ Womens 100ct 223-0407 16.73

Centrum Silver Chewable 60ct 172-2214 17.73

Centrum Silver W/ Lutein Tablets 220ct 357-8200 28.73

Ester C 500mg Tablets 60ct 205-8337 9.52

VITAMINS & SUPPLEMENTS, continued Flaxseed Oil 1000mg Softgel 1000mg 60ct 109-2675 10.17

Ocuvite Tablet 60ct 370-2016 12.79

Osteo Bi-Flex Triple Strength Caplets 80ct 200-7144 33.45

Osteo Bi-Flex Triple Strength Caplets 40ct 117-7765 19.87

Viactiv Calcium Chew Carmel + D 60ct 105-5912 10.72

Viactiv Calcium Chew Milk Chocolate + D 60ct 154-5144 10.72

Vitafusion B Complex Chew Energy 70ct 554-2634 7.25

Vitamin C 500mg 250ct 105-7322 13.23

Windmill Vitamin A 10000iu Softgel 100ct 105-6951 6.09

Windmill Vitamin B Complex With Vitamin C + Iron 100ct 105-7165 9.14

Windmill Folic Acid 400 Mcg Tabs 180ct 105-7660 6.70

Windmill Potassium Gluconate 99mg Tab 100ct 105-7868 6.23

Windmill Vitamin B 6 100mg Tab 100ct 105-7058 8.13

RiverSpring Star (HMO SNP) is a health plan with a Medicare contract. Enrollment in

RiverSpring Star (HMO SNP) depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. ElderServe Health, Inc. Notice of Non-Discrimination ElderServe Health, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ElderServe Health, Inc. does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. ElderServe Health, Inc.:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters

o Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such

as:

o Qualified interpreters

o Information written in other languages If you need these services, contact Civil Rights Coordinator. If you believe that ElderServe Health, Inc. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you may file a grievance with: Civil Rights Coordinator 80 West 225th Street Bronx, NY, 10463 Phone: 1-347-842-3660, TTY 711 Fax: 1-888-341-5009 You may file a grievance in person or by mail, phone, or fax. If you need help filing a grievance, Civil Rights Coordinator, is available to help you. You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW, Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 1-800-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

http://www.hhs.gov/ocr/office/file/index.html

Multi-Language Insert ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-580-7000 (TTY 711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-580-7000 (TTY 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-580-7000（TTY 711)。 PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-800-580-7000 (TTY 711). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-580-7000 (TTY 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-580-7000 (TTY 711). ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-580-7000 (TTY 711). 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-800-580-7000 (TTY 711).번으로 전화해 주십시오. ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-580-7000 (телетайп: 711). لحوظة نت إذا :م تحدث ك ر ت غة، اذك ل إن ال ساعدة خدمات ف م ة ال غوی ل ر ال تواف ك ت مجان ل ال صل .ب م ات رق ب

م 1-800-580-7000 كم: (711). رق ب صم وال ف ال ھات ध्यान द: यद आप हदी बोलते ह तो आपके ि लए मफु्त म भाषा सहायता सेवाएं उपलब्ध ह। 1-800-580-7000 (TTY 711). पर कॉल कर। ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-800-580-7000 (TTY 711). ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-580-7000 (TTY 711). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-580-7000 (TTY 711). UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-800-580-7000 (TTY 711). 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-800-580-7000 (TTY 711). まで、お電話にてご連絡ください。

Health Plans1-800-580-7000 (TTY 711)

8 a.m. to 8 p.m. EST. – 7 days a week.

RiverSpringStar.org

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Over-the-Counter Catalog€¦ · RiverSpring Star (HMO SNP) For more information, call us . 1-877-715-9398 (TTY 711) 9:30 a.m. to 11:00 p.m. EST. – 7 days a week. RiverSpringStar.org