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Prescription Drug Claim Form - English

Complete the Medicare Part D Prescription Drug Claim Form for reimbursement of prescription drug benefits, including instructions for various situations...

PDF
(794.1kb)

Prescription Drug Claim Form – English

Learn how to complete the Medicare Part D Prescription Drug Claim Form for reimbursement of prescription drug benefits, including instructions for various...

PDF
(705.3kb)

Prescription Drug Claim Form - Spanish

Se ofrece el formulario de reclamación para medicamentosrecetados como una herramienta para ayudarle a que se paguesu reclamación lo antes posible.

PDF
(705.3kb)

Prescription Drug Claim Form – Spanish

Se ofrece el formulario de reclamación para medicamentosrecetados como una herramienta para ayudarle a que se paguesu reclamación lo antes posible.

PDF
(1.5mb)

Prescription Drug Claim Form – VillageHealth (English)

The Prescription Drug Claim Form is offered as a tool to assist in getting your claim paid as soon as possible.

PDF
(1.3mb)

Prescription Drug Claim Form – VillageHealth (Spanish)

Se ofrece el formulario de reclamación para medicamentosrecetados como una herramienta para ayudarle a que se paguesu reclamación lo antes posible.

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Will a SCAN Medicare Advantage Plan Lower the Costs of My Brand-Name Prescription Drugs?

Medicare Annual Enrollment Period goes October 15 through December 7. Here are 5 resources that can help you prepare for enrollment and choose the plan...

FAQ

Where do I find the additional drug coverage Group # ?

This information can be located on your other insurance card.

FAQ

Where do I find the additional drug coverage ID # ?

This information can be located on your other insurance card.

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