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Caremark EFT Set-Up Request Please complete all sections in RED on your computer then print sign and fax as indicated below. EFT Request Type New EFT Set-Up Change to Existing EFT Set-Up Cancel EFT Pharmacy Type Independent Chain NPI NCPDP Tax ID Chain Code Pharmacy / Chain Name Address street city state zip Phone without dashes/slashes Fax Contact Name Contact Email EFT Banking Information Bank Account ABA Routing Number Account Name Account Type Checking Bank Name Bank Address street city...
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