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WellCare Mail-Order Pharmacy Prescription Form 2010-2025 free printable template

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Print Form Mail-Order Pharmacy Prescription Form Phone: 866-740-2539 Please fax completed form to WSP Mail-Order Pharmacy: 877-709-1694. Member Information Member ID: Date: Patient Name: Date of Birth:
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How to fill out WellCare Mail-Order Pharmacy Prescription Form

01
Obtain the WellCare Mail-Order Pharmacy Prescription Form from the WellCare website or your healthcare provider.
02
Fill in your personal information such as name, address, and contact details at the top of the form.
03
Provide your WellCare member ID number.
04
List the medications you wish to order, including the medication name, strength, dosage, and quantity required.
05
Include the prescribing physician's information, including their name, phone number, and signature if required.
06
Check if you need to include any prior authorization or additional documents for specific medications.
07
Review the completed form for accuracy and completeness.
08
Submit the form via mail or fax to the designated mail-order pharmacy address provided on the form.

Who needs WellCare Mail-Order Pharmacy Prescription Form?

01
Anyone enrolled in WellCare who requires medications on a regular basis and prefers the convenience of receiving them via mail.
02
Patients who are unable to visit a pharmacy in person due to health, mobility, or transportation issues.
03
Individuals needing to manage chronic conditions that require ongoing medication refills.

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What is the difference between CVS Caremark and CVS pharmacy? CVS Caremark is an ONLINE Pharmacy, meaning that you get your prescriptions in the mail or overnighted to you. CVS Pharmacy is a walk-in drug store, that also has delivery services available. Usually Caremark is cheaper.
CVS Caremark Mail Service Pharmacy is Wellcare's preferred mail-service pharmacy. You will be able to receive up to a three-month supply of your medication right to your door.
CVS Caremark® manages the pharmacy benefits for Sutter Health Plus members, including retail, mail order and specialty prescriptions, claims processing, and medication prior authorization request.
CVS Health Corporation (previously CVS Corporation and CVS Caremark Corporation) is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance provider, among many other brands.
Your secure Caremark account. Aetna Medicare partners with CVS Caremark®. This enables us to provide you with quality prescription drug coverage. And the services you need to easily manage your benefits.
CVS Caremark® is Wellcare's preferred mail order service. You may receive up to a 90-Day supply of your medication right to your door.

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The WellCare Mail-Order Pharmacy Prescription Form is a document used by patients to request prescription medications to be delivered to their home via WellCare's mail-order pharmacy service.
Patients who are enrolled in WellCare's mail-order pharmacy service and need prescription medications delivered to their home are required to file the WellCare Mail-Order Pharmacy Prescription Form.
To fill out the WellCare Mail-Order Pharmacy Prescription Form, patients should provide their personal information, medication details, physician's information, dosage, and any specific instructions as required by the form.
The purpose of the WellCare Mail-Order Pharmacy Prescription Form is to facilitate the order of prescription medications to be mailed to patients, ensuring that they receive their medications conveniently and promptly.
The WellCare Mail-Order Pharmacy Prescription Form must include the patient's name, address, phone number, prescription details such as medication names and dosages, the prescribing physician's information, and any special instructions or refills requested.
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