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Mail Service Order Form Mail this form to CVS CAREMARK PO BOX 659541 SAN ANTONIO TX 78265-9541 Enter ID below if not shown or if different from above The Dow Chemical Company Prescription Plan Sponsor or Company Name Please use blue or black ink capital letters and ll in both sides of this form. New Prescriptions - Mail your new prescriptions with this form. Number of New prescriptions Number of Re ll prescriptions Re lls - Order by Web phone or write in Rx number s below. ZIP Code Evening...

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