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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Gunderson Health Plan, Inc. Attn: Pharmacy Department 1900 South Avenue, NCA201 La Crosse,
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Gundersen Health Plan Inc is a health insurance company that offers a variety of health insurance plans.
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Employers who offer Gundersen Health Plan Inc as an option for their employees are required to file the necessary paperwork.
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Employers must report information such as employee enrollment status, premium amounts, and any changes to the plan.
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