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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: CVS Earmark PO Box 52000. MC109 Phoenix, AZ 850722000 Fax Number: 18556337673 You
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What is this form may be?
This form may be a tax form used to report income or other financial information to the government.
Who is required to file this form may be?
Individuals or businesses meeting certain criteria may be required to file this form.
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This form may be filled out by providing accurate and complete information as per the instructions provided by the government.
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The purpose of this form may be to ensure accurate reporting of financial information and to calculate taxes owed.
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