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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Blue Cross Medicare Rx (PDP)SM Attn: Clinical Review Department 1305 Corporate Center
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What is this form may be?
This form is a tax form used to report income and expenses for individuals or businesses.
Who is required to file this form may be?
Any individual or business that has earned income or incurred expenses may be required to file this form.
How to fill out this form may be?
The form should be filled out with accurate and detailed information about income and expenses.
What is the purpose of this form may be?
The purpose of this form is to report financial information to the government for tax purposes.
What information must be reported on this form may be?
Income, expenses, deductions, and credits must be reported on this form.
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