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Fax completed form to: 18556337673 Questions, please call: 18553440930 24 hours a day 7 days a week TTY users call: 18662361069 Important Information about Prescription Drug Coverage To: Fax: From:
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Step 7: Save the completed form on your computer or device.
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Step 9: Compose a new fax and enter the recipient's fax number in the designated field.
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Fax completed form to the designated fax number provided.
Anyone who has been instructed to do so by the relevant authority.
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The purpose is to provide necessary information or documentation in a timely manner.
The required information will vary depending on the specific form being faxed.
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