Get the free Instructions: Complete this form and mail it with the required physician prescriptio...

Instructions Complete this form and mail it with the required physician prescription s to Fairview Mail Service Pharmacy 711 Kasota Ave. I will contact Fairview Mail Service when I want my prescription s filled. Updating demographic information PLEASE PRINT Refer to your employee benefits information for copay amounts. Minneapolis MN 55414 Please select from the following New prescription s - Place on my medication profile. I permit Fairview Mail Service Pharmacy to release all information to...

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