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Send completed form and supporting documentation to:Prescription Drug Acclaim Form Communicate P.O. Box 340 Tulsa, Oklahoma 741010340Member ReimbursementPreparing Your Claim Form Complete all sections

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How to fill out send completed form and

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5. Use the provided drop-down menus, checkboxes, or radio buttons to select options.
6. If there are spaces for signatures or dates, sign or date the form accordingly.
7. Review the completed form to ensure accuracy and completeness.
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9. Depending on the requirements, you can send the completed form via email, fax, or mail.
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11. Note: Always double-check the submission requirements and follow any additional instructions provided.

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