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COVID-19 TEST KIT REIMBURSEMENT REQUEST FORM Use this form to request reimbursement for FDA authorized COVID-19 test kits purchased on or after January 15, 2023, at a retail store, pharmacy or online

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How to fill out covid-19 over-form-counter test reimbursement

01

Obtain the over-the-counter test from a reputable source.

02

Fill out the necessary information on the reimbursement form, including your personal details, test details, and payment information.

03

Make sure to attach a copy of your receipt or proof of purchase with the form.

04

Submit the completed form and supporting documentation to the designated reimbursement office or email address.

05

Wait for processing and approval of your reimbursement request.

Who needs covid-19 over-form-counter test reimbursement?

01

Individuals who have purchased and taken an over-the-counter covid-19 test and are looking to be reimbursed for the cost.

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What is covid-19 over-form-counter test reimbursement?

The covid-19 over-form-counter test reimbursement is a program to provide financial assistance for individuals who have incurred costs for over-the-counter covid-19 tests.

Who is required to file covid-19 over-form-counter test reimbursement?

Individuals who have purchased over-the-counter covid-19 tests and incurred costs are required to file for reimbursement.

How to fill out covid-19 over-form-counter test reimbursement?

To fill out the covid-19 over-form-counter test reimbursement, individuals need to provide details of the purchased tests, proof of payment, and personal information.

What is the purpose of covid-19 over-form-counter test reimbursement?

The purpose of the covid-19 over-form-counter test reimbursement is to alleviate the financial burden on individuals who have purchased over-the-counter covid-19 tests.

What information must be reported on covid-19 over-form-counter test reimbursement?

The information required for covid-19 over-form-counter test reimbursement includes details of the purchased tests, proof of payment, and personal information of the individual.

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