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UniversityHealthServices 202StudentHealthCenter University Park,PA16802 18008217285(Toll-free) 8148654847(Phone) 8148635371(FAX)PHARMACY EMPLOYEE/RETIREEENROLLMENTFORM INSTRUCTIONS: 1. ThisformisforfirsttimeUHSPharmacycustomers.

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How to fill out pharmacy employeeretiree enrollment form

01

Obtain the pharmacy employee/retiree enrollment form from the pharmacy HR department or website.

02

Fill out the form with your personal information, including name, address, date of birth, and contact information.

03

Provide details about your employment history with the pharmacy, including dates of employment and job title.

04

Review the form for accuracy and completeness before submitting it to the pharmacy HR department.

05

Sign and date the form as required to certify that the information provided is accurate and complete.

Who needs pharmacy employeeretiree enrollment form?

01

Pharmacy employees and retirees who are eligible for pharmacy benefits through their employer.

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What is pharmacy employeeretiree enrollment form?

The pharmacy employeeretiree enrollment form is a form used for enrolling pharmacy employees and retirees in a particular healthcare plan.

Who is required to file pharmacy employeeretiree enrollment form?

Employers are required to file the pharmacy employeeretiree enrollment form on behalf of their employees and retirees.

How to fill out pharmacy employeeretiree enrollment form?

The pharmacy employeeretiree enrollment form can be filled out online or submitted via mail with the required information on the form.

What is the purpose of pharmacy employeeretiree enrollment form?

The purpose of the pharmacy employeeretiree enrollment form is to ensure that pharmacy employees and retirees are properly enrolled in a healthcare plan.

What information must be reported on pharmacy employeeretiree enrollment form?

The pharmacy employeeretiree enrollment form requires information such as personal details, healthcare plan selection, and any dependents to be enrolled.

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