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REQUEST FOR MEDICARE PRESCRIPTION DRUG COVERAGE DETERMINATION This form may be sent to us by mail or fax: Address: Express Scripts, Inc. Attention: Prior Authorization Department Part D Mail Stop
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How to fill out mail stop b401-03 8640

How to fill out mail stop b401-03 8640:
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Start by writing the recipient's name on the first line. This could be an individual's name or the name of a department or organization.
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On the third line, include the street address "8640". This is the physical location where the mail stop is located within a larger building or facility.
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Remember to include any additional information, such as company or department name, suite number, or other relevant details, on subsequent lines if required.
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