Filing a Claim
Your Claim Form Must Be Submitted By Or Postmarked By November 30, 2024. NOTE: YOU MAY RECEIVE PAYMENT FROM ONLY ONE OF THESE PROGRAMS AND YOU ARE NOT ELIGIBLE TO RECEIVE A REFUND FOR A PRESCRIPTION FOR WHICH YOU ALREADY RECEIVED A REFUND.
What would you like to do? Note: you may receive payment from only one of the below programs, not both.
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