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Your complete claim will be processed within 14 days of receipt of your request. • doctor’s name or dea number. Cvs caremark corporation, et al., no. Part b vaccine claim form. • always have your.

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• participant name • drug name/strength or ndc number. Do not staple or tape receipts or attachments to this form. Mail completed forms with receipts to: Cvs caremark medicare part d claims. Keep a copy.

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Please See Highlighted Area To The Left For Reference.

Allow for mail time plus claims processing. Rxbin # 610415 mail to: Cvs caremark medicare part d claims processing p.o. » always allow up to 30 days from the time you receive the response to allow for mail time plus claims processing.

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• do not staple receipts or attachments to this form. Web if 610415 is the rxbin # on your card mail the completed form to: Sign it in a few clicks. Keep a copy of all documents submitted for your records.

• Always Have Your Card Available At Time Of Purchase.

Web prescription reimbursement claim form important! • if problems are encountered at the pharmacy, call the number on the back of your card. Medicare part d prescription claim form; Your complete claim will be processed within 14 days of receipt of your request.

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