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Mail Service Pharmacy Tips
Walgreens Mail Service
Illinois Comprehensive Health
• Complete attached registration form. You may also register yourself (and dependents, if applicable) at Insurance Plan
• New prescriptions must be mailed to the mail Use black ink only. Enclose form with prescription(s) and payment. PARTICIPANT INFO.
Suffix extension † Patient needs snap-on caps • For long-term medications you need right away: ask your doctor for two prescriptions—one for a small supply to fill at a participating retail pharmacy, and one for a long-term supply to fill through the mail. • If two or more prescriptions are sent in for multiple family members, the prescriptions will be shipped, as a single order, to an adult family member at the Shipping Address (Please do not use P.O. Box) address given on the order form. If you prefer different shipping arrangements for privacy or other reasons, please contact our Customer Care Center. • Most orders are shipped by U.S. Postal Service. Controlled substances may require an adult signature upon receipt. Packaging does not show ALLERGIES:
any indication that medications are enclosed. HEALTH CONDITIONS:
• Emergency prescriptions can be shipped overnight. • Include payment, if applicable to avoid any delays. PAYMENT – CHECK OR CREDIT CARD (VISA, MASTERCARD, DISCOVER, AMERICAN EXPRESS)
It is standard pharmacy practice to substitute Rx Type • Make checks payable to Walgreens Mail Service. generic equivalents for brand-name drugs whenever possible. Walgreens Mail Service will • Refills cannot be transferred from other dispense an FDA-approved generic equivalent pharmacies. Request a new prescription from your whenever available, permitted by your prescriber, and allowable by law. If you do not want a Customer Care Center:
generic equivalent, please call our Customer 1-888-265-1807 (TTY: 1-800-573-1833)
Monday–Friday, 8:00 a.m. – 10:00 p.m. (Eastern) Saturday–Sunday, 8:00 a.m. – 5:00 p.m. (Eastern) Refills by Phone:
Mail to: Walgreens Mail Service P.O. Box 29061, Phoenix, AZ 85038-9061 Turn page and complete dependent info. on the other side of this form.
Shipping Address (if different than participant) ALLERGIES:
Shipping Address (if different than participant) ALLERGIES:
Please Note: By submitting this form, you have authorized
Customer Care Center:
release of all information to Walgreens Mail Service (and other necessary parties) as required to process your prescriptions and their refills under your benefit plan. Monday-Friday, 8 a.m. – 10 p.m. (Eastern) Saturday-Sunday, 8 a.m. – 5 p.m. (Eastern)


The codrington school: student's health record

The Codrington School: Student's Health Record The following information is most important to the school. Please complete all parts fully and accurately. This form must be completed and placed on file in the admission's office when the student enters school. This enables us to care for your child. Please inform the director of admissions of any changes in the child's medical conditio

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MASSA FALIDA DO BANCO ROYAL DE INVESTIMENTO S.A. CNPJ nº 21.594.726/0001-70 Classses Valores em R$ 1,00 I - CRÉDITOS COM PRIVILÉGIO GERAL 1) Os assim definidos em outras leis civis e comerciais, salvo disposição contrária da Lei n.o 11.101/05 a) Hon 8.513,52 II - CRÉDITOS QUIROGRAFÁRIOS 1) aqueles não previstos nos demais incisos do art. 83 da Lei 11.101/05009 AGÊ

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