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If your benefit plan allows, this form offers you the convenience of ordering your prescription drugs by mail.
Pharmacy Mail Order Form
Please print the form and mail with your original, written prescription and payment to:
P.O. Box 2110
Pittsburgh, PA 15230-2110
On behalf of BlueChoice HealthPlan, Caremark assists in the administration of the program. Caremark is an independent company that provides pharmacy benefits management.