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Benefit highlights: retail plan

Forms to mail in a prescription?  
To mail in a prescription your doctor has already written, you can:
Save time by printing mail order forms online and mailing completed forms and your prescription to:
  Medco
PO Box 747000
Cincinnati, OH 45274-7000
Prescription mail order form
 

Health, allergy, and medical questionnaire
Print this form if this is your first mail service order or if you need to report any changes in your health. Return your questionnaire with your prescription or refill order form.
 

  • View and print a .pdf version of the form. To view the .pdf form, you will need to download a free copy of Adobe® Reader® if you do not have it installed already.
Request mail order forms to be mailed to you. You should expect to receive your order in seven to 10 days.
Important message to all Medicare beneficiaries whose private health plan has elected to be billed primary for Medicare Part B covered drugs. Click here for more information.
Forms to request a new prescription
Print and bring a fax form to your doctor to request new prescriptions. This form can be completed and faxed to our mail order pharmacy by your doctor.
Claim forms for retail pharmacy purchases
Request claim forms to be mailed to you so you may submit expenses for medications you purchased at a retail pharmacy. You should expect to receive your order in seven to 10 days.
Or, view and print a .pdf version of the claim form. You will need to download a free copy of Adobe® Reader® if you do not have it installed already.
Print your temporary prescription card
You can view and print a temporary prescription card that will display in your browser and can be printed on any printer.

 


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Everyday Specials!


Everyday Specials
Your Medicine Cabinet Needs an Annual Checkup, Too! Clean out your medicine cabinets at least once a year. Save 15% on these Medicine Cabinet Essentials. Click here to save 15% on these Medicine Cabinet Essentials.
Welcome to 365 Well St., your destination to health and wellness! Want to know more about your health status? Check out your HQ (Health Quotient) by taking our on-line health assessment.