You may submit a Prescription Drug Reimbursement Form (also available by calling our Forms Hotline at 212-539-0539) with a copy of the paid pharmacy receipt, indicating the patient name, drug name, dosage and quantity.
You may submit a Prescription Drug Reimbursement Form (also available by calling our Forms Hotline at 212-539-0539) with a copy of the paid pharmacy receipt, indicating the patient name, drug name, dosage and quantity.