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For Pharmacies

Prescription Drug Coverage - Member Rights

Pharamcies need to post this form where customers can see it. The form and Instructions are provided below.

Prescription Drug Coverage and Your Rights - Form CMS-10147 (PDF)

Instructions (PDF)

S5954_3232_1107 Last Modified Date: 2/1/2008

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Privacy Statement -- Grievance, Appeals and Exceptions -- Contract Termination
Rights and Responsiblities

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