gabug
07-01-2008, 05:25 PM
This voucher is valid for reimbursement at retail pharmacies only.
* Please dispense this Eli Lilly and Company product at no charge to the patient. Transmit claims online to Wellpoint NextRx.
* This voucher should be accompanied by a prescription and is for new prescriptions only.
* Processor requires Valid Prescriber DEA #, Patient Name, and Person Code for claim adjudication.
* Please remove this sample identification number from the patient profile after the claim is processed.
* For assistance in filing this claim, please call the Help Desk at 1-866-291-1621.
http://kwikpenvoucher.humalog.com/voucher.cfm
* Please dispense this Eli Lilly and Company product at no charge to the patient. Transmit claims online to Wellpoint NextRx.
* This voucher should be accompanied by a prescription and is for new prescriptions only.
* Processor requires Valid Prescriber DEA #, Patient Name, and Person Code for claim adjudication.
* Please remove this sample identification number from the patient profile after the claim is processed.
* For assistance in filing this claim, please call the Help Desk at 1-866-291-1621.
http://kwikpenvoucher.humalog.com/voucher.cfm