BlueChoice HealthPlan

group administrators

Pharmacy Mail-order Form

(You will need the Adobe Acrobat Reader to view or print some of the items on this page.)

If your benefit plan allows, this form offers you the convenience of ordering your prescription drugs by mail.

Please print the form and mail with your original, written prescription and payment to:

Caremark
P.O. Box 2110
Pittsburgh, PA 15230-2110

Pharmacy Mail Order Form