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West Virginia Public Employees Insurance Agency Bayer Meter Request FAX Order Form Please complete this form and FAX to Bayer HealthCare LLC Diabetes Care Customer Order Services Department Telephone 1-877-229-3777 FAX 1-800-876-2243 Pharmacy Name Contact Person Telephone Number Request Date Instrument to be shipped directly to the following patient Patient must be a West Virginia Public Employees Insurance Agency Plan West Virginia Children s He.

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