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(excluding credit card payment): VISA Discover MasterCard American Express Use Credit / Debit Card on File $ , . / Credit / Debit Card # Expiration Date Last 4 digits of Credit / Debit Card Expiration Date / I authorize CIGNA Home Delivery Pharmacy to bill my credit / debit card for this and all future orders. I understand that my credit / debit card will be billed the following amounts in effect at the time my order is filled: any applicable copayment(s), coinsurance and/or deduct.

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Express Scripts uses a variety of carriers including: USPS, DHL, FedEx, and UPS.

Express Scripts is now a Cigna company. Because of this, Express Scripts Pharmacy, one of the country's largest home delivery pharmacies, is now our home delivery pharmacy. We look forward to working together to better serve you and all of your pharmacy, health and wellness needs.

Call Express Scripts at 877-603-1032, and let them do all the work. For most medications, Express Scripts will be able to contact your doctor and arrange for your first mail-order supply. Ask your doctor for a new prescription for up to a 90-day supply, plus refills for up to one year (if appropriate).

We are now part of EvernorthSM–health services built on the recognition that health makes progress possible. Elevating health for all. Evernorth combines powerful health services capabilities and offerings to create innovative and effective solutions.

Your doctor's office can send your prescription to us electronically from their office or by fax. Go to Forms & Cards under Benefits in the top menu of the home page and select the appropriate form. your prescription to the address listed.

Ask your doctor to send your prescription directly to the mail order pharmacy. Or fill out an order form on the pharmacy's website and attach your prescription. Get your prescriptions delivered safely and conveniently to your doorstep. They'll usually come as a 90-day supply.

Standard shipping is part of your plan's benefit at no extra cost to you. You can get next-day or two-day shipping for an extra fee. We ship most medication through the U.S. Postal Service. We use United Parcel Service (UPS) to ship certain controlled substances.

your daily medications delivered to you with free standard shipping. Through Express Scripts® Pharmacy, you can order up to 90-days' worth of long-term, daily medication (or the amount allowed by your plan).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232