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Incomplete forms will be returned. Mail original signed form to Medco Health Solutions Inc. Attn Pharmacy Administration and Contracting Unit 100 Parsons Pond Drive MS-1-EFT-D-1 Franklin Lakes NJ 07417 Important Information Once this form has been completed and returned to Medco Medco will implement the setup process. Provider pharmacy must submit a voided check if the electronic fund transfer is going to a checking account. If a voided check doe.

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