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Get Healthstuff Over The Counter Items Reimbursement Form

HealthStuff Over-the-Counter Items Reimbursement Form FAX form and receipt to 1-877-849-5068 OR MAIL form and receipt to WellCare OTC DMR Center P. Grand Total Total claim amount should include tax for each item. By signing this form I confirm that the request for reimbursement is for eligible over-the-counter items and is not covered by any other plan or program. If you have questions regarding eligible items please refer to your HealthStuff.

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