Get Amerigroup Over-the-counter Selection Form & Instructions. Amerigroup Over-the-counter

This guide provides a user-friendly overview of how to complete the Amerigroup Over-the-Counter Selection Form and its associated instructions. Following these steps will help ensure that your order is processed correctly and efficiently.

Follow the steps to complete your order carefully.

1. Select the ‘Get Form’ button to access the Amerigroup Over-the-Counter Selection Form. This will allow you to fill out your order.
2. Begin filling out the order form by entering your last name, first name, address, city, state, ZIP code, birth date, and daytime phone number. Ensure that the shipping address matches the address on file with Amerigroup.
3. Choose the items you wish to order by checking the box next to each product. Keep in mind the spending limit based on your membership: $25 for SMMC MMA members and $15 for SMMC LTC members. Be aware that items such as cotton balls and alcohol swabs do not count towards your limit.
4. Review your selections to ensure they stay within the allowed budget, and remember that any unspent funds will not roll over to the next month.
5. Once you have completed your order, fold the form carefully and place it in an envelope. Make sure to use a first-class stamp.
6. Mail the envelope to Wellpartner Pharmacy at the designated address. Expect to receive your items within 10-15 working days.
7. If you do not receive your order as expected, contact Wellpartner Customer Service for assistance.

Begin completing your Amerigroup Over-the-Counter Selection Form online today!