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  • Gentry Health Services Medmutual Advantage

Get Gentry Health Services Medmutual Advantage

Simply Supplies Product Order Form STEP 1 Complete your information below Member ID (from your Member ID card)Date of Birth (month/day/year)MaleFemaleFirst NameLast NameStreet Number and NameCityApt/Suite.

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How to fill out the Gentry Health Services Medmutual Advantage online

This guide provides a clear and supportive approach to completing the Gentry Health Services Medmutual Advantage form online. By following these instructions, you will be able to successfully submit your product order with ease and confidence.

Follow the steps to fill out your online order form correctly.

  1. Press the ‘Get Form’ button to obtain the Gentry Health Services Medmutual Advantage form and open it for editing.
  2. Provide your Member ID number as indicated, which can be found on your Member ID card. This information is essential for identification.
  3. Enter your date of birth in the format of month/day/year.
  4. Select your gender by marking either 'Male' or 'Female' as applicable.
  5. Fill in your first name and last name in the designated fields.
  6. Complete your address by providing the street number and name, along with any apartment or suite number, if necessary.
  7. Indicate your city and select your state from the dropdown menu.
  8. Input your daytime phone number for contact purposes.
  9. Provide your ZIP code to ensure accurate delivery.
  10. Check the box if you are providing a new address.
  11. Optionally, provide your evening phone number if you wish to provide an alternative contact.
  12. In the product selection section, fill in the product number, product name, and quantity for each item you wish to order, ensuring you do not exceed your plan’s allowance.
  13. Add up the total cost of the products selected to ensure everything is accurately accounted for before submission.
  14. Once all sections are completed, save your changes, and you may choose to download, print, or share the form as needed.

Complete your order online today to ensure timely delivery of your supplies.

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Contact support

At no cost to you, get the convenience of having over-the-counter medicine, medical supplies and personal care items delivered to your home with our Simply Supplies program.

Medical Mutual members have access to the Aetna® Open Choice® PPO network when they live, travel or spend significant time outside of the SuperMed® PPO network service area. The SuperMed service area includes the state of Ohio, as well as Boone, Campbell and Kenton counties in Kentucky.

Select 'Print' to mail your completed form and itemized bill to: Medical Mutual, P.O. Box 6018 Cleveland OH 44101-1018.

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