Follow the steps to successfully complete your order form.

1. Press the ‘Get Form’ button to access the Keystone Otc Store Order Form and open it in your preferred editor.
2. Fill in your personal information, including your date of birth, member ID number (located on your health ID card), last name, first name, middle initial, street name, street number, apartment or suite number, city, state, ZIP code, email, and daytime phone number. If this is a new address, check the box provided.
3. Select the OTC products you wish to order by entering the item number, product name, quantity, and price for each item. Ensure that your total order amount does not exceed your quarterly benefit allowance.
4. Review your completed order form carefully to confirm that all information is accurate and that you have included only the products you need.
5. Once satisfied with your order, you can save the changes to your document, download it for your records, or choose to print it out.
6. Mail your completed order form to the OTC Servicing Center at the specified address or, if you prefer, place your order via phone.

Start filling out your order form online today for quick and easy access to your OTC benefits.