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Get S1030 Mkt3 App 12 Al .indd

Black ink and print clearly. Keep the bottom copy for your records. Mail the top copy in the return envelope that is included in your packet, or send to: Blue Cross and Blue Shield of Alabama Attention: Payment Processing P.O. Box 2768 Birmingham, Alabama 35202-2768 Fax Number: 1-888-246-0230 BlueRx (PDP) is a Medicare-approved Part D sponsor. BlueRx (PDP) is provided by Blue Cross and Blue Shield of Alabama and BlueCross BlueShield of Tennessee, Independent Licensees of the Blue Cross and Bl.

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