CVS Caremark Payer Sheet
Number M Rx Number 436-E1 Product/Service ID Qualifier Ø3 M If billing for a multi-ingredient prescription, Product/Service ID Qualifier (436-E1) is zero (ØØ) 4Ø7-D7 Product/Service ID M If billing for a multi-ingredient prescription, Product/Service ID (4Ø7-D7) is zero (Ø) 442-E7 Quantity Dispensed R 4Ø3-D3 Fill Number R ................
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