Request for Redetermination of Medicare Prescription Drug ...
drug, you have the right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination. This form may be sent to us by mail or fax: Address: Fax Number: Allwell . 1-866-388-1766. Attn: Medicare PharmacyAppeals . P.O. ................
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