This form is used by employees to request reimbursement for prescriptions paid out of pocket. Reimbursement is not guaranteed, and other contractors will review the claims subject to limitations, exclusions, and provisions of the plan. Submit the form electronically to CVS Caremark.
Mail completed forms with receipts to:
CVS Caremark
P.O. Box 52136
Phoenix, Arizona 85072-2136
106-49669A Prescription_Reimbursement_Claim_Form