Pharmacy Documents

Medicare Prescription Payment Plan Fact Sheet (English)

Medicare Prescription Payment Plan Fact Sheet (Spanish)

Medicare Prescription Payment Plan Participation Request Form (English)

Medicare Prescription Payment Plan Participation Request Form (Spanish)

Medication Therapy Management (MTM) Program (Bilingual)

Navitus Request for Medicare Prescription Drug Coverage Determination (English)

Navitus Request for Medicare Prescription Drug Coverage Determination (Spanish)

Navitus Request for Redetermination of Medicare Prescription Drug Denial (English)

Navitus Request for Redetermination of Medicare Prescription Drug Denial (Spanish)

Personal Medication List (English)

Personal Medication List (Spanish)

Pharmacy Directory – Community First Medicare Advantage Mezquite Dual (English)

Prescription Drug Claim Form

Real Time Benefit Tool (RTBT) Medicare

Real Time Benefit Tool Guide

Request for Medicare Prescription Drug Coverage Determination Form (English)

Request for Medicare Prescription Drug Coverage Determination Form (Spanish)

Request for Redetermination of Medicare Prescription Drug Denial (English)

Request for Redetermination of Medicare Prescription Drug Denial (Spanish)