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Download the COVID-19 Resource Guide (as of March 27, 2023), created especially for our valued customers.

Pharmacy Forms

PDF  Prescription Drug/COVID-19 At-Home Test Kit Claim Form

Use this claim form to submit eligible pharmacy expenses for reimbursement, including COVID-19 at-home test kits you paid out of pocket for. You have to submit one claim form for each person and each prescription. Full instructions can be found on page 2. ID: 3272 NJ 03/22