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Claim History

RX# Date Drug Name Qty Days of Supply Copay
BK Pharmacy (NABP: 0513425)
(559) 228-1888 		4578 N First St
Fresno, CA 93726
115031 10/31/2020 Multivit/FL CHW 0.25MG 100 30 $25
115031 10/31/2020 Multivit/FL CHW 0.25MG 100 30 $25
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Benefits Summary

Tier Level 30-Day Supply Copay 90-Day Supply Copay
Tier 1 15$ 30$
Tier 1 15$ 30$

Copay calculations are estimates only. The copay for any specific claim may be different from that listed herein. For more information, please refer to your benefit summary or call client services at (877) 846-03397. Each member will pay standard copays until the group pays out $2,000 in benefits, at which point all copays will be 35%.

Mail Order

BK Pharmacy (Code = “quickpass”)
Closed:
5/25/2020
6/26/2020
7/3/20209
9/7/2020
11/26/2020
11/27/2020
12/24/2020 1pm (1/2 day)
12/25/2020
1/1/2021

Download Mail Order Form (PDF)

Helpful Links

Download Mail Order Form (PDF)
Download Mail Order Form (PDF)

Formulary Lookup

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Our website’s formulary information is provided as a guide and is updated periodically. The drugs on your formulary were selected to give you the highest standard of quality and the greatest potential value from your prescription drug benefit.

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Calcium CHW 500 MG Bottle
Calcium CHW 500 MG Bottle
Calcium CHW 500 MG Bottle
Calcium CHW 500 MG Bottle
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