Az-and-me-application-form

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[PDF]Application for Free AstraZeneca Medicines - AZ…https://www.azandmeapp.com//us/574-azme-app/pdf/non_speciality.pdf

Please do not send your medical records with your application. MAIL your completed application, prescription, and Medicare documentation (if applicable) to: AZ&Me Prescription Savings Program PO Box 222178 Charlotte, NC 28222 Or Your doctor’s office may FAX your completed application…

https://www.azandmeapp.com/content/dam/website-services/us/574-azme-app/pdf/non_speciality.pdf 

Download an Application | AZ&Me™ Prescription Savings …https://www.azandmeapp.com//download-an-application.html

Medicare patients who do not complete the re-enrollment process by 1/31/2022, will need to submit a new AZ&Me application to be considered for the program PLEASE NOTE: You must …

https://www.azandmeapp.com/resources-and-downloads/download-an-application.html 

AstraZeneca Prescription Savings Program | AZ&Me™https://www.azandmeapp.com

Medicare patients who do not complete the re-enrollment process by 1/31/2022, will need to submit a new AZ&Me application to be …

https://www.azandmeapp.com/ 

[PDF]Application for Free AstraZeneca Medicines - AZ…https://www.azandmeapp.com/content/dam/website-services/us/574-azme

AZ&Me Prescription Savings Program Application Checklist The following items must be submitted by mail or by fax to complete your application. Keep this page for your records. Send ALL the following TOGETHER: n A completed application…

https://www.azandmeapp.com/content/dam/website-services/us/574-azme-app/pdf/US-29764-NONBRANDED%20AZME%20Specialty%20Application%202019-FINAL-6-4-19.pdf