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AHCCCS Health Plans BIN PCN Group Number PBM Phone Number AHCCCS FFS 001553 AZM OptumRx 855-577-6310 AHCCCS FFS – Secondary to Commercial 001553 AZM OptumRx 855-577-6310 AHCCCS FFS – Dual Eligibles for Covered OTC Prescriptions 001553 AZM OptumRx 855-577-6310 United Healthcare Community Plan (Acute, CRS, DD, LTC) 610494 4100 ACUAZ OptumRx ...

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Instead, call us at 1-800-222-APWU (2798) or, if you are a current member, at the number listed on the back of your identification card. Please note that email sent to us will be shared with our customer service representatives or the staff members who are best able to address your questions.

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455-EM PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER 1=Rx Billing M Imp Guide:For Transaction Code of “B1,” in the Claim Segment, the Prescription/Service Reference Number Qualifier (455-EM) is “1” (Rx Billing). 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUMBER 12 bytes M Magellan Medicaid Administration Florida D.0.

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NEIGHBORHOOD PHARMACY 800-800-7616 . HIGHLIGHTS. Obtain the lowest price on short-term acute care prescription drugs. Use your card at participating chain and independent pharmacies nationwide. Save on your out-of-pocket expenses. Discounts range from 10% to 60% on most medications.

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Local retail pharmacy (non-network): If the pharmacy you choose does not participate in the OptumRx network, you can still use that pharmacy. You will pay the entire amount of the prescription, or the cost share from your other insurance and then submit a VA form 10-7959a, CHAMPVA Claim Form, to be reimbursed for the claim. Meds by Mail:

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Rx Bin: 610494 Rx PCN: 9999. Contact a customer care representative toll-free at (866) 336-9371 (TTY 711) This card is for Pharmacy Benefits Administered by OptumRx.

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