Download your Claim Form to Submit through Regular Mail or by FAX

[ Home ] [ Claim Forms ] [ New Patient ] [ Refill Request ] [ Transfer ] [ Ask Your Pharmacist ] [ Your UCP Staff ] [ Frequently Asked Questions ]

Click the links below to download the claim form (in PDF format), then print it out and submit your request by mail or FAX machine.

Instructions

Active Washington Teamsters
Retired Washington Teamsters

Retired Washington Construction Teamsters
Inland Empire Teamsters
Utah-Idaho Teamsters
Utah Agc Teamsters
Westport Shipyard, Inc.

Medicare Part D - Community Care Rx

NWA Employees

Our mailing address is:

Union Center Pharmacy
2324 Eastlake Ave E, Suite 405
Seattle, WA 98102
Our FAX Number is:
206-448-4406
 

 

Contact Information
  
Copyright © 2001-05 Union Center Pharmacy, Inc. All rights reserved.
Revised: September 2, 2005.