Request For Medicare Prescription Drug Coverage Determination Form Page 4
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Required Explanation:___________________________________________________________
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This information is available for free in other languages. Please call our Customer Service number
at 1-888-285-2249 (TTY/TDD users should call 711). We are open between 8 a.m. and 8 p.m.,
local time, 7 days a week. If you are calling from February 15 through September 30, alternate
technologies (for example, voicemail) will be used on the weekends and holidays.
Esta información está disponible en otros idiomas de forma gratuita. Comuníquese a nuestro
número de Servicio al cliente al 1-888-285-2249 (los usuarios de TTY/TDD deben llamar al 711).
Nuestro horario es de 8 a.m. a 8 p.m., hora local, los 7 días de la semana. Si usted llama del 15
de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán tecnologías
alternas (por ejemplo, correo de voz).
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