Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Chickasaw Nation Refill Center before sending sensitive documents. FaxFlow is not affiliated with this organization.
Chickasaw Nation Refill Center fax number
(580) 421-8701
Prescription Program Enrollment
Used for: Submit enrollment forms and prescriptions for the Chickasaw Nation Refill Center Native & Non-Native Spouse Prescription Program
Fax destination details
- Department
- Prescription Program Enrollment
- Purpose
- Submit enrollment forms and prescriptions for the Chickasaw Nation Refill Center Native & Non-Native Spouse Prescription Program
- Form
- Form 02905NN — Chickasaw Nation Refill Center Native & Non-Native Spouse Prescription Program Enrollment Form
- Address
- 933 N Country Club Road, Ada, OK 74820
- Voice phone
- +1 580-421-8725
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fax or mail the completed enrollment form and prescriptions to Chickasaw Nation Refill Center; include required documents (CDIB, tribal citizenship, prescription insurance card, marriage license) and sign the Acknowledgement of Receipt of Notice of Privacy Practices.
Official form instructions are published as a downloadable file on the organization's website.
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