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HealthWell Foundation fax number

(800) 282-7692

Grant, Claims & Pharmacy Card inquiries

Used for: Submission of HealthWell copayment assistance grant applications and related documentation, including reimbursement forms and claims for copayments and premiums.

Fax destination details

Department
Grant, Claims & Pharmacy Card inquiries
Purpose
Submission of HealthWell copayment assistance grant applications and related documentation, including reimbursement forms and claims for copayments and premiums.
Form
Reimbursement Form — Reimbursement Request Form – Copayment (HealthWell Copayment Reimbursement Request Form)
Address
20440 Century Blvd., Suite 250, Germantown, MD 20874
Voice phone
(800) 675-8416

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.

Fill patient information, HealthWell Identification Number, and billing details; select recipient (clinic/hospital/patient/pharmacy); upload supporting docs; submit via HealthWell Portals or fax to 800-282-7692.

Review official form instructions

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