Forms

Please take a look at these important Subscriber Forms.

Physician Fax Form
Prescription Drug Claim Form (Coming Soon!)
Mail Order Registration Form

* By clicking this link, you will be leaving the Part-D Plan-specific Web pages.

** Per a GEO Access analysis conducted by Prime Therapeutics. 10/7/2005.

Last updated 12/19/2005 - S5715-MRK-NMWebsite

Blue Cross and Blue Shield of New Mexico refers to HCSC Insurance Services Company, which is a wholly owned subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company. These companies are independent licensees of the Blue Cross and Blue Shield Association and offer or provide services for Medicare Part D products under HCSC Insurance Services Company's contract S5715 with the Centers for Medicare and Medicaid Services.

SM Service Mark of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.

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