AveMariaPharmacyServices.com

• Savings – Members save up to 50% off their medication using this prescription drug savings program.

• Free – no enrollment or monthly fees.  Can be used by your entire family.  Cannot be used in conjunction with any other pharmacy card or discount.

• Acceptance – Over 40,000 pharmacies including Walgreens, ACME, Albertsons,Bi-Mart, Bioscrip, Brooks, Buehler, Carr, Coborns, CUB, CVS, Dillon, Discount Drug Mart, Dominicks, Drug Town, Duane Read, Eckerd, Epic, Family Fare, Farm Fresh, Food City, Fred Meyer, Fred’s Pharmacy, Fry’s, Giant Eagle, Glen’s, Harris Teeter, HEB, Hy-Vee, K-Mart, Kroger, K-VA-T Foods, Longs Drug Store, Marc’s, Medicap, Medicine Shoppe, Meijer, OSCO, Pmida, P&C Foods, Publix, Quality Markets, Randalls, Rite Aid, Safeway Supermarkets, SAV-ON, Seaway, Shop & Save, Shopko, Shop-Rite, Smiths Pharmacies, Snyder Drug, Spartan Drugs, Star Pharmacies, Stop & Shop, Super D, Target, The Pharm, Third Party Station, Tom Thumb, tops, USA Drug, USA Express, Vons, Walgreens, Wal-Mart, Weis Market, Winn-Dixie.

Please print off this sheet and fill in the member name and ID number before using.  This card can be used immediately.

_______________________________________________________________________________________________

Name:  _____________________________________

ID/SS #:   ___  ___  ___  ___  ___  ___  ___  ___  ___

(SS# or any random 9 digit number)

Pharmacist Instructions:

Process claim through Pharmacy Data Management (PDM)

Processor ID/BIN#: 610020

Processor Control #:URX001

Rx Plan Group #:  WHS-2111

Pharmacy Help Desk: 1-800-329-0988 (pharmacist only)

Customer Service For Members: 1-540-777-7179

Terms and conditions:  Participating pharmacies must transmit prescription claims online to Pharmacy Data Management. 

This card is not insurance.

For inquires on electronic claims submission, pharmacies may call 1-800-329-0988.

This card is owned by U-Rx program.  U-Rx may revoke, repossess, modify or cancel at any time.  Use of this card constitutes acceptance thereof.  The unauthorized or fraudulent use of this card to obtain prescription drugs is punishable by law.  The person named on this card assumes responsibility for the use of the card.