BTF Co-Pay Form*
District Info and Co-Pay Form

 

* These forms require the free Adobe Acrobat. Click the image and download it for free! (Instructions for Download)

 

Friday, March 6, 2009 is the Deadline for submitting prescription co-pay claims for the calendar year 2008.

REQUIREMENTS FOR RECEIVING YOUR SUPPLEMENTAL BENEFIT FUND $ 2.00 RX CO-PAY REIMBURSEMENT:

DO NOT SUBMIT INDIVIDUAL RECEIPTS.

YOU MUST OBTAIN A COMPUTER GENERATED ROSTER FROM YOUR PHARMACIST.

COMPLETE THE REQUESTED INFORMATION ON THE YELLOW RX CO-PAY CLAIM FORM.

ATTACH THE ROSTER TO THE CLAIM FORM AND MAIL IT TO THE SBF OFFICE:

BTF/SBF RX CO-PAY
271 PORTER AVENUE
BUFFALO, NY 14201

DEADLINE FOR SUBMITTING ALL 2008 PRESCRIPTIONS IS FRIDAY MARCH 6, 2009.

 

??? ANY QUESTIONS ??? PLEASE CALL (716) 881-5462.

 

SBF DIRECTOR: DAVID WALKER
SBF TRUSTEES: PHIL RUMORE, JOEL MERCADO, MICHAEL EAGAN DARLENE RICHARDSON , SUE RAICHILSON (12/08)