Claim form must be submitted to Anthem NO LATER than Wed., December 31, [removed]Claim Form — Flu Shot Only One patient and one provider per claim form, please. See reverse side for claim filing instructions. PLEASE PRIN - Anthem Blue Cross - Document - PDFSEARCH.IO

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Date: 2014-10-28 20:16:59 Medicine Influenza vaccine Itemized deduction Influenza Public key certificate Blue Cross Blue Shield Association Anthem Health Taxation in the United States Vaccines		Claim form must be submitted to Anthem NO LATER than Wed., December 31, [removed]Claim Form — Flu Shot Only One patient and one provider per claim form, please. See reverse side for claim filing instructions. PLEASE PRIN Document is deleted from original location. Use the Download Button below to download from the Web Archive. Download Document from Web Archive File Size: 517,38 KB

Document is deleted from original location. Use the Download Button below to download from the Web Archive.