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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
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Document Date: 2014-10-28 20:16:59
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File Size: 517,38 KB
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City
Denver /
/
Company
Wellpoint /
Anthem /
Medical Service Inc. /
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Facility
Rocky Mountain Hospital /
/
IndustryTerm
insurance company 9c /
/
MedicalCondition
flu /
Health Fair flu /
/
Organization
Rocky Mountain Hospital /
Blue Cross and Blue Shield Association /
/
Position
participating physician /
/
ProvinceOrState
Colorado /
/
SocialTag
Medicine
Influenza vaccine
Itemized deduction
Influenza
Public key certificate
Blue Cross Blue Shield Association
Anthem
Health
Taxation in the United States
Vaccines