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Get Premera Blue Cross Disabled Dependent Form

You or your physician may submit the information along with the completed and signed form to the following address Premera Blue Cross Membership Billing MS 737 PO Box 3048 Spokane WA 99220 Our medical department will review this information for a determination of future coverage. If additional medical information is required we will contact you or the physician. If you have questions about the form please call Customer Service at 800-722-1471. 00.

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