• Request At-Home COVID-19 Tests

    Fill out the information below so that we can submit a request to your insurance for your at-home COVID-19 tests. If you are a Medicare or Medicaid member, please contact the pharmacy at (682) 708-3499 for assistance.
  • Patient Information

    Please fill in the information for the person who the tests are for. You must submit a separate request for each person on your insurance plan.
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    Pick a Date
  • Contact Information

    We will text and email you about your order status. Standard data rates may apply.
  • Rx Insurance Information

    All fields are required. However, Group ID and Rx PCN are only required if present on your insurance card.
  • Sample Rx Insurance Card

    Your card may not look exactly like these examples.

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