Complete this form to submit a claim to for pharmacy purchases.
Express Scripts Rx Reimbursement and Coordination of Benefits Claim Form
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Department of Human Resource Management
For inquiries or to schedule an appointment, contact us.
State Office Building
Suite 2120
Salt Lake City, Utah
84114-1531
Suite 2120
Salt Lake City, Utah
84114-1531
Phone: (801) 538-3025
Fax: (801) 538-3081
TDD: (801) 538-3696
Fax: (801) 538-3081
TDD: (801) 538-3696
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