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VIAL

Med Tier Adjustment

Multi Source Indicator

Notes

EXCL FROM PHARMACY

Strength

500MG/4ML

Benefit Code

QCD

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ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call1-800-472-2689(TTY: 711).

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-472-2689 (TTY: 711 ).

ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID chamar 1-800-472-2689 (TTY: 711 ).

ATTENTION : si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Appelez le Service adhérents au numéro indiqué sur votre carte d’assuré appel 1-800-472-2689 (TTY : 711 ).

注意：如果您讲中文，我们可向您免费提供语言协助服务。请拨打您 ID 卡上的号码联系会员服务部通话 1-800-472-2689（TTY 号码：711 )。

ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-472-2689 TTY: 711 ).

LƯU .: Nếu quý vị n.i Tiếng Việt, c.c dịch vụ hỗ trợ ng.n ngữ được cung cấp cho quý vị miễn ph.. Gọi cho Dịch vụ Hội vi.n theo số tr.n thẻ ID của quý vị Cuộc gọi 1-800-472-2689 (TTY: 711 ).

ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов 1-800-472-2689 (телетайп: 711 ).

ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្ រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ វាសមា ជិកតាមល េខន ៅល. ើប ័ណ្ណ សម្ គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ 1-800-472-2689 (TTY: 711) ។

ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata 1-800-472-2689 (TTY: 711 ).

참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-472-2689 (TTY : 711)로 회원 서비스에 연락하십시오.

ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας υπηρεσίες γλωσσικής βοήθειας, δωρεάν. Καλέστε την Υπηρεσία Εξυπηρέτησης Μελών στον αριθμό της κάρτας μέλους σας (ID Card) κλήση 1-800-472-2689 (TTY: 711 ).

UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej. Należy zadzwonić do Działu obsługi ubezpieczonych pod numer podany na identyfikatorze zadzwoń 1-800-472-2689 (TTY: 711 ).

ध्यान दें: य दि आप ह िन् दी बोलते ह ैं, तो भा षा सहाय ता सेवा एँ, आप के लि ए नि :शुल्क उपलब्ध ह ैं। सदस्य सेवा ओं को आपके आई.डी. कार ्ड पर दि ए गए नंबर पर कॉल करें कॉल 1-800-472-2689 ( टी .टी .वा ई.: 711).

ધ્યાન આપો: જો તમે ગુજરા તી બોલતા હો, તો તમને ભા ષા કીય સહાય તા સેવા ઓ વિ ના મૂલ્યે ઉપલબ્ધ છે. તમા રા આઈડી કાર ્ડ પર આપેલા નંબર પર Member Service ને કૉલ કરો કૉલ કરો 1-800-472-2689 (TTY: 711).

PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-472-2689 (TTY: 711 ).

お知らせ：日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください呼び出す 1-800-472-2689（TTY: 711 ）。

ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-472-2689 (TTY: 711 ).

ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-472-2689 (TTY: 711).

BAA !KOHWIINDZIN DOO&G&: Din4 k’ehj7 y1n7[t’i’go saad bee y1t’i’ 47 t’11j77k’e bee n7k1’a’doowo[go 47 n1’ahoot’i’. D77 bee an7tah7g7 ninaaltsoos bine’d44’ n0omba bik1’7g7ij8’ b44sh bee hod77lnih call 1-800-472-2689 (TTY: 711).

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Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. ® Registered Marks and SM Service Marks of the Blue Cross and Blue Shield Association.
®´ Registered Marks of Blue Cross Blue Shield of Massachusetts, Inc. ®´ Registered Marks, TM Trademarks, and SM Service Marks are property of their respective owners. © 2024 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.