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How It Works
Pricing
Our Story
Connection Request
Blogs
Reach Out

Apply Now

Medication Request

CABRx Group Companies

CABRx Health Plan Enrollment Form

Medications

Please list the medication you are needing help with. You can add an additional medications if there are multiple.

Medication

Medication Name

Medication Dosage

Medication Cost

Add Medication Remove Medication

If you are human, leave this field blank.

Application Submitted!

Your information has been sent to our team for review. A Prescription Bliss representative will be in contact within 24 to 48 hours to discuss your eligibility status and next steps.

Warmly,

Your Prescription Bliss Team

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111 W. Columbus Ave. | PO Box 7
Bellefontaine, OH 43311

(877) 792-5477

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