Direct Reimbursement Requests

Unable to use your Sav-Rx card at the time of purchase? Direct reimbursement requests may be submitted via mail or electronically through the patient portal

Electronic Submission

Under the “Communications” section of the Patient Portal, select the “Direct Reimbursement Request” form type. You will be prompted to enter information relevant to the claim. Remember to upload all relevant receipts

Mail-in Submission

Print, fill out and mail this form to

attn: Reimbursement Department
224 North Park Ave
Fremont, NE, 68025