• Glidden Group Health Insurance

    402 W Canfield Ave. Coeur d Alene, Idaho 83815

    PHONE: 208-640-3787

  • MEDICATION LIST

    PLEASE PROVIDE AN UPDATED, ACCURATE AND COMPLETE LIST OF ALL YOUR MEDICATIONS.
  • By completing this form, you are authorizing Glidden Group Health Insurance to analyze your prescription drug utilization and are requesting a recommendation for your Part D Prescription drug coverage or Medicare advantage plan and authorizing to receive a call and/or an email regarding my Prescription drug coverage options.

    I understand that I am volunteering this prescription medication information to evaluate my prescription drug coverage options. This information is completely confidential.


  • Patient Medications

    Be sure to include all medications, over-the-counter, diabetic, dietary supplements and vitamins.
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