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Flexible Rx RebateWeb
  • Administrator
  • >
  • Register Organization

To register an organization to RebateWeb, complete this form and click 'Submit.'

Required*

 

Mailing Address:

 

                 CMS Invoice Contact:

()-x

        Organization Administrator:

same as CMS Invoice Contact

()-x

Associated Labeler Codes *

Select Labeler Cd Start Quarter End Quarter