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“Drive Medical Universal Walker Tray with Cup Holder” has been added to your cart.
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Product
Price
Quantity
Subtotal
OMRON 5 Series Upper Arm Blood Pressure Unit
$
81.27
OMRON 5 Series Upper Arm Blood Pressure Unit quantity
$
81.27
OMRON Series 7 Blood Pressure Unit
$
110.80
OMRON Series 7 Blood Pressure Unit quantity
$
110.80
Drive Medical Universal Walker Tray with Cup Holder
$
54.99
Drive Medical Universal Walker Tray with Cup Holder quantity
$
54.99
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Subtotal
$
247.06
Total
$
247.06
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Medicare Claim Insurance Purchase Request
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Medicaid Claim Insurance Purchase Request
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Agree
No Fault Claim Insurance Purchase Request
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(Required)
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(Required)
Documents Section Upload (i.e. prescriptions)
Max. file size: 2 GB.
I agree to allow CapsuleAID and its authorized representatives to contact me about my medical supplies, orders, and related subject.
(Required)
Agree
Workers Comp Claim Insurance Purchase Request
To complete this order we need some information, please fill out below to the best of your ability and our team will contact you if there are any additional requirements.
Name
(Required)
First Name
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(Required)
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(Required)
DD dash MM dash YYYY
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Mediciad
No Fault
Workers Comp
Other
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(Required)
Insurance ID
(Required)
Documents Section Upload (i.e. prescriptions)
Max. file size: 2 GB.
I agree to allow CapsuleAID and its authorized representatives to contact me about my medical supplies, orders, and related subject.
(Required)
Agree
Other Claim Insurance Purchase Request
To complete this order we need some information, please fill out below to the best of your ability and our team will contact you if there are any additional requirements.
Name
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First Name
Last Name
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(Required)
Email
(Required)
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(Required)
DD dash MM dash YYYY
Insurance Type
Medicare
Mediciad
No Fault
Workers Comp
Other
Insurance Provider
(Required)
Insurance ID
(Required)
Documents Section Upload (i.e. prescriptions)
Max. file size: 2 GB.
I agree to allow CapsuleAID and its authorized representatives to contact me about my medical supplies, orders, and related subject.
(Required)
Agree
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