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Incontinence Products Referrals & Free Samples

Incontinence Products Referrals & Free Samples. Telephone Office: 317.924.2464 Toll Free: 866.614.7693 Fax: 317.924.3171. Office & Distribution Center Show Room & Customer Pickup Hours 4011 Millersville Road Monday through Friday: 9:00am to 5:00pm

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Incontinence Products Referrals & Free Samples

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  1. Incontinence Products Referrals & Free Samples Telephone Office: 317.924.2464 Toll Free: 866.614.7693 Fax: 317.924.3171 Office & Distribution CenterShow Room & Customer Pickup Hours 4011 Millersville Road Monday through Friday: 9:00am to 5:00pm Indianapolis, Indiana 46205 Closed Weekends and Holidays • MCE Member • Referral • To be completed by • Healthcare Provider: • Please fax Prescriptions (see below) • Contact information of patient or legal custodian if a minor or assigned: • Name___________________________ • Phone___________________________ • Medicaid #_______________________ • Private Pay Individual • Free Samples • To be completed by • Individual Patient or Caregiver: • Please call 317-924-2464 with the following information • Name___________________________ • Address _________________________ • Phone___________________________ Attach Prescription here for MCE Referral • Please include the following: • Standard information – pt name, date, refills etc • ICD9 code • Words “Incontinence Products” DKC In-Home Healthcare Supply Co. Is an Indiana Hoosier Healthwise Provider

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