Account Number (required)
Payment Reason (required) Select 90-Unit and supplies 91-BCBS Check 92-Recurring 93-Purchase Comfortrac 94-Purchase supplies 95-Paying statement 96-Purchase Unit 97-Payment Notes 98-Other
Payment Amount (required) $
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Do you want to discontinue your supplies?
Please contact patient support at (800) 495-6670 or (720) 779-0218 to discontinue monthly supplies.
